University of Birmingham.
Maynooth University.
Behav Ther. 2023 Nov;54(6):939-955. doi: 10.1016/j.beth.2022.07.010. Epub 2022 Aug 6.
A large array of randomized controlled trials and meta-analyses have determined the efficacy of Acceptance and Commitment Therapy (ACT). However, determining that ACT works does not tell us how it works. This is especially important to understand given the current emphasis on Process-Based Therapy, the promise of which is to identify manipulable causal mediators of change in psychotherapy, and how their effectiveness is moderated by individual contexts. This paper outlines four key areas of concern regarding ACT's status as a Process-Based Therapy. First, the relationship between ACT and Relational Frame Theory has been widely asserted but not yet properly substantiated. Second, most of the studies on ACT's core process of change, psychological flexibility, have used invalid measures. Third, while lots of research indicates means by which individuals can be helped to behave consistently with their values, there is virtually no research on how to help people effectively clarify their values in the first instance, or indeed, on an iterative basis. Finally, the philosophy underlying ACT permits a-moral instrumentalism, presenting several ethical challenges. We end by making several recommendations for coherent methodological, conceptual, and practical progress within ACT research and therapy.
大量的随机对照试验和荟萃分析已经确定了接纳与承诺疗法（ACT）的疗效。然而，确定 ACT 有效并不能告诉我们它是如何起作用的。鉴于目前对基于过程的治疗的重视，以及其识别心理治疗中可操作的因果中介因素变化的承诺，以及其有效性如何受到个体环境的调节，这一点尤其重要。本文概述了关于 ACT 作为基于过程的治疗的地位的四个关键问题。首先，ACT 与关系框架理论之间的关系虽然被广泛断言，但尚未得到适当证实。其次，关于 ACT 的核心变化过程，即心理灵活性的大多数研究都使用了无效的测量方法。第三，尽管大量研究表明了可以帮助个人按照自己的价值观行事的方法，但实际上几乎没有研究如何帮助人们有效地澄清自己的价值观，或者事实上，在迭代的基础上。最后，ACT 所依据的哲学允许非道德的工具主义，提出了几个伦理挑战。最后，我们对 ACT 研究和治疗中在方法学、概念和实践方面的连贯进展提出了一些建议。
