We are the Association for  Child and Adolescent Mental   health or ACAMH for short and this is ACAMH Learn Act or acceptance and commitment therapy is a  third wave therapy sometimes people get confused   about what's meant by that but essentially  the idea is is that the first way of therapy   occurred with behaviour therapy this was 50s 60s  and then there was the cognitive behaviour therapy   Revolution um and then after that came the third  wave of therapies and I I'll talk a little bit   about a differences between um some of those waves  because I think that sort of helps explain where   act came from I think what you also need to know  from the outset is that people sometimes think   that like the waves replaced each other like CBT  replaced behaviour therapy or uh mindfulness and   third wave approaches a replacing CBT but that's  not the case at all behaviour therapy is still   used throughout the world today to help people  with various presenting issues as is cognitive   behaviour therapy and so I don't think there's  competition be between the waves I think these   are just um different approaches or different  tools that a therapist might have to work   with now the key difference between a second  wave approach like CBT for example the third   wave approach is whereas the core therapeutic  process of change in a CBT type approach might   be to to help someone re-evaluate or change  their thoughts the uh third wave approaches   an act in particular comes from the perspective  that you don't necessarily have to change one's   thoughts in order to be able to change one's  behaviour in functional ways and so ACT aims   to uh develop what's called psychological  flexibility in its clients which sounds a   lot like jargon psychological flexibility it's  a really simple idea it's the idea that we can   train ourselves to be able to have our unwanted  thoughts and feelings which of course are often   the symptoms of mental health problems that we  can train ourselves to have those or develop a   relationship with those experiences whereby  we don't need to get rid of them we don't   need to change them we can just become aware  of them and become and relate to them um in   in a more of an accepting way whilst moving  our feet towards things that are important to   us which are often uh in act called our values  and so yeah that's what act is is essentially a   therapy that aims to help people become more  accepting of their inner experiences and to   control their behaviour um such that they're  able to do things that are important to them I'm glad you've asked me this question actually  because I think when people first come to ACT   they get so sort of wrapped up in the idea  of psychological flexibility and the tools   that the ACT therapist has to work with  uh like different processes of act that   they don't really see some of the theoretical  underpinnings some of the important rationale   that sort of leads to the ACT model and the  reason why I think that's important is one I   find it interesting but two I think it offers  a different perspective on what uh contributes   to the development of mental health problems but  also sort of like what to do about them and so I   I'm going to try and sort of give you some of  that theoretical underpinning and I hope that   you have the same level of enthusiasm about it  as I do and so act comes from the perspective   that context is important when informing mental  health when informing what goes on in our minds   and don't get me wrong it doesn't suggest  that there are no biological independence,   and if you see in fact like people that are um  influential in act will quite happily marry up   epigenetics and act um but it does suggest that  the things that happen to us in our lives in our   past and in our present are likely to contribute  to the development of mental health problem I   don't think that's such a radical claim you know  I think we so easily as Society Place abnormality   within people and we often downplay context as  a causal factor in development of mental health   problems but I think if we if I was to say to  my students for example or other people hey look   the things that happen in our life are likely to  impact what happens up there I don't think that's   something that will be hard for people to accept  and in fact what you've got to do is look at   some of the research on poverty and how there are  mental health inequalities depending on how much   money we have to see oh look context is important  when it comes to the development of mental health   problems and so that's like a core part of the ACT  model the idea that our experiences across time   likely contribute to what's going on inside us and  then the next thing that the app model would the   next part of the rationale then would um involve  looking at that context and when you think of the   context when you think of what human life is a  lot of the context isn't particularly nice things   happen to us in our lives that aren't aren't great  people die and people lose their jobs people live   in chronic pain people have workplaces where they  feel undervalued or family relationships that   aren't going too well people can be frustrated  or isolated or exhausted or they might find   themselves with the ambiguity of you know world  changing pandemic and if none of those things   are going on for people which is really unlikely  then they could also struggle with spirituality   in the meaning of life like the the the list of  draining events that human beings can go through   is pretty vast and so then you know if context  informs mental health problems but often context   isn't that great then that sort of means that  we're all destined to struggle in somewhere to   suffer in some way and so the at perspective sort  of normalizes human suffering doesn't pathologize   it it suggests that look if context is important  and context is hard then we're likely to suffer   um and so that's sort of like the first part  of that but act also suggests that look human   beings have