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Overview of ACT
Acceptance and commitment therapy (ACT) is regarded as part of the “third wave” of cognitive- behavioral therapy (CBT) that has emerged over the past quarter century (Hayes, 2004). It is a transdiagnostic approach recognized by Division 12 of the American Psychological Association (Society of Clinical Psychology, n.d.) as having strong research support in the treatment of chronic pain and modest empirical support in addressing depression, mixed anxiety, obsessive–compulsive disorder, and psychosis. Rather than seeking to directly change problematic thoughts, emotions, and other private events, ACT and related approaches within the latest generation of CBT writ large incorporate mindfulness, acceptance, and decentering/defusion strategies to change the function of such psychological events and alter how clients relate to them (Hayes, Luoma, Bond, Masuda, & Lillis, 2006).
Unlike other third-wave approaches such as dialectical behavior therapy (Linehan, 1993), mindfulness-based cognitive therapy (MBCT; Segal, Williams, & Teasdale, 2002), and metacognitive therapy (Wells, 2009), ACT is unique in (a) being explicitly grounded within a modern pragmatic philosophy of behavioral science known as functional contextualism (Hayes, 1993), (b) being informed by relational frame theory as an associated account of human language and cognition (Hayes, Barnes-Holmes, & Roche, 2001), and (c) identifying increased psychological flexibility, or the ability to make behavioral adjustments in the service of one’s values, as its superordinate goal. Some discussion of each of these defining features of ACT is necessary to understand its stance on the self.
Functional contextualism
As it pertains to psychology, functional contextualism can be seen as a refinement of many of the basic tenets first articulated within Skinner’s (1974) philosophy of radical behaviorism (Vilardaga, Hayes, Levin, & Muto, 2009). These include the instigation of deliberate behavioral change as a pragmatic goal of psychology and viewing all human activity, including what psychologists say and do in studying it, as a function of the current situational and historical contexts within which behavior occurs. Beyond psychology, functional contextualism is more usefully viewed as a paradigmatic approach to a comprehensive behavioral science formed by integrating psychology with biology, sociology, anthropology, and any other related disciplines that can contribute to the goal of predicting and influencing human behavior with sufficient precision, scope, and depth. Interested readers are encouraged to consult Biglan and Hayes (1996) and Hayes, Barnes-Holmes, and Wilson (2012) for more detailed coverage of functional contextualism and contextual behavioral science, respectively, than can be provided here.
Of greatest relevance for the purpose of this chapter is recognition that functional contextualism holds “successful working” as its truth criterion. The words, terms, concepts, and other verbal constructions that proponents and practitioners of ACT use in speaking about the self are accordingly seen as mere tools. As with any tools, their value or “truth” is to be ultimately determined by whether they serve their intended practical purpose within ACT of increasing psychological flexibility and alleviating human suffering, and not by the degree to which the words or concepts map onto or correspond to some external reality (Pepper, 1942). In short, when the self is talked about in ACT, no assertion is being made about the ontological status of some psychological entity or agent. To the extent that certain “self-language” is used in speaking about and conducting ACT, it is because doing so in those particular ways has at least so far been useful.
Relational frame theory
The pragmatic and functional contextualistic perspective taken towards the verbal behavior of both clients and therapists within ACT has been explicated most thoroughly within relational frame theory (RFT; Hayes et al., 2001). Many organisms show an ability to respond to the relationship among stimuli based on their physical properties (Reese, 1968; e.g., a pigeon can be trained to reliably peck the larger of two discs). However, in the absence of intellectual and developmental disabilities, only humans – from around the same age that language acquisition occurs – have demonstrated relational responding under arbitrary stimulus control as well as an ability to derive untrained relationships among stimuli/relata within a network (Barnes-Holmes et al., 2001).
