ACT and traditional CBT
When using ACT interventions, I have had many clients say to me that they can't just "be mindful" and "accept" all of their cognitions because some of them might be important to listen to. To illustrate, a client who continues to have the thought "I'm going to get fired from my job" will say to me "How do I know this may not be realistic?" In some cases, of course, the thought may be realistic.
I have used a metaphor which, I think, combines a traditional CBT approach with an ACT approach. I instruct clients to treat their minds like they would approach a child who is afraid to go to sleep because there is a "monster in the closet." Specifically, I tell clients that the way one would approach a child who is afraid to go to sleep because he fears a monster in the closet would involve two steps. First, you would look into the closet and assure the child that there is no monster there. Thus, in effect, one is "testing" the thought with evidence. If the child continued to say that there is a monster in the closet, one would say to the child "that is just your mind making scary thoughts" and would not continue to check the closet. This, in effect, would be using acceptance and defusion.
So, back to the original example, if somebody has the thought "I'm going to get fired," I tell the client "Let's use the monster in the closet" approach. Let's look at the evidence and see if there are, indeed, any realistic components. Assuming there are not, I then guide clients to the ACT approach and practice acceptance and defusion.
I have found this metaphor helpful and I think it has helped clients see the wisdom of using ACT. However, I wonder, theoretically, if this is ACT consistent. I would love to hear any thoughts on this.
Daniel Mattila
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