THE SIX CORE THERAPEUTIC PROCESSES OF ACT

Contacting the Present Moment (Be Here Now)

Defusion (Watch Your Thinking)

Defusion means learning to “step back” and separate or detach from our thoughts, images, and
memories. (The full term is “cognitive defusion,” but usually we just call it “defusion.”) Instead of
getting caught up in our thoughts or being pushed around by them, we let them come and go

Acceptance (Open Up)

Acceptance means opening up and making room for painful feelings, sensations, urges, and
emotions. We drop the struggle with them, give them some breathing space, and allow them to be.

Self-as-Context (Pure Awareness)

For example, as you go through life, your body changes, your thoughts change, your feelings change,
your roles change, but the “you” that’s able to notice or observe all those things never changes. It’s
the same “you” that’s been there your whole life. With clients, we generally refer to it as “the
observing self” rather than use the technical term “self-as-context.”

Values (Know What Matters) Deep in your heart, what do you want your life to be about? What do
you want to stand for? What you want to do with your brief time on this planet? What truly matters
to you in the big picture?

Committed Action (Do What It Takes) Committed action means taking effective action, guided by our
values. It’s all well and good to know our values, but it’s only via ongoing values-congruent action
that life becomes rich, full, and meaningful.

Psychological flexibility is the ability to be in the present moment with full awareness and openness
to our experience, and to take action guided by our values. Put more simply, it’s the ability to “be
present, open up, and do what matters.”

(And on that note, I should mention that throughout this book, I use the phrase “thoughts and
feelings” as a form of shorthand. By “thoughts,” I mean all manner of cognitions, including memories
and images, and the term “feelings” includes emotions, sensations, and urges.)

- Vježba s knjigom (knjiga=problemi, brige) – dok je ispred lica ne vidimo ništa, dok guramo
umaramo se, dok je u našem krilu ne smeta nas i sve možemo.

ACT speculates that there are two core psychological processes—“cognitive fusion” and
“experiential avoidance”—that are responsible for most psychological suffering. Section 1 of the
transcript is a metaphor for cognitive fusion: getting caught up or entangled in our thoughts, or
holding on to them.

experiential avoidance: the ongoing struggle to avoid, suppress, or get rid of unwanted thoughts,
feelings, memories, and other “private experiences.” (A private experience means any experience
you have that no one else can know about unless you tell them: emotions, sensations, memories,
thoughts, and so on.
Workability The whole ACT model rests on a key concept: “workability.” Please engrave that word—
workability—into your cerebral cortex, because it’s at the very heart of every intervention we do. To
determine workability, we ask this question: “Is what you’re doing working to make your life rich,
full, and meaningful?” If the answer is yes, then we say it’s “workable,” so there’s no need to change
it. And if the answer is no, then we say it’s “unworkable,” in which case we can consider alternatives
that work better. Thus in ACT we don’t focus on whether a thought is true or false, but whether it is
workable. In other words, we want to know if a thought helps a client move toward a richer, fuller,
and more meaningful life. To determine this, we may ask questions like these: “If you let this
thought guide your behavior, will that help you create a richer, fuller, and more meaningful life? If
you hold on to this thought tightly, does it help you to be the person you want to be and do the
things you want to do?”

One thing I can guarantee you: in this room, we’re never going to have a debate about what’s true
and what’s false. What we’re interested in here is what’s helpful or what’s useful or what helps you
to live a better life. So when your mind starts telling you “I’m fat,” what happens when you get all
caught up in those thoughts?

“Is this working to give you the life you want?

Does holding on tightly to those thoughts help you to live the life you truly want?

How does it work in the long run, if you let that belief be in charge of your life?

If you let those thoughts push you around, does that help you to be the person you want to be?

Note that in the transcript above, the therapist makes no attempt to change the content of the
thoughts. In ACT, the content of a thought is not considered problematic; it’s only fusion with the
thought that creates the problem.

The more time and energy we spend trying to avoid or get rid of unwanted private experiences, the
more we’re likely to suffer psychologically in the long run. Anxiety disorders provide a good example.
It’s not the presence of anxiety that comprises the essence of an anxiety disorder. After all, anxiety is
a normal human emotion that we all experience. At the core of any anxiety disorder lies excessive
experiential avoidance: a life dominated by trying very hard to avoid or get rid of anxiety. For
example, suppose I feel anxious in social situations, and in order to avoid those feelings of anxiety, I
stop socializing. Now I have “social phobia.” The short-term benefit is obvious—I get to avoid some
anxious thoughts and feelings—but the long-term cost is huge: I become isolated and my life “gets
smaller.” Alternatively I may try to reduce my anxiety by playing the role of “good listener.” I
become very empathic and caring toward others, and in social interactions, I discover lots of
information about their thoughts, feelings, and desires, but I reveal little or nothing of myself. This
helps in the short run to reduce my fear of being judged or rejected, but in the long run, it means my
relationships lack intimacy, openness, and authenticity.