Deriving relationships among stimuli based on arbitrary rather than physical properties is viewed within RFT as generalized operant behavior that normally originates through informal discrete trial training involving vocal and verbal interactions between young children and their caretakers. For example, children may learn through conversations with adults that the relative value of coins may not be determined by differences in size; i.e., a smaller coin may buy more candy than a larger one. Once acquired, however, relational framing may be maintained not only by the prevention and solution of problems, but also through a self-sustaining coherence-producing process (Torneke, 2010). In much the same way that self-stimulatory behaviors may be maintained by the sensory consequences they produce (Lovaas, Newsome, & Hickman, 1987), constructing elaborate relational networks about our lives and who we are may be supported in part by their “making sense” (Wray, Dougher, Hamilton, & Guinther, 2012).
The developmental process of relational responding is perhaps illustrated most readily in the establishment of coordinational framing through naming. Multiple instances of adult reinforcement for correctly pointing to identified objects (“Where’s the ball?”) and naming them (“What is this?”) by children establish generalized relational frames of coordination, equivalence, or identity between objects and words (i.e., “This is a that”). Unfortunately, as will be seen, similar relational frames surrounding the self (e.g., “I am a failure”) can also be constructed with potentially profound psychological implications.
Defining properties of relational framing
From an RFT perspective, the emotional impact of such self-statements is best comprehended by considering the three defining properties of relational framing: (a) mutual entailment, (b) combinatorial entailment, and (c) transformation of stimulus functions.
Mutual entailment
The bidirectional nature of mutual entailment, or responding to one event in terms of the other and vice versa, is not limited to frames of coordination (e.g., if I’m told that Bill is older than Joe, Joe being younger than Bill can be derived), as illustrated by naming. There is a correspondence between words (“ball”) and things (“spherical toys”) such that they are equivalent to and can be derived from each other. Similarly, the statement “I am a failure” places “I” and “failure” in a relational frame of identity with each other such that “I” = “failure” and “failure” = “I.”
Combinatorial entailment
The property of combinatorial entailment points to relationships that can be derived between relata that are each mutually entailed with a shared stimulus. This can be illustrated by comparative framing; for example, if I am a failure compared to Bill, and Bill is a failure compared to Joe, then I am also a failure relative to Joe.
Transformation of stimulus functions
Identifying oneself as a failure in either an absolute or comparative sense would ostensibly be devoid of any negative emotional impact were it not for the transformation of stimulus functions as the third defining feature of relational framing. The negative emotional connotations of the word “failure” can in effect become transferred and attached to who I take myself to be when I describe myself in that way. This dominance of certain derived stimulus functions over other derived and direct stimulus functions is what is referred to in ACT as fusion (Strosahl, Hayes, Wilson, & Gifford, 2004, p. 39). “I am a failure” and its psychological consequences exemplify fusion with a flawed conceptualized self. The self-statement has meaning and is responded to not as mere words, but as an essential and literally truthful declaration of who I am.
Deictic framing
There are multiple types of relational responding, with frames of coordination and comparison having been cited thus far. A type of framing that is particularly relevant in understanding ACT’s approach to the self involves what are known as deictic relations. Verbal–social communities question and differentially reinforce accurate reporting by their members of experiences and behaviors that have occurred in the past, are ongoing now, and will be happening in the future. One’s own behavior becomes established as a discriminative stimulus in this process (Skinner, 1945) and gives rise to a repertoire of self-awareness or the behavior of “seeing that I am seeing” (Skinner, 1988, p. 286). Such reporting, however, is only reinforced if it conforms to the deictic parameters of person (“I vs. you”), location (“here vs. there”), and time (“now vs. then”); these parameters also participate in frames of opposition or distinction with each other (e.g., there is no “here” without a “there” and no “I” without a “you”). Stated somewhat differently, young children who are asked, “What are you doing now?” are corrected if they erroneously report what some other child is currently doing across the room or what they were doing 10 minutes ago.
