Acceptance and commitment therapy

Acceptance and commitment therapy (ACT, typically pronounced as the word "act") is a form of counseling and a branch of clinical behavior analysis.[1] It is an empirically-based psychological intervention that uses acceptance and mindfulness strategies mixed in different ways[2] with commitment and behavior-change strategies, to increase psychological flexibility. The approach was originally called comprehensive distancing.[3] Steven C. Hayes developed Acceptance and Commitment Therapy in 1982 in order to create a mixed approach which integrates both cognitive and behavioral therapy.[4] There are a variety of protocols for ACT, depending on the target behavior or setting. For example, in behavioral health areas a brief version of ACT is called focused acceptance and commitment therapy (FACT).[5]

The objective of ACT is not elimination of difficult feelings; rather, it is to be present with what life brings us and to "move toward valued behavior".[6] Acceptance and commitment therapy invites people to open up to unpleasant feelings, and learn not to overreact to them, and not avoid situations where they are invoked. Its therapeutic effect is a positive spiral where feeling better leads to a better understanding of the truth.[7] In ACT, 'truth' is measured through the concept of 'workability', or what works to take another step toward what matters (e.g. values, meaning).



ACT is developed within a pragmatic philosophy called functional contextualism. ACT is based on relational frame theory (RFT), a comprehensive theory of language and cognition that is an offshoot of behavior analysis. Both ACT and RFT are based on B. F. Skinner's philosophy of Radical Behaviorism.[8]

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 helps the individual get in contact with a transcendent sense of self known as "self-as-context"—the you who is always there observing and experiencing and yet distinct from one's thoughts, feelings, sensations, and memories. 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.[3]

While Western psychology has typically operated under the "healthy normality" assumption which states that by their nature, humans are psychologically healthy, ACT assumes, rather, that psychological processes of a normal human mind are often destructive.[9] The core conception of ACT is that psychological suffering is usually caused by experiential avoidance, cognitive entanglement, and resulting psychological rigidity that leads to a failure to take needed behavioral steps in accord with core values. As a simple way to summarize the model, ACT views the core of many problems to be due to the concepts represented in the acronym, FEAR:

Cards used as a therapeutic activity in ACT treatment
Cards used as a therapeutic activity in ACT treatment.
  • Fusion with your thoughts
  • Evaluation of experience
  • Avoidance of your experience
  • Reason-giving for your behavior

And the healthy alternative is to ACT:

  • Accept your reactions and be present
  • Choose a valued direction
  • Take action

Core principles

ACT commonly employs six core principles to help clients develop psychological flexibility:[9]

  1. Cognitive defusion: Learning methods to reduce the tendency to reify thoughts, images, emotions, and memories.
  2. Acceptance: Allowing unwanted private experiences (thoughts, feelings and urges) to come and go without struggling with them.
  3. Contact with the present moment: Awareness of the here and now, experienced with openness, interest, and receptiveness. (e.g., mindfulness)
  4. The observing self: Accessing a transcendent sense of self, a continuity of consciousness which is unchanging.
  5. Values: Discovering what is most important to oneself.[10]
  6. Committed action: Setting goals according to values and carrying them out responsibly, in the service of a meaningful life.

Correlational evidence has found that absence of psychological flexibility predicts many forms of psychopathology. A 2005 meta-analysis showed that the six ACT principles, on average, account for 16–29% of the variance in psychopathology (general mental health, depression, anxiety) at baseline, depending on the measure, using correlational methods.[11]:12–13 A 2012 meta-analysis of 68 laboratory-based studies on ACT components has also provided support for the link between psychological flexibility concepts and specific components.[12]


A 2008 meta-analysis concluded that the evidence was still too limited for ACT to be considered a supported treatment, and raised methodological concerns about the research base.[13] A 2009 meta-analysis found that ACT was more effective than placebo and "treatment as usual" for most problems (with the exception of anxiety and depression), but not more effective than CBT and other traditional therapies.[14] A 2012 meta-analysis was more positive and reported that ACT outperformed CBT, except for treating depression and anxiety.[15]

A 2015 review found that ACT was better than placebo and typical treatment for anxiety disorders, depression, and addiction.[16] Its effectiveness was similar to traditional treatments like cognitive behavioral therapy (CBT).[16] The authors suggested that the CBT comparison of the previous 2012 meta-analysis may have been compromised by the inclusion of nonrandomized trials with small sample sizes. They also noted that research methodologies had improved since the studies described in the 2008 meta-analysis.[16]

The number of randomized clinical trials and controlled time series evaluating ACT for a variety of problems is growing. In 2006, only about 30 such studies were known,[11] but in 2011 the number had approximately doubled.[17] The website of the Association for Contextual Behavioral Science states that there were 171 randomized controlled trials (RCTs) of ACT published as of December 2016,[18] and over 20 meta-analyses and 45 mediational studies of the ACT literature as of Spring 2016.[18] Most studies of ACT so far have been conducted on adults and therefore the knowledge of its effectiveness when applied to children and adolescents is limited.


