When it comes to all the labels out there, it seems that after all these years, the inception of the first version of the DSM-V that the approach is not giving us the types of results that we had been hoping for. This makes sense when you think about the birth of psychological approaches coming from within the medical system.
At that time, infectious disease was the main focus and when it comes to infectious disease, we were thrilled to discover that there were approaches and medicines we could use that would pretty much work one to one. Have a biological pathogen? Here is an anti-biotic. Have an ache or pain? Here is a pill for that. So it is not a giant leap to think that we could apply this approach to mental health and psychological problems. We also did the same thing with chronic health issues. In both these instances though, it seems there are far too many variable to formulate this same one to one ratio of success. If we look back at the evidence, it is plain to see that we have not. In fact, it could be said that this approach has helped to erode our trust in the system to address both of the issues, chronic and mental health. There are just to many variable to account for.
With the advances in behavioral and cognitive science, specifically, contextual behavioral science, including Relational Frame Theory, and the processes that were identified and confirmed, (the bases for Acceptance and Commitment Therapy) we have now been able to identify a series of underlying processes that we should consider in working with phycological health.
These are as follows:
1. Most psychological difficulties, challenges and many pathologies have to do with the avoidance and manipulation of private events, that is a person's internal personal events. Think thoughts, emotions, associates, memories and sensations that all come bundled together.
2. All psychological avoidance has to do with cognitive fusion and its various effects. That is the individual is unaware of the influence of a rule or belief, seeing this personal event as truth, seeing the world through a biased or distorted perspective, and reacting to it again, as if it is true. Of course when we do this (and we all do) we end up often time turning that prediction (which is what it actually is, a prediction) into a reality. It is the self-fulfilling prophecy at work and it is self-perpetuating and resistant to change. There is a built in control factor, which leads me to the next point.
3. Conscious control belongs primarily in the area of overt, purposive behavior. The thing is, the control behaviors have been used and reinforced to the point where they have become automatic, unconscious, and reinforced to the point that to try and move away from them can become highly distressing. These behaviors are rooted in language, so when you see strange loops, there is most certainly an outdated, unworkable and inappropriate verbal rule involved. These rules are some of the main targets of several therapies as well as ACT.
4. Two things are needed to transform the situation: acceptance and motion. Learning how to be in the present moment, see or "unhook" from these underlying cognitive descriptions of personal events, develop a willingness to experience and move in a valued direction are key to building greater psychological flexibility. This allows us to take a new direction and in order to do so, we have to let go of older ones. If a problem is chronic, our solutions are probably part of the problem. Yet, how do we determine what direction to go? What would make a person's life more fulfilling?
5. While there are some themes that are universal, the value of any action is its workability measured against a person's true values, those he/she would have if it were truly a free choice. Those can be somewhat tricky to untangle and discover, but there is a large sum of evidence indicating that this second half of the equation (motion) is as important as the first (acceptance). The bottom line issue is living well, not having small sets of “good” feelings. This leads to the final premise that:
6. People are not broken, and in the areas of acceptance and defusion they have the psychological resources they need if they can be harnessed. They were doing the best they could with the knowledge and skills that they have had at their disposal. If there was a better way to operate, that would have been the route that they took, right?
Something worth keeping in mind both in working with others and in dealing with your own personal events as well.
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