For the purpose of this chapter what is most critical to appreciate across multiple interchanges of this sort is that the one constant is the perspective or vantage point from which such self-reports are provided. From a behavior-analytic and RFT perspective, this particular dimension or sense of self – that which is referred to in ACT as “the observing self” (Hayes & Gregg, 2000) or self-as-context (Hayes, 1995) – is a byproduct of the verbal–social contingencies involved in shaping self-awareness, and it plays a key role in the development of perspective taking (McHugh & Stewart, 2012). To the degree to which such perspective taking has a transcendent quality to it, a sense of spirituality can also be seen as emerging from this same process (Hayes, 1984). Perhaps not surprisingly, then, and as will be discussed later, activating and strengthening this self-observational repertoire within ACT can have a transformational and calming impact.
Psychological flexibility
The overarching goal of ACT is to increase psychological flexibility or the ability to adjust one’s behavior to be congruent with personal values (Hayes et al., 2012). Values, in turn, are defined as “freely chosen, verbally constructed consequences of ongoing dynamic, evolving patterns of activity, which establish predominant reinforcers for that activity that are intrinsic in engagement in the valued behavioral pattern itself” (Wilson & DuFrene, 2008, p. 64). It is useful to think of following one’s values as an ongoing intrinsically reinforcing process that can be engaged in through a myriad of goal-directed approaches. For example, the value of being a loving parent could be realized by deliberate acts as large as saving for a child’s college education or as small as reading a bedtime story or worrying about a child’s future welfare. The purpose of ACT is to enhance the person’s ability to live a meaningful and values-consistent life by removing barriers to psychological flexibility. Accordingly, to the extent that matters and issues pertaining to the self serve as such obstacles, they are strategically targeted within ACT. While almost all clients receive and benefit from some “self-work” in ACT, the degree of focus on this varies from client to client based on a case conceptualization of how three different senses of self contribute to psychological flexibility versus suffering.
Three senses of self
Although talk of three different senses or dimensions of self is common within ACT (Hayes et al., 2012, chapter 8), it should be reiterated that each can be viewed through a behavior-analytic lens (Lattal, 2012). From this perspective, “the self” in the aggregate within ACT can be conceptualized as an integrated set of behavioral repertoires (Wilson, Bordieri, & Whiteman, 2012) involving (a) a conceptualized self, (b) a knowing self, and (c) an observing self (Hayes & Gregg, 2000). As will become apparent, some of the experientially based techniques, exercises, and metaphors within ACT are designed to target only one of these dimensions, while others may simultaneously address two or even all three.
The conceptualized self
According to RFT and ACT, we continually construct various types of relational frames, including but by no means limited to those of coordination and comparison, about an almost limitless domain of objects and relata, including ourselves. These individual frames can, in turn, be related to each other, thereby creating coherent relational networks. For instance, we not only evaluate our worth against absolute standards and/or by socially comparing ourselves to others, but even more importantly construct narratives that logically explain and justify such formulations. What is referred to in ACT as the conceptualized self is essentially a storytelling repertoire about who we are and how and why we came to be that person (e.g., “I’ll never amount to anything given the way others have mistreated me.”). Unfortunately, psychological flexibility can be severely reduced when we closely identify with or “buy into” our life stories, particularly when they support a negatively evaluated conceptualized self. When we fuse with such narratives, our own self-awareness can become distorted. Being oblivious to and dismissive of any psychological experiences that would challenge the dysfunctional life story only helps maintain it. Moreover, acting in alternative, life-affirming ways (e.g., as if “I could amount to something”) may not only be framed as impossibilities, but threaten the very sense of who we are (e.g., “I’m not the kind of person who could ever.”). Sadly, clients may consequently rigidly prefer to “be right” about the life story they have constructed and that keeps them stuck rather than have their lives work for them.
ACT therapists have been advised to suggest that their clients in effect reinvent themselves everyday as a means of liberation from the arbitrary constraints imposed by the self-as-concept. Consistent with this, it is important to underscore that from an ACT perspective the concern is with psychological inflexibility that can arise from fusion with any life story, and not with the narrative per se. As evidenced by narcissism, attachment to a positive conceptualized self can be just as limiting as a negatively evaluated one. Thus, ACT does not primarily seek to tear down one relational network and replace it with another, but to assist clients in defusing from and deconstructing the narratives that have boxed them in and that have limited the ways in which they can lead a valued life. Clients may indeed incidentally end up telling a different story about their lives, but the old story can and often does reappear.
