FORMAN CHRISTIAN COLLEGE UNIVERSITY LAHORE

DEPARTMENT OF PSYCHOLOGY

MSCP-I

ACT ASSIGNMENT

SUBMITTED TO: DR UZMA

ZAINAB ALI 263175875

ARIBA SADIA 263176100

 Bipolar Disorder

Introduction

Bipolar Disorder is a chronic psychopathological condition with dramatic shifts in

mood and activity levels to a point that it leads to functional impairment (DSM V-TR). The

episodes may be those of Mania, Hypomania and depression based on it’s types and severity

levels.

The Acceptance and Commitment Therapeutic Model provides a strong lens in

understanding how people can get stuck in the loop of these episodes and how these internal

experiences, including their thoughts, feelings, identities and behavioural patterns hinders

them from living a functional and meaningful life. ACT explains 6 core principles, that lead

to psychological inflexibility, together known as the ‘Inflexibility Hexaflex’.

ACT Inflexibility Hexaflex in Bipolar Disorder

ACT Inflexibility Key features of the How It Appears in Bipolar Disorder

Process concept (with Examples and techniques)

Cognitive Fusion -Taking thoughts as During mania, which is an elevated state,

literal truths. (being a person may experience thoughts like “I

stuck) am unstoppable, I need no sleep” This

may promote risk taking and impulsive

-overidentification with
behaviours as the insight is hindered and
thoughts that are transient
the person may get themselves into
-reactive rather than
trouble. In depression, the negative
reflective
cognitive triad (Beck) may lead to

thoughts such as those related to self: “I’m

 worthless”, towards the world/others:

“People hate me”, and towards the future:

“nothing will ever change”. This may lead

to behavioural inhibition or withdrawal

and in extreme cases towards

hopelessness and suicidal ideation. The

cognitive fusion in case of clients

suffering from Bipolar 1 or 2 may

negatively hamper their functioning

leading to impairments and poor

prognosis, if unaddressed.

❖ E.g. Radio Doom and Gloom

exercise can help client to defuse

from their negative thoughts

taking them as something running

in the background like a radio

broadcast that they chose not to

attend

Experiential -Supress/ escape difficult In Bipolar, the depressive episodes make

Avoidance emotional the client avoid meaningful activities and

states/thoughts/internal healthy social contact or meaningful

experiences escape and supress shame and indulge in

isolating or oversleeping. In maniac or

-distractions or numbing
hypomanic episodes, they might use
strategies
 -short term relief> long unhealthy coping such as drinking or

term benefit overwork or other distractions to avoid

being emotionally vulnerable and

emotionally dysregulated. ACT focuses on

the willingness to “feel” and “process”

rather than avoid and suppress.

❖ Willingness and Acceptance

Exercises can help the clients

practice accepting and making

room for uncomfortable emotions

(e.g., sadness, anger) and engage

with it non-reactively.

Dominance of -living in In a depressive episode, the client may

the past/ruminations ruminate over failures or shortcoming

Conceptualized (e.g., “My life is destroyed, there is

-future anxieties/fantasies
Past/Future nothing left, i have no hopes”). In maniac
-disconnection from the
episodes, they may obsessively plan a
present
business empire or impulsively take future

related decisions and miss the present

moment entirely. ACT emphasises contact

with the present moment instead to live a

fuller and more meaningful life which is

more functional and less distressful.

 ❖ The grounding exercises in ACT,

clients use anchor techniques to

return to the present moment (e.g.,

“5-4-3-2-1” grounding). This

infused mindfulness and helps

them pull out from past/future

worries.

Attachment to -inflexibility/rigidity Those suffering from Bipolar, may label

the themselves and devalue their identities

-idealised or devalued
Conceptualized like “I’m doomed or mentally ill”
self
Self (depression) or idealise themselves under

grandiosity as “I’m the chosen one, i am

above all” (mania). This can be deeply

internalized. ACT encourages a sense of

self-as-context, allowing room to observe

thoughts without fusing with identity.

Such as in ACT exercise of Leaves on a

Stream, the client can see their thoughts as

just floating thoughts and not something

that is infused with their identity.

❖ The ACT technique of Observer

Self (Self-as-Context) can help

clients by guiding them to

experience themselves as a context

 to their feelings/thoughts and not

as the content. E.g. “being more

than your thoughts”.

Lack of Values -lack of insight and self In depression clients may cut meaning

Clarity awareness from everything (“Nothing matters

anymore”), while in mania they may

-confused personal values
replace values with stimulating, pleasure-
-lack of meaningful goals
seeking or ego-boosting behaviours. ACT
(what truly matters to
focuses on clarifying what truly matters
them)
and return to values-based living despite

mood state.

❖ Values Card Sort or Values

Exploration Worksheets can be

used as one of the ACT techniques

to reconnect to one’s values or

redefine them.

Inaction / -not taking committed In a depressive episode one may feel

Avoidant actions extremely fatigued, neglect tasks, socially

Persistence / withdraw or miss therapy and/or other

Impulsivity commitments. On the other hand, mania

or hypomania can make people take

radical uninformed decisions such as

quitting jobs, reckless spending, impulsive

sexual encounters, ACT emphasizes

 committed action aligned with values even

in the presence of difficult mood states.

❖ ACT Technique in this regard can

include, Committed Action

Planning, wherein clients choose

small yet meaningful steps that are

value based (e.g., “Attending one

class despite low energy” or

“showing up to a therapy session

regardless of the mood state”).

Reflective Summary

In Bipolar disorders, psychological inflexibility may emerge as recurring patterns of

fused thoughts with mood variability (mood dependent thoughts), avoidance of difficult

emotions, disconnection from the present and viewing self-as-content. Clients often transition

between low and high mood and physical states that may be pathologically impairing, such as

those in hypomania/mania and depression and both of which comes in the way of their true

values and taking or maintaining meaningful actions.

When we adopt and ACT lens, our goals is to not control or change mood stated but to

introduce flexibility, openness and acceptance, in terms of being an observer rather than a

victim and taking committed meaningful, value driven actions even in the face of distress.

ACT techniques such as Observer Self practices, Leaves on a Stream, Radio Doom and

Gloom, and Values-based goal setting offer both ACT practitioners and clients a map to
navigate the chaos, in terms of taking symptoms as something that can be moved with instead

of fighting against them or eliminating them.

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental

disorders (5th ed., text rev.; DSM-5-TR).

[Link]

Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression.

Guilford Press.

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2012). Acceptance and commitment therapy:

The process and practice of mindful change (2nd ed.). Guilford Press.

Association for Contextual Behavioral Science. (n.d.). The hexaflex model of psychological

flexibility and inflexibility. Retrieved June 8, 2025, from

[Link]

ACT Mindfully. (n.d.). Free ACT resources. Retrieved June 8, 2025, from

[Link]