ACT, dialectical behavior therapy (DBT), functional analytic psychotherapy (FAP), mindfulness-based cognitive therapy (MBCT) and other acceptance- and mindfulness-based approaches are commonly grouped under the name "the third wave of cognitive behavior therapy".[13][19] The first wave, behaviour therapy, commenced in the 1920s based on Pavlov's classical (respondent) conditioning and operant conditioning that was correlated to reinforcing consequences. The second wave emerged in the 1970s and included cognition in the form of irrational beliefs, dysfunctional attitudes or depressogenic attributions.[20] In the late 1980s empirical limitations and philosophical misgivings of the second wave gave rise to Steven Hayes' ACT theory which modified the focus of abnormal behaviour away from the content or form towards the context in which it occurs.[20] ACT research has suggested that many of the emotional defenses individuals use with conviction to try to solve their problems actually entangle humans into greater suffering. Rigid ideas about themselves, lack of focus on what is important in their life and struggling to change sensations, feelings or thoughts that are troublesome only serve to create greater distress.[21]

Steven C. Hayes described this group in his ABCT President Address as follows:

Grounded in an empirical, principle-focused approach, the third wave of behavioral and cognitive therapy is particularly sensitive to the context and functions of psychological phenomena, not just their form, and thus tends to emphasize contextual and experiential change strategies in addition to more direct and didactic ones. These treatments tend to seek the construction of broad, flexible and effective repertoires over an eliminative approach to narrowly defined problems, and to emphasize the relevance of the issues they examine for clinicians as well as clients. The third wave reformulates and synthesizes previous generations of behavioral and cognitive therapy and carries them forward into questions, issues, and domains previously addressed primarily by other traditions, in hopes of improving both understanding and outcomes.

ACT has also been adapted to create a non-therapy version of the same processes called Acceptance and Commitment Training. This training process, oriented towards the development of mindfulness, acceptance, and valued skills in non-clinical settings such as businesses or schools, has also been investigated in a handful of research studies with good preliminary results.[22] This is somewhat similar to the awareness–management movement in business training programs, where mindfulness and cognitive-shifting techniques are employed.

The emphasis of ACT on ongoing present moment awareness, valued directions and committed action is similar to other psycho-therapeutic approaches that, unlike ACT, are not as focused on outcome research or consciously linked to a basic behavioral science program, including approaches such as Gestalt therapy, Morita therapy and Voice Dialogue, IFS and others.

Wilson, Hayes & Byrd explore at length the compatibilities between ACT and the 12-step treatment of addictions and argue that, unlike most other psychotherapies, both approaches can be implicitly or explicitly integrated due to their broad commonalities. Both approaches endorse acceptance as an alternative to unproductive control. ACT emphasizes the hopelessness of relying on ineffectual strategies to control private experience, similarly the 12-step approach emphasizes the acceptance of powerlessness over addiction. Both approaches encourage a broad life-reorientation, rather than a narrow focus on the elimination of substance use, and both place great value on the long-term project of building of a meaningful life aligned with the clients' values. ACT and 12-step both encourage the pragmatic utility of cultivating a transcendent sense of self (higher power) within an unconventional, individualized spirituality. Finally they both openly accept the paradox that acceptance is a necessary condition for change and both encourage a playful awareness of the limitations of human thinking.[23]


Some published empirical studies in clinical psychology have argued that ACT is not different from other interventions.[24][25] Stefan Hofmann argued that ACT is similar to the much older Morita therapy.[26]

A meta-analysis by Öst in 2008 concluded that ACT did not yet qualify as an "empirically supported treatment", that the research methodology for ACT was less stringent than cognitive behavioral therapy, and that the mean effect size was moderate.[13] Supporters of ACT have challenged those conclusions by showing that the quality difference in Öst's review was accounted for by the larger number of funded trials in the CBT comparison group.[27]

Several concerns, both theoretical and empirical, have arisen in response to the ascendancy of ACT. One major theoretical concern is that the primary authors of ACT and of the corresponding theories of human behavior, relational frame theory (RFT) and functional contextualism (FC), recommend their approach as the proverbial holy grail of psychological therapies.[28] Psychologist James C. Coyne, in a discussion of "disappointments and embarrassments in the branding of psychotherapies as evidence supported", said: "Whether or not ACT is more efficacious than other therapies, as its proponents sometimes claim, or whether it is efficacious for psychosis, is debatable".[29] The textbook Systems of Psychotherapy: A Transtheoretical Analysis provides criticisms of third-wave behaviour therapies including ACT from the perspectives of other systems of psychotherapy.[30]

