Understanding Clinical Psychology and Acceptance and Commitment Therapy

An interview with author, therapist, and podcaster Diana Hill, PhD

How Would You Define Psychological Flexibility?

Psychological flexibility encompasses the ability to remain present, embrace the entirety of one's experience—including thoughts, emotions, and sensations—and align with personal values to take action, even in challenging circumstances. This quality serves as the foundation for effectiveness in various roles such as parenting, partnering, and professional endeavors. Additionally, it proves invaluable in addressing mental health issues like depression and anxiety, as many of these concerns stem from behavioral inflexibility.

How Does ACT Relate To Psychological Flexibility?

In ACT, we describe psychological flexibility as your capacity to hold thoughts lightly to hold emotions lightly. Rather than getting entangled in your thoughts and fighting thoughts, or even changing thoughts, it's being, being more flexible with them. It's having a little bit of space from them so that you can move more freely. You can have you're less rigid in, in your behavior and in your actions. ACT is very much a behavioral psychology and it's built on the back of cognitive behavioral therapy.

ACT is referred to as “third wave” psychology. The first wave being behaviorism, the second way of being cognitive behavioral approaches, which for a long time, were things like changing your thoughts or challenging your thoughts or look for the evidence. Does this support your thought or not?

But with ACT, you are actually doing something different with thoughts, which is not changing challenging or you know, disputing thoughts, but rather just noticing them as mental activity that happens that you can choose to listen to, or not that there's an observer self that can choose to pay attention to thoughts or not. And that you choose that based on whether or not they're workable for you or helpful for you or in line your values where you want to be going in your life,

How Does ACT Relate To Traditional Cognitive Behavioral Therapy?

In Acceptance and Commitment Therapy (ACT), psychological flexibility is described as the ability to hold thoughts and emotions lightly, rather than becoming entangled in them or attempting to change them. Rather than engaging in a struggle with thoughts, ACT encourages individuals to create space from them, allowing for greater freedom of movement and less rigidity in behavior and actions. ACT, rooted in behavioral psychology and stemming from cognitive behavioral therapy, represents a "third wave" approach in psychology.

While the first wave of psychology focused on behaviorism and the second wave emphasized cognitive behavioral approaches, ACT diverges by not aiming to change or challenge thoughts. Instead, it encourages individuals to simply notice thoughts as mental events that they can choose to engage with or not. This process involves recognizing an observer self that can decide whether thoughts are aligned with one's values and goals, allowing for a more intentional and adaptive response to internal experiences.

How Have You Come To Think About “Mental Health” More Generally?

The concept of acceptance is deeply intertwined with many mental health issues, such as Obsessive Compulsive Disorder (OCD). In OCD, individuals experience intrusive thoughts that may seem unusual or inappropriate, leading to attempts to suppress or eliminate them. This often results in engaging in compulsive behaviors, like counting or repetitive actions, in an effort to gain control over these thoughts.

Similarly, in depression, individuals may become entangled in negative self-perceptions and attempt to avoid or suppress these thoughts by withdrawing from activities or social interactions. However, these efforts to rid oneself of distressing thoughts or emotions often exacerbate suffering.

Herein lies a fundamental distinction with ACT: rather than focusing on symptom reduction, it emphasizes living a more fulfilling life aligned with personal values. This approach extends beyond addressing mental health conditions and encompasses various aspects of life, including work performance, athletic endeavors, and parenting. Ultimately, ACT seeks to promote human flourishing by shifting the focus from symptom management to cultivating a life rich in meaning and purpose.

How Do You See Mindfulness Coming Into The Picture Here?

Mindfulness is a cornerstone among the six core processes of psychological flexibility. My colleague Debbie and I refer to it as "my stillness" in our work. It entails being fully present, aware, and awake, allowing us to observe and respond to the current moment effectively. However, within ACT, mindfulness encompasses more than just being present; it involves understanding and aligning with personal values—the second crucial process. As one becomes more present, they naturally become more attuned to their values.

Mindfulness also plays a vital role in facilitating committed action. When individuals aim to take meaningful steps in their lives, being mindful during these actions enhances their efficacy.

While mindfulness is integral, ACT extends beyond it, incorporating additional components such as values clarification, behavioral change, and perspective-taking. Therefore, while mindfulness remains a key aspect, ACT represents a comprehensive approach that integrates various processes to foster psychological flexibility and meaningful living.