Editor's note: The following was adapted from the edited volume, Mindfulness and Acceptance in Social Work, edited by Matthew S. Boone.
Last week, we kicked off our discussion of acceptance and commitmtent therapy (ACT) in the context of social work. The flexibility, workability, synchronicity with social work values, and evidence base of ACT suggest that the model's six behavioral processes (acceptance, self as context, defusion, contact with the present moment, values, and committed action) present clinically appropriate and beneficial treatments in social work. Today, we'll go into a condensed version of ACT known as Focused Acceptance and Commitment Therapy, or FACT (Linde & Strosahl, 2014), a model within ACT that is particularly well-suited for brief behavior interventions. The following has been excerpted from Linde and Strosahl’s “Doing ACT Briefly: The Practice of Focused Acceptance and Commitment Therapy,” in the recently published volume, Mindfulness and Acceptance in Social Work (Boone, 2014).
An Overview of FACT
One of the undeniable facts of human existence is that it is so hard for us to be happy. This is because our capacity for language is a double-edged sword. For example, on one hand it allows us to imagine a variety of futures so that we may problem solve, plan, and organize to achieve desired ends. On the other hand, we can also imagine a better life, determine that it is not achievable, and fall into helpless passivity. This and other language processes that help us transcend life’s difficulties cause suffering when misapplied. And so happiness is not the natural resting state of human existence. Rather, suffering is ubiquitous because language and cognition are both essential and destructive.
In FACT, there are three processes related to the “dark side” of language: fusion, rule-following, and avoidance. Simply stated, fusion means losing perspective on thoughts, feelings, memories, and sensations. We cease to see thoughts as just thoughts, memories as memories, and so on. Instead, these inner experiences begin to dominate our conception of ourselves. We look inside at what we assume to be our own identity, and it does not look pretty. To paraphrase the comic strip character Pogo, “I have met the enemy and it is me.”
The second siren, rule-following, like other language processes, is handy in many contexts. When in peril, we should seek safety. If hungry, we should find food. Rules such as these and countless others help us navigate everyday decisions efficiently. But then we come upon negative thoughts, feelings, and memories. Because we are socialized to believe that being healthy is to be free of such things, we identify them as threats to our well-being. This sets off rules that say that we should analyze what is going on and then control or eliminate it in the service of achieving wellness. Even though we all have ample personal evidence to show that painful, unwanted private experiences are not subject to voluntary control, we remain “law-abiding citizens,” as it were, adhering to impossible rules rather than learning from experience.
The third siren, avoidance, stems from the other two. To lead a full life, one with meaning, we inevitably encounter experiences that are distressing: challenge, failure, rejection, physical pain, loneliness, and so forth. If this is all seen as threatening and we are unwilling to tolerate it, we must then restrict our range of activity. This is behavioral avoidance. Its counterpart, emotional avoidance, may come in a variety of forms: distraction, worrying about trivial concerns, attempting to suppress thoughts, emotions, or memories, endlessly ruminating about past failures and why we can’t be happy like others, and so on. As we attempt to free ourselves from distressing, unwanted private experiences, the paradoxical result is that they become more intrusive and dominant. In order to avoid something, we must be vigilant for it, and darn if it isn’t there every time we check!
In this way, suffering and emotional and behavioral avoidance act in a self-perpetuating cycle that can take many forms. We withdraw from activity suspected of causing distress, and as we become less engaged with the world, we have more opportunity to ruminate, thus magnifying the distress and prompting more avoidance. We find ourselves less involved with meaningful pursuits. We may escalate avoidance in ways that compound the problem, perhaps making rash decisions, perhaps avoiding decisions altogether. We look for numbing or escape with chemicals, food, self-harm, and suicidal thinking and behavior. Even television can provide this numbing and escape. Like alcohol, television in moderation is benign for most of us, but the “dosage” may begin to displace physical, intellectual, and social activity, allowing us the vicarious experience of rich lives while making our own lives seem impoverished in comparison.
In FACT, it is not painful private experience that is unhealthy. Rather, what is unhealthy is the attempt to avoid, control, or suppress such experience. Emotion control is not the solution; it is the problem. When we do things that really matter—when we broaden rather than constrict our lives—failure, rejection, reminders of trauma, and a host of other unwanted experiences await us. However, it is precisely in these situations where vitality, purpose, and meaning are achieved. Pain may be inevitable, but it is dignified when we do what matters. Unfortunately, most clients enter therapy with the opposite view—that painful private experiences are the “enemy” of health and must be vanquished. They hope that the clinician will help them with an unachievable goal.
In FACT, we quickly help the client reframe the problem as following rules that invite failure (e.g., not having anxiety in a situation that is by definition anxiety producing) and divert the focus away from what really matters (e.g., participating in the situation because it is important). This is achieved using a sequence of focusing questions that bring clients into contact with the futility of their struggle. Once they recognize that their rules do not produce the results they expect, they are able to try something different. For many, this is all they need to begin to explore new options.
Other clients will be “stuck” and will require more skills to escape their unworkable patterns. We teach them to make room for distressing private experience, to stand in the presence of socially programmed rules and self-generated narratives without being dominated by them, and to pursue what they value. This is achieved by teaching skills that promote acceptance, mindfulness, and values-based living.
To learn more about FACT, its applicability, and case formulation and treatment options, you can check out Mindfulness and Acceptance in Social Work or Strosahl, Robinson, and Gustavson’s Brief Interventions for Radical Change.
Boone, M. S. (2014). Mindfulness and Acceptance in Social Work: Evidence-Based Interventions and Emerging Applications. Oakland, CA: New Harbinger Publications.
Linde, T., & Strosahl, K. (2014). Doing ACT Briefly: The Practice of Focused Acceptance and Commitment Therapy. Mindfulness and Acceptance in Social Work: Evidence-Based Interventions and Emerging Applications. 163-185.