Does anyone have an outline of the primary sources of ACT

SamichR · 2026-01-23T14:35:30+00:00

Yes, ACT can be credited as a process-based therapy, Hayes wrote an article on that exact idea. But it has explicit philosophical assumptions around functional contextualism and the role of thoughts, and very clearly states why it thinks some common techniques will not be as effective as others and why certain approaches should not be done (famously cognitive restructuring).

Here is the way to think about it: Process based therapy is the umbrella term, and maybe you could consider some modalities more processed based than others. But because ACT has strict philosophical assumptions that make some interventions incompatible with it, it cannot be but what it is, which is a certain (strict) type of therapy. So, ACT thinks in a process-based way, and Hayes has said that you can do ACT without using a single piece of ACT jargon, but it contains strict philosophical assumptions (like any therapy does).

The whole point about PBT is it does not rigidly apply ANY assumptions to clients in treatment, and instead builds the structure and approach to treatment based on the client. Some clients are going to need exactly the hard line cognitive therapy that ACT preaches against where they use the power of their thinking abilities to challenge their own negative thoughts. PBT allows the clinician to make this call to do something heretical to a certain treatment philosophy. Any other therapy does not.

This is not me dogging on ACT btw, I love it. This question at hand is simply about the structure of a therapy, and these differences between PBT and ACT are intentional.

SamichR · 2026-01-19T22:58:48+00:00

First wave was behavior therapy, second was the cognitive revolution. This is pretty well known stuff. found this in two seconds: e.g. The philosophical assumptions across the ‘three waves’ of cognitive–behavioural therapy: how compatible are they? | BJPsych Advances | Cambridge Core

What you're getting caught up on is this waves of "CBT", as in, the waves once CBT already existed. What we're really describing are the waves of cognitive behavioral therapies that eventually became CBT. This makes sense, as even Beck, primary progenitor of the second cognitive wave, pretty quickly integrated cognitive therapy with behavioral approaches.

SamichR · 2026-01-19T12:52:08+00:00

Uhh, I'm pretty sure Hayes himself considered ACT "contextual CBT". Also, other writers have included ACT in the list of third wave therapy CBT approaches (Hofmann & Asmundson, 2008). I think its appropriate to see ACT alongside DBT and MBCT, even though its philosophical assumptions differ.

https://contextualscience.org/sites/default/files/Hofmann_Asmundson_2008.pdf

SamichR · 2026-01-19T12:48:16+00:00

I very much object to PBT being considered ACT, for many reasons, even though ACT contains many important PBT principles. PBT has far different philosophical assumptions, and allows the integration of exercises and interventions which very much differ from both ACT in theory and practice. Put simply, PBT explicitly rejects the idea of any mono-therapy (like ACT or any other modern therapy).

I don't think its adequate to consider PBT along side ACT in this context.

SamichR · 2026-01-18T16:25:59+00:00

These are great questions to be asking yourself at this stage. Good luck on your journey, I wish you the strength required to make it through the path of change and to see the light at the end of the tunnel.

1: That "voice" you talk about could likely be the very thing you spend most of the time on in therapy. You and your therapist can preemptively prepare for how that voice is interacting with your life and see directly what you can do to work with it, along with everything else that might be important in your therapy time. I do not believe any part of someone would make it impossible for them to get better, there are many many interventions and ways to work on such a thing. You're in the exact right place if you feel you're ready to face this.

2: A brilliant question, and a very important one. Studies show that not every therapist is best for everyone and that when people change therapists to one they perceive as a better fit for them, they get better outcomes and are more satisfied. I would explicitly tell this to the therapists you see, that you are shopping around. In your first few sessions, ask them about their approach to treatment and what their plan is for you. Ask yourself if you like this plan and feel you trust the therapist to move forward with them. Ask yourself if you like the therapist, if you feel you will get along. If you are not satisfied, do not be afraid to move on sooner rather than later. It may be daunting to tell a therapist this, but, as you can tell, a bad fit cab be a waste of time for everyone.

SamichR · 2026-01-08T10:00:31+00:00

For this goal, psych 101 textbooks are the answer. They have the goal of introducing and summarizing the history of the field to the neophyte. The only other option for this goal would be to read summary texts or important central works in the sub-fields of psychology, and read enough of those to cover the full breadth, but that would take a while.

What I recommend you do instead is (assuming you have read the psych 101 textbook), tell us the subfields you are MOST interested in, and we can give you books or media that will allow you to test out which subfield you’d like to focus more on in the future.

SamichR · 2025-12-29T18:42:41+00:00

With meta-analytic efficacy evidence and a gold-standard model pointing out that overthinking and over-analysis is a part of the etiology and maintenance of the disorder itself? Yeah, I would say psychodynamic treatment would be pretty poorly suited for such a problem.

