Қабылдау және міндеттеме терапиясы: Психологиялық икемділікті арттыру жолы

Form of cognitive behavioral therapy

Acceptance and commitment therapy (ACT, typically pronounced as the word "act") is a form of psychotherapy, as well as a branch of clinical behavior analysis. It is an empirically based psychological intervention that uses acceptance and mindfulness strategies along with commitment and behavior change strategies to increase psychological flexibility. This approach was first called comprehensive distancing. ACT protocols vary with the target behavior and the setting. For example, in behavioral health, a brief version of ACT is focused acceptance and commitment therapy (FACT). The goal of ACT is not elimination of difficult feelings, but to be present with what life brings and to "move toward valued behavior". In ACT, "truth" is measured through the concept of "workability", or what works to take another step toward what matters (e. g., values, meaning).

The website of the Association for Contextual Behavioral Science states that there were over 1,000 randomized controlled trials (RCTs) of ACT, over 500 meta analyses/systematic reviews, and 78 mediational studies of the ACT literature as of April 2024. Organizations that have stated that acceptance and commitment therapy is empirically supported in certain areas or as a whole according to their standards include (as of March 2022): in 2011 the number had doubled to more than 60 ACT randomized controlled trials, and in 2023 there were more than 1,000 randomized controlled trials of ACT worldwide. A 2008 meta analysis concluded that the evidence was still too limited for ACT to be considered a supported treatment. A 2009 meta analysis found that ACT was more effective than placebo and "treatment as usual" for most problems. The authors also noted that research methodologies had improved since the studies described in the 2008 meta analysis. In 2020–2021, after three RCTs of ACT by the World Health Organization (WHO), WHO released an ACT based self help course Self Help Plus (SH+) for "groups of up to 30 people who have lived through or are living through adversity". As of July 2023, there are six RCTs of Self Help Plus. In 2022, a systematic review of meta analyses about interventions for depressive symptoms in people living with chronic pain concluded "Acceptance and commitment therapy for general chronic pain, and fluoxetine and web based psychotherapy for fibromyalgia showed the most robust effects and can be prioritized for implementation in clinical practice".

The Association for Contextual Behavioral Science is committed to research and development in the area of ACT, RFT, and contextual behavioral science more generally. As of 2023 it had over 8,000 members worldwide, about half outside of the United States. It holds annual "world conference" meetings each summer, with the location alternating between North America, Europe, and South America. The Association for Behavior Analysis International (ABAI) has a special interest group for practitioner issues, behavioral counseling, and clinical behavior analysis ABA:I. ABAI has larger special interest groups for autism and behavioral medicine. ABAI serves as the core intellectual home for behavior analysts. ABAI sponsors three conferences/year—one multi track in the U. S., one specific to autism and one international. The Association for Behavioral and Cognitive Therapies (ABCT) also has an interest group in behavior analysis, which focuses on clinical behavior analysis. ACT work is commonly presented at ABCT and other mainstream CBT organizations. The British Association for Behavioural and Cognitive Psychotherapies (BABCP) has a large special interest group in ACT, with over 1,200 members. Doctoral level behavior analysts who are psychologists belong to the American Psychological Association's (APA) Division 25—Behavior analysis. ACT has been called a "commonly used treatment with empirical support" within the APA recognized specialty of behavioral and cognitive psychology.

ACT, dialectical behavior therapy (DBT), functional analytic psychotherapy (FAP), mindfulness based cognitive therapy (MBCT) and other acceptance and mindfulness based approaches have been grouped by Steven Hayes under the name "the third wave of cognitive behavior therapy". However, this classification has been criticized and not everyone agrees with it. According to Hayes' classification, the first wave, behaviour therapy, commenced in the 1920s based on Pavlov's classical (respondent) conditioning and operant conditioning that was correlated to reinforcing consequences. The second wave emerged in the 1970s and included cognition in the form of irrational beliefs, dysfunctional attitudes or depressogenic attributions. In the late 1980s empirical limitations and philosophical misgivings of the second wave gave rise to Steven Hayes' ACT theory which modified the focus of abnormal behaviour away from the content or form towards the context in which it occurs. Steven C. Hayes described the third wave in his ABCT President Address as follows:

