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Acceptance and commitment therapy
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===The hexaflex=== ACT consists of 6 main processes: acceptance, defusion, being present, self as context, values and committed action. These are often presented graphically in the form of a hexagon. Because the ultimate goal of ACT is to increase the client’s psychological flexibility, this hexagon is commonly referred to as the hexaflex.<ref name="Gordon2017" /> ====Acceptance ==== ACT differs from traditional cognitive behavioral therapy in its focus on acceptance.<ref name="Hayes2006" /> Rather than trying to teach people to better control their unpleasant sensations, clients learn to accept them in the appropriate context. According to ACT, it is psychologically healthy to have unpleasant thoughts and feelings.<ref name="Hayesbook" /> Attempts to avoid, suppress, or eliminate unwanted private experiences are considered counterproductive.<ref name="Cioffi1993">{{Cite journal | last = Cioffi | first = D. | last2 = Holloway | first2 = J. | date = Feb 1993 | title = Delayed costs of suppressed pain | url =https://www.ncbi.nlm.nih.gov/pubmed/8433273 | journal = Journal of Personality and Social Psychology | volume = 64 | issue = 2 | pages = 274–282|issn=0022-3514|pmid=8433273}}</ref> Asking a person not to think of chocolate biscuits, for example, will most likely result in that person thinking about chocolate biscuits. Negating unpleasant experiences often results in experiential avoidance, which might bring short-term relief but often exacerbates problems in the long term. Persons who drink to numb hurtful experiences for example, will most likely increase rather than solve their problems.<ref name="Hayesbook" /> As an alternative, ACT proposes a willingness to come into contact with a person's whole experience, including the painful aspects. Acceptance doesn’t mean liking or wanting these experiences or giving up on doing anything about it, but simply accepting that they are there.<ref name="Hayes2013">{{Cite journal | last = Hayes | first = Steven C. | last2 = Levin | first2 = Michael E. | last3 = Plumb-Vilardaga | first3 = Jennifer | last4 = Villatte | first4 = Jennifer L. | last5 = Pistorello | first5 = Jacqueline | date = Jun 2013 | title = Acceptance and commitment therapy and contextual behavioral science: examining the progress of a distinctive model of behavioral and cognitive therapy | url = https://www.ncbi.nlm.nih.gov/pubmed/23611068 | journal = Behavior Therapy | volume = 44 | issue = 2 | pages = 180–198|doi=10.1016/j.beth.2009.08.002|issn=1878-1888|pmc=3635495|pmid=23611068}}</ref> ==== Cognitive defusion ==== Humans tend to experience language in a very literal way. According to ACT, many psychological problems occur when persons so strongly believe the contents of their mind that they become fused with their cognitions.<ref name="Hayesbook" /> Cognitive defusion techniques are used to undermine the negative effects of language by teaching clients to get some distance from their thoughts. Clients are for example encouraged to label and provide context to their internal experiences. The feeling "I’m no good" could be rephrased as "I am having the thought that I am no good."<ref name="McHugh2011" /> Other de-literalization techniques include repeating words so often that their meaning becomes obscured.<ref name="Hayesbook" /> The resulting detachment from inner thoughts and feelings is designed to increase psychological flexibility and the range of behavioral responses toward mental experiences. ACT teaches how one can be aware of one's flow of experiences without attachment to them.<ref name="Sixprocesses">{{Cite web | last = Hayes | first = S | date = 2006 | url = https://contextualscience.org/the_six_core_processes_of_act | title = The Six Core Processes of ACT | website = Association for Contextual Behavioral Science | access-date = 2019-03-17}}</ref> ==== Being present ==== ACT promotes a non-judgmental relation with events and internal experiences as they occur.<ref name="Sixprocesses" /> This means observing them in the present and not trying to relate them to possible causes or consequences. Focusing on the present increases psychological flexibility, as it does not restrict interpretations and actions based on what happened in the past or what might happen in the future. According to ACT, searching for possible explanations of why something happened and ruminating about ''what if'' realities, are often unhelpful in working out psychological problems.