Acceptance and Commitment Therapy (ACT) has emerged over the last twenty years within the context of the Third Wave of Cognitive Therapies, and has been utilised with reported success in a range of therapeutic and mental health settings. Social and self-stigma related to seeking assistance for mental health and other concerns has been shown to reduce client engagement with therapeutic support. Numerous studies have been undertaken that support ACT as an empirically validated framework for engaging stigmatised client groups. This paper provides a review of the key philosophical underpinnings and prominent techniques employed in ACT. Further, the paper highlights the utility of ACT in treating mental illness and other conditions by encouraging therapeutic participation through a use of techniques that inherently reduce the self and social stigma related to psychological disturbance and disability.
KeywordsAcceptance and Commitment TherapyStigmaMental HealthTherapeutic Engagement
Corrigan, P.W. (1998) The Impact of Stigma on Severe Mental Illness. Cognitive and Behavioral Practice, 5, 201-222. http://dx.doi.org/10.1016/S1077-7229(98)80006-0
Corrigan, P.W. (2004) How Stigma Interferes with Mental Health Care. American Psychologist, 59, 614-625. http://dx.doi.org/10.1037/0003-066X.59.7.614
Clement, S., Schauman, O., Graham, T., Maggioni, F., Evans-Lacko, S., Bezborodovs, N., et al. (2014) What Is the Impact of Mental Health-Related Stigma on Help-Seeking? A Systematic Review of Quantitative and Qualitative Studies. Psychological Medicine, 1-17. http://dx.doi.org/10.1017/S0033291714000129
Vogel, D.L., Wade, N.G. and Hackler, A.H. (2007) Perceived Public Stigma and the Willingness to Seek Counseling: The Mediating Roles of Self-Stigma and Attitudes Toward Counselling. Journal of Counselling Psychology, 54, 40-50. http://dx.doi.org/10.1037/0022-0167.54.1.40
Starr, S., Campbell, L.R. and Herrick, C.A. (2002) Factors Affecting use of the Mental Health System by Rural Children. Issues in Mental Health Nursing, 23, 291-304. http://dx.doi.org/10.1080/016128402753543027
Sirey, J.A., Bruce, M.L., Alexpoulos, G.S., Perokic, D.A., Raue, P., Friedman, S.T., et al. (2001) Perceived Stigma as a Predictor of Treatment Discontinuation in Young and Older Outpatients with Depression. The American Journal of Psychiatry, 158, 479-481. http://dx.doi.org/10.1176/appi.ajp.158.3.479
Kushner, M.G. and Sher, K.J. (1991) The Relation of Treatment Fearfulness and Psychological Service Utilization: An Overview. Professional Psychology: Research and Practice, 22, 196-203. http://dx.doi.org/10.1037/0735-7028.22.3.196
Hayes, S.C. (1987) A Contextual Approach to Therapeutic Change. In: Jacobson, N., Ed., Psychotherapists in Clinical Practice: Cognitive and Behavioral Perspectives, Guilford, New York, 327-387.
Harris, R. (2006) Embracing Your Demons: An Overview of Acceptance and Commitment Therapy. Psychotherapy in Australia, 12, 2-8.
Hayes, S.C. (2005) Stability and Change in Cognitive Behavior Therapy: Considering the Implications of ACT and RFT. Journal of Rational-Emotive & Cognitive Behavior Therapy, 23, 131-151. http://dx.doi.org/10.1007/s10942-005-0007-9
Hayes, S.C., Barnes-Holmes, D. and Roche, B. (Eds.) (2001) Relational Frame Theory: A Post-Skinnerian Account of Human Language and Cognition. Plenum Press, New York.
Hayes, S.C., Levin, M.E., Plumb-Vilardaga, J., Villatte, J.L. and Pistorello, J. (2013) Acceptance and Commitment Therapy and Contextual Behavioral Science: Examining the Progress of a Distinctive Model of Behavioral and Cognitive Therapy. Behavior Therapy, 44, 180-196. http://dx.doi.org/10.1016/j.beth.2009.08.002
Hayes, S.C. (2004) Acceptance and Commitment Therapy, Relational Frame Theory, and the Third Wave of Behavioral and Cognitive Therapies. Behavior Therapy, 35, 639-665. http://dx.doi.org/10.1016/S0005-7894(04)80013-3
Biglan, A. and Hayes, S.C. (1996) Should the Behavioral Sciences Become more Pragmatic? The Case for Functional Contextualism in Research on Human Behavior. Applied and Preventative Psychology: Current Scientific Perspectives, 5, 47-57. http://dx.doi.org/10.1016/S0962-1849(96)80026-6
Hayes, S.C. (1993) Analytic Goals and the Varieties of Scientific Contextualism. In Hayes, S.C., Hayes, L.J., Reese, H.W. and Sarbin, T.R., Eds., Varieties of Scientific Contextualism, Context Press, Reno, 11-27.
