Acceptance and Commitment Therapy (ACT) After Brain Injury
Giles N. Yeates, Fiona Ashworth in Psychological Therapies in Acquired Brain Injury, 2019
In ACT sessions, techniques are developed in order to undermine unworkable rules and promote adaptive rules (‘rules’ and ‘language’ are interchangeable here). This requires a ‘new mode of mind’ and is not therefore just a technique that can be readily stuffed into a clinical bag of tricks. ACT is based on an ‘assumption of destructive normality’, promoting a mindfulness and acceptance-based approach entailing a willingness to experience odd or uncomfortable thoughts, feelings, or physical sensations in order to respond with ‘psychological flexibility’. Psychological flexibility is defined as the ability to connect with the present moment and experience the thoughts and feelings without unhelpful defence, and to persist in action that is consistent with values, or change that action when the situation demands (Kim et al., 2011). ACT assumes that suffering is a normal and an unavoidable part of human experience, and our very attempts to control or avoid painful experiences in fact contribute to long-term suffering (e.g., Harris, 2007). Minds are therefore seen as not having evolved to make us feel happy, but to keep us alive. ACT differs from therapeutic models which prioritise symptom reduction (such as CBT), as psychological flexibility does not directly aim to change ‘happiness’ or ‘freedom from pain’, which ACT explains are counterproductive targets for pursuit.
Co-occurring Depression, Anxiety, and Chronic Pain
Andrea Kohn Maikovich-Fong in Handbook of Psychosocial Interventions for Chronic Pain, 2019
Various studies provide support for the role of enhancing psychological flexibility as an effective treatment intervention for anxiety, depression, and chronic pain (Kashdan, 2010; McCracken & Velleman, 2010; Masuda & Tully, 2011). Psychological flexibility is defined as “a process based in the interaction of cognition and direct environmental contingencies that allows a person’s behavior to persist or change in line with their long term goals and values” (McCracken & Velleman, 2010, p. 141). The theory underlying the helpfulness of psychological flexibility posits that there are two sets of influences on behavior: those arising from direct contact with the environment, behavior, and associated consequences; and those arising from cognitively based processes, such as rules.
Does it Pay to Pay Attention?
Adam Gledhill, Dale Forsdyke in The Psychology of Sports Injury, 2021
Psychological flexibility refers to a willingness to remain in contact with undesirable internal experience in the service of one's values or important goals (Bond et al., 2011). It encompasses several processes that take place over time and is most prominent in an individual's ability to adapt to the fluctuating demands in situations, reconfigure mental resources, shift their perspective and balance desires, needs and life domains (Kashdan & Rottenberg, 2010). The six core processes of psychological flexibility (known as the ‘hexaflex’; Hayes et al., 1999) are acceptance, cognitive diffusion, self as context, being present, values and committed action. Conversely, an absence of psychological flexibility is characterized by experiential avoidance, cognitive fusion, attachment to conceptualized self, dominance of conceptualized past and weak self-knowledge, lack of clarity with values and inactivity, impulsivity and avoidance (Harris, 2009). A lack of psychological flexibility could be important in injury rehabilitation as the associated avoidant behaviour can serve to exacerbate the very situation that the avoidance was there to protect against. Consider the example of a sprinter with a troublesome, recurrent hamstring injury not attending a scheduled rehabilitation appointment because they woke feeling some re-injury anxiety or a heightened sense of tension, or pain perception. They didn't attend the session, because they didn't want to make things worse. However, by avoiding the rehabilitation session, inherently they increase the chances of making the situation worse further down the line.
Committed Action, Disability and Perceived Health in Individuals with Fibromyalgia
Published in Behavioral Medicine, 2019
Santiago Galán, Rubén Roy, Ester Solé, Mélanie Racine, Rocío de la Vega, Mark P. Jensen, Jordi Miró
One psychosocial intervention that has been receiving increased attention is Acceptance and Commitment Therapy (ACT). 11 One of the goals of ACT is to improve function by increasing the patient's psychological flexibility. Psychological flexibility is defined as the ability to persist or to change behavior as appropriate and needed in a setting of competing psychological influences, guided by values and goals and dependent on the specific context.12 In support of the role of psychological flexibility in patient function, measures of this construct have been shown to be associated with less pain-related intensity and interference, less anxiety and depressive symptoms, and better physical and mental function in individuals with various chronic pain conditions, such as migraine, whiplash, chronic low back pain, and fibromyalgia (FM).13–16
From form to function: Values and committed action strengthen mindful practices with context and direction
Published in Journal of Sport Psychology in Action, 2019
Patrick Smith, Emily Leeming, Michelle Forman, Steven C Hayes
Psychological flexibility is influenced through a small set of processes underlying behavioral functioning and health: emotional and cognitive openness, flexible contact with the present moment from a perspective-taking or observing sense of self, values, and committed action. These processes interact dynamically and are modeled in a hexagonal arrangement referred to as the hexaflex. They are commonly grouped into three dyads of Open, Centered, and Engaged (Appendix A). Each of the six flexibility processes help undermine a reciprocal psychologically rigid process: experiential avoidance; cognitive fusion; attachment to the conceptualized self; inflexible attention; dominance of complaint, cognitively fused, or avoidant values; and impulsivity, inaction, or avoidant persistence, respectively (Hayes et al., 2012).
Evaluation of a program for training psychologists in an acceptance and commitment therapy resilience intervention for people with multiple sclerosis: a single-arm longitudinal design with a nested qualitative study
Published in Disability and Rehabilitation, 2022
Ambra Mara Giovannetti, Michele Messmer Uccelli, Alessandra Solari, Kenneth I. Pakenham
Resilience is a psychological protective factor that enables a person to bounce back and sustain good mental health while dealing with adversity [1]. It involves negotiating, managing, and adapting to significant stressors or trauma by activating both internal (i.e., mindfulness, acceptance, cognitive flexibility, and active coping) and external (i.e., social support, financial capital, and community services) resources [2]. Psychological flexibility is closely associated with resilience [3,4]. According to acceptance and commitment therapy (ACT), psychological flexibility involves behaving consistently with one’s chosen values even in the presence of unwanted internal experiences such as emotional discomfort or self-critical thinking and is fostered by six processes [5]: (1) acceptance – openness to experience, (2) cognitive defusion – observing thoughts rather than taking them literally, (3) present moment awareness – mindfulness, (4) self-as-context – contact with a sense of self that is continuous and provides flexible perspective taking, (5) values – freely chosen personally meaningful life directions, and (6) committed action – values-guided effective action [6].
Related Knowledge Centers
- Acceptance & Commitment Therapy
- Cognitive Flexibility
- Cognitive Therapy
- Mental Health
- Psychotherapy
- Trait Theory
- Coping
- Experiential Avoidance
- Job Control
- Acceptance & Commitment Therapy
- Acceptance