Weakening the conceptualized self
Behavior analysts typically have conceptualized therapeutic targets as either behavioral deficits or excesses. From this vantage point, overidentification and fusion with the conceptualized self can be construed as a behavioral excess that has the effect of limiting psychological flexibility. ACT adopts a two-pronged strategy long-recognized by behavior analysts as effective in reducing behavioral excesses. One aspect of this overall strategy involves the use of defusion techniques and exercises to weaken behavioral control exerted by stories and other verbal constructions about the self. However, focusing exclusively on eliminating behavioral excesses, such as fusion with the conceptualized self, fails the “dead-man test” of Ogden Lindsley (Malott, Whaley, & Malott, 1991, p. 10). That is, it establishes not fusing with the life story as a singular client goal, which a dead man, as well as woman, could do even better. As will subsequently be seen, ACT accordingly combines defusion work surrounding the self-as-concept with efforts to also strengthen and reactivate repertoires of alternative and incompatible behavior involving the other two aspects of the self.
Efforts to loosen the grip of the conceptualized self can occur at multiple levels within ACT. At the simplest level are defusion exercises that target single self-relevant statements such as “I’m stupid.” Nearly a hundred years ago, Titchener (1916, p. 425) argued that the literal meaning of words can at least be briefly suspended by rapidly repeating them aloud. ACT has adapted this procedure as a defusion exercise by having clients say aloud single self-critical labels over and over (e.g., “stupid, stupid, stupid…”). With enough repetitions, the key word loses its meaning (i.e., its derived stimulus function is no longer dominant) and only its direct stimulus function remains (i.e., the mere sound of the word). While the impact of this exercise may be rather fleeting, it – and other similar defusion techniques, such as expressing the negative self-statement in a cartoon voice or singing it as lyrics to a familiar tune (Strosahl et al., 2004, pp. 41–42) – can be repeated by clients as needed, to at least temporarily open up more space for psychological flexibility each time.
As discussed, fusion with a coherent and logically consistent narrative that justifies and explains the validity of negative self-statements (e.g., “why I am stupid”) is more problematic, and also more of a challenge to weaken. ACT attempts to do so by asking clients to first articulate their life story before deconstructing and then rewriting it (Strosahl & Robinson, 2008; Zettle, 2007). Initially, clients are asked to write out their account of the key events in their lives that have led up to and substantially contributed to their presenting problems. Clients and therapists then collaborate by underlining factual descriptions within the documents (e.g., “My parents divorced when I was 8.”) in order to separate them from their attributed consequences (e.g., “And as a result I’ve remained distrustful of those close to me.”). Following this deconstruction, the client is asked to write another story using these same objective facts, but with a different array of consequences and overall ending (e.g., “My parents divorced when I was 8 which has caused me to value my marriage even more.”). If necessary, this last step can be repeated several times with a variety of alternative endings. For instance, some of the endings may represent an improvement over the client’s current status (e.g., having a better job), while others may represent a deterioration (e.g., having fewer friends). With a different ending, new facts may emerge that support it and be woven into the revised life story (Zettle, 2007, p. 104). However, as suggested earlier, the overall purpose is not to simply trade one fused narrative for another, but to experientially illustrate that an assortment of life scripts can be constructed, some of which afford more psychological flexibility than others. Clients can then be asked to reflect on which narrative they prefer – “If it were within your power to choose one of these storylines for yourself over the others, which one would be the most helpful to you in having the kind of life you’d want for yourself?”
Related posts:
The self in schema therapy
The self in posttraumatic stress disorder
Self processes in obsessive–compulsive disorder
Painful incoherence: the self in borderline personality disorder
Basic self disturbance in the schizophrenia spectrum: a review and future directions
Future directions in examining the self in psychological disorders
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