Acceptance and Commitment Therapy - Essay Example

Acceptance and Commitment Therapy Acceptance and Commitment Therapy (ACT) Introduction Acceptance and Commitment Therapy (ACT) is one of the recent stress management techniques that have shown to be effective in helping people living with chronic conditions. Unlike other behavioural therapies, ACT denounces the ‘health normality’ assumption and considers that psychological processes creates stress and are destructive to human beings. People living with chronic diseases such as diabetes, asthma, epilepsy or even HIV/AIDS often suffer from stress in managing their conditions. In addition, to the stress created at the workplace, school or home, ACT is seen as the most effective technique to reduce psychological stress impacts to these people. The paper critically analyses how emotional control and avoidance contributes to more suffrage to people struggling with chronic conditions. Using empirical evidence, the paper also discusses the six principles of psychological flexibility to show how ACT is more helpful chronically ill people than mindfulness-based cognitive therapy (MBCT). What is Acceptance and Commitment Therapy? ACT is a behavioural therapy based on empirical science, but, emphasis much on acceptance, values, living in the present moment, compassion, forgiveness and so forth. ACT challenges the Western psychology claims towards stress management. The most significant difference between ACT and other behavioural therapies is that its goal is not to reduce symptoms of stress. ACT does not aim at getting rid of stressful thoughts, but, achieves symptom reduction as a by-product. ACT has gained a lot of popularity in the recent past due to its ability in reducing stress among people living with chronic conditions (CADTH, 2012). The particular clinical conditions addressed by ACT may include depression, workplace stress, anxiety, cancer-related stress, drugs use and alcoholism as well as chronic conditions. Why is ACT more helpful than Mindfulness-Based Cognitive Therapy (MCBT)? ACT and MCBT are among the various ‘third wave’ behavioural therapies that emphasises much on mindfulness skills development. ACT was created by Steve Hayes in 1986, and currently has lots of empirical evidence, which supports its effectiveness. MBCT differs from ACT in that it uses manual treatment protocols for use with groups suffering from depression and stress. On the other hand, ACT is designed for use with individuals, groups and couples. ACT can as well be used in short and long term therapies in various groups of clinical populations. Additionally, ACT does not use manualized protocols for treatment. Instead, the therapist can create their own techniques and sometimes involve the clients in creating the mindfulness techniques (Bernardy et al., 2013). In the context of chronic conditions, therefore, ACT is the best method compared MCBT in the management of stress emanating from the often long-lasting effects of chronic diseases. Diseases such as asthma, arthritis, diabetes and COPD are usually persistent and come with time. Thus, the patients face many difficulties in managing their conditions in addition to other forms of stress common in healthy people such as anxiety, drug abuse and workplace stress. ACT can be applied in a wide range of clinical populations, unlike MCBT, which is limited to people suffering from stress and depression (Davis and Sautra, 2013). As stated earlier, symptom reduction is not a goal of ACT. Instead, ACT aims at teaching mindfulness skills, which result in symptom reduction as a by-product (Hayes, Strosahl, 2004). In an ACT point of view, getting rid of symptoms creates clinical disorders as well. In other words, struggling with the ‘private experience’ is another form of stress (symptom). The aim to transform the relationship between the client and the ‘painful thoughts’ does not yield other forms of stress. Therefore, ACT would be more help to this population than MBCT because it provides an almost everlasting solution. In a recent meta-analysis that involved assessing whether mindfulness skills and acceptance can be learnt by self-help, ACT proved to be very beneficial in helping people suffering from physical and mental problems (Cavanagh, 2014). The meta-analysis and systematic review regarding self-help interventions included 15 RCTs, 7 ACTs and other minor interventions. The meta-analysis found that mindfulness-based interventions were more effective that the control-based interventions. The analysis findings imply that engaging in mindfulness actions is better than emotional control. ACT is, therefore, the best technique to deal with people experiencing chronic pains and psychological stress. MCBT, on the other hand, targets at the ‘symptoms’ and establishes control measures, which have proven less effective in stress management (Bernardy et al., 2013). A