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Some words about ACT:
Acceptance and Commitment Therapy


on The Beacon Deacon Web Site

I remember reading the February 13, 2006, article in Time Magazine entitled Happiness Isn’t Normal (later entitled The Third Wave of Therapy) by John Cloud. I never studied acceptance and commitment therapy (ACT) in graduate school as it is a newer approach that didn’t really exist then. However, I think it seems really like a mix between cognitive therapy and existentialism. The article makes some assumptions about cognitive behavioral therapy (CBT) that are too simplistic or even incorrect. Language like "mindfulness" throws up a red flag to me. It comes from mystical concepts that, when taken to the extreme, are more of a neo-paganistic approach. However, being mindful in and of itself is not wrong. In the article, it says ACT therapists/researchers "are focusing less on how to manipulate the content of our thoughts and more on how to change their context--to modify the way we see thoughts and feelings so they can’t push us around and control our behavior." This is true about good CBT, too. Metacognition (a CBT concept) consists of beliefs about thoughts. Seeing context and how thoughts and feelings interrelate are part of good CBT. Manipulation is never good therapy in any approach. And advice is rarely to be given. The article says, "Hayes and like-minded therapists don’t try to prove or disprove such thoughts. Whereas cognitive therapists speak of ‘cognitive errors’ and ‘distorted interpretations,’ Hayes and the others teach mindfulness, the meditation-inspired practice of observing thoughts without getting entangled in them, approaching them as though they were leaves floating down a stream." This statement is chalked full of problems. Some thoughts and beliefs are indeed destructive. When we get away from knowing what is true and good and what is false and not good, we begin to trek down the path of moral relativism. This is where "mindfulness" begins to go down a path I disagree with. Ellis’ Rational-Emotive Behavioral Therapy and Skinner’s Behavioral Therapy, cousins of CBT, do look at behavior over feelings and I have problems with those theories in and of themselves. Ellis’ approach was especially harsh at times and I would even say manipulative and unethical at some times. However, CBT involves Thought, Feeling, and Behavior without exclusion. I was a CBT therapist for the most part. It looks at how thoughts and feelings interact and influence behavior and vice versa. It makes sense in a Christian world view where our beliefs and convictions drive our actions. I agree that trying to focusing on negative thoughts can intensify them, but the article’s example of telling the dieter to not eat pizza causing them to obsess about pizza is a grossly misinformed assumption. If I had a client who was having such problem, I would explore his or her beliefs about needs and desires and how to meet those needs and desires in a healthy manner. I would not say to not eat pizza. The article says, "To be sure, cognitive therapy doesn’t ask people to suppress negative thoughts, but it does ask us to challenge them, to fix them. By contrast, ACT tries to defuse the power of thoughts. Instead of saying ‘I’m depressed,’ it proposes saying ‘I’m having the thought that I’m depressed.’ Hayes isn’t saying people don’t really feel pain (he has felt plenty of it), but he believes we turn pain into suffering when we try to push it away. ACT therapists use metaphors to explain acceptance...." I agree with the first statement that CBT does not ask one to suppress negative thoughts. Yet, CBT also says, "I’m having thoughts that I’m depressed." The most simplistic CBT model is the A-B-C Model: Antecedent influences Belief which influences emotional Consequence. The model goes deeper and it can be A-B-C, C-A-B-C, C-B-C-B-C-B-C-A-B-C, etc. It looks like in the article’s statement that ACT is claiming the B and C of CBT’s A-B-C Model by saying it proposes "I’m having the thought that I’m depressed." Where ACT does have value is where it says to not push the pain away. While CBT does not promote pushing pain away, often therapists in that approach do ignore feelings when they shouldn’t. We are not to fight pain or run from it, but to walk with Jesus through it. While that statement is neither CBT or ACT, it can be used in both approaches from what I know. Ultimately it comes down to 1 Thessalonians 5:21: "Test everything. Hold on to the good."