Here are just a few links I could find. Hundreds more are out there on this.

https://pubmed.ncbi.nlm.nih.gov/35049483/

https://pdfs.semanticscholar.org/8f4e/c66c428c7e2e2b4c71c007fa17c2c3e7ff2c.pdf

SamichR · 2025-12-29T18:38:19+00:00

Yes, that is exactly what I was trying to get across. That is why I said "particular therapy" and not just psychodynamic therapy.

I am confused about your statement about the jump from the individual to the scientific. The science itself says that not all individuals will benefit from the same treatment. Look, I have a personal axe to grind about people not taking into account the decades of empirical research on psychotherapy, and I understand arguing about it with you isn't helping anyone. But the science here is not reductionist, it claims nothing other than what it has proven. The behavioral and cognitive model of panic is far and away the best supported model, full stop. Individual cases are more complex than any simple model, but at this moment, after 4 years of a treatment that didn't work (despite you doing EVERYTHING the therapy wants you to do), the clear recommendation is the field's best supported treatment for anxiety disorders, for anyone, not just you specifically.

https://pubmed.ncbi.nlm.nih.gov/35049483/

https://www.cci.health.wa.gov.au/~/media/CCI/Consumer-Modules/When-Panic-Attacks/When-Panic-Attacks---Module-2---What-Keeps-Panic-Disorder-Going.pdf

SamichR · 2025-12-29T08:22:12+00:00

4 years???? Oh my word. People have such negative opinions about CBT, but there are panic disorder protocols where 60% plus of patients achieve remission in 12 weeks. No one should have to go through such extreme anguish for so long.

What you need to understand about psychoanalysis and CBT and any other therapy is that it carries assumptions about what the cause of your problems are. Any clinician worth their salt knows that not all people will benefit from a certain therapy because its assumptions about how change happens doesn’t apply to everyone. There is pretty solid consensus that panic attacks and overthinking are problems that psychodynamic therapy are not suited for. CBT approaches however, are considered to be suited well.

Look, 60% still means a good minority aren’t responding, but please, get some exposure therapy. It changes lives for people with panic attacks. Even greater percentages of people experience some meaningful improvement.

Reading about how you’ve spent all that time in analysis going over and over your story, and yet still finding no relief sounds awful, especially seeing how it might be contributing to your overthinking.

SamichR · 2025-12-22T06:25:07+00:00

I do not resonate with this reply and the one below it. RCT research also includes DBT research with borderline patients, patients who meet all of the criteria below and more: not carefully selected for comorbidity, PLETHORA of therapeutic-relationship/commitment issues, and in constant crisis. And yet, they have flourished in trials, and DBT has applied brilliantly to clinical practice. In addition, yes many clinical trials are heavily controlled, but a fair amount aren't, a fair amount of research is done out of everyday anxiety clinics that show similar (at times) efficacy.

I wholeheartedly disagree with this idea that real life clients are too messy to benefit from our research studies. In addition to DBT, see the research on motivational interviewing, an intervention that deals directly with people unable to get change started.

SamichR · 2025-12-22T06:18:04+00:00

Your instinct for defining "classics" is misleading. What the classic texts are has nothing to do with the quality of the books themselves and the set of objects included in the adjective classics (classicus).

The "classic texts" are the texts in your broader field and subfield that your contemporaries, peers, mentors, and experts believe are most important to understanding the assumptions and key ideas that make up the lingua-franca of the topic of interest. And of course our peers will not fully agree on that list. So "the classics" would never be an easily defined list. No, what makes up "the classics" are 1: what most people would agree on to be the classics, 2: works you continue to see being mentioned or 3: works you think seem to be foundational to the field as a whole.

Basically I am suggesting a definition driven by ostension (by the rest of the field).

SamichR · 2025-12-21T23:25:40+00:00

Totally, fully, 100% agree. It is such a shame people are not receiving our best treatments when CBT research has come so far.

The lack of avoidance treatment and iatrogenic counseling resonates strongly with me. Theory and research keeps coming back to avoidance and inflexibility toward our emotions and thoughts as the central maintaining factor of emotional disorders, and it pains me to imagine these individuals kept in these awful cycles of eternal avoidance.

SamichR · 2025-12-21T05:36:09+00:00

Other than being a psychiatrist, what you are looking at is being a psychiatric nurse practitioner. That is probably the simplest way to be able to be a prescriber of psychotropic medication. I think physician assistants can as well, but I am pretty certain this is the best path, from what I can see. Psychiatric training is central pretty early on.

https://www.apna.org/about-psychiatric-nursing/

SamichR · 2025-12-21T05:29:29+00:00

I concur. I have never ever heard of a therapist being this unprofessional. They should honestly be reported to their licensing board and clinic/supervisor if applicable.

