The Acceptance and Commitment Therapy (ACT) is a type of therapy that falls within the so-called third generation therapies, which emerged between the 80s and 90s in the United States and are part of the behavioural and cognitive therapeutic models.

While first and second generation therapies focused and (focus) on combating automatic or distressing thoughts and replacing them with supposedly more adaptive ones, third generation therapies emphasize dialogue and functional context and seek acceptance and non-judgmental attitude as a way to find well-being.

What are first and second generation therapies

Third generation or third wave therapies belong to behavioral therapies. To understand what these therapies are, I will first talk about first and second generation therapies.

The first generation therapies (1960s) are the therapies that were born with the aim of overcoming the limitations of psychoanalytic therapy, which was dominant at that time. When we talk about first generation therapies we are talking about Watson’s Classical Conditioning and Skinner’s Operant Conditioning. These types of therapies had their usefulness in treating, for example, fears or phobias, and were based on the principles of conditioning and learning.

However, neither the associationist learning model and the stimulus-response paradigm characteristic of Watson, nor even Skinner’s experimental advance were effective in the treatment of certain psychological problems that some people presented. Then, the second generation therapies appeared (70’s), which are, mainly, the Cognitive-Behavioral Therapies (CBT) as, for example, the Rational Emotional Therapy (RET) of Albert Ellis and the Cognitive Therapy of Aaron Beck, which consider the thought or cognition as the main cause of the human behavior and, therefore, of the psychological disorders.

However, the second wave of behavioral therapies continued (and continues) to use techniques and procedures from the first generation and therefore focus on the modification, elimination, avoidance and ultimately the alteration of private events (thoughts, beliefs, emotions, feelings and even one’s own bodily sensations).

In other words, these forms of therapy revolve around the idea that if the reason for the behavior is a private event, it must be modified in order to change the behavior. This premise is widely accepted today, which results in what is socially established as normal and correct behaviour or mental illness. Something that fits perfectly with a medical-psychiatric and even pharmacological model.

What characterizes third generation therapies

Third generation therapies emerged in the 1990s , and differ from the latter because they approach disorders from a contextualist, functional perspective, and their main objective is not to reduce the symptoms presented by the patient, but to educate him/her and reorient his/her life in a more holistic way. They are based on the idea that it is not the events that cause the patient’s discomfort or anxiety, but how we link emotions to them and how we relate to them. It is not a matter of avoiding what causes us suffering, because this can have a rebound effect (as many researches indicate), but the ideal situation is to accept our own mental and psychological experience, and thus reduce the intensity of the symptoms.

Sometimes it can be strange to work in this type of therapy, which invites the person to see, thanks to different techniques (experiential exercises, metaphors, paradoxes, etc), that what is socially or culturally accepted causes him/her an attempt to control his/her private events that is in itself problematic. This control is not the solution, but the cause of the problem .

The importance of functional contextualism

One aspect to highlight of the third generation therapies is that are based on a functional and contextual perspective of the pathologies , which is called functional contextualism. That is, the behaviour of the individual is analysed from the context in which it occurs, because if it is decontextualised, then it is not possible to discover its functionality.

On the one hand, it is interesting to know how the person relates to the context according to his/her history and current circumstances, always taking into account verbal behaviour and clarification of values. Verbal behaviour is what the patient says to himself and to others, but it is not important for the content but for the function. A patient may say that he feels self-conscious and very embarrassed when he has to speak in public. What is important is not whether he feels ashamed or is self-conscious, but whether this way of thinking is doing him good or harm.

Moreover, in third generation therapies, no distinction is made between observable and private behaviour, since the latter is also assessed from the point of view of functionality.

Acceptance and Commitment Therapy

Without a doubt, one of the best known third generation therapies is Acceptance and Commitment Therapy (ACT), which aims to create a rich and meaningful life for the patient, accepting the pain that inevitably comes with it .

ACT is presented as an alternative to traditional psychology and is a model of psychotherapy that is scientifically supported and uses different techniques: paradoxes, experimental exercises, metaphors, work with personal values and even mindfulness training. It is based on the Relational Framework Theory (RFT) , and therefore is framed in new theory of language and cognition.

Human language can transform us, but it can also create psychological suffering. That is why it is necessary to work with the meanings of language, its functions and its relationship to private events (emotions, thoughts, memories…). Moreover, self-discovery and clarification of values are essential elements in this type of therapy , in which the patient must ask himself and question what kind of person he wants to be, what is truly valuable in his life and from what beliefs and values he acts.

Commitment to our values

If we look around us, it seems clear that much of our suffering is determined by our beliefs of what is right or wrong , beliefs that are culturally learned and that are grounded in the values promoted by Western society. While most therapies view suffering as abnormal, ACT understands that suffering is part of life itself. Therefore, ACT is said to question social ideology and models of healthy normality, in which happiness is understood as the absence of pain, anxiety or worry.

ACT, which in English means “to act”, emphasizes taking effective action guided by our deepest values, in which we are fully present and committed.

Principles of this type of therapy

ACT employs some principles that allow patients to develop the mental flexibility needed to improve their emotional well-being.

It’s these six:

1. Acceptance

Acceptance means recognizing and approving our emotional experience , our thoughts or our feelings. It has to do with treating us with love and compassion in spite of the fact that we are not perfect. We should not fight against our private events or run away from them.

In fact, the acceptance of the present situation contributes to the fact that many of the aspects of our life that we perceive as problems cease to be so, thus diminishing the level of anxiety and the factors of discomfort associated with it.

2. Cognitive defusion

It is about observing our thoughts and cognitions as what they are , pieces of language, words, images, etc. Simply observing and letting go without judging them. In this way we adopt a distant and more rational view of things.

3. Present experience

The present is the only time we can live . Being in the here and now with an open mind and full consciousness, participating fully with due attention to what is happening in and around us is the key to our well-being.

4. The “Observer Self”

It means to detach oneself from the conceptualized “I” , that is, from the attachment to one’s own narratives. From the perspective of the “I” as an observer we see things from a non-judgmental point of view.

5. Clarity of values

The ACT demands a work of self-knowledge that allows us to clarify our values from the depths of our soul What is truly valuable for us? Where do we really want to be or go? These are some of the questions that need to be answered. But always with honesty.

6. Committed action

The direction we take must always be determined by our own values and not by social impositions. We have to get involved in meaningful actions for ourselves. In this way we are much more likely to commit ourselves to our projects and make them progress at the pace we want.

Bibliographic references:

  • Hayes, S.C. (2004). Acceptance and commitment therapy, relational frame theory, and the third wave of behavioral and cognitive therapies. Behavior therapy, 35, 639-665.
  • Luciano, M.C. and Valdivia, M.S. (2006). Acceptance and Commitment Therapy (ACT): Foundations, characteristics and evidence. Roles of the Psychologist, 27, 79-91.