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Journal of Service Science and Management, 2014, 7, 216-221
Published Online June 2014 in SciRes. http://www.scirp.org/journal/jssm
http://dx.doi.org/10.4236/jssm.2014.73019
How to cite this paper: Larmar, S., Wiatrowski, S. and Lewis-Driver, S. (2014) Acceptance & Commitment Therapy: An
Overview of Techniques and Applications. Journal of Service Science and Management, 7, 216-221.
http://dx.doi.org/10.4236/jssm.2014.73019
Acceptance & Commitment Therapy: An
Overview of Techniques and Applications
Stephen Larmar, Stanislaw Wiatrowski, Stephen Lewis-Driver
Griffith School of Human Services and Social Work, Griffith University, Brisbane, Australia
Email: s.larmar@griffith.edu.au
Received 2 March 2014; revised 1 April 2014; accepted 25 April 2014
Copyright © 2014 by authors and Scientific Research Publishing Inc.
This work is licensed under the Creative Commons Attribution International License (CC BY).
http://creativecommons.org/licenses/by/4.0/
Abstract
Acceptance and Commitment Therapy (ACT) has emerged over the last twenty years within the
context of the Third Wave of Cognitive Therapies, and has been utilised with reported success in a
range of therapeutic and mental health settings. Social and self-stigma related to seeking assis-
tance for mental health and other concerns has been shown to reduce client engagement with
therapeutic support. Numerous studies have been undertaken that support ACT as an empirically
validated framework for engaging stigmatised client groups. This paper provides a review of the
key philosophical underpinnings and prominent techniques employed in ACT. Further, the paper
highlights the utility of ACT in treating mental illness and other conditions by encouraging thera-
peutic participation through a use of techniques that inherently reduce the self and social stigma
related to psychological disturbance and disability.
Keywords
Acceptance and Commitment Therapy, Stigma, Mental Health, Therapeutic Engagement
1. Introduction
While the primary intent of counselling and psychotherapeutic interventions is to provide psychosocial support,
the potential stigmatising effects of accessing such support, especially for those suffering from mental health
concerns, may prohibit engagement [1]-[4]. The consequences of stigmatisation may include delays in therapeu-
tic outcomes [5], exiting therapy prematurely [6] or choosing not to access treatment [7]. Given the impact of
potentially stigmatising attitudes towards counselling, greater consideration is necessary for the facilitation of
therapeutic approaches that minimise the effects of stigmatisation and promote widening participation and so-
cially inclusive therapeutic practices. This paper provides an overview of ACT and posits that the underlying
philosophy and techniques inherent in the process serve to redress potentially stigmatising effects encountered in
S. Larmar et al.
217
alternative forms of therapy, thus rendering the ACT approach as a cogent framework to accommodate a di-
verse population of individuals experiencing mental health concerns.
2. Acceptance and Commitment Therapy: An Overview
Developed by Hayes [8] in the late 1980’s, ACT emerged from behaviourist approaches to therapy. Behaviour
therapy is conceptualized within three corresponding categories or “generations” that include: behaviour therapy;
cognitive behavioural therapy (CBT) and the “third generation” or “third wave” of behaviour therapy [9] [10].
ACT is grounded in behaviourism, but is underpinned by analysis of cognitive processes [11]. In light of in-
creasing empirical evidence, attempts have been made to classify ACT in its own right as a distinct, unified
model of behaviour change linked to “contextual behavioural science” [12]. This third wave of behaviourism
supports openness and acceptance of psychological events, including those that are traditionally perceived to be
negative or irrational [13]. The chief purpose of ACT is to encourage individuals to respond to situations con-
structively, while simultaneously negotiating and accepting challenging cognitive events and corresponding
feelings, rather than replacing them. A key feature of ACT is the emphasis on the notion that behaviours and
emotions can exist simultaneously and independently. ACT encourages the individual to accept and integrate
into their lived experiences challenging affective responses and to recognise and eliminate the controlling di-
mensions that specific contextual situations exert upon them [9].
ACT is underpinned by functional contextualism [14], a pragmatic philosophical position that recognises that
psychological events (encompassing cognition, affective responses and behaviour) are influenced by antecedents
within a specific context [15]. According to Hayes [13] the
“… core components of functional contextualism are a) focus on the whole event, b) sensitivity to the role of
context in understanding the nature and function of an event, c) emphasis on a pragmatic truth criterion, and d)
specific scientific goals against which to apply the truth criterion”.