Neukrug, E.S. (2011) Counseling Theory and Practice. Brooks/Cole, Boston.
Robb, H. (2007) Values as Leading Principles in Acceptance and Commitment Therapy. International Journal of Behavioral Consultation and Therapy, 3, 118-123.
Hayes, S.C., Luoma, J.B., Bond, F.W., Masuda, A. and Lillis, J. (2006) Acceptance and Commitment Therapy: Models, Processes and Outcomes. Behavior Research and Therapy, 44, 1-25. http://dx.doi.org/10.1016/j.brat.2005.06.006
Dewane, C. (2008) The ABCs of ACT: Acceptance and Commitment Therapy. Social Work Today, 8, 36.
Bach, P. and Hayes, S. (2002) The Use of Acceptance and Commitment Therapy to Prevent the Rehospitalization of Psychotic Patients: A Randomized Controlled Trial. Journal of Consulting and Clinical Psychology, 70, 1129-1139. http://dx.doi.org/10.1037/0022-006X.70.5.1129
Zettle, R.D. (2005) The Evolution of a Contextual Approach to Therapy: From Comprehensive Distancing to ACT. International Journal of Behavioral Consultation and Therapy, 1, 77-89.
Takahashi, M., Muto, T., Tada, M. and Sugiyama, M. (2002) Acceptance Rationale and Increasing Pain Tolerance: Acceptance-Based and FEAR-Based Practice. Japanese Journal of Behavior Therapy, 28, 35-46.
Vogel, D.L., Wade, N.G. and Haake, S. (2006) Measuring the Self Stigma Associated with Seeking Psychological Help. Journal of Counseling Psychology, 53, 325-337. http://dx.doi.org/10.1037/0022-0167.53.3.325
Hayes, S.C., Wilson, K.G., Gifford, E.V., Bisset, R., Piasecki, M., Batten, S.V., Byrd, M. and Gregg, J. (2004) A Preliminary Trial of Twelve-Step Facilitation and Acceptance and Commitment Therapy with Polysubstance-Abusing Methadone-Maintained Opiate Addicts. Behavior Therapy, 35, 667-688. http://dx.doi.org/10.1016/S0005-7894(04)80014-5
Zettle, R.D. and Hayes, S.C. (1986) Dysfunctional Control by Client Verbal Behavior: The Context of Reason Giving. Analysis of Verbal Behavior, 4, 30-38.
Hayes, S.C. and Wilson, K.G. (1994) Acceptance and Commitment Therapy: Altering the Verbal Support for Experiential Avoidance. The Behavior Analyst, 17, 289-303.
Eifert, G.H. and Forsyth, J.P. (2005) Acceptance and Commitment Therapy for Anxiety Disorders. New Harbinger Publications Inc., Oakland.
Cooper, A.E., Corrigan, P.W. and Watson, A.C. (2003) Mental Illness Stigma and Care Seeking. Journal of Nervous and Mental Disease, 191, 339-341. http://dx.doi.org/10.1097/01.NMD.0000066157.47101.22
Sibicky, M. and Dovidio, J.F. (1986) Stigma of Psychological Therapy: Stereotypes, Interpersonal Reactions, and the Self-Fulfilling Prophecy. Journal of Counseling Psychology, 33, 148-154. http://dx.doi.org/10.1037/0022-0167.33.2.148
Dalrymple, K.L. and Herbert, J.D. (2007) Acceptance and Commitment Therapy for Generalized Social Anxiety Disorder: A Pilot Study. Behavior Modification, 31, 543-568. http://dx.doi.org/10.1177/0145445507302037
Forman, E.M., Herbert, J., Moitra, E., Yeomans, P. and Geller, P. (2007) A Randomized Controlled Effectiveness Trial of Acceptance and Commitment Therapy and Cognitive Therapy for Anxiety and Depression. Behavior Modification, 31, 772-799. http://dx.doi.org/10.1177/0145445507302202
Gaudiano, B.A. and Herbert, J.D. (2006) Acute Treatment of Inpatients with Psychotic Symptoms Using Acceptance and Commitment Therapy: Pilot Results. Behavior Research and Therapy, 44, 415-437. http://dx.doi.org/10.1016/j.brat.2005.02.007
Gratz, K.L. and Gunderson, J.G. (2006) Preliminary Data on an Acceptance-Based Emotion Regulation Group Intervention for Deliberate Self-Harm among Women with Borderline Personality Disorder. Behavior Therapy, 37, 25-35.