Psychologist Jonathan W. Kanter said that Hayes and colleagues "argue that empirical clinical psychology is hampered in its efforts to alleviate human suffering and present contextual behavioral science (CBS) to address the basic philosophical, theoretical and methodological shortcomings of the field. CBS represents a host of good ideas but at times the promise of CBS is obscured by excessive promotion of Acceptance and Commitment Therapy (ACT) and Relational Frame Theory (RFT) and demotion of earlier cognitive and behavior change techniques in the absence of clear logic and empirical support."[31] Nevertheless, Kanter concluded that "the ideas of CBS, RFT, and ACT deserve serious consideration by the mainstream community and have great potential to shape a truly progressive clinical science to guide clinical practice."[31]

ACT currently appears to be about as effective as standard CBT, with some meta-analyses showing small differences in favor of ACT and others not. For example, a meta-analysis published by Francisco Ruiz in 2012 looked at 16 studies comparing ACT to standard CBT.[32] ACT failed to separate from CBT on effect sizes for depression, anxiety or quality of life. The author did find separation between ACT and CBT on the "primary outcome" – a heterogeneous class of 14 separate outcome measures that were aggregated into the effect size analysis. This analysis however is limited by the highly heterogeneous nature of the outcome variables used in the analysis, which has the tendency to increase the number needed to treat (NNT) to replicate the effect size reported. More limited measures, such as depression, anxiety and quality of life decrease the NNT, making the analysis more clinically relevant, and on these measures ACT did not outperform CBT.

A 2013 paper comparing ACT to cognitive therapy (CT) concluded that "like CT, ACT cannot yet make strong claims that its unique and theory-driven intervention components are active ingredients in its effects."[33] The authors of the paper suggested that many of the assumptions of ACT and CT "are pre-analytical, and cannot be directly pitted against one another in experimental tests."[33]

Professional organizations

The Association for Contextual Behavioral Science is committed to research and development in the area of ACT, RFT, and contextual behavioral science more generally. As of 2017 it had over 7,600 members worldwide, about half outside of the United States. It holds annual "world conference" meetings: The 16th will be held in Montreal, in July 2018.[34]

The Association for Behavior Analysis International (ABAI) has a special interest group for practitioner issues, behavioral counseling, and clinical behavior analysis ABA:I. ABAI has larger special interest groups for autism and behavioral medicine. ABAI serves as the core intellectual home for behavior analysts.[35][36] ABAI sponsors three conferences/year—one multi-track in the U.S., one specific to Autism and one international.

The Association for Behavioral and Cognitive Therapies (ABCT) also has an interest group in behavior analysis, which focuses on clinical behavior analysis. ACT work is commonly presented at ABCT and other mainstream CBT organizations.

The British Association for Behavioural and Cognitive Psychotherapies (BABCP) has a large special interest group in ACT, with over 1,200 members.

Doctoral-level behavior analysts who are psychologists belong to the American Psychological Association's (APA) Division 25—Behavior analysis.[37] ACT has been called a "commonly used treatment with empirical support" within the APA-recognized specialty of behavioral and cognitive psychology.[38]