<ref name="Hayesbook" /> ==== The chessboard metaphor ==== According to ACT, people interpret their experiences as relating to a coherent self, an identity that determines interpretations of thoughts and feelings and their behavioral consequences. A person who labels herself as incompetent or shy for example might behave in a manner that maintains that self-description.<ref name="Twohig2012">{{Cite journal | last = Twohig | first = Michael P. | author-link = | date = Nov 2012 | title = Acceptance and Commitment Therapy | url = https://linkinghub.elsevier.com/retrieve/pii/S1077722912000508 | journal = Cognitive and Behavioral Practice|language=en | volume = 19 | issue = 4 | pages = 499–507|doi=10.1016/j.cbpra.2012.04.003|pmc=|pmid=|access-date=|quote=|via=}}</ref> ACT promotes detachment from such verbally constructed identities as they may cause psychological rigidity. As an alternative ACT proposes the self as context, where one steps back from all definitions and descriptions about one's self. The self as context is the idea that our selves are the observer of our experiences and not the content we observe.<ref name="Gordon2017" /> ACT assumes that persons with psychological problems often fail to distinguish themselves as separate from their experience. The chessboard metaphor is used to description the use of detachment.<ref>{{Cite book | title = Acceptance & Commitment Therapy for the Treatment of Post-traumatic Stress Disorder & Trauma-related Problems: A Practitioner's Guide to Using Mindfulness & Acceptance Strategies | pages = 116|isbn=978-1-57224-472-6|edition= | volume = |language=en| title-link = | url = https://books.google.co.uk/books?id=Qlm6BX-K40QC&lpg=PA116&=PA116#v=onepage&q=chess-board=true|access-date= | date = 2007| publisher = New Harbinger Publications | last = Walser | first = Robyn D. | author-link = | last2 = Westrup | first2 = Darrah | author-link2 = |veditors=|others=|doi=|oclc=|quote=|archive-url=|archive-date=|location=|editor-last = |editor-first = | editor1-link = |editor-last2 = |editor-first2 = }}</ref> Clients are told that their inner experiences are similar to playing chess, and different chess pieces can be used to their represent thoughts, feelings, and experiences. The chess pieces might represent either comfortable ("good") or uncomfortable ("bad") experiences, and are placed on the chessboard in a group according to whether they represent "good" or "bad" experiences. Larger pieces are used to represent the more distressing experiences such as traumatic events. Clients are encouraged to see these thoughts, feelings and experiences as in conflict, with the client only winning when the "good" beats the "bad". The fear of the bad itself is also a part of the game, so it is added to the board as a new piece. There is no winning this game because new experiences continue to happen, and the bad experiences (the client's history) can't be erased. Clients are then encouraged to see themselves as the ''chessboard'' instead: the chessboard never wins or loses, it simply observes the good and bad thoughts, feelings and experiences. This chessboard metaphor of detachment is a central part of ACT.<ref name="Hayesbook" /> ==== Values ==== ACT encourages clients to get in touch with their personal values. Actions are often determined by social conformity and attempts to please others with the result that one loses touch with core values. When we say someone made a bad choice, we usually refer to the negative outcome of an action rather than the values that guided it. ACT therapists frequently use the funeral thought experiment to help clients think about their values.<ref name="Hayesbook" /> Clients are asked to think about what they want their loved ones to say at their own funeral. Usually, people want to be remembered as loving and generous, not as someone who made a lot of money. Consequently, clients learn to differentiate means from goals, the important from the unimportant. ==== Committed action ==== Finally, ACT encourages effective action based on those chosen values. The eventual goal of ACT is to encourage behavioral change. As noted by one ACT textbook: ''"If a client does not change his or her behavior, then all of our efforts working on defusion–acceptance, present moment–self-as perspective, and values are for naught."''<ref name="Hayesbook" /> Clients are encouraged to lessen experiential avoidance. A person with agoraphobia, for example, might be afraid to go out to the supermarket to buy groceries. By avoiding such experiences patients could get stuck in a self-perpetuating cycle. ACT tries to break that cycle. Exercises on acceptance or cognitive defusion are meant to diminish the behavioral consequences of unpleasant experiences.<ref name="Twohig2012" />
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