224 ASSESSMENT AND INTERVENTION STRATEGIES
••Self as context—ACT focuses on helping clients release their attachment to an
unhealthy conceptualized self and embrace a transcendent sense of self through a vari-
ety of mindfulness/meditation, experiential exercises, and metaphors (Hayes, Follette,
et al., 2004).
••Being present—this refers to the promotion of an active, open, effective, and
nonjudgmental awareness or contact with the present moment rather than fusion and
avoidance which interfere with “being present in the moment.”
••Values—clients are encouraged to select and clarify their fundamental life values
which can be described as “chosen qualities of purposive action” (Hayes, Follette, et al.,
2004). For example, clients can be asked what they would like to see written on their
tombstone.
••Committed action—this involves choosing specific goals and then taking respon-
sibility for behavioral changes, adapting and persisting with behavioral patterns that
will lead to desired goals. Various intervention strategies such as psychoeducation, prob-
lem solving, behavioral homework, skills training, and exposure can be used to achieve
committed action (Hayes, Follette, et al., 2004).
There are fundamental differences between ACT and cognitive therapy in their
view of cognition. In cognitive therapy the term cognition refers to a thought process,
whereas ACT considers it private behavior and so focuses on changing its function
rather than its content (Hofmann & Asmundson, 2008). Furthermore, Hofmann and
Asmundson (2008) note that the two approaches differ in their emotion regulation strat-
egy, with cognitive therapy emphasizing change in the antecedents of emotion and ACT
focusing on experiential avoidance or the response side of emotion regulation. This leads
to fundamental differences in therapeutic approach, with ACT using mindfulness and
other strategies to teach a nonevalutive, nonjudgmental approach to negative thoughts
that encourage their acceptance and integration into a wide variety of actions (Luoma
& Hayes, 2003). Of course, cognitive therapy emphasizes the evaluation and correction
of negative thought content through cognitive and behavioral intervention strategies.
According to ACT, the main problem in the anxiety disorders is experiential avoid-
ance, that is, an unwillingness to experience anxiety including its attendant thoughts,
feelings, behaviors, and bodily sensations (Orsillo, Roemer, Lerner, & Tull, 2004). As
a result, anxious individuals struggle against their anxiety, relying on ineffective and
futile external and internal control strategies as well as escape and avoidance to alleviate
the unacceptable anxiety. The goal of ACT is the reduction of experiential avoidance,
which prevents the attainment of valued goals by teaching the anxious person experien-
tial acceptance defined as “a willingness to experience internal events, such as thoughts,
feelings, memories, and physiological reactions, in order to participate in experiences
that are deemed important and meaningful (Orsillo et al., 2004, p. 76).
Orsillo and colleagues describe a 16-session individual ACT/mindfulness interven-
tion for GAD that promotes experiential acceptance of anxiety through training in mind-
fulness, acceptance, cognitive defusion, meditation, relaxation, and self- monitoring. In
addition an emphasis is placed on defining life values that have been impeded by expe-
riential avoidance and commiting to behavioral changes that focus on valued activities
so that the individual is behaving intentionally rather than reactively. In an open trial
Roemer and Orsillo (2007) reported that ACT led to significant reductions on measures
of GAD severity, worry, general anxiety, and stress symptoms that were maintained at