something that other animals don't  have we have language and so not only do we have   a context that's particularly hard but we're also  able to reflect and compare and analyze and mind   read and predict and do all these things that are  really useful for human beings in helping us to   essentially to become the dominant species on the  planet but they're also um those skills are also   likely to be at the heart of psychological angst  of of problems so because of that psychological   troubles are a really normal part of being being  a human being part of fabric of of being a human   being however the the fact that Society is painted  such inner angst as abnormal and happiness to be   normal happiness to be the normal Affairs what  we as a society do is we spot our own suffering   we label it as abnormal think right we got to do  something about this and what we think is like   with all abnormalities we got to get rid of our  abnormality and so then what we start doing are   things that are likely to to to make things worse  in the long run by in other words we try to avoid   our own suffering we do things to try to avoid  own suffering like that might be um drinking   alcohol it might be drugs it might be playing  computer games it might be eating 10 tubs of   Ben and Jerry there's lots of different ways that  we try and avoid our own experiences and often as   a result of those avoidance attempt the hole  that we're in actually gets bigger in the long   run or maybe the the worst thing that we can do  in an attempt to not feel something or not think   something is we start avoiding places where those  things are likely to be cued and so and making   that move like avoiding places where we're likely  to think about certain things feel certain things   is likely to like constrict our life likely to  make our life worse in the long run so you know   for example if um there was a if I had a partner  and I love this partner a lot and they ended up   um leaving at some point then would I avoid going  to places that I went to with that partner well   possibly maybe I'd avoid going for my walks or  avoid going to the beach or avoid going to the   cinema the thing is if I avoid going to those  places my life goes like this as a result which   is likely to not be good for psychological health  and so like up to this point the rationale goals   context informs mental health problems context  is sometimes not nice and we've got language   therefore mental health problems are normal  because they've been painted as abnormal we try   our best to avoid these inner experiences and our  attempts at avoidance are likely to lead us to um   to to a worse place and that's the point of which  psychological flexibility steps in it steps in as   the opposite to avoidance it's trying to help  people to embrace or to have or to be willing   to experience their inner discomfort and to be  really clear about where they want their life   to be headed and to help people to make steps  towards that life in the presence of them with   their unwanted thoughts and feelings and so it's  that sort of that rationale that I think is really   interesting about the ACT model that's the thing  that Drew me to the ACT model more than technique   but of course the question then becomes how do you  build psychological flexibility and the way that   you do that is by drawing upon the six core act  processes so these would they're called diffusion   our willingness selfless context mindfulness  values and committed action and the idea is   is that the app clinician will use exercises  techniques metaphors and language to try and   bring those processes to life to train their  clients in those skills and the idea is is that   the more that a client bring those skills to their  to their life of fulfillment and so that's sort of   like the ACT perspective on Mental Health that's  where it came from and I think it's pretty cool I've got absolutely no qus in saying that act  is an evidence-based therapy in fact in 2015 I   published a book called the research journey of  act and it detailed all of the research efforts   that have been made in the previous 30 years  or something and what it showed is that lots   of research has had been done on act up  to that point now the research evidence   differed in quality to begin with when you  start a research Journey you might sort of   I don't know publish a case study and then you  might publish something using single case design   and then you might publish a random um an open  trial so like a pre-post sort of study where   you just measure something at pre- intervention  and measure something at post intervention and   sort of see if there's any change and of course  those sort of designs got problems haven't got   a control group and so then sort of like a step  up from that would be a randomized control trial   with a weightless control say so you compare the  people with the receiving the active intervention   to people who are just receiving nothing and  then of course what you get to are randomized   control trials that have an active comparison so  for example you might compare act against CBT for   example now at the time of writing the book this  there was lots and lots of evidence for ACT using   all of those types of research design and now in  2023 it's more or less exploded like if you look   at the numbers of randomized control trials on  ACT being published over the last 30 years the   graph goes like this like it's incredible I think  there over a thousand randomized control trials   have been conducted on act up to this point and  so I've got no problem in saying that act works   for people it makes it difference in people's  lives according to the research evidence I   think there are a few things to say about act  research which is which is interesting that's   why I think it is is interesting one is act is  a trans diagnostic approach so it suggests that   experiential avoidance is at the heart of moress  all psychological suffering irrespective of what   name or label you want to put on that