درمان مبتنی بر پذیرش و تعهد: مدل، فرآیندها و نتایج

The present article presents and reviews the model of psychopathology and treatment underlying Acceptance and Commitment Therapy (ACT). ACT is unusual in that it is linked to a comprehensive active basic research program on the nature of human language and cognition (Relational Frame Theory), echoing back to an earlier era of behavior therapy in which clinical treatments were consciously based on basic behavioral principles. The evidence from correlational, component, process of change, and outcome comparisons relevant to the model are broadly supportive, but the literature is not mature and many questions have not yet been examined. What evidence is available suggests that ACT works through different processes than active treatment comparisons, including traditional Cognitive-Behavior Therapy (CBT). There are not enough well-controlled studies to conclude that ACT is generally more effective than other active treatments across the range of problems examined, but so far the data are promising.

The behavior therapy movement began with two key commitments. Behavior therapy was to be a field designed to (1) produce a scientifically based analysis of behavioral health problems and their treatment cast in terms of basic psychological processes, and (2) develop well-specified and empirically validated interventions for such problems. Franks and Wilson's (1974) well-known early definition of behavior therapy shows that dual commitment clearly, asserting that behavior therapy was based on “operationally defined learning theory and conformity to well established experimental paradigms” (p. 7). Over the 40 years of development of behavior therapy, however, only the latter of these two commitments has been firmly kept. Many methods of change in the contemporary cognitive and behavioral therapies are linked to relatively narrow clinical theories, not to basic principles derived from “operationally defined learning theory” or indeed any other basic science. The failure to provide an adequate basic account has reduced the scientific progressivity of the behavioral and cognitive therapies, and the overall coherence of the resulting science. Focusing merely on validation of an ever-expanding list of multi-component manuals designed to treat a dizzying array of topographically defined syndromes and sub-syndromes creates a factorial research problem that is scientifically impossible to mount. Such a “brute force” empirical approach makes it increasingly difficult to teach what is known or to focus on what is essential. Linkage to basic principles helps solve this problem because it allows the diversity of methods that result from clinical creativity to be distilled down to a manageable number of common core processes (cf. Harvey, Watkins, Mansell, & Shafran, 2004). It also fosters the practical value and coherence of psychology itself by allowing empirical clinical psychology to contribute the development of the discipline. The present article briefly considers why the linkage to basic principles was weakened, and examines evidence regarding the model of psychopathology and change that underlies Acceptance and Commitment Therapy (ACT, said as a single word, not as initials; Hayes, Strosahl, & Wilson, 1999). ACT has followed a very different developmental approach by consciously developing a basic research program to meet the needs of modern behavioral and cognitive therapies such as ACT, in the hopes that the models that result will be more fruitful.