Difficulty in moving from the "A" of ACT to the "C"
I have posted to the public list-serve on this topic. I'm also interested in any responses from here if this is an appropriate forum.
To whit: As a patient in therapy working for five months with ACT, my greatest difficulty so far has been with moving from stage 1 of ACT (the practice of defusion, mindfulness, acceptance, and willingness) to stage 2 (the progressive adding-in of values, commitments, and pattern-smashing). Basically I am treading water at this point, which seems like a bad idea as it could reinforce the wrong things.
The book by Hayes, Strosahl, and Wilson warns that this is a tough transition, and that clients with long-standing issues such as chronic depression are in real danger of stalling out here - "many actions are started, few are maintained." This certainly describes me.
My therapist has not worked with me in going through all the valued domains; we've focused on defining values in just a few key areas. Predictably I find the thought of actually going after these values terrifying. There must be a way to approach this that doesn't involve the first jump feeling like it's off a cliff - where's that paperback book or piece of paper when you need it? My therapist has not suggested a structured program of increasing exposure or small steps first - he's much more lassez-faire than that. Everything is very informal - but somehow I feel what I need is formal assistance, a trackable structure to build on, etc. Even though I'm a reasonably bright guy, setting up a behavior mod program on my own has defeated me so far. I'm not just trying to lose weight or get rid of a phobia.
The workbook suggests setting up simple programs of graded exposures, commitments, etc. - but I run into the same problem: I don't really know where to begin, and so I don't begin at all. Meanwhile my values begin to feel like so much hot air - similar to the many ambitious projects I have started in the past, but then dropped.
Obviously this is all subjective and predictable - but I doubt I'm the only person out there struggling to make this transition from A to C. Comments on the public list-serve (where I have posted a similar message on this theme) suggest to me that many of us can manage the defusion exercises easily enough, but after that we spend an awful lot of time getting nowhere in terms of behavior change. The usual response on the list-serve is to tell each other to be patient - but I think that's only because we don't know what else to do.
Are there any additional resources to help individuals working either alone or with a therapist in setting up a commitment/behavior change program, other than those described in the workbook? Are there any plans to develop such resources? It seems like this is a potential sticking point ... yet for ACT to have succeed as it has, many people must have managed it. I just don't know how.

Behavior change
You say "many actions are started, few are maintained." So having a behavioral goal is not the problem.
Inside the pain of that would it be acceptable to start with even one that you intend 100% to maintain, and act with regard to it .... and then when you slip, open up to the pain of that, and then intend 100% to maintain that one, and take action; and then when you slip ....
If you keep doing that, maintaining happens. If you cycle fast enough after slips you will keep moving.
The power is in the process of acceptance, defusion, and mindful values-based action. That is the engine, not a demand for permanence and achievement
I don't really agree that the general sense on the "ACT for the Public" list serve is that folks are getting no where in terms of behavior change. I think what you are picking up on is that folks keep seeing how old issues keep cycling back and you have to keep redoing and redoing the work.
I think that is just the process. I've been doing this work personally (nevermind professionally) for 25 years ... and being out of balance has been true for me throughout that time. It's like riding a bicycle -- you are never in perfect balance -- but if you adjust quickly you keep moving and your face never actually hits the pavement.
My advice: Talk to your therapist ... and look honestly and comprehensively at what is really going on for you.
- S
Steven C. Hayes, University of Nevada
An additional comment on ACT and behavior change methods
One more thing -- this is meant generally and not specifically to you (I don't want to get in the way of your therapy)
The specific ACT books out there have much more in the way of specific behavioral components than do the generic ones. ACT is a behavior therapy so behavior change and behavioral methods are central. But that part of the model is the part that really needs to be fitted to your specific problem. Generic ACT books have to be more broadly useful -- but because of that they also have to be less specific in some areas.
If you are mindful to stay within an ACT model you can mix ACT with any well structured, and empirically supported behavior change method. Those that are more behavioral and less cognitive are especially easy because you will not run into incompatibilities as frequently.
Once you know the specific problem area, you can find good behavioral methods with a little research.
So, for example, if you pull your hair, a procedure called "habit reversal" works well -- but probably more is automatic pulling than pulling used to regulate emotions. ACT is especially well tuned to the latter situation so an ACT / habit reversal combination is very logic -- and sure enough early research shows that some pullers are emotional avoiders, and that the cobmination treatment work very well in randomized trials, and primarily because it changes those emotional avoidance patterns.
If you are going to try to deal with hair pulling using self-help books a generic ACT program -- like the one in Get Out of Your Mind and Into Your Life-- can be combined with habit reversal programs you can also find in book or article form.
Eventually most of these specific areas will have thoroughly behavioral ACT books ... give it a couple of years and their will be dozens .. but for now that is the way to do it.
- S
Steven C. Hayes, University of Nevada
A lot to chew on
I'm not sure how to respond - which I take as a good thing rather than otherwise - other than to say thanks for the possibilities.
I don't mean to jump all over my therapist - despite my kvetching the help he's given me is something no book could have provided. I will be moving to a different town for the summer & fall and so won't be seeing him for awhile, so for now it's the workbook for me & some exploration as you suggest.
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Randy Burgess
Writer, editor, book doctor
www.raburgess.com
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Re: Applying ACT in your Life
Have you asked your therapist to present a less "laissez faire" and more structured "behavior mod program"? ACT can work with either type of "stage 2" as you call it. There are resources to help you do this, but since you are already seeing a therapist, why not talk about this with him or her?
Jonathan Kandell, LCSW, LISAC
Tucson AZ