Recommended Therapies: 2) ACT and Other Therapies
Acceptance and Commitment Therapy (ACT)
Acceptance and Commitment Therapy (ACT) is a type of third-wave cognitive behavioral therapy. It combines acceptance—such as flexibility, openness, compassion, and forgiveness—with commitment, which means acting on our core values and taking responsibility. ACT also uses mindfulness meditation to help people become more psychologically flexible and make positive changes in their behavior.
Steven Hayes, an American clinical psychologist, developed ACT. He first called it “comprehensive distancing” and combined ideas from cognitive and behavioral therapy to create this approach. ACT is built on a practical philosophy called Functional Contextualism, which is based on Relational Frame Theory (RFT)—a theory about language and thinking that comes from behavioral analysis. Both ACT and RFT are rooted in B. F. Skinner’s Radical Behavioral Philosophy.
We can’t always change the things that cause us stress. There will always be difficult people and pressures to handle. So, it’s important to find ways to manage stress that we can’t avoid. ACT is an effective tool for this. Instead of challenging negative thoughts, as in CBT, ACT teaches people to notice, accept, and even embrace their thoughts and feelings, especially the ones they find unpleasant. This acceptance helps people connect with a deeper sense of self, called “self-as-context,” which is the part of us that observes and experiences. This is different from “self-as-content,” which is made up of our thoughts, feelings, and sensations.
In other words, we are not our fears or pains—we are the ones who experience and observe them. This idea helps us create some distance from difficult feelings, instead of being completely caught up in them. ACT’s goal is to help people become more flexible in their thinking, clarify what matters most to them, and take actions that bring more openness, energy, and meaning to their lives.
The goal of ACT isn’t to get rid of difficult feelings, but to help us become more comfortable with them as we move toward our core values. ACT encourages people to face unpleasant feelings and stop overreacting—either by avoiding situations or by making too much of them. As people feel calmer, they understand their situations better, which helps them feel even better, creating a positive cycle.
ACT uses mindfulness to help people notice their automatic reactions. Instead of challenging upsetting thoughts by looking for evidence or trying to be more rational, ACT teaches people to accept and let go of these thoughts. This acceptance helps end the struggle to make things different. ACT helps people focus on what they can control and commit to making their lives better.
Assumptions and Principles of ACT
ACT suggests that many problems come from a lack of psychological flexibility. This can look like getting too caught up in our thoughts and feelings, overthinking or trying to justify them, or avoiding tough situations. Instead, ACT recommends accepting unwanted thoughts and behaviors, being mindful and present, and choosing a meaningful direction in life, then taking steps to follow it.
In ACT therapy, we learn to pay attention to our self-talk, especially when dealing with stressful events like difficult relationships. We can shift from saying things like “I am x” to “I have the thought that….” This change creates distance between us and our thoughts, showing that we are not defined by them—they are just experiences that come and go. The thought becomes less powerful, not because we got rid of it, but because our relationship to it has changed. This shows how language can shape our experience, as explained by Relational Frame Theory (RFT).
A word, sentence, or symbol can mean different things depending on the context. In Relational Frame Theory (RFT), a stimulus can have different meanings based on the situation. For example: a) Driving that car was a piece of cake. b) You baked a delicious cake. In these sentences, the word “cake” means something different in each context.
When you face and accept your current problems, you stop fighting your past, thoughts, and emotions. Instead, you start practicing more confident and hopeful behaviors that match your values and goals. ACT focuses on changing both how you talk to yourself and how you act. This approach is similar to the Serenity Prayer by Reinhold Niebuhr: “God, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.” It’s important to figure out what you can and cannot change. For example, physical disabilities and past trauma are things that can’t be changed and are best accepted.
There is also a non-therapy version of ACT called Acceptance and Commitment Training. It helps people build mindfulness, acceptance, and important skills in places like businesses or schools. Although ACT has faced some criticism about its methods and theories, it is still widely used, and there is more evidence supporting its effectiveness than its weaknesses.
Resources and Further Reading
Zettle, R. D. (2011). The evolution of a contextual approach to therapy: From comprehensive distancing to ACT. International Journal of Behavioural Consultation and Therapy, 7(1), 76-82.