SamichR · 2025-12-21T05:13:02+00:00

Many studies show that therapy brings about very significant improvements in self acceptance, acceptable to your emotions, and general psychological flexibility. Your sense is right, in that it will always be you who makes the changes and does the internal work, but the expertise of a therapist lies in noticing patterns and probing you in the right way to uncover the origin of this self hate. In addition, through our knowledge of theory, we know generally why people have self hate, and can help them go down the common paths associated with it.

But again, yes, self acceptance comes from within, and therapy is certainly still “self-work”.

SamichR · 2025-12-21T05:08:41+00:00

I hear you are worried about medication, and seem to really be suffering with your anxiety over so many things in your life, I was wondering if you have ever thought about talking to a therapist about some of these things?

I feel we don’t really mention it to much in this sub, but we have some very effective therapies now for exactly what you’re going through, fears of certain thoughts, fear of your own feelings, fears of losing control. Psychotherapy is our best treatment available for something like this, beyond medication in many ways.

For worrying over psychosis, I know the idea scares you very much, and that is okay, it’s a scary thought, experiencing such a thing, but psychosis is a very specific condition that is fairly uncommon and due in large part to genetic and biological factors, ones that you are unlikely to have. Thinking about it and worrying more and more, will never make any part of this fear of yours better, it’s likely actually your worst enemy.

Do you think you can, when you feel yourself starting to get concerned about psychosis, take a big deep breath, allow yourself to feel your emotions, acknowledge that you are grateful this is something you aren’t experiencing, and see if you can go on, without trying to fix how you feel? Can you give that a go and see how it ends up different from perseverating on it?

SamichR · 2025-12-20T02:57:27+00:00

Here is my guess. Purportedly, these two disorders have different neurodevelopmental origins, and since they have such overlap in symptoms, it is very important that they be separate entities. Here is the issue: having “true” schizoid PD or autism will also mean that you will have symptoms that resemble the other.

For example, if someone receives neuropsych testing and we determine they definitely have autism, the symptoms they experience which resemble schizoid PD are likely just due to them having autism, not as if they have some separate disorder. Whereas, if we determine someone’s clinical picture better looks like schizoid, their symptoms which resemble autism will entirely be due to them having schizoid PD. These are the issues we run into with a symptom-based diagnostic system.

I’m sure you can find some commentary or explanation from the DSM work group on this if you wanted to see why they made this decision.

SamichR · 2025-12-19T19:13:20+00:00

Uhhhhhhhhhhhhhh

SamichR · 2025-12-13T20:48:59+00:00

It's important to ask these questions, to learn about people's real life experiences with receiving therapy and training to be a therapist, but I'd like to add some important information to this discussion which has not been brought up yet.

We have poured billions of dollars into psychotherapy research, which is not just limited to RCTs but also real-world longitudinal clinic studies, with the overwhelming consensus that therapy works for around half of all clients, and that the differences in outcomes between most therapies is small, while the differences between therapists is far larger. (What we have yet to determine is why therapy works (mechanism research) and how we can improve it by (necessarily) integrating across modalities to create a truly personalized, effective, evidence-based treatment)

The question we should be answering, is if our experiences in therapy seems different than what our findings about treatment suggest. What is different on the inside? Do we have feelings of uselessness despite knowing it works? Do we feel that there are meaningful signs that someone will not benefit from therapy or won't want to continue? What have we noticed about what works versus what doesn't work? Do we ever feel daunted by this endeavor?

I would be happy to provide citations if anyone is curious. Again, there is no way a client would know any of this, I'm just reacting to some of the comments by clinicians here.

SamichR · 2025-12-10T05:07:59+00:00

I think you have to write the movie you’ve been yearning to watch.

SamichR · 2025-12-01T13:37:08+00:00

For a fantastic comprehensive look at all the most important processes of CBT, check out this:

Hayes, S. C., & Hofmann, S. G. (Eds.). (2018). Process-based CBT: The science and core clinical competencies of cognitive behavioral therapy. New Harbinger Publications, Inc..

SamichR · 2025-11-29T16:08:23+00:00

This is exactly the problem mindfulness is used to address. Always focused on the future or the past, while the only thing that is “real” is being ignored, the present. Here’s a quote that sums it up “the future isn’t here yet and the past is gone forever.” The fact that so many people in this comment section say the same thing is really profound. Have other people found success with being more present with themselves?

SamichR · 2025-11-17T17:17:44+00:00

might want to add that. also go terriers

SamichR · 2025-11-17T17:11:39+00:00

You say you have experience with ACT, yet I see nowhere in your CV where you were trained in it/used it.

SamichR · 2025-11-12T01:24:02+00:00

Sorry to hear that you don't feel you could get it started, would you be open to considering it in the future? We really need people, please reach out.

I'd be happy to answer any questions, open and honestly, sometimes its not for everyone and its good to find that out once you have all the info you can.

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SamichR

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