Table Of ContentAcceptAnce And commitment therApy
Acceptance
and Commitment
Therapy
the process and practice
of mindful change
Second edition
Steven C. Hayes
Kirk D. Strosahl
Kelly G. Wilson
THE GUILFORD PRESS
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© 2012 The Guilford Press
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Library of Congress Cataloging-in-Publication Data
Hayes, Steven C.
Acceptance and commitment therapy : the process and practice of mindful
change / Steven C. Hayes, Kirk D. Strosahl, Kelly G. Wilson.–2nd ed.
p. cm.
Includes bibliographical references and index.
ISBN 978-1-60918-962-4 (hardcover)
1. Acceptance and commitment therapy. 2. Values
clarification. 3. Language and emotions. I. Strosahl, Kirk,
1950– II. Wilson, Kelly G. III. Title.
RC489.C62H39 2012
616.89′1425—dc23
2011019744
To Barry and Trudy—
For helping ACBS through a critical time,
lifting the work and moving it forward.
Your vision was infectious, and I will always be grateful.
—S. C. H.
To my wife and lifelong soul mate, Patti.
Your keen intellect, constant encouragement, and support
and total acceptance of who I am—
with occasional requests for change—
have made me a better person.
To my brother Mark,
who has been gone barely a year now—
you will remain in my heart forever.
To my mom, Joyce, who at 93 is still reading novels,
playing the viola, and doing all the things that make up being alive—
what a role model you’ve been.
—K. D. S.
To my daughters Sarah, Emma, and Chelsea . . .
I love you to the moon and back.
—K. G. W.
About the Authors
Steven C. Hayes, PhD, is Nevada Foundation Professor in the Department
of Psychology at the University of Nevada. His career has focused on the
analysis of the nature of human language and cognition and its applica-
tion to the understanding and alleviation of human suffering.
Kirk D. Strosahl, PhD, is a primary care psychologist at Central Washing-
ton Family Medicine, in Yakima, Washington, where he is promoting the
use of ACT in general medical practice with predominantly low-income
underinsured or uninsured clients.
Kelly G. Wilson, PhD, is Associate Professor of Psychology at the Univer-
sity of Mississippi, where he is also Director of the Center for Contextual
Psychology and the ACT Treatment Development Group.
vi
Preface
What Is New in This Edition
Acceptance and commitment therapy (ACT) was introduced in book
form in the first edition of this volume in 1999. The underlying model
was still underdeveloped, and we had not yet articulated our strategy of
knowledge development. We knew that, but it was already well past time to
put our then nearly 20-year-old “baby” out in front of the public. The first
book on relational frame theory (RFT) was published 2 years later.
Something rather remarkable then occurred. Some very high- quality
clinicians and researchers were attracted to the work and increasingly
began to take responsibility for it. Clinicians were excited. RFT research
quickened. A worldwide conversation began on the Internet, an associa-
tion was formed, and other books were published. Regular national, inter-
national, and regional conferences were held, and existing societies began
giving the work progressively higher visibility. Training innovations flow-
ered. The research data began to flow in. Internationally, experts in sev-
eral languages emerged. The development pace quickened, and the data,
both basic and applied, increasingly guided refinements. Honest critics
appeared, further refining the work.
The result has been considerable conceptual, technological, and
empirical progress over the past dozen years. We were able to distill ACT
down to six key processes and their interrelationships, revolving around a
central concern, namely, psychological flexibility. Data increasingly showed
that ACT works largely through the following psychological flexibility pro-
cesses: defusion, acceptance, flexible attention to the present moment,
self-as-context, values, and committed action.
As we had hoped, we began to see that ACT methods could be inte-
grated with other empirically supported approaches and that psychological
vii
viii Preface
flexibility fostered other important behavioral processes. The range of
problems ACT methods were shown to be useful with was impressive, and
the range of the psychological flexibility model was startling. The model
that worked with depression also worked with smoking. The model that
worked with heroin addiction also worked with diabetes management. The
protocols varied greatly, of course, and the behavioral methods included
were often specific to that particular usage. As a result, the number of ACT
methods now exceeds what would fit into any single book—or even two or
ten—but the model and its processes of change appear to be similar across
a wide variety of behavior change areas.
