Acceptance and Commitment Therapy (ACT): A Powerful Contextual Approach to Promoting Youth Mental Health in Schools
Young people spend much of their lives at school, and school has many significant impacts on their well-being and mental health. Schools are educational institutions with the primary aim of providing a formal learning environment and space to stu-dents under the supervision of teachers. As such, schools offer a special environ-ment for fostering students’ healthy growth, and it is important to draw attention to the deeper goals of education, which revolve not only around students’ academic performance but also their physical and emotional health (Arslan & Yıldırım, 2022). Additionally, psychological disorders increase in childhood and adolescence (Arslan, 2019, 2020), and psychological symptoms during these years predict future mental health issues (Copeland et al., 2009; Keenan et al., 2009). Hence, it is crucial to present mental health interventions in school settings in order to reduce mental health symptoms and to improve student well-being. Acceptance and commitment therapy (ACT) is a form of cognitive-behavioral therapy that aims to help individuals increase psychological flexibility and improve their quality of life. The goal of ACT is to assist people in developing a greater awareness of their unwanted thoughts, emotions, and sensations and accepting them as they are, rather than attempting to suppress or avoid them (Hayes et al., 1999). This approach enables individuals to take a step back from their thoughts and emo-tions and focus on what truly matters to them. It then guides individuals in clarify-ing their values and setting goals that align with those values, which act as guiding principles for their behavior and life choices. The purpose of this approach is to help individuals learn to acknowledge and accept their internal experiences, rather than avoiding them (Hayes et al., 2006). By doing so, individuals can cultivate resilience and gain a flexible and wider behavioral repertoire.
ACT has demonstrated effectiveness in treating a wide range of mental health conditions, including depression, anxiety, and posttraumatic stress disorder. Research studies have shown that ACT is equally, if not more, effective than other forms of cognitive-behavioral therapy for treating these conditions (Shabani et al., 2019; Tanhan et al., 2020). Furthermore, ACT has also shown promise in addressing chronic pain and improving the overall physical and mental health outcomes of individuals with chronic medical conditions. In conclusion, the evidence suggests that ACT may be particularly suitable for school-based interventions aimed at enhancing youth mental health and well-being. Thus, the present chapter aims to provide an overview of the theoretical foundations and practical applications of ACT within the context of school settings.
A Few Words on Human Nature from ACT Perspective
Human beings are complex organisms with biological, psychological, social, spiri-tual, and economic dimensions. Throughout their lives, individuals encounter bodily sensations, feelings, emotions, memories, urges and thoughts, which range from pleasant experiences such as happiness, joy, and peace, to unpleasant ones like sad-ness, anger, shame, and pain. Regardless of how we label them, it is undeniable that every individual, by virtue of being human, undergoes these experiences, both plea-surable and unpleasant, as an inherent aspect of their nature and constitution. Sometimes, as human beings, we have the ability to derive deep meaning and richness from both pleasant and unpleasant situations. Reflecting on the history of humanity or our own culture, certain individuals come to mind, such as artists, poets, philosophers, prophets, or revered figures for believers. We may also encoun-ter such individuals within our own communities or even find instances in our own lives where we exemplify this capacity. As we navigate these experiences, we have the potential to gradually cultivate a more meaningful and fulfilling life for our-selves, our families, loved ones, the people around us, our neighborhoods, cities, countries, and ultimately, all of humanity. This process of enrichment and meaning extends beyond humans and begins to influence plants, other living beings, the Earth, and the universe within our environment. However, there are times when we fail to utilize these pleasant (e.g., joy) or unpleasant (e.g., sadness) situations to cre-ate a richer and more meaningful life for ourselves and those around us. In fact, it is possible to gradually construct a more painful, superficial, empty, and purposeless existence for ourselves, others, and the world as a result of these circumstances. This raises the fundamental question of why there are instances when we can enhance life’s meaning and richness, regardless of whether the situations are pleas-ant or unpleasant, and why there are times when we make life unbearable, devoid of meaning, and filled with suffering. Numerous functional answers exist for this fun-damental question, and there is a growing interest in positive psychology within the fields of mental health and education (Tanhan, 2019). In this context, psychological flexibility has gained increasing significance in theory and practice across various disciplines, including education, psychology, mental health, and the business world (Arslan, 2023). In essence, our psychological flexibility can be considered strong when we can construct a more meaningful and fulfilling life, navigating both bitter and sweet situations with the support of current, scientific, and effective research. Conversely, when we struggle with our disturbing inner experiences and can not find meaning and depth to our lives, our psychological inflexibility or rigid-ity becomes apparent, resulting in shallow and purposeless way of life.
