Acceptance &

Commitment Therapy
-a mindfulness-based, values-directed behavioural therapy
Muhammad Munib-Ur-Rehman
Clinical Psychologist/ Lecturer
Department of Psychology
GC University, Lahore
 CBT
(Cognitive Behavioral Therapies)

 Behavioral Activation  Acceptance and

 Cognitive Therapy Commitment Therapy
 Rational Emotive (ACT)
Behavior Therapy  Dialectical Behavior
(REBT) Therapy (DBT)
 Exposure and Response  Functional Analytic
Prevention (ERP) Psychotherapy (FAP)
 Cognitive Processing  Mindfulness-Based
Therapy (CPT) Cognitive Therapy
 Prolonged Exposure (PE) (MBCT)
 Integrated Behavioral  Mindfulness-Based Stress
Couples Therapy Reduction (MBSR)
and more…etc.
The Essence of ACT: 2 major goals
• Acceptance of unwanted private experiences which are out of personal control
• Commited action towards living a valued life
• In other words … “Embrace your demons, and follow your heart!”
• –The aim of ACT is to create a rich, full and meaningful life, while accepting the pain that
inevitably goes with it.
• –The goal of ACT is to increase psychological flexibility. Psychological flexibility has two
components: 1) the ability to be psychologically present – i.e. aware, attentive, open to, and
engaged in your experience; 2) the ability to control your behaviour to serve valued ends
• Official ACT definition: The goal of ACT is to increase psychological flexibility: the ability to
contact the present moment and the psychological reactions it produces, as a fully conscious
human being, and based on the situation, to persist with or change behaviour for valued ends
 Core Processes in ACT
• There are six core processes in ACT:
1. Contact with the Present Moment
• Conscious awareness of your experience in the present moment enables you to perceive accurately what
is happening.
• Gives you important information about whether to change or persist in behaviour
• Enables you to ‘catch’ cognitive fusion ‘in flight’
• Allows you to engage fully in what you are doing
2. Acceptance
• Actively contacting psychological experiences directly, fully, and without needless defense
• Definition: defused, open, undefended contact with the present moment, as a fully conscious
• human being.
• ‘Opening yourself fully to experience, as it is, not as your mind says it is’
• Committed action is: values-guided, effective & mindful
 Core Processes in ACT
3. Defusion
• Looking at thoughts, rather than from thoughts
• Noticing thoughts, rather than being caught up in thoughts
• Seeing thoughts as what they are, not as what they seem to be
• Aim of Defusion is NOT to feel better, nor to get rid of unwanted thoughts
• Aim of Defusion IS to reduce influence of unhelpful cognitive processes upon behaviour; to facilitate
being psychologically present & engaged in experience; to facilitate awareness of language processes, in
order to enhance psychological flexibility
4. Self-as-context
• A transcendent sense of self: a consistent perspective from which to observe and accept all changing
experiences. (Often called The Observing Self)
• It is a process, not a thing: an awareness of awareness itself: ‘pure awareness’
 Core Processes in ACT
5. Values
• Chosen life directions
• ‘Your heart’s deepest desires for the sort of person you want to be and the things you
want to do in your time on this planet; in other words, what you want to stand for in
life’
• Provide motivation & inspiration
• Provide guidance for your actions
• Give life meaning, Give a sense of abundance
• Are different to goals
6.Committed Action
• Overt behavior in the service of values
• (may require skills training)
Hexaflex: 6 Core Processes