Ossman, W.A., Wilson, K.G., Storaasli, R.D. and McNeill, J.W. (2006) A Preliminary Investigation of the use of Acceptance and Commitment Therapy in Group Treatment for Social Phobia. International Journal of Psychology and Psychological Therapy, 6, 397-416.
Roemer, L. and Orsillo, S.M. (2007) An Open Trial of an Acceptance-Based Behavior Therapy for Generalized Anxiety Disorder. Behavior Therapy, 38, 72-85. http://dx.doi.org/10.1016/j.beth.2006.04.004
Twohig, M.P. and Woods, D.W. (2004) A Preliminary Investigation of Acceptance and Commitment Therapy and Habit Reversal as a Treatment for Trichotillomania. Behavior Therapy, 35, 803-820. http://dx.doi.org/10.1016/S0005-7894(04)80021-2
Woods, D.W., Wetterneck, C.T. and Flessner, C.A. (2006) A Controlled Evaluation of Acceptance and Commitment Therapy Plus Habit Reversal for Trichotillomania. Behavior Research and Therapy, 44, 639-656. http://dx.doi.org/10.1016/j.brat.2005.05.006
Zettle, R.D. (2003) Acceptance and Commitment Therapy (ACT) vs Systematic Desensitization in Treatment of Mathematics Anxiety. The Psychological Record, 53, 197-215.
Dahl, J., Wilson, K.G. and Nilsson, A. (2004) Acceptance and Commitment Therapy and the Treatment of Persons at Risk for Long-Term Disability Resulting from Stress and Pain Symptoms: A Preliminary Randomized Trial. Behavior Therapy, 35, 785-801. http://dx.doi.org/10.1016/S0005-7894(04)80020-0
Gutierrez, O., Luciano, C., Rodriguez, M. and Fink, B.C. (2004) Comparison between an Acceptance-Based and a Cognitive-Control-Based Protocol for Coping with Pain. Behavior Therapy, 35, 767-784. http://dx.doi.org/10.1016/S0005-7894(04)80019-4
Hayes, S.C., Bissett, R.T., Korn, Z., Zettle, R.D., Rosenfarb, I.S., Cooper, L.D., et al. (1999) The Impact of Acceptance versus Control Rationales on Pain Tolerance. The Psychological Record, 49, 33-47.
Lundgren, T. and Dahl, J. (2005) Development and Evaluation of an Integrative Health Model in Treatment of Epilepsy: A Randomized Controlled Trial Investigating the Effects of Short-term ACT Intervention Compared to Attention Control in South Africa. Association for Behavior Analysis, Chicago.
Lundgren, T., Dahl, J., Melin, L. and Kies, B. (2006) Evaluation of Acceptance and Commitment Therapy for Drug Refractory Epilepsy: A Randomized Controlled Trial in South Africa: A Pilot Study. Epilepsia, 47, 2173-2179. http://dx.doi.org/10.1111/j.1528-1167.2006.00892.x
McCracken, L.M., Vowles, K.E. and Eccleston, C. (2005) Acceptance-Based Treatment for Persons with Complex, Long Standing Chronic Pain: A Preliminary Analysis of Treatment Outcome in Comparison to a Waiting Phase. Behavior Research and Therapy, 43, 1335-1346. http://dx.doi.org/10.1016/j.brat.2004.10.003
Reeve, D. (2000) Oppression within the Counseling Room. Disability and Society, 15, 669-682. http://dx.doi.org/10.1080/09687590050058242
Twohig, M.P., Shoenberger, D. and Hayes, S.C. (2007) A Preliminary Investigation of Acceptance and Commitment Therapy as a Treatment for Marijuana Dependence in Adults. Journal of Applied Behavior Analysis, 40, 619-632. http://dx.doi.org/10.1901/jaba.2007.619-632
Luoma, J.B., Kohlenberg, B.S., Hayes, S.C., Bunting, K. and Rye, A.K. (2008) Reducing Self-Stigma in Substance Abuse through Acceptance and Commitment Therapy: Model, Manual Development, and Pilot Outcomes. Addiction Research and Theory, 16, 149-165. http://dx.doi.org/10.1080/16066350701850295
Luoma, J.B., Twohig, M.P., Waltz, T., Hayes, S.C., Roget, N., Padilla, M. and Fisher, G. (2007) An Investigation of Stigma in Individuals Receiving Treatment for Substance Abuse. Addictive Behaviors, 32, 1331-1346. http://dx.doi.org/10.1016/j.addbeh.2006.09.008