Acceptance and Commitment Therapy (ACT)
ACT is regarded as one of the most effective empirically supported therapy approaches within the third wave of cognitive-behavioral psychotherapies (Hayes et al., 1999). ACT is built upon three significant sub-foundations: functional contex-tualism, which offers a philosophical framework; relational frame theory, which elucidates the relationship between behavior, language, and cognition; and the psy-chological flexibility and inflexibility models, which refer to processes of behav-ioral change. For our current topic, the psychological flexibility model serves as the central basis of ACT interventions, emphasizing their utmost importance. Psychological flexibility refers to the ability to create space for our subjective inter-nal experiences, such as our own feelings, bodily sensations, thoughts, and personal experiences, whether pleasant or unpleasant (Hayes et al., 1999). The psychological flexibility model encompasses six fundamental processes, albeit with slight varia-tions in naming across different sources. Together, these six processes form the core of the psychological flexibility model (Hayes et al., 1999; Strosahl et al., 2004). A brief description of each process was provided.
Flexible Attention to the Present Moment Flexible attention to the present moment involves purposefully and non-judgmentally contacting the present moment, regard-less of whether the experiences are pleasant or unpleasant. It entails being aware of bodily sensations, feelings, thoughts, and experiences and allowing them to come and go without attachment or avoidance.
Defusion or Cognitive Defusion Defusion commonly refers to creating distance between ourselves and our memories, beliefs, and thoughts. This enable us observ-ing cognitive experiences without getting caught up in their content regardless of they are true or not. By allowing to see thoughts not as the only reality, but only as
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the productions or actions of mind, defusion skills decrease the controlling function of cognitive processes over one’s own actions.
Acceptance Avoidance of inner experiences is a process commonly implicated in psychopathology and behavioral problems. Thus, acceptance skills of ACT, involve adopting an open, non-judgmental, and flexible attitude toward our internal experi-ences, whether they are desirable or undesirable. It means making room for these experiences in our lives without attempting to change or control them. Acceptance allows us to engage fully with our present moment and reduce unnecessary struggle.
Self-as-Context When we are caught up in difficult inner experiences, we some-times feel and behave as if our existence is just made up of these things. Self-as- context refers to the unchanging sense of self that remains constant amidst the changes in our age, physical characteristics, emotions, thoughts, and bodily sensa-tions. Self-as-context or Observing Self is the unique skill for human beings which allow us to witness and observe these changes. While we often focus on our think-ing (called as self-as-content in ACT terminology), this sense of self is often over-looked, but it is always there to be used.
Values Values are principles, qualities, or directions that guide our actions, are a source of motivation and contribute to a meaningful and fulfilling life. Unlike goals, which have an end point, values are ongoing and provide a compass for our behav-ior. Clarifying and living according to our values helps us lead a purposeful and rich life.
Committed Action Committed action involves taking ongoing, value-driven actions that align with our values. These actions, no matter how small, contribute to a more meaningful and fulfilling life for ourselves, our loved ones, and humanity. Committed action supports value-oriented behaviors and is facilitated by developing the skills of the other five processes mentioned above.
Overall, the processes of ACT aim to cultivate psychological flexibility and enhance well-being by promoting a present-moment focus, defusion from thoughts and emotions, acceptance of experiences, connection with the unchanging sense of self, alignment with values, and committed action. Together, these six processes help the individual to lead a meaningful life by creating a flexible and broad behav-ioral repertoire.