Grounded in an empirical, principle focused approach, the third wave of behavioral and cognitive therapy is particularly sensitive to the context and functions of psychological phenomena, not just their form, and thus tends to emphasize contextual and experiential change strategies in addition to more direct and didactic ones. These treatments tend to seek the construction of broad, flexible and effective repertoires over an eliminative approach to narrowly defined problems, and to emphasize the relevance of the issues they examine for clinicians as well as clients. The third wave reformulates and synthesizes previous generations of behavioral and cognitive therapy and carries them forward into questions, issues, and domains previously addressed primarily by other traditions, in hopes of improving both understanding and outcomes. ACT has also been adapted to create a non therapy version of the same processes called acceptance and commitment training. This training process, oriented towards the development of mindfulness, acceptance, and valued skills in non clinical settings such as businesses or schools, has also been investigated in a handful of research studies with good preliminary results. The emphasis of ACT on ongoing present moment awareness, valued directions and committed action is similar to other psychotherapeutic approaches that, unlike ACT, are not as focused on outcome research or consciously linked to a basic behavioral science program, including approaches such as Gestalt therapy, Morita therapy, and others. Hayes and colleagues themselves stated in their book that introduced ACT that "many or even most of the techniques in ACT have been borrowed from elsewhere—from the human potential movement, Eastern traditions, behavior therapy, mystical traditions, and the like". Wilson, Hayes & Byrd explored at length the compatibilities between ACT and the 12 step treatment of addictions and argued that, unlike most other psychotherapies, both approaches can be implicitly or explicitly integrated due to their broad commonalities.

The textbook Systems of Psychotherapy: A Transtheoretical Analysis includes various criticisms of third wave behaviour therapy, including ACT, from the perspectives of other systems of psychotherapy, including the complaint that third wave therapies "display an annoying tendency to gather effective methods from other traditions and label them as their own".

In a 2012 blog post, psychologist James C. Coyne criticized the process and studies initially used by the APA to favorably evaluate ACT for the treatment of psychosis in its labeling system for evidence based medicine. In particular, it relied on only one full randomized trials, supplemented by a pilot study and a feasibility study, despite the criteria for "strong evidence" requiring a treatment to be supported by many such trials. In 2016, this and other critiques were cited by William O'Donohue and coauthors in a paper on "weak and pseudo tests" of ACT and added that while "no doubt there are studies of ACT that are quite good", they had examined three trials of ACT that were "weakened and thus made easier to pass", and they listed over 30 ways in which such trials were "weak or pseudo tests".

In 2013, psychologist Jonathan W. Kanter said that Hayes and colleagues "argue that empirical clinical psychology is hampered in its efforts to alleviate human suffering and present contextual behavioral science (CBS) to address the basic philosophical, theoretical and methodological shortcomings of the field. CBS represents a host of good ideas but at times the promise of CBS is obscured by excessive promotion of Acceptance and Commitment Therapy (ACT) and Relational Frame Theory (RFT) and demotion of earlier cognitive and behavior change techniques in the absence of clear logic and empirical support." Authors of a 2013 paper comparing ACT to cognitive therapy (CT) concluded that "although preliminary research on ACT is promising, we suggest that its proponents need to be appropriately humble in their claims. In particular, like CT, ACT cannot yet make strong claims that its unique and theory driven intervention components are active ingredients in its effects." The authors of the paper suggested that many of the assumptions of ACT and CT "are pre analytical, and cannot be directly pitted against one another in experimental tests." In 2012, ACT appeared to be about as effective as standard CBT, with some meta analyses showing small differences in favor of ACT and others not. For example, a meta analysis published by Francisco Ruiz in 2012 looked at 16 studies comparing ACT to standard CBT. ACT failed to separate from CBT on effect sizes for anxiety, however modest benefits were found with ACT compared to CBT for depression and quality of life. The author did find separation between ACT and CBT on the "primary outcome" – a heterogeneous class of 14 separate outcome measures that were aggregated into the effect size analysis. This analysis however is limited by the highly heterogeneous nature of the outcome variables used in the analysis, which has the tendency to increase the number needed to treat (NNT) to replicate the effect size reported. More limited measures, such as depression, anxiety and quality of life decrease the NNT, making the analysis more clinically relevant, and on these measures ACT did not outperform CBT. A 2012 clinical trial by Forman et al. found that Beckian CBT obtained better results than ACT. Several concerns, both theoretical and empirical, have arisen in response to the ascendancy of ACT. One theoretical concern was that the primary authors of ACT and of the corresponding theories of human behavior, relational frame theory (RFT) and functional contextualism (FC), recommended their approach as the proverbial holy grail of psychological therapies. In 2012, in the preface to the second edition of Acceptance and Commitment Therapy, the primary authors of ACT clarified that "ACT has not been created to undercut the traditions from which it came, nor does it claim to be a panacea."