ACT for Adolescents
Acceptance and Commitment Therapy (ACT) is a relatively new form of cognitive-behavioral therapy. Rather than addressing specific psychiatric disorders, ACT posits that the nature of our difficulties is rooted in psychological rigidity: problems develop when we become stuck in rumination, painful emotions, or behavioral avoidance. To promote helping us get unstuck, ACT encourages people to develop skills in six areas: acceptance, cognitive defusion, contact with the present moment, self-as-context, values and committed action. This constellation of skills is represented in what is affectionately known as the “ACT hexaflex”, as shown below (Hayes et al., 2006). ACT has been growing in popularity due to the expanding body of research that demonstrates its efficacy and effectiveness. Further, I have seen its helpfulness with many of my clients, especially adolescents.
There are three ways to deliver ACT to adolescents. The first way uses the original ACT hexaflex, the second way uses the DNA-V model (developed by Louise Hayes specifically for teens), and the third way uses a mixture of both models based on the preferences of the practitioner and the client. In this post, I will be comparing the “traditional” hexaflex model to the DNA-V model.
For anyone who already knows the hexaflex model, the DNA-V model might initially lead to some discomfort (unless of course you are in an enlightened stage of absolute defusion from your mind). There are some new components and certain areas of the hexaflex are more emphasized than other areas. When I first encountered the DNA-V model, I had thoughts such as, “This doesn’t make any sense. I can already tell I’m not going to like this.” However, I stepped into my Noticer space to realize that my Advisor was overprotecting me from a new idea that might be helpful to my adolescent clients. I then tried to be adventurous (by moving into Discoverer mode) and took action to learn more about these potentially useful and fun metaphors.
While exploring, I learned that values lie at the heart of the DNA-V model, which invites teens to regularly check-in and notice if they are listening to and working towards the most important parts of their lives. To facilitate this process, various modes of being are available, including the Discoverer, Noticer, and Advisor. The client’s goal is to learn to move between these spaces in order to gain more flexibility. In the session, the client is asked to walk into the different areas, which are labeled on the floor with pieces of paper. This on-going movement helps teens to realize that they can choose to move into one of these spaces at any time at their own discretion. The Discoverer space involves risk taking, adventure, exploration, movement and action towards values. In this mode, teens can grow and develop by taking up a new hobby, making a new friend, or learning about a subject that interests them. Next, the Noticer space is similar to mindfulness with a particular focus on noticing body sensations, emotions, and thoughts from the Advisor. Within this space, teens are better able to appreciate life around them and also slow down in order to make well thought out (rather than impulsive) decisions. Finally, the Advisor is akin to the Mind metaphor, which is often used in the traditional hexaflex model. The Advisor helps teens to stay safe and to learn useful information efficiently; however, the Advisor sometimes leads teens to be inflexible and rigidly follow rules as well. One of the main goals of ACT is teach teens to partner with their Advisor when it is being helpful and to step away from their Advisor (into another space) when it is leading to inflexibility.
Initially, it might appear that this model is dissimilar from the ACT hexaflex. However, upon closer examination, we find that the same ACT processes are present, but packaged in a more client-friendly way. Acceptance and defusion involve using both the Advisor and the Noticer, while contact with the present moment and committed action use all three areas (Discoverer, Noticer, and Advisor).
Outside of the circle lies the Self Context and the Social Context. The Self Context is similar to the self as context from the hexaflex, but the Social Context is a new area that is developmentally helpful for adolescents (and possibly adults as well). The Social Context includes a focus on attachment and social groups. I consider this to be a built in value that encourages the development of social skills to help create stronger social networks.
Ultimately, the DNA-V model is more developmentally appropriate for adolescents than the hexaflex model. DNA-V includes two key developmental components, the Discoverer and Social Context. Adolescents are encouraged to actively explore their environment, try-on different values, and experiment with different kinds of behavior. Further, they are invited to attend to their social network, which is a very powerful and healing force for this age group. Most importantly, this model includes metaphors and activities that involve movement, play, and silliness. During therapy, teens are moving around the room and sitting on the floor to engage in experiential activities. As adolescents become adults, it is important for them to remember and nourish the little kid that is inside each of us. For more detailed information on the DNA-V model, please explore Louise Hayes’ (2015) book cited below.
Citations
Hayes, S.C., Luoma, J., Bond, F., Masuda, A., and Lillis, J. (2006). Acceptance and Commitment Therapy: Model, processes, and outcomes. Behaviour Research and Therapy, 44, 1 - 25.
Hayes, L. L., & Ciarrochi, J. (2015). The Thriving Adolescent: Using Acceptance and Commitment Therapy and Positive Psychology to Help Teens Manage Emotions, Achieve Goals, and Build Connection. New Harbinger Publications.