Acceptance or change: Treating socially anxious college students with ACT or CBGT.

Abstract

Traditionally, cognitive-behavioral therapy has worked from the assumption that anxiety, depression and other forms of emotional discomfort are caused by maladaptive or irrational patterns of thinking. Cognitive-behavioral therapists have developed an information-processing model, whereby hypothesized structures, or schemas, are causally involved in the development of psychopathology. Early maladaptive schemas predispose clients to distort events in a characteristic fashion (Young, Beck, & Weinberger, 1993). Treatment is aimed at identifying and modifying maladaptive beliefs and the underlying schemas from which they arise. Numerous interventions have been developed to accomplish these goals and many of these treatment procedures have received strong empirical support (Chambless & Hollon, 1998). Acceptance-based therapeutic procedures stand in contrast to treatments that emphasize the modification of private events (thoughts and feelings). Rather than viewing psychological difficulties as the result of faulty thought processes that need to be changed, therapies that emphasize acceptance consider the struggle to change or avoid private events as problematic itself. Avoiding private experiences that are not under voluntary control requires the individual to avoid situations that elicit these experiences. This solves one problem but creates another one as a result of constricting activities and not taking part in life's events (Hayes & Wilson, 1994). To illustrate, the speech anxious student never speaks up in class and avoids unpleasant feelings; but there are costly long-term effects of her behavior. She has systematically passed off occasions that would have prepared her for future professional and personal opportunities. Hayes, Wilson, Gifford, Follette, & Strosahl (1996) have conceptualized a number of different topographically-defined behavioral disorders along the functional dimension of experiential avoidance. Acceptance-based methods encourage clients to let go of the struggle and come to accept the inevitable internal and external events of their lives (Wulfert, 1994). The concept of acceptance is not new in the field of psychology. It serves as a key component in numerous psychological traditions and clearly plays some role in almost all psychological interventions. As Hayes (1994) conveys, acts of psychological acceptance can occur on a continuum and may be differentially valued across psychotherapeutic approaches. Acceptance of one's own private experience lies at the heart of the theories and therapies of the humanistic tradition, such as Rogers' (1951) client-centered therapy. Acceptance was strongly encouraged in client-centered therapy through the use of empathic listening and a shared understanding of feelings. Gestalt therapy also stresses the immediacy of experiencing, and holds the assumption that much of the dysfunction in our modern society is the result of people becoming experience-phobic and avoiding their own feelings (Greenberg, 1994). However, solid evidence to empirically support these acceptance-based interventions is largely absent from the scientific literature as humanistic and experiential types of therapies have historically been much less subjected to empirical evaluation. If the humanistic traditions represent one end of the acceptance spectrum, behavioral and cognitive-behavioral approaches have fallen on the other end of the continuum. Until recently, the explicit incorporation of acceptance has been scarce in these approaches as they traditionally have emphasized change. A glance at some of the techniques used in contemporary behavioral interventions evidences this fact. Clients judged to exhibit maladaptive thinking are instructed to examine the evidence for their beliefs. They are taught to identify their automatic thoughts, label them according to established categories of cognitive distortions and replace them with more adaptive rational responses (Young et al. …

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