ACT and Anxiety: A brief history.

Photo by Talles Alves on Unsplash

Angela Cathey, MA, LPC & Todd A. Ward, PhD, BCBA-D

bSci21Media, LLC

Brett DiNovi, M.A., BCBA

Brett DiNovi & Associates

Acceptance and Commitment Therapy (“ACT”) is considered ‘third-wave’ behavior therapy. ‘Third-wave’ refers to developmental timeline within psychotherapeutic traditions of the behavior-based therapies. The first ‘wave’ is said to include treatment packages and techniques that evolved from the work of B.F. Skinner, John B. Watson, and others whose work helped make clear the underlining principles driving behavior.

While the first-wave behavior therapies were highly successful at treating many issues, psychotherapists struggled to address many issues common in high functioning adults without taking into account the functions of verbal behavior. This led to a second wave of behavior therapies that are known collectively as ‘cognitive-behavioral.’ This movement is often identified heavily with Aaron T. Beck (Cognitive-behavioral Therapy) and Albert Ellis’ (Rational Emotive Behavior Therapy; REBT). These treatments departed from radical behavioral principles by using explanatory mid-level constructs to explain the experience of clients and how people tended to relate to their own ‘internal’ behavior. Treatments from the second-wave of the behavior therapies achieved a great deal of success at dealing with the issues most commonly reported by high functioning adults (e.g., anxiety, depression, etc.). Third-wave therapies including: Acceptance and Commitment Therapy (ACT), Compassion Focused Therapy (CFT), Functional Analytic Therapy (FAP), and Dialectical Behavior Therapy (DBT) are often identified around their commonalities of including, but not limited to, their tendency to include mindfulness and acceptance foci.

Acceptance and Commitment Therapy (ACT) differs in some respects to these other third-wave therapy modalities due to its tight growth out of Relational Frame Theory (RFT). In the 80’s as the second-wave of behavior therapies began to hit full stride at solidifying component packages to address common issues of the human condition some radical behavioral researchers went the other direction. Steven C. Hayes, Dermont Barnes-Holmes, Carmen Luciano, and Yvone Barnes-Holmes, among others, began basic and applied research to elaborate on B.F. Skinner’s work to address verbal behavior. This work investigated verbal behavior as a generalized operant and focused on the properties of human verbal behavior.

Out of this work came the hexaflex model of Acceptance and Commitment Therapy (ACT). The six processes described by the hexaflex model, including: 1) Present Moment Focus, 2) Values, 3) Defusion, 4) Self-as-Context, 5) Committed Action, and 6) Mindfulness were meant to make it easier for therapists to track the effects of verbal behavior and its properties in flight, and further to give the treatment modality a vernacular that would likely function well with the high functioning clientele typically seen in adult psychotherapy clinics. Thus, ACT’s roots are far more behavioral than many may realize.

In relation to the treatment of anxiety, depression, and other issues common to high functioning adults – ACT has been able to garner high levels of support as an empirically supported treatment in a funding environment where therapy research and acceptance for psychotherapy treatment reimbursement is largely determined at competitive success against other treatments at the group-level using Randomized Controlled Trials and group focused methodology.

ACT makes an excellent bridge for radical behaviorists to learn to extend their work with high functioning populations and to detach from the functions of their own verbal rigidity. With the inclusion of the properties of verbal behavior to traditional behavior analysis the ubiquity of human suffering in situations where current direct contingencies might seem to health, as well as the opposite, the ability of humans to excel where direct contingencies would seem to drive dysfunction – is well elaborated.

Anxiety from the ACT perspective becomes more than conditioning histories attached to specific objects and elaborates on how language and verbal behavior may transform direct contingencies and past experience into the present. The addition of these properties vastly increases our ability and flexibility in treating severe anxiety and motivating individuals to achieve highly in the face of enormous challenges. To hear more about ACT, it’s history in relation to the other behavior therapies, and metaphors often used to help clients better track their own behavioral processes, check out this recent video by Brett DiNovi & Associates.

Also be sure to subscribe to Brett DiNovi’s YouTube channel and let him know what you would like to see in future videos.  Also be sure to subscribe to bSci21 via email to receive the latest articles directly to your inbox!

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Brett DinoviBrett DiNovi, M.A., BCBA has the unique and distinguished experience of studying the principles of applied behavior analysis under the rigorous scrutiny of both Dr. Julie S. Vargas (formerly Skinner) and Dr. E.A. Vargas at West Virginia University’s internationally recognized program. For the past 26 years, Brett has used behavior analytic principles to create large scale change across school districts, Fortune 500 companies using principles of Organizational Behavior Management (OBM), and across individual learners. Brett has been a OBM consultant in Morgantown WV, an instructor at West Virginia University, a guest lecturer at numerous universities, a speaker on multiple Comcast Newsmakers TV programs, an expert witness in due process hearings, has publications in the Journal of Applied Behavior Analysis, and has been in in executive leadership positions across schools and residential programs nationwide. In addition to an award from South Jersey Biz Magazine for “Best Places to Work,” an award for “Best of Families” in Suburban Magazine, and the distinguished “Top Ranked U.S. Executives” award, Brett’s proudest accomplishment is being a role model and father for his daughter and two stepchildren (one of which has autism). Brett can be reached at [email protected]


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