See also


  1. ^ Jennifer C Plumb; Ian Stewart; Galway JoAnne Dahl; Tobias Lundgren (Spring 2009). "In Search of Meaning: Values in Modern Clinical Behavior Analysis". Behav. Anal. 32 (1): 85–103. doi:10.1007/bf03392177. PMC 2686995. PMID 22478515.
  2. ^ Hayes, Steven. "Acceptance & Commitment Therapy (ACT)".
  3. ^ a b Zettle, Robert D. (2005). "The Evolution of a Contextual Approach to Therapy: From Comprehensive Distancing to ACT". International Journal of Behavioral Consultation and Therapy. 1 (2): 77–89. doi:10.1037/h0100736.
  4. ^ Freeman, Arthur (2010). Cognitive and Behavioral Theories in Clinical Practice. Newyork, NY: The Guilford Press. p. 125. ISBN 978-1-60623-342-9.
  5. ^ "Focused Acceptance and Commitment Therapy (FACT): Mastering The Basics". Association for Contextual Behavioral Science. Archived from the original on 2016-04-07. Retrieved 2016-04-07.
  6. ^ Hayes, Steven C.; Strosahl, Kirk D.; Wilson, Kelly G. (2012). Acceptance and Commitment Therapy: The Process and Practice of Mindful Change (2 ed.). New York: Guilford Press. p. 240. ISBN 978-1-60918-962-4.
  7. ^ Shpancer, Noam (September 8, 2010). "Emotional Acceptance: Why Feeling Bad is Good". Psychology Today.
  8. ^ Kohlenberg, Robert; Hayes, Steven; Tsai, Mavis (1993). "Radical Behavioral Psychotherapy: Two Contemporary Examples". Clinical Psychology Review. 13 (6): 579–592. CiteSeerX doi:10.1016/0272-7358(93)90047-p.
  9. ^ a b Harris, Russ (August 2006). "Embracing your demons: an overview of Acceptance and Commitment Therapy" (PDF). Psychotherapy in Australia. 12 (4): 2–8.
  10. ^ Robb, Hank (2007). "Values as Leading Principles in Acceptance and Commitment Therapy". International Journal of Behavioral Consultation and Therapy. 3 (1): 118–23. doi:10.1037/h0100170.
  11. ^ a b Hayes, Steven C.; Luoma, Jason B.; Bond, Frank W.; Masuda, Akihiko; Lillis, Jason (2006). "Acceptance and Commitment Therapy: Model, processes and outcomes". Behaviour Research and Therapy. 44 (1): 1–25. doi:10.1016/j.brat.2005.06.006. PMID 16300724.
  12. ^ Levin, Michael E.; Hildebrandt, Mikaela J.; Lillis, Jason; Hayes, Steven C. (2012). "The Impact of Treatment Components Suggested by the Psychological Flexibility Model: A Meta-Analysis of Laboratory-Based Component Studies". Behavior Therapy. 43 (4): 741–56. doi:10.1016/j.beth.2012.05.003. PMID 23046777.
  13. ^ a b c Öst, Lars-Göran (2008). "Efficacy of the third wave of behavioral therapies: A systematic review and meta-analysis". Behaviour Research and Therapy. 46 (3): 296–321. doi:10.1016/j.brat.2007.12.005. PMID 18258216.
  14. ^ Powers MB, Zum Vörde Sive Vörding MB, Emmelkamp PM (2009). "Acceptance and commitment therapy: A meta-analytic review". Psychotherapy and Psychosomatics. 78 (2): 73–80. CiteSeerX doi:10.1159/000190790. PMID 19142046.
  15. ^ Ruiz, F. J. (2012). "Acceptance and commitment therapy versus traditional cognitive behavioral therapy: A systematic review and meta-analysis of current empirical evidence". International Journal of Psychology and Psychological Therapy. 12 (3): 333–358.
  16. ^ a b c A-Tjak, JG; Davis, ML; Morina, N; Powers, MB; Smits, JA; Emmelkamp, PM (2015). "A meta-analysis of the efficacy of acceptance and commitment therapy for clinically relevant mental and physical health problems". Psychotherapy and Psychosomatics. 84 (1): 30–6. doi:10.1159/000365764. PMID 25547522.
  17. ^ Ruiz, F. J. (2010). "A review of Acceptance and Commitment Therapy (ACT) empirical evidence: Correlational, experimental psychopathology, component and outcome studies". International Journal of Psychology and Psychological Therapy. 10 (1): 125–62.
  18. ^ a b Hayes, Steven C. "State of the ACT Evidence". Association for Contextual Behavioral Science. Retrieved 2017-05-30.
  19. ^ Martell, Christopher R.; Michael E. Addis; Neil S. Jacobson (2001). Depression in Context: Strategies for Guided Action. New York: W. W. Norton. p. 197. ISBN 978-0-393-70350-4.
  20. ^ a b Leahy, R. L. (2004). Contemporary cognitive therapy: Theory, research, and practice. New York, NY: Guilford Press.
  21. ^ Hayes, S. C., & Smith, S. (2005). Get Out of Your Mind and into Your Life: The New Acceptance and Commitment Therapy. Santa Rosa, CA: New Harbinger Publications.
  22. ^ Hayes, S.C.; Bond, F.W.; Barnes-Holmes, D. & Austin, J. (2007). Acceptance And Mindfulness at Work: Applying Acceptance and Commitment Therapy And Relational Frame Theory to Organizational Behavior Management. Binghamton, NY: Haworth Press.
  23. ^ Wilson, Kelly G.; Hayes, Steven C.; Byrd, Michelle R. (2000). "Exploring Compatibilities Between Acceptance and Commitment Therapy and 12-Step Treatment for Substance Abuse". Journal of Rational-Emotive and Cognitive-Behavior Therapy. 18 (4): 209–234. doi:10.1023/A:1007835106007.
  24. ^ Hofmann, Stefan G.; Asmundson, Gordon J.G. (2008). "Acceptance and mindfulness-based therapy: New wave or old hat?". Clinical Psychology Review. 28 (1): 1–16. doi:10.1016/j.cpr.2007.09.003. PMID 17904260.
  25. ^ Arch, Joanna J.; Craske, Michelle G. (2008). "Acceptance and commitment therapy and cognitive behavioral therapy for anxiety disorders: Different treatments, similar mechanisms?". Clinical Psychology: Science and Practice. 15 (4): 263–279. CiteSeerX doi:10.1111/j.1468-2850.2008.00137.x.
  26. ^ Hofmann, Stefan G. (December 2008). "Acceptance and commitment therapy: new wave or Morita therapy?". Clinical Psychology: Science and Practice. 15 (4): 280–285. doi:10.1111/j.1468-2850.2008.00138.x. the criticism offered by ACT against CBT is based on a misrepresentation of the empirical evidence. Moreover, the strategies of ACT are not specific to the theory and philosophy underlying ACT. There are considerable similarities between ACT and Eastern holistic approaches, such as Morita therapy, which was developed 80 years ago.
  27. ^ Gaudiano, Brandon A. (2009). "Öst's (2008) methodological comparison of clinical trials of acceptance and commitment therapy versus cognitive behavior therapy: Matching apples with oranges?". Behaviour Research and Therapy. 47 (12): 1066–70. doi:10.1016/j.brat.2009.07.020. PMC 2786237. PMID 19679300.
  28. ^ Routier, Cédric P. (2007). "Relational frame theory (RFT) and acceptance and commitment therapy (ACT): Emperor's tailors or knights of the holy grail?". Acta Comportamentalia. 15 (3): 45–69.
  29. ^ Coyne, James C. (22 October 2012). "Troubles in the branding of psychotherapies as 'evidence supported'". PLOS. Archived from the original on 4 March 2016. Retrieved 4 May 2016.
  30. ^ Prochaska, James O.; Norcross, John C. (2014). Systems of psychotherapy: a transtheoretical analysis (8th ed.). Australia; Stamford, CT: Cengage Learning. pp. 310–312. ISBN 9781133314516. OCLC 851089001.
  31. ^ a b Kanter, Jonathan W. (June 2013). "The vision of a progressive clinical science to guide clinical practice". Behavior Therapy. 44 (2): 228–233. doi:10.1016/j.beth.2010.07.006. PMID 23611073.
  32. ^ Ruiz Jiménez, Francisco José (2012). "Acceptance and commitment therapy versus traditional cognitive behavioral therapy: A systematic review and meta-analysis of current empirical evidence". International Journal of Psychology and Psychological Therapy. 12 (3): 333–358.
  33. ^ a b Herbert, James D.; Forman, Evan M. (June 2013). "Caution: the differences between CT and ACT may be larger (and smaller) than they appear". Behavior Therapy. 44 (2): 218–223. doi:10.1016/j.beth.2009.09.005. PMID 23611071.
  34. ^ "Conferences". Association for Contextual Behavioral Science. Retrieved 2017-11-07.
  35. ^ Twyman, J.S. (2007). "A new era of science and practice in behavior analysis". Association for Behavior Analysis International: Newsletter. 30 (3): 1–4.
  36. ^ Hassert, Derrick L.; Kelly, Amanda N.; Pritchard, Joshua K.; Cautilli, Joseph D. (2008). "The Licensing of Behavior Analysts: Protecting the Profession and the Public". Journal of Early and Intensive Behavior Intervention. 5 (2): 8–19. doi:10.1037/h0100415.
  37. ^ "About the Behavior Analysis Division". American Psychological Association. Retrieved 2018-08-07.
  38. ^ "Behavioral and Cognitive Psychology Public Description". American Psychological Association. Retrieved 2018-08-07.

