ACTing autonomously

The prevalence of mental health issues is rising, with over 47% of the US population meeting the criteria for a mental disorder at some point in their lifetimes (Kessler et al., 2007). These shocking statistics underline the importance of developing interventions to help individuals with mental health concerns. 

Since the 1950s, psychologists have recognised the importance of autonomy, referring to the perception of control over one's life, in psychological welfare (White, 1959). Martin Seligman argued that the perception of autonomy is fundamental in preventing depression (Seligman, 1975) and maintaining a sense of self-worth (Lefcourt, 1976). The perception that one lacks control over one's environment can manifest a variety of mental health issues, including, but not limited to, suicidal ideation (Nicolopoulos et al., 2018), depression (Bjørkløf et al., 2018; Myles, unpublished data), loneliness (Andrew & Meeks, 2018) and anxiety (Cheng et al., 2013). 

In the 1980s, Acceptance and Commitment Therapy (ACT) was developed by Steven Hayes as a therapeutic intervention for a range of mental health concerns (Hayes, 2006). This therapy advocates the importance of behaving mindfully in a manner that is in line with one's core values. ACT accepts that life will often be challenging but underlines the importance of responding to these challenges mindfully to create a meaningful and fulfilling life (Harris, 2019). 

One of the principal tools in ACT is the 'choice point'. This involves the client imagining that they are standing at a T junction when faced with a decision. Turning right is termed a 'towards move' and improves one's life in a meaningful way, whereas turning left is an 'away move' and does not improve one's life. Making an away move is very tempting, often because it provides short term reward or relief. For example, I try to maintain a healthy lifestyle but am rarely motivated to go for a run (towards move) on a Friday night and would much rather order a pizza (away move). ACT uses various techniques to help individuals resist away moves in the pursuit of towards moves. 

ACT assumes that the choice point is effective because making towards moves brings one closer to one's core values, with the, often implicit, assumption that making away moves is unhelpful. However, I have found that clients often benefit from adopting the philosophy of the choice point, even when making away moves. But why?

When framing decisions as explicit choices that one might otherwise make with little consideration, the choice point 'forces' the individual to recognise that they are making a choice. This might afford greater perceived autonomy as, even if one makes an away move, one must explicitly recognise that they have decided to behave in a particular manner. Therefore, explicit recognition that one is making a decision, irrespective of whether it improves one's life, may be therapeutically beneficial through bolstering one's sense of control.

The philosophy of the choice point is relevant to all and not just those with mental health concerns. Conceptualising decisions in this way helps one to act in accordance with one's core values and make meaningful improvements to one's life. Crucially, even if one decides to order that pizza (which happens to me more frequently than I would care to admit), framing decisions in this way can improve one's perception of control through mindful awareness of one's actions.

Liam Myles
Assistant Psychologist
Surrey and Borders Partnership 
NHS Foundation Trust 

References

Andrew, N., & Meeks, S. (2018). Fulfilled preferences, perceived control, life satisfaction, and loneliness in elderly long-term care residents. Aging & mental health, 22(2), 183-189.

Bjørkløf, G. H., Engedal, K., Selbæk, G., Maia, D. B., Borza, T., Benth, J. Š., & Helvik, A. S. (2018). Can depression in psychogeriatric inpatients at one year follow-up be explained by locus of control and coping strategies? Aging & mental health, 22(3), 379-388. 

Cheng, C., Cheung, S. F., Chio, J. H. M., & Chan, M. P. S. (2013). Cultural meaning of perceived control: a meta-analysis of locus of control and psychological symptoms across 18 cultural regions. Psychological bulletin, 139(1), 152.

Harris, R. (2019). ACT made simple: An easy-to-read primer on acceptance and commitment therapy. New Harbinger Publications.

Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: Model, processes and outcomes. Behaviour research and therapy, 44(1), 1-25.

Kessler, R. C., Angermeyer, M., Anthony, J. C., De Graaf, R. O. N., Demyttenaere, K., Gasquet, I., ... & Kawakami, N. (2007). Lifetime prevalence and age-of-onset distributions of mental disorders in the World Health Organization's World Mental Health Survey Initiative. World psychiatry, 6(3), 168.

Lefcourt, H. M. (1976). Locus of control and the response to aversive events. Canadian Psychological Review, 17(3), 202.

Myles, L. The Mediating Role of Perceived Control and Desire for Control in the Relationship between Personality and Depression. 

Nicolopoulos, A., Boydell, K., Shand, F., & Christensen, H. (2018). Why Suicide? Adolescent Research Review, 3(2), 155-172.

Seligman, M. E. (1975). Helplessness. On depression, development and death.

White, R. W. (1959). Motivation reconsidered: The concept of competence. Psychological review, 66(5), 297.