The Third Wave of Therapy

Sunday, Feb. 05, 2006 By JOHN CLOUD

TIMOTHY ARCHIBALD FOR TIME

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The commitment part of acceptance and commitment therapy--living according to your values--sounds weightless at first. Many people are so depressed or lonely or caught up in daily life that they aren't sure what their values are. ACT therapists help you identify them with techniques like having you write your epitaph. They also ask you to verbalize your definition of being a good parent or a good worker. The therapist helps you think about what kind of things you want to learn before you die, how you want to spend your weekends, how you want to explore your faith. The point isn't to fill your calendar with Italian lessons and fishing trips but to recognize that, for instance, you like to fish because it means you spend time with your family or in the mountains or alone--"whatever is in fishing for you," says Hayes. One task in Get Out of Your Mind asks you to give yourself a score of 1 to 10 each week for 16 weeks to show how closely your everyday actions comport with your values. If you really enjoy skiing with friends but end up watching TV alone every weekend, you get a 1. (But if you really love holing up with reruns of The O.C., go for it; ACT is pretty nonjudgmental.)

Now seems like a good time to stipulate that all this can sound vacuous and gaggingly self-helpy. But the scientific research on ACT has shown remarkable results so far. In the January edition of the journal Behaviour Research and Therapy, Hayes and four co-authors summarize 13 trials that compared ACT's effectiveness to that of other treatments after as long as a year. In 12 of the 13, ACT outperformed the other approaches. In two of the studies, depressed patients were randomly assigned to either cognitive therapy or ACT. After two months, the ACT patients scored an average of 59% lower on a depression scale. Those were small studies, just 39 patients total, but ACT has shown wide applicability. In a 2002 study, Hayes and a student looked at 70 hospitalized psychotics receiving the standard medication and counseling. Half were randomly assigned to four 45-min. ACT sessions; the other half formed the control. Four months later, the ACT patients had to be rehospitalized 50% less often. They actually admitted to more hallucinations than those in standard care, but ACT had reduced the believability of their hallucinations, which were now viewed more dispassionately. Hayes likes to say ACT effectively turned "I'm the Queen of Sheba" into "I'm having the thought that I'm the Queen of Sheba." The psychotics still heard voices; they just didn't act on them as much. They learned to hold their thoughts more lightly, increasing their psychological flexibility.