External links

Association for Contextual Behavioral Science

The Association for Contextual Behavioral Science (ACBS) is a worldwide nonprofit professional membership organization associated with acceptance and commitment therapy (ACT), and relational frame theory (RFT) among other topics. The term "contextual behavioral science" refers to the application of functional contextualism to human behavior, including contextual forms of applied behavior analysis, cognitive behavior therapy, and evolution science. In the applied area Acceptance and Commitment Therapy is perhaps the best known wing of contextual behavioral science, and is an emphasis of ACBS, along with other types of contextual CBT, and efforts in education, organizational behavior, and other areas. ACT is considered an empirically validated treatment by the American Psychological Association, with the status of "Modest Research Support" in depression and "Strong Research Support" in chronic pain, with several others specific areas such as psychosis and work site stress currently under review. ACT is also listed as evidence-based by the Substance Abuse and Mental Health Services Administration of the United States federal government which has examined randomized trials for ACT in the areas of psychosis, work site stress, and obsessive compulsive disorder, including depression outcomes. In the basic area, Relational Frame Theory is a research program in language and cognition that is considered part of contextual behavioral science, and is a focus of ACBS. Unlike the better known behavioral approach proposed by B.F. Skinner in his book Verbal Behavior, experimental RFT research has emerged in a number of areas traditionally thought to be beyond behavioral perspectives, such as grammar, metaphor, perspective taking, implicit cognition and reasoning.

Buddhism and psychology

Buddhism includes an analysis of human psychology, emotion, cognition, behavior and motivation along with therapeutic practices. A unique feature of Buddhist psychology is that it is embedded within the greater Buddhist ethical and philosophical system, and its psychological terminology is colored by ethical overtones. Buddhist psychology has two therapeutic goals: the healthy and virtuous life of a householder (samacariya, "harmonious living") and the ultimate goal of nirvana, the total cessation of dissatisfaction and suffering (dukkha).Buddhism and the modern discipline of Psychology have multiple parallels and points of overlap. This includes a descriptive phenomenology of mental states, emotions and behaviors as well as theories of perception and unconscious mental factors. Psychotherapists such as Erich Fromm have found in Buddhist enlightenment experiences (e.g. kensho) the potential for transformation, healing and finding existential meaning. Some contemporary mental-health practitioners such as Jon Kabat-Zinn increasingly find ancient Buddhist practices (such as the development of mindfulness) of empirically proven therapeutic value, while Buddhist teachers such as Jack Kornfield see Western psychology as providing complementary practices for Buddhists.