suffering  and so therefore you'll find act studies for   schizophrenia you find ACC with depression or  anxiety or smoking addiction or drug addiction   you'll find at use for workplace stress you use at  work or to train functional behaviours in leaders   you'll act see Act use with individuals with  intellectual disabilities you'll see act used   um in a sporting context to help Sports people  relate to their inner thoughts in functional   ways and control their behaviour so that's the  first thing I find really cool about it in fact   sort of like my book is split up according to the  different areas that has been used and there's so   many of them I think the second thing to say  about act research is it had to play sort of a   symptom reduction game now this is a hard thing  to get your head around but it's an interesting   thing to get your head around which is act doesn't  really make any predictions for symptom reduction   so like for example if there was a study measuring  depression for example and at pre-intervention   someone's called 10 and at post intervention  someone's called 10 arbitrarily and so they   they were still experiencing the same levels  of depression from an act perspective that's   not the end of the world because the aim in act  isn't really to change people's inner experiences   but to give them the flexibility to have those  inner experiences but to control their feet to   to do the things that are important to them  and so what we'd really be looking at at post   intervention is are they doing more things that  are important to them and that would be a metric   of success from that perspective but of course  act doesn't exist in a in a bubble it exists in   a societal context and a lot of the decision  makers within Society they rap the success of   an intervention based on symptom reduction so  a lot of act research has been done on a shown   symptom reduction from pre-to post intervention  that tends to happen with act research but in   fact that's not the be or and end all and I  think the the the last thing I want to say   about act research which I think is really cool  is a lot of mediational analysis has been done   with act research I think this is really cool I  think this is sort of cut and edge stuff when it   comes to research and Clinical Psychology and  that is it's not enough to know that something   works from pre to post intervention we need to  make sure that the changes happening through   the processes that we are expecting and so the  process in Act is psychological flexibility in   other words we want our intervention to improve  levels of psychological flexibility and then   what we want is are those changes in psychological  flexibility to mediate outcome to change outcome   and I think from a really early stage people in  the ACT Community have been trying their best   to run mediation analysis to make sure that  the change in psychological flexibility is   what's powering outcome um and so yeah you'll  find quite a few mediation on and they're not   perfect of course and the main measure that's  used in act research has got some problems with   it but the right questions are being asked  uh which I which I really like but if you   put a gun against my head and says is act an EV an  evidence-based therapy I would definitely say yes So metaphor is everywhere in act I feels like I  live in the world of metaphor and a lot of the the   metaphors in act I find really powerful at mapping  onto people's experiences one of the metaphors   that I really like is the tug of war with the  monster and how uh we often try to to to win a tug   of war with a monster despite the fact that that  monster is really strong and the way that this is   used in Act is the idea that like we try to defeat  our unwanted thoughts and feelings we try to get   rid of them we try to pull them into a big hole  um but the stronger that we pull the more that we   pull them the harder that monster pulls and and  that monster pulls you closer to the big hole   that's between you and it just takes some time to  learn that one option in that game is to drop the   Rope so I find that one a really powerful one in  terms of illustrating what we mean by acceptance   um and there are exercises like in diffusion this  in the diffusion process of act there's some cool   exercises about like thanking your mind for a  thought like gives you the opportunity to step   away from your mind and to spot and to be aware of  how it's working and then to control behaviour and   functional ways in terms of like my favourites,  some the more popular acts exercises and metaphors   I think that one that people find powerful is a  Valu clarification exercise and that's literally   like a card sword there's just a bunch of values  things like compassion and kindness and honesty   and persistence like loads of words that describe  qualities of action like who do we want to be in   this world how do we want to hold ourselves and  there's a load of them and people are required to   gradually uh cut down those words to very very few  and those very very few words then help someone   to be clear about the sort of person they want  to be in the world um I had one person do the   exercise a long time ago said that at the end of  it they felt nak they felt stripped back like you   know the to the essence of who who they wanted to  be and then of course they were able to use that   information to choose behaviours that were in line  with those values to bring their values to life   and from that perspective the more that we can do  that like act in a way that's consistent with our   values then the better our will be so that's like  one of probably the my favourite exercise to do   myself and to De with people and then in terms  of a metaphor I don't think you can get away   from passengers on the bus as a classic metaphor I  haven't come I haven't seen a better metaphor than   that which sort of like gets across the whole of  the ACT model in one go and it sort of goes like   this that we're all driving in our bus of life