I was recently surprised to discover an article I co-authored cited by Aaron T. Beck. This is ironic as this article has nothing to do with ACT or contextual behavioral science (it was a work on a pleasure scale in schizophrenic disorders). Of course, one would have wondered why the father of cognitive therapy would have referenced an article on ACT, if not to criticize the work of defusion in ACT. I’m careful about the trial of intent – I don’t know after all – but it’s true that defusion seems to be at the antipodes of cognitive restructuring so dear to Beck.
It’s understood: on the side of cognitive restructuring, we consider thoughts as potentially dysfunctional, we look for arguments to oppose them, we argue with them in order to replace them with others or to modify them. When it comes to cognitive defusion, we are only interested in the form of thoughts and we do not discuss them, we do not try to replace them, they are not considered dysfunctional, even if they are accompanied by painful emotions. A priori, the two approaches look as if they were in opposition. In appearance at least…
Upon closer inspection, especially when looking at their function, perhaps these two seemingly opposing approaches to CBT converge. Of particular interest, one characteristic of cognitive restructuring should question us: various studies have indeed shown that the reduction in symptoms during CBT is relatively rapid and appears before the introduction of a cognitive intervention, strictly speaking (IIardi & Craighead, 1994; Hayes, 2004). Perhaps it is, then, necessary that we take a detailed look into what the active ingredient is within the cognitive restructuring process…
It turns out that before introducing the cognitive restructuring phase (search for arguments for and against thoughts, search for alternative thoughts), the therapist asks the patients to observe their thoughts, to look at them as an objective phenomenon, distinct from them, as an object of study in short. When therapists encourage their patients to write down their thoughts as soon as they appear, they actually lead them to an observer position and help them access some form of distancing. If I can observe something, it means that I am distinct from it; therefore, I am not my thoughts if I am capable of observing them. This particular phase of preparation for cognitive restructuring per se could constitute its real active ingredient, and not the actual debate with the thoughts. Indeed, to debate one’s thoughts is still to be at grips with them…
In any case, this is ACT’s bet, which, through defusion, attempts to make this process systematic. In defusion, we seek to distance ourselves as much as possible from thoughts by observing them with curiosity, as autonomous events, without trying to get to the bottom of what they are saying.
Paradoxically, not arguing is a form of ultimate distancing. In an actual debate, the most denigrating blow that can be delivered by one of the contradictors is to refuse to debate with the other, thus signifying the unimportance of his arguments, which do not even deserve to be answered… In defusion, the distancing is extreme because we do not even bother to take an interest in what our thoughts are saying or to even engage with them at all. Therefore, they actually have less control over us. They become even more negligible.
In summary, the ACT defusion approach systematizes the active ingredient of cognitive restructuring, namely, the distancing achieved by observing one’s thoughts as an external object. This may still be an empirical question that deserves to be confirmed (although some studies have already shown the ineffectiveness of the complete cognitive restructuring approach, see Jacobson et al., 1996; Longmore, & Worrell , 2007), but it seems that ACT is going in the same direction as cognitive restructuring. It just goes more directly.
Hey Aaron! Will you join us?
Translated by Chelsea Davis-Laurin
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References:
Hayes, S. C. (2004). Acceptance and commitment therapy and the new behavior therapies: Mindfulness, acceptance, and relationship. In S.C. Hayes, V.M. Follette & M.M. Linehan (Eds.), Mindfulness and acceptance: Expanding the cognitive-behavioral tradition (pp. 1–29). New York: Guilford.
Ilardi, S. S., & Craighead, W. E. (1994). The role of nonspecific factors in cognitive‐behavior therapy for depression. Clinical Psychology: Science and Practice, 1(2), 138-155.
Jacobson, N. S., Dobson, K. S., Truax, R A., Addis, M. E., Koerner, K., Gollan, J. K., Gortner, E. & Prince, S. E. (1996). A component analysis of cognitive-behavioral treatment for depression. Journal of Consulting and Clinical Psychology, 64,295-304.
Longmore, R. J., & Worrell, M. (2007). Do we need to challenge thoughts in cognitive behavior therapy? Clinical Psychology Review, 27, 173–187.