Clinical behavior analysis

Clinical behavior analysis (CBA; also called clinical behaviour analysis or third-generation behavior therapy) is the clinical application of behavior analysis (ABA). CBA represents a movement in behavior therapy away from methodological behaviorism and back toward radical behaviorism and the use of functional analytic models of verbal behavior—particularly, relational frame theory (RFT).

Clinical formulation

A clinical formulation, also known as case formulation and problem formulation, is a theoretically-based explanation or conceptualisation of the information obtained from a clinical assessment. It offers a hypothesis about the cause and nature of the presenting problems and is considered an adjunct or alternative approach to the more categorical approach of psychiatric diagnosis. In clinical practice, formulations are used to communicate a hypothesis and provide framework for developing the most suitable treatment approach. It is most commonly used by clinical psychologists and psychiatrists and is deemed to be a core component of these professions. Mental health nurses and social workers may also use formulations.

Cognitive emotional behavioral therapy

Cognitive emotional behavioral therapy (CEBT) is an extended version of cognitive behavioral therapy (CBT) aimed at helping individuals to evaluate the basis of their emotional distress and thus reduce the need for associated dysfunctional coping behaviors (e.g., eating behaviors including binging, purging, restriction of food intake, and substance misuse). This psychotherapeutic intervention draws on a range of models and techniques including dialectical behavior therapy (DBT), mindfulness meditation, acceptance and commitment therapy (ACT), and experiential exercises.

CEBT has been used primarily with individuals suffering from eating disorders, as it offers an alternative when standard CBT is unsuccessful in relieving symptoms. Research indicates that CEBT may help reduce emotional eating, depression, and anxiety and also improve self-esteem.

CEBT was developed in 2006 by British psychologist Emma Gray (née Corstorphine). Its key components include psychological education; techniques to enhance awareness of emotions and motivation to change; and strategies to restructure beliefs about the experience and expression of emotions.

Although (CEBT) was initially developed to help individuals suffering from eating disorders, its effectiveness in helping people to better understand and manage their emotions has meant that it is increasingly being used by psychologists as a 'pretreatment' to prepare patients for the process of therapy for a range of problems including anxiety, depression, obsessive compulsive disorder (OCD), and post traumatic stress disorder (PTSD), which can often be emotionally challenging.

Cognitive restructuring

Cognitive restructuring (CR) is a psychotherapeutic process of learning to identify and dispute irrational or maladaptive thoughts known as cognitive distortions, such as all-or-nothing thinking (splitting), magical thinking, over-generalization, magnification, and emotional reasoning, which are commonly associated with many mental health disorders. CR employs many strategies, such as Socratic questioning, thought recording, and guided imagery, and is used in many types of therapies, including cognitive behavioral therapy (CBT) and rational emotive behaviour therapy (REBT). A number of studies demonstrate considerable efficacy in using CR-based therapies.

Compassion-focused therapy

Compassion focused therapy (CFT) is a system of psychotherapy developed by Paul Gilbert that integrates techniques from cognitive behavioral therapy with concepts from evolutionary psychology, social psychology, developmental psychology, Buddhist psychology, and neuroscience. According to Gilbert, "One of its key concerns is to use compassionate mind training to help people develop and work with experiences of inner warmth, safeness and soothing, via compassion and self-compassion."

Dermot Barnes-Holmes

Dermot Barnes-Holmes (born 1963) was Foundation Professor at the Department of Psychology at National University of Ireland, Maynooth. He is known for an analysis of human language and cognition through the development of Relational Frame Theory with Steven C. Hayes, and its application in various psychological settings. He was the world's most prolific author in the experimental analysis of human behaviour between the years 1980 and 1999. He was awarded the Don Hake Basic/Applied Research Award at the 2012 American Psychological Association Conference in Orlando, Florida. He is a past president and fellow of the Association for Contextual Behavioral Science, is a recipient of the Quad-L Lecture Award from the University of New Mexico and most recently became an Odysseus laureate of the Flemish Science Foundation and a fellow of the Association for Behavior Analysis International. In 2015 he accepted a life-time senior professorship at Ghent University in Belgium. He originally conceptualized and programmed the Implicit Relational Assessment Procedure (IRAP).

Flexibility (personality)

Flexibility is a personality trait that describes the extent to which a person can cope with changes in circumstances and think about problems and tasks in novel, creative ways. This trait is used when stressors or unexpected events occur, requiring a person to change their stance, outlook, or commitment. Flexible personality should not be confused with cognitive flexibility, which is the ability to switch between two concepts, as well as simultaneously think about multiple concepts. Researchers of cognitive flexibility describe it as the ability to switch one's thinking and attention between tasks. Flexibility, or psychological flexibility, as it is sometimes referred to, is the ability to adapt to situational demands, balance life demands, and commit to behaviors.

