Acceptance and commitment therapy — structured clinical viva

Markers want a consultant-level account of ACT as third-wave contextual therapy aimed at psychological flexibility, coherent formulation of waiting-for-symptom-elimination as avoidance/fusion, hexaflex processes with techniques, fair evidence (metas + quality caveats), CBT comparison without brand warfare, and combined care rather than forced medication stop.[1][2][3][4]

Third-wave/contextual CBT (Hayes lineage) targeting psychological flexibility: contact the present as a conscious person and change or persist in behaviour when doing so serves valued ends — not primarily erasing private events.[1]

Acceptance; cognitive defusion; present-moment contact; self-as-context; values; committed action.[1]

Control agenda / experiential avoidance: life (club, friendships) postponed until emptiness and self-criticism disappear — short-term protection, long-term isolation and depression maintenance.[2] Fusion with rules such as "I cannot rejoin until thoughts stop." ACT response: willingness + defusion + values-based committed action (graded return to club) while thoughts may still occur.[1]

No. Present-moment skills are one process; ACT also requires acceptance/defusion, self-as-context, values, and committed action. Mindfulness apps alone are not ACT fidelity.[1]

Hayes 2006 process model; Powers 2009 and A-Tjak 2015 metas (benefit vs inactive controls; often comparable to established treatments in several comparisons); Öst 2014 critical update (efficacy with methodological caveats); Bai 2020 depression synthesis; disorder-specific lines (anxiety comparative, OCD Twohig, psychosis Bach/Gaudiano/Shawyer as adjunctive contexts).[1][3][4][5][6]

No. ACT is compatible with antidepressants; combined care is common for moderate–severe depression. Do not unsupervised stop; review response, side effects, and duration with the prescriber while starting values-based behavioural work.[1][6]

Acute high suicide risk needing containment, mania, delirium, medical emergency, severe intoxication — stabilise first. Also reconsider modality when formulation demands specialised trauma-focused protocols or full DBT programme structures.[1]