systematic review conducted in 2012 to update the empirical evidence supporting commitment and acceptance status showed that ACT improved its outcomes since 2008 (Smout, 2012). The meta-analysis showed that ACT significantly improved since 2008. ACT was found to be applicable to anxiety disorders, chronic pains, social phobia and more. The analysis, which also included 33 RCTs, warranted the use of ACT in people experiencing physical and mental difficulties. As indicated earlier, MCBT is suitable for short term therapies while ACT can be used in both short and long-term therapies. It, therefore, means that ACT can be used in recurring health conditions, unlike MCBTs, which are essentially meant for short term periods. With ACT, the therapist can teach the clients mindfulness skills, which will help them in managing stress in their lives. MCBT would not be viable for chronically-ill clients, because of its small coverage and usefulness for short periods (CADTH, 2012). Another difference between ACT and other behavioural therapies including MCBTs is that it does not rest on the ‘health normality’ assumption. Most Western behavioural therapies are based on the assumption that human beings are psychologically healthy by nature. If humans are given a healthy lifestyle and environment, they will live happily without any psychological stress. In this sense, psychological stress is seen as an abnormal human condition. However, ACT denounces this assumption and claims that cognitive processes of normal human minds often create suffering to humans. ACT, therefore, creates the assumption of ‘destructive normality’ where the human language is seen as the root of psychological suffrage. Human language is viewed as a complex system of words, sounds, images, physical gestures and facial expressions. The definition of human language brings forth the actual assumption of the interrelationship between human language and psychological suffrage. ACT claims that human language set humans up to struggle with their own feelings and thoughts in a process known as experiential avoidance (Harris and Hayes, 2009). ACT claims that humans are always in the attempt to avoid loneliness, depression, anxiety and so on. Additionally, they tend to spend more in trying to get rid of ‘private experience’ resulting in psychological stress in the long term. Research has shown that high experiential avoidance is often associated with depression, anxiety disorders, poorer school performance, lower quality of life and many more (Feros et al., 2011). In a systematic review and analysis to evaluate the interventions based on acceptance, the people with chronic pain, ACT showed small to medium effects on mental and physical health of these patients. ACT was found to be an alternative, but, not superior to CBT technique in stress management (Veehof et al., 2011). The analysis reveals that ACT is helpful to people living with chronic conditions because it yields short to medium results, but, lasts for a longer time than the other behavioural therapies. MCBT method will target and solve a problem as soon as it arises. ACT, however, will try to create a healthy relationship with the clients and their ‘painful thoughts’ that is beneficial when the chronic diseases get worse at some points in time. Principles of ACT that enhance Psychological Flexibility ACT is also based on the argument that emotional control is a problem, not a solution. When the affected people engage in control of their thoughts and feelings, they create another source of stress and engage in the vicious cycle of psychological suffrage. ACT uses six principles to show how emotional control is detrimental to people’s lives. First, defusion is based on the process of ‘stepping back’ and observing our human language, without being caught up in its complex system of words, images and sounds. Cognitive fusion is the opposite of defusion where the victims are caught up in the language. When our thoughts overcome our ability to avoid them or seem to be literal truth, we tend to fuse or merge with our thoughts, which enormously influence our behaviours (Feros et al., 2011). In ACT, cognitive defusion is seen as the best of dismantling emotional control, which makes the ‘private experience’ less influential to human behaviour. Acceptance is the second principle of ACT, which involves making room for private experiences such as sensations, unpleasant feelings in the human mind. The idea behind acceptance is to allow the feelings to come and go without paying attention to them, running away from them or struggling with them. Acceptance and commitment action therapy for patients with chronic pain were assessed over the internet in an empirical study conducted in 2013 (Buhrman et al., 2013). The research findings proved that internet-based treatment by focusing on the acceptance and committed action is effective. In addition, the ACT yielded significant improvements, which were maintained in a six-month follow-up. Another randomized controlled trials (RCTs) were carried in 2013, to support ACT in treating patients with chronic pain (Burhman et al., 2013) The third principle of ACT involves creating contact with the present moment through openness and receptiveness. As discussed earlier, bring full awareness to whatever one is doing is the best way to distract feelings and thoughts that may arise. In this way, one can reduce the ‘symptoms.’ This principle can be linked to ‘observing self’ concept in ACT, which involves accessing a transcendent/superior sense of self. In this way, one can experience himself/herself, but, not his/her thoughts, memories, sensations, urges, images, feelings and so on. In an empirical study conducted in 2011, accessing ‘oneself’ and living in the present moment proved success in reducing stress among chronic pain patients. The research findings revealed that the self-help and manual-based ACT intervention, which was conducted in several weeks added value to the lives of chronic pain patients (Thorsell et al., 2011). In a partially controlled trial test conducted in 2011, ACT showed positive results even after the chronic pain patients were follow up for three years. The patients showed increased social and physical functioning after three years post treatment. Establishing one’s values is the fifth principle of ACT that helps in therapeutic treatments. This involves classifying what is important in one’s life, for example, developing good relationships with one’s friends. Values can be linked to the sixth core principle of ACT that is the ‘committed action’ principle. Being committed in a therapeutic context involves setting goals based on one’s values and taking effective actions and strategies to achieve them. In this way, the client will have completed the process of ‘symptoms reduction’ using ACT. In a pilot study trying the group-based commitment and acceptance conducted in 2013, ACT showed significant improvements for women with fibromyalgia, suffering from stress and chronic pain. A three-month follow-up showed that commitment to certain actions resulted to lower disabilities and higher pain acceptance over the time (McCracken, Sato and Taylor, 2013). Conclusion Acceptance and Commitment Therapy (ACT) is more helpful than other behavioural therapies due to various reasons. While MCBT aims at direct ‘symptom reduction,’ ACT achieves the reduction in symptoms as a by-product. In ACT, the feelings and painful thoughts are classified as ‘private experiences’ that are indeed the ‘symptoms.’ Using this approach, therefore, ACT aims at reducing psychological stress by teaching mindfulness skills that are essential in managing stress both in the short and long term. The fact that chronic diseases affect the patients after some time makes ACT the best technique over MCBT because it focuses on a wide range of clinical population and can be applicable to short and long term therapies. Using the six principles, ACT creates psychological flexibility in human minds, which enables the reduction of stress among people experiencing physical and mental difficulties (chronically-ill patients). References Bernardy, K., Klose, P., Busch Angela, J., Choy Ernest, H.S. and Häuser, W. (2013). Cognitive behavioural therapies for fibromyalgia. New York: John Wiley & Sons, Ltd. Buhrman, M., Skoglund, A., Husell, J., Bergstrom, K., Gordh, T., Hursti, T., Bendelin, N., Furmark, T. and Andersson, G. (2013). Guided internet-delivered acceptance and commitment therapy for chronic pain patients: a randomized controlled trial. Behaviour Research & Therapy 51(6), 307-315. Canadian Agency for Drugs and Technologies in Health (CADTH) (2012). Mindfulness Training for Chronic Pain Management: A Review of the Clinical Evidence and Guidelines. CADTH: Ottawa, Canada. Cavanagh, K., Strauss, C., Forder, L. and Jones, F. (2014). Can mindfulness and acceptance be learnt by self-help? A systematic review and meta-analysis of mindfulness and acceptance-based self-help interventions. Clinical Psychology Review 34(2), 118-129. Davis, M.C. and Zautra, A.J. (2013) An online mindfulness intervention targeting socioemotional regulation in fibromyalgia: results of a randomized controlled trial. Annals of Behavioral Medicine 46(3), 273-284. Feros, D.L, Lane, L, Ciarrochi, J.,& Blackledge, J.T. ( 2011).  Acceptance and Commitment Therapy (ACT) for improving the lives of cancer patients: a preliminary study. New York: Wiley & Sons Ltd. Harris, R., & Hayes, S. C. (2009). ACT made simple: An easy-to-read primer on acceptance and commitment therapy. Boston: Springer. Hayes, S. C., & Strosahl, K. D. (2004). A practical guide to acceptance and commitment therapy. Boston, Mass: Springer. McCracken, L.M., Sato, A. and Taylor, G.J. 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