Hayes, Steven. “Acceptance & Commitment Therapy (ACT)”. ContextualPsychology.org
Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2009). Acceptance and commitment therapy. Washington, DC: American Psychological Association.
Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2011). Acceptance and commitment therapy: The process and practice of mindful change. Guilford Press.
Forman, E. M., Herbert, J. D., Moitra, E., Yeomans, P. D., & Geller, P. A. (2007). A randomised controlled effectiveness trial of acceptance and commitment therapy and cognitive therapy for anxiety and depression. Behaviour modification, 31(6), 772-799.
Hayes, S. C. (2004). Acceptance and commitment therapy, relational frame theory, and the third wave of behavioural and cognitive therapies. Behaviour therapy, 35(4), 639-665.
Barnes-Holmes, S. C. H. D., & Roche, B. (2001). Relational frame theory: A post-Skinnerian account of human language and cognition. Springer Science & Business Media.
Well-Being Therapy
Dr Giovanni Fava has developed Well-Being Therapy (WBT), a specific short-term therapeutic strategy based on Jahoda-Ryff’s psychological model of well-being (http://www.well-being-therapy.com/therapy). WBT was validated through randomised controlled trials. It emphasises self-observation, the use of a structured diary, interaction between patients and therapists, and some homework. Patients are encouraged to identify incidents of well-being in a diary and place them into a situational context. Once instances of well-being are correctly recognised, the patient is encouraged to identify thoughts and beliefs that disturb their well-being (e.g., automatic negative thoughts).
The drive for self-observation is based on well-being instead of distress, where cognitive restructuring may take place along the six dimensions of psychological well-being (autonomy, environmental mastery, personal growth, positive relationships, purpose in life and self-acceptance - Carol Ryff, 1995). Hence, activities likely to promote well-being are encouraged. The findings from controlled studies indicate that WBT can promote flourishing and resilience. These interventions lead to a positive evaluation of self, a sense of continued growth, the belief that life is purposeful, the quality of relationships with others, the capacity to manage one’s life and a sense of self-determination. A decreased vulnerability to depression and anxiety has also been demonstrated after well-being therapy in high-risk populations.
Note: Marie Jahoda (1958) and Carol Ryff (1989) are influential figures in the study of psychological well-being, but their contributions differ. Jahoda focused on defining positive mental health, while Ryff developed a model of psychological well-being with six core dimensions.
Resources and Further Reading
Fava, G. A. (1999). Well-being therapy: Conceptual and technical issues. Psychotherapy and psychosomatics, 68(4), 171-179.
Fava, G. A., Rafanelli, C., Cazzaro, M., Conti, S., & Grandi, S. (1998). Well-being therapy. A novel psychotherapeutic approach for residual symptoms of affective disorders. Psychological medicine, 28(2), 475-480.
Ryff, C.D., & Singer, B. (1998). The contours of positive human health. Psychological Inquiry, 9, 1-28.
Ryff, C.D. (1995). Psychological well-being in adult life. Current Directions in Psychological Science, 4, 99-104.
Dr Frankl’s Logotherapy
In 1942, Dr Viktor Frankl (1905-1997) and his family were taken to a Nazi concentration camp. He was the only family member to survive the Holocaust (Shoah). In 1945, he returned to Vienna and published a book on his theories based on his observations during his time in the concentration camps. Before his death, his book, “Man’s Search for Meaning”, had been published in 24 languages.
Dr Frankl believed that humans are motivated by a “will to meaning”, which equates to a desire to find meaning in life. He argued that life can have “meaning” even in the most miserable circumstances and that the motivation for living comes from recognising that meaning. Taking it a step further, Dr Frankl wrote: “Everything can be taken from a man but one thing: the last of the human freedoms (freedom of will), to choose one’s attitude in any given set of circumstances.” This opinion was based on his experiences of suffering and on his attitude toward finding meaning in them. In this way, he believed that when we can no longer change a situation, we are forced to change ourselves.
Healing Through Meaning
Dr Frankl’s therapeutic approach, logotherapy, was based on three philosophical and psychological concepts, i.e., freedom of will, will to meaning, and meaning in life. Logotherapy was recognised as the third school of Viennese therapy after Freud’s psychoanalysis and Alfred Adler’s individual psychology.
