6.3 ACT Made Simple

1. Background of ACT

As long as a person is alive, pain is inevitable. This is because:

1. Life is difficult.
2. A difficult life inevitably brings painful emotions.
3. The normal human mind automatically amplifies psychological pain.

I wanted to find out whether there was a way to deal with this pain, and then I discovered ACT as a tool.

Its aim is to maximize human potential so that people can live rich and meaningful lives while effectively dealing with the pain that follows them.

2. What Is ACT?

ACT is a newer generation of cognitive behavioral therapy.

The English letter A is an abbreviation of Action, which shows that it tells us how to take action.

In Chinese, it is translated as Acceptance and Commitment Therapy:

• Acceptance: accept the thoughts and emotions that cause us pain.
• Commitment: take action guided by values.

The details are described below.

3. The Content of ACT

3.1. The ACT Hexaflex

3.1.1. Psychological Flexibility

3.1.1.1. Past

3.1.1.1.1. Acceptance

1. What it is: accepting our emotions and thoughts.

For example, when something happens it triggers feelings. These feelings are expressed as emotions such as happiness, anger, sadness, joy, anxiety, and fear. Most of the time emotions and feelings are consistent, but sometimes we suppress feelings and express other emotions. These emotions, together with the thinking processes of our brain, produce many ideas, which are thoughts.

2. Why acceptance is needed: 3.1.2.1. Experiential Avoidance — the opposite of acceptance
3. How to accept: acknowledge that you have these thoughts and that they are normal.

3.1.1.1.2. Cognitive Defusion

1. What it is: seeing your emotions and thoughts and taking a step back. See our thoughts instead of becoming entangled in them. For example, when something happens, it causes us to think and many ideas arise in the mind; these ideas are thoughts.
2. Why cognitive defusion is needed: See 3.1.2.2. Cognitive Fusion — the opposite of cognitive defusion
3. How to practice cognitive defusion: negative emotion journal.

3.1.1.2. Present

3.1.1.2.1. Contact With the Present Moment

1. What it is: devote your full attention to what is happening here and now. For example, if I am writing now, fully immerse myself in writing.
2. Why contact with the present moment is needed: otherwise we may miss life or find it difficult to do things well.
3. How to live in the present: mindfulness.

3.1.1.2.2. Self as Context

1. What it is: the brain has two processes, one that thinks and another that observes. For example, while I am writing, another “me” is observing me writing.

• Thinking self: responsible for thinking, meaning judging thoughts.
• Observing self: responsible for observing, meaning noticing thoughts.

2. Why self as context is needed.
3. How to practice self as context: notice thoughts and name them + mindful breathing. A negative emotion journal is better, but it cannot be done in real time.

3.1.1.3. Future

3.1.1.3.1. Values

1. What they are: values.

2. Why values are needed: values empower people; life needs a sense of direction.

3. How to clarify values: What I Think About When I’m Anxious — How I Understand Life.

4. How to deal with value conflicts?

If the problem is time allocation, such as allocating time between love and work, then it is a time conflict rather than a value conflict.

If it is truly a dilemma:

1. Acknowledge that you are in a dilemma; essentially, a problem has multiple possible solutions.
2. Perform a cost-benefit analysis and examine the advantages and disadvantages of each solution.
3. Say your choice out loud and commit to it.

3.1.1.3.2. Committed Action

1. What it is: doing what should be done, taking action toward values, including physical and mental activity.
2. Why action is needed: having a direction without taking action changes nothing.
3. How to act: life planning.

3.1.2. Psychological Inflexibility

3.1.2.1. Experiential Avoidance — the Opposite of Acceptance

1. What it is: actively trying to stop feelings and thoughts from controlling you, including struggling and avoiding; fundamentally it comes from the human fight-or-flight response.
2. Why experiential avoidance causes pain.

Take social interaction as an example:

1. Avoidance: suppose I feel anxious in social situations. To avoid those anxious feelings, I stop participating in social activities.
2. Only listening: try to reduce anxiety in social situations by playing the role of a “good listener.”
3. Medication: take diazepam or other mood-altering medication to reduce anxiety.
4. Enduring: socialize despite the anxiety and grit your teeth through it, meaning enduring your feelings.
   1. Enduring and acceptance are different.