Functional analytic psychotherapy

Functional analytic psychotherapy (FAP) is a psychotherapeutic approach based on clinical behavior analysis (CBA) that focuses on the therapeutic relationship as a means to maximize client change. Specifically, FAP suggests that in-session contingent responding to client target behaviors leads to significant therapeutic improvements.

FAP was first conceptualized in the 1980s by psychologists Robert Kohlenberg and Mavis Tsai who, after noticing a clinically significant association between client outcomes and the quality of the therapeutic relationship, set out to develop a theoretical model of behavioral psychotherapy based on these concepts. Behavioral principles (e.g., reinforcement, generalization) form the basis of FAP. (See § The five rules below.)

FAP is an idiographic (as opposed to nomothetic) approach to psychotherapy. This means that FAP therapists focus on the function of a client's behavior instead of the form. The aim is to change a broad class of behaviors that might look different on the surface but all serve the same function. It is idiographic in that the client and therapist work together to form a unique clinical formulation of the client's therapeutic goals, rather than one therapeutic target for every client who enters therapy.

Functional contextualism

Functional contextualism is a modern philosophy of science rooted in philosophical pragmatism and contextualism. It is most actively developed in behavioral science in general and the field of behavior analysis and contextual behavioral science in particular (see the entry for the Association for Contextual Behavioral Science). Functional contextualism serves as the basis of a theory of language known as relational frame theory and its most prominent application, acceptance and commitment therapy. It is an extension and contextualistic interpretation of B.F. Skinner's radical behaviorism first delineated by Steven C. Hayes which emphasizes the importance of predicting and influencing psychological events (including thoughts, feelings, and behaviors) with precision, scope, and depth, by focusing on manipulable variables in their context.

Generalized anxiety disorder

Generalized anxiety disorder (GAD) is an anxiety disorder characterized by excessive, uncontrollable and often irrational worry about events or activities. This excessive worry often interferes with daily functioning, and sufferers are overly concerned about everyday matters such as health issues, money, death, family problems, friendship problems, interpersonal relationship problems, or work difficulties. Individuals may exhibit a variety of physical symptoms, including: feeling tired, fidgeting, headaches, numbness in hands and feet, muscle tension, difficulty swallowing, vomiting, diarrhea, breathing difficulty, trembling, irritability, restlessness, sleeping difficulties, sweating and rashes.These symptoms must be consistent and ongoing, persisting at least six months, for a formal diagnosis of GAD. GAD is also common in individuals with a history of substance abuse and a family history of the disorder. Standardized rating scales such as GAD-7 can be used to assess severity of GAD symptoms.Medications which have been found to be useful include duloxetine, pregabalin, venlafaxine, and escitalopram.In a given year, approximately two percent of American adults and European adults experience GAD. Globally about 4% are affected at some point in their life. GAD is seen in women twice as much as men.

List of cognitive–behavioral therapies

Cognitive behavioral therapy is an umbrella term that encompasses many therapeutical approaches, techniques and systems.

Acceptance and commitment therapy is a "third wave" cognitive behavior therapy, developed by Steven C. Hayes based in part on relational frame theory.

Anxiety management training was developed by Suinn and Richardson (1971) for helping clients control their anxiety by the use of relaxation and other skills.

Applied behavior analysis, described by Baer, Wolf and Risley in 1968, is the science of applying experimentally derived principles of behavior to improve socially significant behavior.

Behavioral activation is a behavioral approach to treating depression, developed by Neil Jacobson and others.

Behavior modification is a term originally used by Edward Thorndike in 1911.

Behavior therapy

Cognitive therapy was developed by Aaron Beck.

Cognitive analytic therapy

Cognitive behavior modification

Cognitive behavioral analysis system of psychotherapy

Cognitive emotional behavioral therapy

Cognitive processing therapy for Post traumatic stress disorder

Compassion focused therapy

Computerised cognitive behavioral therapy

Contingency management

Dialectical behavior therapy

Direct therapeutic exposure

Exposure and response prevention

Functional analytic psychotherapy

Metacognitive therapy

Mindfulness-based cognitive therapy

Multimodal therapy

Problem-solving therapy

Prolonged exposure therapy

Rational emotive behavior therapy, formerly called rational therapy and rational emotive therapy, was founded by Albert Ellis.

Reality therapy

Relapse prevention

Schema therapy

Self-control therapy

Self-instructional training was developed by Donald Meichenbaum, influenced by the developmental psychology of Alexander Luria and Lev Vygotsky, designed to treat the mediational deficiencies of impulsive children.

Stress inoculation training

Systematic desensitization is an anxiety reduction technique, developed by Joseph Wolpe.

Systematic rational restructuring was an attempt by Marvin Goldfried to reanalyze systematic desensitization in terms of cognitive mediation and coping skills.

List of psychotherapies

This is an alphabetical list of psychotherapies.