For all of these reasons, the present volume has a different look and feel
than the book we wrote more than a decade ago. This edition focuses on
the psychological flexibility model as a unified model of human functioning. As the
current volume has evolved, referring to this model as the “ACT model” (as
we used to do) seemed a bit too confining because the model goes beyond
any intervention approach. This book is less a step-by-step linear clinical
manual than it is a guide to learning how to do ACT in a natural way. It is
intended to be useful to those just beginning to explore the model as well as
to those who are already well experienced in using it. Practitioners need to
learn to see psychological flexibility processes in the moment and respond in
a model-consistent way, and this book is intended to help them accomplish
precisely that aim. Clinicians already know how to do some of what is in the
ACT approach—so long as they use their methods in a way that is function-
ally consistent with the psychological flexibility model. Once that linkage is
better appreciated, people can begin to try these methods now. Yes, there
will need to be further training and guidance. But it can start now.
We have tried in this volume to make the proximal foundations of
ACT—functional contextualism and RFT—easier to understand. Instead
of suggesting that readers simply skip the difficult theory and model chap-
ters (Chapters 2 and 3) if they like, we have worked hard to make them
more readily accessible. We may have oversimplified (and we have certainly
left out many details), but we want those who connect with the work to
have a basic foundation from which further exploration is possible. There
are hundreds of scholarly articles on ACT, its underlying model, and basic
foundations—this volume is just a primer. We also make our development
strategy—which we call contextual behavioral science (CBS)—more evi-
dent, especially in the concluding chapter. That might seem strange in
a clinical book, but the purpose of ACT is not ACT über alles. We are not
interested in brand names or personalities. Our purpose is progress. Fur-
ther elaborating our model of knowledge development is how we are trying
to accomplish that, as the best way to speed up progress is to have all hands
on deck, whether they are clinicians, basic scientists, applied researchers,
philosophers, or students. An open, values-based community embracing a
Preface ix
common mission can be far more productive than scores of professors in
an ivory tower. If the development model is maximally well understood, it
will be clear why we are not playing the empirically supported treatments
game in quite the same way as usual (even though admittedly we are part
of that tradition). Yes, we care about randomized trials—but we also care
about much, much more than that. We want empirically supported processes
to be solidly linked to effective procedures (Rosen & Davidson, 2003). We
have a strategy for creating long-term progress, and we are determined to
follow that strategy. It may work, it may not, but we invite the reader to join
us in that journey.
Our assuming this perspective does not mean that a front-line clini-
cian needs to be an RFT geek or needs to drop his or her practice and
become a researcher. Clinicians and other practitioners are important to
the development of this approach, and they have a right to demand much
of behavioral science. We want to show precisely how progress in such areas
as basic science as well as the philosophical underpinnings can help those
with more practical interests also accomplish their purposes.
We can now enumerate some 60 books on ACT worldwide. The rate
of publication of relevant empirical sources is soaring. This program of
research and practical development has been examined at length in vari-
ous review articles (e.g., Hayes, Bissett, et al., 2004; Hayes, Luoma, Bond,
Masuda, & Lillis, 2006; Öst, 2008), and even skeptical observers agree that
we are making progress (e.g., Powers, Vörding, & Emmelkamp, 2009). Such
substantive progress enables us to reduce the frequency of scholarly refer-
ences in most sections of this book. The first edition contained some highly
dense empirical and conceptual passages—chiefly to justify that serious
academic attention be directed to our model—but the text’s density made
it harder for readers to understand or read with ease. Provided that those
interested are willing to read beyond this single volume, point-by-point
empirical justification no longer seems critical to our present purposes. We
have included enough broad strokes for the reader to understand how we
conceptually view the data and enough links for readers to find additional
academic foundations with minimal additional effort.
Some of the ideas underlying ACT are rapidly becoming mainstream
conceptions. Critics regularly now say this is what they meant all along. Per-
haps that sense of revisionism rankles ACT authors with a long memory,
but it need not deter new readers since that is how progress is made. On the
other hand, taking a dollop of “acceptance” here and a dash of “defusion”
there does not do justice to the ACT model or provide its full benefits. We
want the entire model and its knowledge development strategy to be fully
comprehended because that level of familiarity seems likely to yield greater
progress in the long run than merely adopting the hot new techniques or
concepts here and there, as if better treatment is a matter of fashion.