I’m not saying CBT is the only way. I used multiple approaches, but CBT was my base of action. It also offered more harmony with a Biblical world view than some other approaches. I believe in the spirit of 1 Thess. 5:21, that we have to glean for what is Biblical. I would take some of the Biblical concepts of ACT, such as not pushing pain away, and use those things that are Biblical. However, is there an ACT professional who will keep it Biblical with such an approach? On a side note, CBT is also the method of choice in the current managed care system due to its proved merit and ability to offer brief therapy, as well. That’s more of a note. I think that the managed care system is a mess! And I think that those who authorize visits have no clue about what a client really needs. Where one needs to be cautious with CBT is to not give in to temptation to ignore feelings. Also, don’t put too much emphasis on the individual’s thought life (there’s the environment and the systems of society and group, too). And, A-B-C just scratches the surface (and I think 2 things happen: some more novice CBT therapists don’t explore deeper than A-B-C while CBT offers the ability to, and those who are not in CBT try to package it as the A-B-C model, which is just one concept of CBT). If I had to put CBT down on paper as far as how I practiced it, I would do it this way: Imagine an oak tree. Acorns fall to the ground as Assumptions, which are unconscious beliefs/goals/desires (e.g., I am going to win this award and be accepted. That is my goal.). These pass through the Antecedent (often an external event, such as NOT winning the award). We view the Antecedent through our Lens (a set of beliefs that may or may not be conscious such as "I am not going to be accepted since I did not get the award. I’m not sure I’ll ever be accepted."). This produces a Primary Emotion ("I’m SCARED that I’m not going to be accepted."). This goes through Evaluation (i.e. How should I handle this emotion -- aggressively, assertively, passively, often an unconscious process. An unhealthy response may be, "I’m going to fight this emotion. My goal was blocked."). Then comes the Secondary Emotion ("I’m angry," for example, which is a very conscious') emotion). Then comes another Belief (just like Assumption, Lens, and Evaluation are beliefs) such as, "To deal with my anger, I need to hit something." Following is the Behavior which involves hitting the wall. Then there is the Consequence (which is not the same as the emotional Consequence in A-B-C). The consequence could be within the mind, such as intensified anger, a newly spawned belief or set of belief/emotive processes (I put a hole in the wall, now I am really scared I am going to get in trouble). This Consequence is like the acorns on the oak tree, which can fall to the ground to form new assumptions. However, these consequences can also impact the lens, the evaluation, etc., so even the tree metaphor is simplistic. It’s kind of a B-A-B-emotionalC-B-emotionalC-B-Behavior-C which recycles fully or partly. In the example, as a therapist, I would work with underlying assumptions, world view (lens), goal setting and evaluation, and conscious beliefs, while empathizing with the emotion at each piece. I would do focus on the belief that they must win the award to be accepted. I would discuss acceptance in Christ. I would encourage making the goal to win the award a desire (in a properly set goal, a person controls all factors related to achieving the goal; in a desire, one does not control all the factors). I would encourage setting proper goals such as "I am going to try my best to win." I might talk about the award in Heaven and in Christ. I would empathize with the pain of the Antecedent of not receiving the award and I would walk with them through the pain and share how Jesus can walk with them through pain ("Even though I walk through the valley of the shadow of death, I will fear no evil, for You are with me; Your rod and Your staff, they comfort me" -- Psalm 23:4). I would explore the beliefs in the lens not being accepted for not winning and uncertainty about ever being accepted. I would encourage a path towards disappointment out of a lost desire as opposed to anxiety out of an uncertain goal or anger out of a blocked goal that was set improperly. I would encourage the person to get beneath the anger to what is really driving it. Yet, in the current state of anger, I would explore not only getting beneath it but how to handle it with Biblical choices so as to produce healthy consequences that glorify God. This is not the best example and is probably more than you wanted to know, but for what it’s worth...

Again it all comes down to "Test everything. Hold on to the good."

Respectfully,

James A. Johnson


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