See the main article psychotherapy for a description of what psychotherapy is and how it developed (see also counseling, and the list of counseling topics).

This list contains some approaches that may not call themselves a psychotherapy but have a similar aim, of improving mental health and well being through talk and other means of communication.

In the 20th century, a great number of psychotherapies were created. All of these face continuous change in popularity, methods and effectiveness. Sometimes they are self-administered, either individually, in pairs, small groups or larger groups. However, a professional practitioner will usually use a combination of therapies and approaches, often in a team treatment process that involves reading/talking/reporting to other professional practitioners.

The older established therapies usually have a code of ethics, professional associations, training programs, and so on. The newer and innovative therapies may not yet have established these structures or may not wish to.

Mode deactivation therapy

Mode deactivation therapy (MDT) is a psychotherapeutic approach that addresses dysfunctional emotions, maladaptive behaviors and cognitive processes and contents through a number of goal-oriented, explicit systematic procedures. The name refers to the process of mode deactivation that is based on the concept of cognitive modes as introduced by Aaron T. Beck. The MDT methodology was developed by Jack A. Apsche by combining the unique validation–clarification–redirection (VCR) process step with elements from acceptance and commitment therapy (ACT), dialectical behavior therapy (DBT), and mindfulness to bring about durable behavior change.

Primary spine practitioner

Primary spine practitioners (also referred to as PSP, Spine Care Clinician, or Spine Care Specialist, or in the broader context a primary musculoskeletal specialist or provider) are health care professionals who are specially trained to provide primary care for patients with spinal disease.

The PSP has the training necessary to provide differential diagnosis, rule out serious pathology (such as infection, fracture, cancer, inflammatory joint disease) and provide evidence-based management for the majority of patients with spinal disease. Evidence-based treatment methods include spinal manipulation and manual therapy, rehabilitative exercises, patient education, motivational techniques and the application of psychological principles, particularly those of cognitive-behavioral therapy and acceptance and commitment therapy.

In addition, the PSP has the ability to recognize the relatively few patients who require special tests (radiography, MRI, laboratory workup) and invasive procedures (injections, surgery) and to serve as the center of care for the purpose of providing counseling for the patient, coordination of care and long term follow up.

An important aspect of this role is educating the patient on the risks, benefits and research evidence of all treatments for spinal pain so that, through a shared decision making process, appropriate choices can be made as to what is the best treatment for the patient.

In addition, the PSP is tasked with helping the patient navigate the often-complex social systems, particularly for patients whose spinal disease arose from a work-related incident or personal injury.

Relational frame theory

Relational frame theory (RFT) is a psychological theory of human language. It was developed originally by Steven C. Hayes of University of Nevada, Reno and has been extended in research notably by Dermot Barnes-Holmes of Ghent University.Relational frame theory argues that the building block of human language and higher cognition is relating, i.e. the human ability to create bidirectional links between things. It can be contrasted with associative learning, which discusses how animals form links between stimuli in the form of the strength of associations in memory. However, relational frame theory argues that natural human language typically specifies not just the strength of a link between stimuli but also the type of relation as well as the dimension along which they are to be related. For example, a tennis ball is not just associated with an orange, but can be said to be the same shape, but a different colour and not edible. In the preceding sentence, 'same', 'different' and 'not' are cues in the environment that specify the type of relation between the stimuli, and 'shape', 'colour' and 'edible' specify the dimension along which each relation is to be made. Relational frame theory argues that while there are an arbitrary number of types of relations and number of dimensions along which stimuli can be related, the core unit of relating is an essential building block for much of what is commonly referred to as human language or higher cognition.

Several hundred studies have explored many testable aspects and implications of the theory such as the emergence of specific frames in childhood, how individual frames can be combined to create verbally complex phenomena such as metaphors and analogies, and how the rigidity or automaticity of relating within certain domains is related to psychopathology. In attempting to describe a fundamental building block of human language and higher cognition, RFT explicitly states that its goal is to provide a general theory of psychology that can provide a bedrock for multiple domains and levels of analysis.

Relational frame theory focuses on how humans learn language (i.e., communication) through interactions with the environment and is based on a philosophical approach referred to as functional contextualism.

Steven C. Hayes

Steven C. Hayes (born August 12, 1948) is a clinical psychologist and Nevada Foundation Professor at the University of Nevada, Reno Department of Psychology, where he is a faculty member in their Ph.D. program in behavior analysis, and coined the term clinical behavior analysis. He is known for devising a behavior analysis of human language and cognition called relational frame theory, and its clinical application to various psychological difficulties, such as anxiety. Hayes also developed a widely-used and evidence-based procedure often used in counseling called acceptance and commitment therapy (ACT), which relies heavily on counterconditioning techniques, such as mindfulness (a private behavior in radical behaviorism), and positive reinforcement.

The Worry Trap

The Worry Trap: How to Free Yourself from Worry & Anxiety Using Acceptance & Commitment Therapy is a self-help book written by Chad LeJeune, Ph.D. in 2007.


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