Logos is the Greek word for meaning, and logotherapy involves helping patients find “their meaning in life”. Dr Frankl believed in three core properties on which his theory and therapy were based: First, people have a healthy core. Second, life offers purpose and meaning but does not promise fulfilment or happiness. Third, the therapist’s primary focus should be on educating and guiding the clients to use their internal resources and providing them with tools to use their inner strengths.
Logotherapy proposes that meaning in life can be discovered in three distinct ways: first, by creating a work or doing a deed; second, by experiencing something or encountering someone; and third, by the attitude we develop toward unavoidable suffering. An example that explains the basic tenets of logotherapy is the story of Dr Frankl meeting with an elderly general practitioner who was struggling to overcome depression after the death of his wife. Dr Frankl helped the elderly man see that his purpose had been to spare his wife the pain of seeing him die first.
Logotherapy consists of six basic assumptions that overlap with its fundamental constructs and ways of seeking meaning:
Body, Mind, and Spirit: Humans are entities consisting of a body (soma), mind (psyche), and spirit (nous). Dr. Frankl argued that we have a body and mind, but the spirit is what we are, or our essence. Note that Frankl’s theory was not based on religion or theology but often had parallels with religious beliefs.
Life Has Meaning in All Circumstances: Dr Frankl believed life has meaning in all circumstances, even the most miserable ones. This means that even when situations seem objectively terrible, there is a higher level of value that involves meaning.
Humans Have a Will to Meaning: Logotherapy posits that humans have a will to meaning, i.e., that meaning is our primary motivation for living and acting and enables us to endure pain and suffering. This idea is distinguished from the will to power and pleasure. Logotherapy is based on an existential analysis that focuses on Kierkegaard’s will to meaning rather than Adler’s Nietzschean doctrine of the will to power or Freud’s will to pleasure.
Freedom to Find Meaning: Dr Frankl argued that individuals have the freedom to (can) access their will to meaning (can find meaning) in all circumstances. This doctrine is based on his experience of pain and suffering and on his choice of attitude in a situation he could not change.
Meaning of the Moment: This assumption holds that for decisions to be meaningful, individuals must respond to the demands of daily life in ways that align with their values and conscience.
Individuals are Unique: Dr Frankl believed every individual is unique and irreplaceable.
Dr Frankl believed that turning suffering into achievement and accomplishment was possible. He viewed guilt as an opportunity to change ourselves for the better and the transient nature of life as a chance to take responsible action. In this way, logotherapy aimed to help people make better use of their spiritual resources to withstand adversity.
Logotherapy Techniques
De-reflection: This logotherapy technique aims to help people shift their focus from themselves to others, so they can become whole and spend less time self-absorbed in their problems or in how to reach a goal.
Paradoxical Intention: This technique has the patients wish for what they feared most and was designed for application in anxiety or phobias, where humour and ridicule can be employed when fear is paralysing. For example, a person who fears looking foolish might be encouraged to try to look ridiculous on purpose. Paradoxically, the fear would be removed when the intention is involved in what we fear most.
Socratic Dialogue: Socratic dialogue could be used in logotherapy to help patients’ self-discovery through their own words. The therapist would highlight some words and help the client understand their meaning. This process allows the client to realise an answer waiting to be discovered (see Columbo’s approach).
It’s easy to see how some logotherapy techniques overlap with newer forms of treatment, such as cognitive-behavioural therapy (CBT) or acceptance and commitment therapy (ACT). Thus, logotherapy may be a complementary approach to cognitive and behaviour-based treatments. Some aspects of logotherapy are routinely used alongside other techniques.
Criticisms of Logotherapy
Other therapists have criticised logotherapy for diminishing the patient’s role in solving their problems (authoritarianism). This concern was based on the argument that logotherapy claims that there is always a clear solution to a problem and that the therapist is responsible for finding it for the client. This assertion seems to undermine the complexity of humans and their lives (Rollo May, 1969).