Now suppose I take Valium, or some other benzodiazepine, to reduce my anxiety. Again, the short-
term benefit is obvious: less anxiety. But long-term costs of relying on benzodiazepines,
antidepressants, marijuana, or alcohol to reduce my anxiety could include (a) psychological
dependence on my medication, (b) possible physical addiction, (c) other physical and emotional side
effects, (d) financial costs, and (e) failure to learn more effective responses to anxiety, which
therefore maintains or exacerbates the issue. Still another way I might respond to social anxiety
would be to grit my teeth and socialize despite my anxiety—that is, to tolerate the feelings even
though I’m distressed by them. From an ACT perspective, this too would be experiential avoidance.
Why? Because, although I’m not avoiding the situation, I’m still struggling with my feelings and
desperately hoping they’ll go away. This is tolerance, not acceptance. If I truly accept my feelings,
then even though they may be very unpleasant and uncomfortable, I’m not distressed by them.

We are not “mindfulness fascists” in ACT; we don’t insist that people must always be in the present
moment, always defused, always accepting. Not only would that be ridiculous, it would also be self-
defeating. We’re all experientially avoidant to some degree. And we all fuse with our thoughts at
times. And experiential avoidance and cognitive fusion in and of themselves are not inherently “bad”
or “pathological”; we only target them when they get in the way of living a rich, full, and meaningful
life.

Experiental avoidance and thought fusion are not always bad -str 25.
ASSESSING PSYCHOLOGICAL INFLEXIBILITY: SIX CORE PROCESSES 32str (46)

Kada nečem negativnom što nas smeta posvećujemo puno vremena i misli, pokušavamo se riješiti
toga, brinemo.. tada to postaje vrlo važna stvar u našem životu. Kada to prihvatimo kao sastavni dio
života, kao nešto što je jednostavno tu, tada to više nije toliko važna stvar i ne trošimo toliko
vremena na nju.

What valued direction does the client want to move in? Here we seek to clarify values: How does the
client want to grow and develop? What personal strengths or qualities does he want to cultivate?
How does she want to behave? How does he want to treat himself? What sorts of relationships does
she want to build? How does he want to treat others in those relationships? What does she want to
stand for in life? What does he want to stand for in the face of this crisis or challenging situation?
What domains of life are most important to her? What values-congruent goals does he currently
have? Once we can answer the question “What valued direction does the client want to move in?”
we can use that knowledge to set valued goals and to guide, inspire, and sustain ongoing valued
action. And if we can’t answer this question, that tells us we’ll need to do some values-clarification
work.
What stands in the client’s way? This question is about the three main barriers to mindful, valued
living: fusion, avoidance, and unworkable action. We can break it down into three smaller questions:

1. What unhelpful thoughts is the client fusing with?

2. What private experiences—thoughts, feelings, memories, urges, and so on—is the client trying to
avoid or get rid of?

3. What is the client doing that restricts or worsens her life in the long run?

Kognitivni model na jednom papiru – kad klijent ispriča neki događaj damo mu taj model i pitamo da
rasčlani taj događaj po kognitivnom modelu, na taj način nauči razliku između misli i osjećaja
Neuspeh – ko je odgovoren za neuspeh?

Kako klijent posamezno čustvo opisuje in razume? Tudi mu mi povemo kako mi razumemo to čustvo.

„Vedno mi se to dogaja“ – spraševat kdaj točno, ali v pon, ali v uto itd.
Anksioznost

Što u konkretnom problemu je tako strasno? Što možemo napraviti ako se to dogodi? Kako rijesiti tu
situaciju?

Nema anksioznosti bez katastrofiziranja. „Neću podnijeti to iskustvo.“ Negativno ocenevanje samega
sebe.
Kako bi neka druga osoba (od povjerenja) reagirala u takvoj situaciji?

Postoje li neki primjeri iz prošlosti kada ste sličnu situaciju riješili, preživjeli,doživjeli, izdržali?

BAI – Beck vprašalnik, anxiety inventory

BDI – Beck depression inventory

ACT goals for depression (example):

ACT alcohol addiction goals example:

Ch. 9

Case conceptualization
Str 78. , ACT Made simple
Happiness

Defusion from thoughts

127
 Schema Therapy
Schema Therapy begins with recognizing a set of universal emotional needs. These include
the needs for safety, stability, nurturance, and acceptance, for autonomy, competence, and
a sense of identity, for the freedom to express one's needs and emotions, for spontaneity
and play, and for a world with realistic limits which fosters the emergence of self-control.
The central project of Schema Therapy - its primary objective - is to help adults get their
own needs met, even though these needs may not have been met in the past.
Schema Therapy avoids making assumptions such as these regarding a ``hierarchy'' or a
gradient of importance. Instead, core needs are all seen as essential and universal,
especially in the lives of adults.