Adapted from Hayes et al., 1999

Psychological Inflexibility

DOMINANCE OF PAST
AND FUTURE

EXPERIENTIA LACK OF CLARITY OR

L CONTACT WITH
AVOIDANCE VALUES

STUCK/
INFLEXIBLE

FUSION INACTION,
WITH IMPULSIVITY, OR
THOUGHTS AVOIDANCE
ATTACHMENT TO
CONCEPTUALIZED SELF
 Functional Contextualism
• Any action or event cannot be separated from its historical and
current context
• Workability
• Relational Frame Theory
• Role of human language and cognition in suffering
Relational Frame Theory
• RFT says that human language is based on relating things to each
other, not just associating them like Pavlov’s dogs.
• This relational ability is learned and becomes arbitrarily applicable,
meaning it works even when there’s no physical similarity between
things.
Relational Frame Theory
1. Relational Framing
• We learn to relate things in all sorts of ways — same as, opposite of, bigger than, better than, etc.
• Examples:
• "A dog is bigger than a cat."
• "My trauma is worse than yours."
• "Success means being rich."
• These are mental constructs, not objective truths, but our brain treats them as real.
2. Arbitrary Relations
• The relations don’t have to be logical or physically true.
• If a child learns "coin = money = power = safety", then losing money might trigger a fear of
annihilation.
• Even if nothing’s actually threatening them.
Relational Frame Theory
3. Mutual Entailment
If A = B, then B = A.
“Car = Vehicle” → You know “Vehicle = Car”.
4. Combinatorial Entailment
If A = B and B = C, then A = C.
You learn webs of meaning that aren’t directly taught.
5. Transformation of Function
• Once things are linked, the emotional or behavioral impact of one transfers to
the other.
• If “snake” is scary, and you link “snake = betrayal = men,” then suddenly men
feel dangerous, even if they’ve done nothing.
Relational Frame Theory & ACT
• RFT shows how language messes us up:
• We don’t just experience pain — we think about it, judge it, avoid it, and amplify it.
• Words and thoughts take on emotional power they were never meant to have.
• ACT tries to loosen the grip of these rigid relational frames through:
• Cognitive defusion (unhooking from thoughts),
• Mindfulness (observing without judging),
• Values work (choosing what matters beyond the mental noise).
• eXAMPLE
You think: “I’m a failure.”
Through RFT, “failure = worthless = unlovable = doomed.”
Now, you’re not just sad — you’re in an existential crisis spiral.
ACT helps you notice that chain, step back from it, and act anyway.
Creative Hopelessness
• It’s the point in therapy where the client realizes:
• "Everything I’ve done to avoid, control, or fix my inner pain has
actually made things worse."
• This realization opens the door to trying something radically
different — like acceptance, mindfulness, and values-based action.
Hence, the "creative" part.
• You're not hopeless about life, you're hopeless about the illusion of
control over internal experiences (thoughts, feelings, memories). And
that hopelessness becomes fertile ground for change.
Creative Hopelessness
Therapists guide clients to examine:
• What have you been trying to do with your emotional pain?
• Has it worked? Really?
• What has it cost you?
Through that, clients often discover:
• Avoidance strategies = short-term relief, long-term damage.
• Control = illusion.
• Real change might mean making room for pain, not running from it.
Acceptance VS Experiential Avoidance
• Experiential Avoidance
 “I am afraid/ ashamed of my feelings”

 “If I don’t do this or do less of this, I won’t feel bad”

• Willingness to fully connect with our inner experiences

• Let go of the tendency to control uncomfortable thoughts, feelings, and
sensations
• Non-judgmental
Defusion VS Fusion
• Cognitive Fusion
 “I think that, so it must be true!”