3.1.2.2. Cognitive Fusion — the Opposite of Cognitive Defusion

1. What it is: passively being controlled by emotions and thoughts.

Example: treat your hands as thoughts and emotions and slowly move them over your face.

2. Types of fusion:

   1. Fusion with the past
      1. Being hooked by thoughts and emotions about the past.
   2. Fusion with the future
      1. Being hooked by worries about the future.
   3. Fusion with self-concept
      1. Being hooked by thoughts and emotions related to self-description and self-evaluation.
   4. Fusion with reasons
      1. I cannot do X (an important action) because…
   5. Fusion with rules.
   6. Fusion with judgments.

3. Why fusion causes pain.

3.2. The ACT Triangle

The hexaflex can be divided into functional units and paired into a triangle.

1. Open up: includes acceptance and cognitive defusion.
2. Be present: includes contact with the present moment and self as context.
3. Do what matters: includes values and committed action.

3.3. ACT and Mindfulness

Mindfulness + values-guided action = ACT.

Mindfulness is not meditation.

4. The Choice Point Tool

4.1. Background

Simplify the complexity of the ACT model.

4.2. What It Is

A tool for quickly describing a problem, identifying the source of pain, and forming an ACT plan for dealing with the problem and the pain.

Every one of us is doing things at every moment. Take one specific event as an example.

4.2.1. Emotions, Thoughts, and Feelings

What thoughts and feelings does this event trigger?

4.2.2. Unhooking and Getting Hooked

Unhooking: corresponds to the four core mindfulness processes of psychological flexibility in ACT: acceptance, cognitive defusion, self as context, and contact with the present moment.

Getting hooked: corresponds to experiential avoidance, cognitive fusion, inflexible attention, and self-concept fusion in psychological inflexibility.

4.2.2.1. Unhooking Skills

1. Acknowledge pain and discomfort: acceptance + cognitive defusion
2. Connect with the body:
3. Engage in what you are doing: contact with the present moment

It is essentially the “how” of each subsection in 3.1.1. Psychological Flexibility.

4.2.3. Toward Moves and Away Moves

Toward moves: what we do moves toward our values. This corresponds to values and committed action in ACT psychological flexibility.

Away moves: what we do moves away from our values. This corresponds to moving away from values and ineffective action in psychological inflexibility.

How do we distinguish the two?

It does not mean that something “right” or “correct” is necessarily a toward move. For example, if drinking alcohol is part of my work, it is a toward move; if drinking is used to escape from life, it is an away move.

5. How Individuals Can Apply ACT

1. Clarify your values: values.
2. When many thoughts, choices, or painful experiences are running through your mind:
   1. First return to the present moment.
      1. Take a deep breath and focus your attention on the present.
      2. Acknowledge that having these thoughts is normal. Do not actively fight or avoid them, and do not passively become entangled in them.
      3. Notice these thoughts, name them, and do not judge them.
   2. Then use the Choice Point tool.
      1. At the bottom: use the negative emotion journal for the situation, cognition, and feelings.
      2. On the right: take values-guided action.

6. How Psychotherapists Can Apply ACT

6.1. Establish a Good Therapeutic Relationship

6.2. Sign Informed Consent

6.3. Collect the Client’s Developmental History

1. The client’s presenting complaint.
2. Initial values assessment.
3. Current life situation.
4. Relevant past experiences.
5. Psychological inflexibility.
6. Motivational factors.
7. Psychological flexibility.
8. The client’s resources.

6.4. Establish Behavioral Goals

1. Emotional goal = how I want to feel.
2. Behavioral goal = what I want to do.

7. References

ACT Made Simple Reading Group 01 - Bilibili
How to distinguish facts, thoughts, and emotions? - Zhihu
Acceptance and Commitment Therapy ACT - ACT Made Simple - Book Sharing 01 Introduction - Bilibili
Acceptance and Commitment Therapy ACT - ACT Made Simple - Book Sharing 02 Choice Point Tool - Bilibili
Acceptance and Commitment Therapy ACT - ACT Made Simple - Book Sharing 03 Cognitive Fusion and Workability - Bilibili
Acceptance and Commitment Therapy ACT - ACT Made Simple - Book Sharing 04 Experiential Avoidance and Psychological Inflexibility - Bilibili
Do you know the difference between “emotion” and “feeling”? - Zhihu
The difference between feelings and emotions - Zhihu