A reductionist approach to therapy that focuses solely on the analysis of ‘dysfunctional’ behaviour, rather
than placing common behavioural responses within an historical and contextual position is rejected in ACT [13].
The approach utilises relational frame theory (RFT), a behaviour analytic theory of human behaviour that serves
to explain the complex interplay of thought processes with behaviours [16] [17]. RFT provides a conceptual
framework for understanding “… the learned ability to arbitrarily relate events, mutually and in combination,
and to change the functions of events based on these relations” [18]. According to RFT maladaptive processes
occur as a result of the individual avoiding “private events” (cognitive processes and affective responses) based
on their negative appraisal of these events. As the individual engages in ACT they learn to integrate these pri-
vate events, consolidate personal values and adopt new ways of behaving [19].
A key assumption of ACT is that psychological processes in most individuals have the potential to be destruc-
tive, in contrast to the predominant Western view that fundamentally, humans are psychologically healthy be-
ings [9]. Unlike cognitive-behavioural approaches that reinforce the dynamic interplay between cognition, beha-
viour and affect and the focus on replacing maladaptive thought processes with healthier cognitions, ACT
teaches individuals to “just notice”, accept and embrace private experiences and focus on behavioural responses
that produce more desirable outcomes [20]. Through this process the individual is encouraged to exercise in-
creased psychological flexibility, drawing on personal values that lead to meaningful action [21].
The acronym FEAR is sometimes utilised in ACT to highlight key variables associated with psychological
disequilibrium: Fusion of thoughts; Evaluation of experience; Avoidance of experience; and Reason-giving for
behaviour [22]. Inherent in the practice of ACT are a number of mindfulness skills that include:
• Acceptance of thoughts and emotions;
• Cognitive defusion which involves developing accurate awareness of thoughts and emotions;
• Awareness of the moment by being open and receptive; and
• Observation of self [9].
By focusing upon accepting and integrating private events rather than “extinguishing” maladaptive thought
patterns, these ACT techniques affectively reduce the self-stigma that often acts as a barrier to client engage-
ment with therapy [4] [23].
3. Therapeutic Techniques Common to ACT
ACT approaches to therapy serve to counteract the negative effects of avoiding affective content, the influence
S. Larmar et al.
218
of dogmatic literal responses to presenting cognitive themes and failure to commit to changes in behaviour [24]
[25]. Like cognitive-behavioural therapy the process assists in the facilitation of changes in the individual’s in-
ternal dialogue or self-talk and their verbal behaviour. The therapist encourages the individual to embrace their
feelings, given that denying or struggling with negative affective responses can be counterproductive to psycho-
logical health [26]. Initially, the therapist assists the individual to clarify challenges in the individual’s world
that they can overcome and those that they need to accept as an ongoing part of their lived experience.
According to Hayes [13] seven core processes are inherent in the practice of ACT. These include:
1) Confronting the system—the therapist assists the individual to examine strategies the individual has
adopted in an attempt to overcome the presenting problem and to “… challenge the linguistic set that defines
both problems and their solutions, because that set is itself viewed to be a problem” [13]
2) Recognising control as the problem—the therapist helps the individual to understand that in terms of
private events (thoughts and feelings) control strategies often may exacerbate the very thoughts and feelings the
individual is trying to manage. ACT recognizes that systems of problem-solving are based on socially con-
structed regulations that are linguistically centred [19]. The therapist helps the individual to see that adhering to
such rules can create the source of the individual’s problem.
3) Identifying cognitive defusion and mindfulness—the therapist facilitates the process of helping the indi-
vidual to achieve cognitive defusion as a means of encouraging greater flexibility in behavioural responses. This
involves assisting the individual to ameliorate the negative impacts of thoughts, rather than attempting to adapt
or replace their content and frequency by reducing the thought’s significance.
4) Developing a transcendent sense of self—the therapist engages the individual in experiences that assist
the individual to move into a position of personal transcendence as a means of momentarily separating them-
selves from the challenging experience in order to more objectively explore physical sensations, emotional res-
ponses, memories and cognitive patterns.
5) Promoting acceptance and willingness—the therapist assists in the promotion of the individual wholly
embracing their experiences in the here and now.