 Getting “hooked” and "caught up" in thoughts

 Confusing thought and reality

 Look at thoughts, not from thoughts

 See thoughts as what they are (i.e., thoughts!)
 Not try to change the content, or eliminate/ distract from our
thoughts
 Reduce the influence of unhelpful cognitive processes on
behavior; notice the language processes
Defusion VS Fusion
• In Cognitive Fusion:
• Thoughts are Reality; it’s as if what we’re thinking is actually present, here and now!
• Thoughts are The Truth; we literally believe them!
• Thoughts are Important; we take them seriously, and give them our full attention!
• Thoughts are Orders; we automatically obey them!
• Thoughts are Wise; we assume they know best and we follow their advice!
• In Cognitive Defusion:
• Thoughts are merely sounds, words, stories, bits of language, passing through our heads.
• Thoughts may or may not be true. We don’t automatically believe them.
• Thoughts may or may not be important. We pay attention only if they’re helpful.
• Thoughts are not orders. We don’t have to obey them.
• Thoughts may or may not be wise. We don’t automatically follow their advice.
 Metaphors to Facilitate Cognitive Defusion
Thoughts are like:
• Clouds floating, or birds flying, across the sky.
• Waves arising from the sea, then falling back in. You can watch the waves from the shore, without being swept away.
• Leaves and sticks floating down a stream. You don’t have to dive in. You can watch from a bridge.
• A passing parade. You can watch the floats pass by. You don’t have to climb on board.
• Trains coming and going while you stand watching from the platform.
• A waterfall. You’re standing behind it, not under it.
• Guests entering a hotel. You can be like the doorman: you greet the guests but you don’t follow them to their rooms.
• Cars passing by while you wait at an intersection.
• Suitcases dropping onto a conveyor belt at the airport. You can watch them pass by, without having to pick them up.
• People passing by you in the street. You can nod your head at them, but you don’t have to stop and have a conversation.
• Wild horses running across the plains. You can admire them but no need to chase them.
• Bubbles rising in a champagne bottle. They rise to the surface and then disappear.
• Fish swimming in a tank. Watch them come and go.
• Children running across a playground. You can stay still and watch, while they run wherever they want to.
• Actors on a stage. You can watch the play; you don’t need to get on stage and perform.
• ‘Pop-ups’ on the internet.
• Junk e-mail. You can’t stop it from coming in – but you don’t have to read it!
• Text messages on your mobile phone.
• Luggage passing by on a conveyor belt.
 Present Moment VS Dominance of
Conceptualized Past and Feared Future
• Dominance of Conceptualized Past and Feared Future
 Ruminate about the past

 Worry about the future

 Notice accurately what is happening in the here and now

 Engage fully in what we are doing
 Take in important information about whether to change or persist in a
behavior
 Mindfulness
Present Moment VS Dominance of Conceptualized
Past and Feared Future
Mindfulness
• The official ACT definition of mindfulness is: “The defused, accepting, open
contact with the present moment and the private events it contains, as a conscious
human being, experientially distinct from the content being noticed.”
• “Bringing one’s complete attention to the present experience on a moment-to-
moment basis.” (Marlatt & Kristeller)
• “Paying attention in a particular way: on purpose, in the present moment, and
nonjudgmentally” (Kabat-Zinn).
• “The nonjudgmental observation of the ongoing stream of internal and external
stimuli as they arise.” (Baer)
• “Awareness of present experience with acceptance.” (Germer, Segal, Fulton)
• “Consciously bringing awareness to your here-and-now experience, with openness,
interest and receptiveness.”
Self-as-Context VS Self-as-Content
• Self as Content
 “I am my narrative and my story can’t change”

 Rigid rule-following

• A transcendent sense of self, i.e., the observing self

• Self as context from where thoughts, feelings, and sensations unfold
• Loosen up attachment to language of conceptualized self
• Sky and weather metaphor
Basic ACT Strategies: Self-as-context

• Spirituality and transcendence as human experiences

• Chessboard
• Sky & weather
• Your Mind is the World’s Greatest Documentary Maker
• Observer exercise: notice who is noticing; notice what doesn’t change
Values VS Lack of Clarity or Contact with Values

• Lack of Clarity or Contact with Values

 Feels un-anchored or direction-less

 Feels stuck

 Existing not based on “what matters”

• The person we want to be, things we want to do, what we want to stand for in
this life
• A direction that guides ongoing action; not a goal
• A sense of meaning, abundance, vitality
Values

• What do you really want?

• What do you want your life to stand for?
• What sort of person do you want to be?
• What sort of relationships do you want to build?
• How do you want to act/behave in the world/ towards others/ towards yourself?
• What do you want to do with your life?
• Funeral / Tombstone / Old man looking back/ Celebration dinner/ Obituary
• Miracle question
• Values first - then goals/actions
Commited Action VS Inaction, Impulsivity, or Persistent Avoidance

• Inaction, Impulsivity, or Persistent Avoidance

 Ineffective pattern of behavior, doing the same thing over and over

expecting different (better) results

 Going through the motions while feeling struck/ trapped

• Take action and make decisions that are in line with our values, even when
life is challenging
ACT: What It Is, What It Isn’t
• Experiential > Didactic
• Use of experiential exercise and metaphors
• Not a specific set of coping skills, techniques, or protocols
• May work on one or more core process, in any order
• Number of sessions: 1- 20+
• Therapeutic relationship, case conceptualization (e.g., life and
problem context, goals, treatment plan), and practice ARE
important
• It is not passive