A number of recent authors have compared acceptance and commitment therapy (ACT) and traditional cognitive behavior therapy (CBT). The present article describes ACT as a distinct and unified model of behavior change, linked to a specific strategy of scientific development, which we term “contextual behavioral science.” We outline the empirical progress of ACT and describe its distinctive development strategy. A contextual behavioral science approach is an inductive attempt to build more adequate psychological systems based on philosophical clarity; the development of basic principles and theories; the development of applied theories linked to basic ones; techniques and components linked to these processes and principles; measurement of theoretically key processes; an emphasis on mediation and moderation in the analysis of applied impact; an interest in effectiveness, dissemination, and training; empirical testing of the research program across a broad range of areas and levels of analysis; and the creation of a more effective scientific and clinical community. We argue that this is a reasonable approach, focused on long-term progress, and that in broad terms it seems to be working. ACT is not hostile to traditional CBT, and is not directly buoyed by whatever weaknesses traditional CBT may have. ACT should be measured at least in part against its own goals as specified by its own developmental strategy.

A modular, transdiagnostic approach to treatment design and implementation may increase the public health impact of evidence-based psychosocial interventions. Such an approach relies on algorithms for selecting and implementing treatment components intended to have a specific therapeutic effect, yet there is little evidence for how components function independent of their treatment packages when employed in clinical service settings. This study aimed to demonstrate the specificity of treatment effects for two components of Acceptance and Commitment Therapy (ACT), a promising candidate for modularization. A randomized, nonconcurrent, multiple-baseline across participants design was used to examine component effects on treatment processes and outcomes in 15 adults seeking mental health treatment. The ACT OPEN module targeted acceptance and cognitive defusion; the ACT ENGAGED module targeted values-based activation and persistence. According to Tau- U analyses, both modules produced significant improvements in psychiatric symptoms, quality of life, and targeted therapeutic processes. ACT ENGAGED demonstrated greater improvements in quality of life and values-based activation. ACT OPEN showed greater improvements in symptom severity, acceptance, and defusion. Both modules improved awareness and non-reactivity, which were mutually targeted, though using distinct intervention procedures. Both interventions demonstrated high treatment acceptability, completion, and patient satisfaction. Treatment effects were maintained at 3-month follow up. ACT components should be considered for inclusion in a modular approach to implementing evidence-based psychosocial interventions for adults.

Imel are cofounders with equity stake in a technology company, Lyssn.io, focused on tools to support training, supervision, and quality assurance of psychotherapy and counseling. Shrikanth S. Narayanan is chief scientist and co-founder with equity stake of Behavioral Signals, a technology company focused on creating technologies for emotional and behavioral machine intelligence. The remaining authors report no conflicts of interest.

Suicidal behavior is exhibited by a diverse population of individuals and spans many diagnostic categories. In order to develop effective prevention and treatment programs, it is important to identify transdiagnostic processes that impact the many pathways to suicidality, are amenable to intervention, and affect clinical outcomes when modified. A growing body of data suggests that experiential avoidance, or the tendency to escape or avoid unwanted psychological experiences, even when such efforts cause harm, may represent one such universal process. This article reviews theory and evidence that support mindfulness and psychological acceptance as a means to target experiential avoidance in suicidal clients and thereby reduce the risk of suicide. The article also provides two case examples of the application of mindfulness to suicidality and discusses how mindfulness may help clinicians in managing the stress associated with treating suicidal clients.

No abstract