However, Dr Frankl maintained that logotherapy only guides and educates patients to take responsibility. The patient/client must always be an active participant rather than a passive recipient. Nonetheless, there is ample evidence that meaning in life correlates with better mental health. Logotherapy is applied in depression, anxiety, phobias, pain, guilt, grief, substance abuse and post-traumatic stress disorder. Dr Frankl believed that many mental health issues are disguised as existential angst and that many patients struggle with a lack of meaning, which he referred to as the “existential vacuum.”
Positive Psychotherapy
Positive Psychotherapy (PPT) should not be confused with positive psychology. PPT is a psychotherapeutic method developed by Nossrat Peseschkian and colleagues in Germany in 1968. It is a humanistic psychodynamic psychotherapy based on the premise that human nature is intrinsically good. PPT is an integrative method that combines humanistic, systemic, psychodynamic, and cognitive-behavioural therapy (CBT) elements.
The founder of positive psychotherapy, Nossrat Peseschkian (1933–2010), was an Iranian-born German psychiatrist, neurologist and psychotherapist. In the late 1960s and early 1970s, he was inspired by different sources, which helped him develop his ideas about PPT. These include humanistic psychology, the humanistic teachings and virtues of the Bahá'í Faith, conflicts between psychoanalysts and behaviour therapists at the time, and his encounters with prominent psychotherapists, such as Viktor Frankl, Jacob Moreno, Heinrich Meng, and others.
PPT was initially called “differentiation analysis”, but in 1977, Peseschkian published his work in English, titled “Positive Psychotherapy”. For him, the term “positive” was a derivative of its Latin origin, positum, which means actual, real or concrete. One distinct feature of positive psychotherapy is the introduction of imagination and intuition into the healing process. This technique uses multicultural stories and metaphors to help people in therapy view their mental health in unique, positive ways. The person in treatment is incorporated into the story to allow them to play an active role in the healing process. This interdisciplinary approach incorporates various forms of psychotherapy to help individuals become actively engaged in the therapy process.
Positive psychotherapists aim to help patients see their abilities, strengths, potential and resources. There are three main principles or pillars of positive psychotherapy:
The principle of hope reflects the therapist’s effort to help the patient understand and see their disorder from a new perspective, so that it can be reinterpreted in a “positive” way.
The principle of balance: Despite social and cultural differences and the uniqueness of every human being, it can be observed that during the management of their problems, people often refer to typical ways of coping in four different areas: a) body (health – psychosomatic); b) achievement (work – stress factors); c) contact (relationships – depression); and d) future (meaning of life – fears and phobia). Although these four areas are inherent in all humans, the emphasis in the West is often more on the body and achievement. In contrast, in the East, it is more on contact and the future (the cross-cultural aspect of positive psychotherapy).
The principle of consultation reflects the fact that therapy and self-help are closely interrelated and consist of five stages: observation (understanding the situation), taking inventory (exploratory interviewing), situational encouragement (focusing on positive aspects), verbalisation (discussing relationships), and expansion of goals (setting achievable positive goals).
Positive psychotherapy assumes all individuals, regardless of gender, ethnicity, age, social class, financial standing or mental health, possess two basic unconscious capabilities: the capability of perception and the capacity of love. According to Peseschkian, these capacities give rise to an individual’s general abilities.
The capability of perception drives a person to seek connections between different aspects of life, the reasons behind daily phenomena, and the meaning of existence.
The capability of love is inborn and relates to a person’s emotional sphere and interpersonal relationships.
Resources and Further Reading
Positive Psychotherapy: Theory and Practice of a New Method, by Peseschkian, Nossrat (Walker, Robert R, Dr Translator), Publisher: Springer-Verlag, Berlin, 1987, ISBN 978-0-387-15794-8 (first German edition 1977 by Fischer Verlag)
Positive Family Therapy, by Peseschkian, Nossrat, Publisher: Springer, ISBN 978-0-387-15768-9, republished by Sterling Publishers Pvt. Ltd, India ISBN 978-81-207-1839-5 (first German edition 1980 by Fischer Verlag)
Psychotherapy of Everyday Life: Training in Partnership and Self Help With 250 Case Histories, by Peseschkian, Nossrat, Publisher: Springer, ISBN 978-0-387-15767-2 (first German edition 1974 by Fischer Verlag).