6) Clarifying values—as part of the therapeutic process the therapist encouragers the individual to develop a
greater awareness of the values that are important to them as a means of motivating acceptance, willingness and
committed action that assists the individual to take control of their lives.
7) Establishing commitment—a culminating process in ACT is the discarding of experiential avoidance and
cognitive fusion and the establishment of committed behavioural responses that are congruent with the individu-
al’s identified values and that serve to empower them [13].
Eifert and Forsyth [27] encapsulate the key stages inherent in ACT, through the delineation of three distinct
therapeutic steps that include:
1) Accepting thoughts and feelings as a means of eliminating the challenges associated with reducing, mod-
ifying or rejecting cognitive or affective influences.
2) Choosing future directions that align with the individual’s goals and underlying values.
3) Taking action through the process of committing to identified areas of the individual’s world that require
change.
4. Effectiveness of ACT: Treatment; Reduction of Stigma; and Increased
Therapeutic Engagement
ACT is gaining international recognition as a therapeutic approach that accommodates a range of individuals
and presenting problems [9] [10] [12]. It facilitates an inclusive approach representing an alternative framework
of counselling that serves to counteract some of the potentially stigmatising effects of therapeutic approaches for
clients with mental illness [4] [28] [29]. The effectiveness of ACT based interventions for individuals with de-
pression, anxiety, specific phobias and a range of other diagnosed mental health concerns has been demonstrated
[20] [30]-[38]. Multiple studies highlight the utility of ACT in enabling individuals to more effectively manage
diagnosed conditions that are recognised as difficult to treat using other counselling modalities. Key findings
emerging from current ACT research indicate that processes foundational to the approach, such as mindfulness,
cognitive defusion, the promotion of acceptance and willingness, as well as commitment to change, are condu-
cive to reducing the potentially stigmatising effects of seeking counselling support.
Beyond its usefulness as an efficacious and inclusive therapeutic intervention for mental illness, a growing
S. Larmar et al.
219
body of research is emerging that highlights the positive impact of ACT in reducing barriers to participation
through application to a range of other complex issues including physical, intellectual and psychosocial chal-
lenges [22] [39]-[45]. ACT has been shown as an effective treatment approach for assisting individuals in the
psychosocial adjustment to pain management and numerous other psychological and physical disabilities. Given
the emphasis in approaches such as cognitive-behavioural therapy, on the replacement of maladaptive thought
processes as part of the adjustment process in managing disablement, chronic pain or biological precursors of
mental illness, individuals seeking counselling may understandably struggle to process inherent, complex thoughts
& entrenched schemas. In contrast, ACT empowers the individual to accept their thought processes as a realistic
and necessary function of psychosocial adjustment, therefore normalising their experience and reducing the po-
tentially stigmatising effects associated with negative cognitive schemas. Further, like many forms of disable-
ment, many of the biological precursors of mental health conditions represent permanent states of being, thus
many of the techniques used in ACT, such as acceptance, can be cogent in assisting individuals to embrace and
integrate the biological features of their condition as part of their core identity.
Research into the effects of ACT for individuals with addictive behaviours and substance abuse also high-
lights the merits of this approach with this identified population [24] [46] [47]. Individuals experiencing sub-
stance abuse and addiction often feel a sense of helplessness in accessing the support necessary to assist them,
given the stigma associated with addictive patterns of behaviour and help seeking responses [48] [49]. ACT
serves to address the potentially stigmatising effects of counselling on the individual by facilitating a process
where the individual can learn to accept themselves, in spite of their addictive behaviours and negotiate a com-
mitment to change based on achievable outcomes. The overall benefits of adopting ACT for populations vul-
nerable to social stigma are significant. Such an approach is pivotal to the elimination of potential barriers to
engagement in counselling and psychotherapy practice.
5. Conclusion
This paper has provided an overview of Acceptance and Commitment Therapy (ACT) as a counselling approach
that extends upon traditional forms of behaviour therapy. The paper examined the philosophical assumptions
foundational to ACT and highlighted techniques and processes common to the approach as a means of summa-
rising the therapeutic framework for ACT as it applies to mental health concerns and a range of other presenting
problems. A summary of empirical studies was presented identifying the validity and utility of ACT across a range
of contexts for a diverse population of client groups. Finally, discussion centred upon the significance of ACT
techniques in eliminating barriers to therapeutic participation and challenging the potentially stigmatizing effects
of more traditional approaches to therapy.
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