Acceptance and Commitment Therapy in Dallas, Texas
Acceptance and Commitment Therapy
ACT has five key processes including cognitive diffusion, experiential acceptance, present moment focus, transcendent self-awareness, valued living.
Cognitive defusion cognitive defusion involves the ability to assess the nature of thoughts resulting in the ability to identify and let go of those that cause suffering. Take for example, a client whose manager corrects her for not getting to work on time and she experiences feelings of failure. Cognitive defusion would include assessing the thoughts and whether they are true, specifically whether being chastised for being late is equivalent to failure.
In Present Moment Focus
In present-moment focus, the goal involves employing a flexibility in the perception of intra and interpersonal event. This means understanding the different things in an individual’s current cognition that are causing distractibility.
Transcendent self-awareness is the ability to experience flexibility in the way an individual perceives themselves. There is no over-arching or dominate aspects of one’s identity that makes it impossible for the individual to feel different sensations or things. It involves not letting certain experiences of the self, hinder an experience in the moment. Someone who is able to have transcendent self-awareness is able to be a boss at work, a partner to their spouse, and nurturer to their children.
Valued Living, “valued living involves living in such a way as to facilitate contact with chosen values.” (Sandoz, Wilson, DuFrene, p.22, 2011) This means that values from an ACT perspective are congruent with an individual’s actions and behaviors that dominate the core of who the individual is. For example, a mother who is breastfeeding and experiencing post-partum depression might be experiencing thoughts and beliefs about her child that is not congruent with her value of being a loving mother. Focusing on the value of being a loving mother, while accepting that pain in motherhood is a normal example of incorporating valued living into treatment.
Experiential acceptance is the process of openly accepting an individual’s experiences without deeming them as positive or negative. It does not mean accepting the accompaniment of unpleasant experiences or not witnessing their experience but allowing them to be there without judgment or action to avoid further suffering.
Considerations for Those Living with Eating Disorders
According to Acceptance and Commitment Therapy for Eating Disorders,
“From an ACT perspective, eating disorders are particular forms of psychological inflexibility.” (Sandoz, Wilson, Dufrene, p.24, 2011) In a practice used to help increase psychological flexibility in the book, “Living in Your Body and Other Things You Hate: How to Let Go of Your Struggle with Body Image Using Acceptance and Commitment Therapy,” the practitioner asks clients to take deep explorations into their inner-awareness through understanding their bodily sensations. Through guided visualizations and meditations that bring awareness to what the client is experiencing in the moment, they’re able to increase the client’s overall psychological flexibility by understanding and noticing their breath, how the body feels, bringing attention to different parts of the body, body scans and more. Through each sensation, the client is asked to breathe through any discomfort they’re feeling while accepting what it feels like to be connected to their bodies. An example of this looks like the following:
“And now let your awareness gently expand out and take in each of the physical experiences you are having right now, from the strongest to the most subtle. If you find your attention drawn into a single sensation, see if you can expand out from that sensation to take in the whole of your physical experience. See if you can let your attention hover there, on the whole, for use a moment.”
(Sandoz. p.61, 2014)
This is an example of how ACT can help increase an individual’s acceptance, present moment awareness, and transcendental self-awareness. Along with implementing mindfulness-based practices that help shift an individual’s tolerance for sensational experiences, ACT helps shape functional targets that help clients interact more effectively with the things in their lives that are causing distress, pain and intolerance. Clinicians also find it helpful to present opportunities for present-moment focus, “the present moment is where contingencies are being presented that can shape effective behavior.” (Sandoz, Wilson, Dufrene, p.24, 2011) This is what clinicians guide individuals through as present-moment awareness that helps implement more self-compassion for what the individual is experiencing. Much like understanding cognitive distortions, in cognitive behavioral therapy, creating acceptance and patience for an individual’s thought process is an integral part of helping achieve present moment focus. Many individuals suffering from eating disorders, struggle with cultivating acceptance for what is. A painful experience that happens in the individual’s life might cause excess suffering and rumination around rigid ways of thinking and behaving and how to avoid the pain in the future. Having control over their eating, the individual gains relief by imagining how she/ he might skip a meal in an attempt to control her weight loss.
Using ACT in helping mitigate these thought cognitions is great for developing present-moment focus and accepting drawing attention to their thought processes in the present moment without complications of the future or past. Using present-moment awareness, allows the eating disordered individuals to leave their rigid focus on their body weight and focus on their present sensations in the moment. It is understood that present-moment focus, acceptance and self-awareness are not tools that should be ideally discounted in the therapeutic process. It is about generating presence for the things that are most meaningful for the eating disordered clients. Even though experiencing the sensations of the body can be especially challenging for eating disordered individuals it is important to cultivate in order to produce adequate change. However, this adequate change is documented through the process of valued living and committed action. In committed action, an example of a therapeutic intervention would look like the following:
“take a moment and list five situations in your life that are both meaningful to you and likely to get your awareness scattered or stuck. Now write two numbers between 1 and 10 next to each situation, representing how meaningful (M) and how challenging (C) that situation is for you, with 10 indicating that the situation is one of the most meaningful or challenging you’ve experienced and 1 indicating that the situation is one of the least meaningful or challenging you’ve experienced. “
(Sandoz. p.71, 2014)
After the individual identifies what has been a challenge for them about staying present and accepting their bodily sensations, they’re asked to make a commitment to living a life that is indicative of present body awareness. An example of this commitment might be noticing the way an individual’s shoe feels as she takes each step forward every morning on the way to school. This process is an example of how one might increase cognitive defusion while staying committed to living within their value system.