and  that when we're driving we get to control where we   drive the bus but sometimes we'll have passengers  on our bus that will come up and try and uh make   us go in directions that aren't of our choosing  so these would be unwanted thoughts and feelings   uh self-doubt and and um various thoughts like  you're not good enough or why do you think you   can get there and feelings like this doesn't feel  nice and so the idea is that like these passengers   that are on your bu can say why why don't you  go over there instead of over there and all of   a sudden you find yourself Meandering around the  city and the idea is that over time we can learn   to relate to those passengers or be willing to  have those passengers and still control our but   still drive to our Valu still drive to the thing  thing that are important to us and that's part   of the aim of the app model is to help people to  relate to those passengers on their bus so that   they can still drive um Drive In in meaningful  directions and so that passengers on the bus   metaphor is a powerful and that still makes  its way into any training that I do and other   people's training as well it seems like we can't  get away from that metap but I just think it's   such a useful one helping people to understand  the basics of the AB Threat Model see I'm not sure   I've really answered that question brilliantly  probably because there are so many exercises   and so many metals that um it's hard to distil  a lot of that down into a quick answer like this   but I think the more the people dive into the app  model and read the books and stuff the more cool   sort of tools exercises metaphors um they'll come  across that illustrate and help act practitioners Yes I did indeed write a book uh it's called  the unbreakable student and it is an act-based   mental health guide for University students  I like to think it's more than that I think   that the the thing that appeals to me about Act  more than anything else is the humanity of it and   yet sometimes when um you read uh self-help books  out there they tend to be technique driven rather   than heart rather than shown a lot of heart and  I think the book shows shows a lot of heart and   the reason why it's got a lot of heart in it is  because originally it wasn't really written for   University students it was actually written for  my own son so my son and I were watching The Lion   King film and in that Lion King film the daddy  lion whoas guys I I'm ruin that film for anyone   watching this and as that happened I sort of  welled up and started crying because it occurs to   me all my world life is really unpredictable and  like I want to be around to guide this little fell   but what happens if I'm not around to guide you  know my son and so the next day I started running   by a book called D Max and the idea was it was a a  a guide um for how to manage mental health and how   to live a life of fulfilment in this in this world  but it was to be given to Max as an 18-year-old   and so of course as I was writing the book I was  writing it to my own son as an 18yearold but I was   picturing the University students that worked with  un help been for the last 15 years and so when the   book was finished a few people suggested oh look  maybe more than one person could benefit from this   information and that was the point at which it  made total sense to make the book not just for   my son but for 18y olds and especially 18 year  olds that had been to University because those   are the people that I work with and so yeah it's a  an act-based uh self-help book if you like I don't   like the word self-help but like a book of advice  a book of information that might help University   students see the world in a different way and give  them some skills to help them to control their   behaviour in in functional ways it's actually not  just an act book it also draws upon the six ways   to well-being and so you'll probably have heard  of the five ways to wellbeing but the um um some   research done in Australia by Dr Gangel Barard  Who is an ex- student of minor War University   uh suggested that happier human beings tend to  do six things so they tend to exercise they tend   to challenge themselves they tend to connect with  others tend to give to others they tend to embrace   the moment they tend to self-care and so in some  ways the the message of my book is really simple   which is students you need to do those things do  those things you're going to increase the chance   of you being okay um but of course often when we  move towards doing such things as those six ways   to well our minds can get in the way and so then  act is used within the book is thread throughout   the book to help students give have to train  students in the ACT skills to train them to relate   to their inner thoughts and feelings in functional  ways such that they're able to move towards their   values and that they are also um able to bring  to life these six ways to well-being and so yeah   that's my uh my ACT book it's probably the thing  I'm most proud of and I really hope that it makes   a difference to the lives of University students  out there uh my final words would be thank you   for having me I've really enjoyed answering  or trying to answer the questions that you've   set um and to any University students out there  that are listening keep your feet moving uh when   the storms in your head come it's okay you're  not abnormal for having them you can relate to   those things really uh really well you just need  to learn those some of those skills to help you   to do that and to clinicians that are out there  working with adolescence or children there are   developmentally friendly um versions of the ACT  model the the one that pops to mind is called DNA   which was put forward by Louise Hayes um and  and so if you're interested in learning more   about ACT or about the dnv model then feel free  to email me and I'll put you in touch with some   people or for you on some resources that might  help you learn about this area of psychology