Graham C. Lee

­Clinical Hypnotherapy

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Graham is a practising Acceptance and Commitment Therapist.

The way to ACT…

Surfing the third wave – a little bit of history

During the last century it has been recognised that there have been three ‘waves’ of behavioural therapies. The first of these which reached its ‘crest’ in the 1950s and 60s focused on ‘conditioning’ which appeared to offer, a relatively brief way of achieving change, compared with the earlier Freudian analytical approaches, which were far from brief and in some cases extended over many years of work. Since this early work on conditioning tended to ignore thoughts and feelings, this led to criticism that behaviourists treated their clients rather like laboratory animals, or like robots that could be programmed.

The second wave of behavioural therapies emerged in the 1970s when cognitive approaches relating to challenging or disputing irrational thoughts, emerged. This led to focus on how thoughts, feelings and behaviours can control our lives and how by examining them and the links between them we may learn to change our responses in a positive way. Cognitive Behavioural Therapy (CBT) dominated this second wave and was rigorously tested in many positive scientific studies.

ACT belongs to what is known as the ‘third wave’ of behavioural therapies – also known as mindfulness based interventions or (MBIs). These came in to prominence in the late 1980’s and 90s and includes: Mindfulness Based Cognitive Therapy (MBCT) and Dialectic Behaviour Therapy (DBT).

ACT (Acceptance and Commitment Therapy) is pronounced as the word ‘act’ for good reason. It’s about taking action. It was developed in the USA by psychologist Steve Hayes, along with his colleagues Kelly Wilson and Kirk Strosahl. The original body of work has been further developed and expanded by others, including Dr Russ Harris who has authored a number of well-respected books including the self-help guide ‘The Happiness Trap’.

Steve Hayes, describes ACT as an ‘oddly counterintuitive model of work’. It can be engaging and playful and teaches us skills to handle unwanted and painful thoughts and feelings in a way in which they have far less significance or negative affect. Mindfulness skills are brought into play here.

It also takes the view that, irrespective of the number of symptoms we have, or how serious those are, provided that we respond to them in a mindful way we will feel happier and better able to function. Unwanted symptoms do ‘miraculously’ tend to reduce, even though this is not the primary aim!

ACT has been scientifically researched and proven to be effective in helping people with a wide range of issues including: anxiety, depression and chronic pain. Even those with severe psychiatric disorders including schizophrenia have gained remarkable benefit. It has also produced similarly high levels of success with some of the less serious conditions which we may encounter in our day-to-day work, such as smoking cessation, weight reduction and reducing stress. The high level of supporting scientific evidence has ensured that ACT has grown in popularity as a form of psychological treatment around the world.

30 years in the making

The original development of ACT was around 30 years ago and yet it was not until nearer to 10 years ago when it began to find its current high level of popularity. There are a number of reasons for this delayed enthusiasm.

30 years ago ACT seemed to fly in the face of conventional psychological theory in the sense that most approaches aimed to reduce unwanted symptoms. ACT takes a different approach and one that is much more focussed in the idea that quality of life is primarily dependent upon mindful, values-guided action.
ACT is mindfulness based intervention and 30 years ago these were in their infancy and seen as a little way out!
The original writings on ACT were peer reviewed as being ‘overly complex’. Heavy on rather complicated theory but light on practicalities.

The ACT acronym.

ACT is sometimes seen as a rather large model but the real beauty of it is the way that it can be simplified and easily explainable.

A = Accept your thoughts and feelings and be present

C = Choose a valued direction

T = Take action!

Key themes for ACT include developing psychological flexibility, encouraging self-awareness and examining beliefs and values. Here we encourage our clients, rather like we would in a coaching exercise to explore their innermost beliefs and values. What would they live and die for? What would they say is their life purpose? Translating this into a behavioural context, what qualities of ongoing action matter? How do clients want to behave on an ongoing basis?

Clients are taught how to ‘defuse’, or separate from their unwanted thoughts, emotions and mental pictures. They learn how to observe them more passively or step back and view them from a distance, rather like clouds passing by in the sky. ACT employs a number of different styles of metaphor, which are often a great way of teaching clients in an indirect and more acceptable manner.