Acceptance and commitment therapy - pathways for general practitioners.

BACKGROUND: Acceptance and commitment therapy (ACT) focuses on helping patients to behave more consistently with their own values and apply mindfulness and acceptance skills to their responses to uncontrollable experiences.
OBJECTIVE: This article presents an overview of ACT, its evidence base and how general practitioners can apply ACT consistent practice in the primary care setting. It describes pathways for general practitioners to develop further expertise in the approach. DISCUSSION: Acceptance and commitment therapy has been associated with improved outcomes in patients with chronic pain (comparable to cognitive behaviour therapy) and several studies suggest that it may be useful in patients with mild to moderate depression. Preliminary evidence of benefit has also been shown in the setting of obsessive-compulsive disorder, psychosis, smoking, tinnitus, epilepsy and emotionally disordered eating after gastric band surgery. Acceptance and commitment therapy starts with a discussion about what the patient wants and how they have tried to achieve these aims. Strategies previously used to avoid discomfort are discussed. Psychoeducation in ACT involves metaphors, stories and experiential exercises to demonstrate the uncontrollability and acceptability of much psychological experience. In its final phase, ACT resembles traditional behaviour therapy consisting of goal setting and graduated activity scheduling toward goals directed by values.