- During the last two decades a number of therapies, under the name of the third wave of cognitive behavior therapy (CBT), have been developed. The commonly known are:
(Ost LG, 2008)
- acceptance and commitment therapy (ACT),
- dialectical behavior therapy (DBT),
- cognitive behavioral analysis system of psychotherapy (CBASP),
- functional analytic psychotherapy (FAP), and
- integrative behavioral couple therapy (IBCT).
- Acceptance and commitment therapy (ACT) is one of the 'third wave' cognitive behavioral therapies (CBTs) found to be effective for a variety of disorders, including several anxiety disorders, depression, pain, trichotillomania, psychotic disorder, drug abuse and the management of epilepsy and diabetes. (Pull CB, 2009)
- Steven C. Hayes, Ph.D.
- Jason B. Luoma, Ph.D.
- Frank W. Bond, Ph.D.
ACT emphasizes such processes as mindfulness, acceptance, and values in helping clients overcome obstacles in their lives. A basic assumption of ACT is that suffering is a normal and unavoidable part of human experience and that it is actually people's attempts to control or avoid their own painful experiences that leads to much long-term suffering and what doesn't work in people's lives. ACT helps people learn ways to let go of the struggle with pain, be more mindful, get clarity on what really matters to them, and to commit to living full, vibrant lives. The goal of therapy is not to eliminate certain parts of one's experience of life, but rather to learn how to experience life more fully, without as much struggle, and with vitality and commitment. (Dr. Jason Luoma, 2009)
ACT is developed within a pragmatic philosophy called functional contextualism. ACT differs from traditional cognitive behavioral therapy (CBT) in that rather than trying to teach people to better control their thoughts, feelings, sensations, memories and other private events, ACT teaches them to "just notice", accept, and embrace their private events, especially previously unwanted ones. ACT aims to help the individual clarify their personal values and to take action on them, bringing more vitality and meaning to their life in the process, increasing their psychological flexibility.
Relational Frame Theory (RFT)
ACT is explicitly contextualistic and is based on a basic experimental analysis of human language and cognition, Relational Frame Theory (RFT). RFT explains why cognitive fusion and experiential avoidance are both ubiquitous and harmful. ACT targets these processes and is producing supportive data both at the process and outcome level. The third-wave treatments are characterized by openness to older clinical traditions, a focus on second order and contextual change, an emphasis of function over form, and the construction of flexible and effective repertoires. (Steven C. Hayes, 2004).
- Mindfulness is the practice of living in the present moment and experiencing things without judgment.
- Mindfulness can be practiced in everyday life as well, during nearly any activity.
A recent meta-analysis combining 18 RCTs found that, there was a clear overall advantage of ACT compared to control conditions (effect size = 0.42). But, ACT was not significantly more effective than established treatments (effect size = 0.18, p = 0.13). (Mark B. Powers, 2009).
ACT and Yoga in Drug -Refractory Epilepsy Patients (Lundgren T, 2008)
A randomized control trial on ACT and yoga among drug-refractory epilepsy patients found that both therapies significantly reduce seizure index and increase quality of life over time. ACT reduced seizure index significantly more as compared with yoga. Participants in both the ACT and yoga groups improved their quality of life significantly as measured by one of two quality-of-life instruments. The ACT group increased their quality of life significantly as compared with the yoga group, and the yoga group increased their quality of life significantly as compared with the ACT group. The study concluded that complementary treatments, such as ACT and yoga, decrease seizure index and increase quality of life.
ACT in Anorexia Nervosa
An evaluative study on the effectiveness of Acceptance and Commitment Therapy (ACT) for treatment of anorexia nervosa (AN) using a case series methodology among participants with a history of prior treatment for AN, found that ACT could be a promising treatment for subthreshold or clinical cases of AN, even with chronic participants or those with medical complications. (Berman MI, 2009).
Ost LG. Efficacy of the third wave of behavioral therapies: a systematic review and meta-analysis. Behav Res Ther. 2008 Mar;46(3):296-321. Epub 2007 Dec 23.
Pull CB..Current empirical status of acceptance and commitment therapy.Curr Opin Psychiatry. 2009 Jan;22(1):55-60.
Mark B. Powers, Maarten B. Zum Vörde Sive Vörding, Paul M.G. Emmelkamp. Acceptance and Commitment Therapy: A Meta-Analytic Review. Psychother Psychosom 2009;78:73-80.
Lundgren T, Dahl J, Yardi N, Melin L. Acceptance and Commitment Therapy and yoga for drug-refractory epilepsy: a randomized controlled trial.Epilepsy Behav. 2008 Jul;13(1):102-8.
Steven C. Hayes (2004). Acceptance and commitment therapy, relational frame theory, and the third wave of behavioral and cognitive therapies. Behavior Therapy Volume 35, Issue 4, Autumn 2004, Pages 639-665 .
Dr. Jason Luoma, (2009) from his website available at http://www.drluoma.com/ACT.html accessed on 22/02/2010.
Berman MI, Boutelle KN, Crow SJ. A case series investigating acceptance and commitment therapy as a treatment for previously treated, unremitted patients with anorexia nervosa. Eur Eat Disord Rev. 2009 Nov;17(6):426-34.