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Acceptance and commitment therapy (ACT, Hayes, Strosahl, & Wilson, 1999) is one of several behavior therapies that place a significant emphasis on acceptance and mindfulness practices (Hayes, 2004; Hayes, Follette, & Linehan, 2004). Acceptance and mindfulness practices in ACT involve "the conscious abandonment of a direct change agenda in the key domains of private events, self, and history, and an openness to experiencing thoughts and emotions as they are, not as they say they are" (Hayes & Pankey, 2003, p. 5). ACT is based on an articulated model of psychotherapy wherein mindfulness- and acceptance-based practices and behavior change strategies coalesce to enhance psychological flexibility (Hayes, Luoma, Bond, Masuda, Lillis, 2006). There have been a number of promising clinical trials suggesting the efficacy of ACT, that indices of psychological flexibility change with treatment, and, in some cases, that these changes in flexibility served as a mediator of outcome (Hayes et al., 2006). Such data support links between multi-component ACT packages, psychological flexibility, and outcome, but do not speak to what aspects of ACT were influential. Thus, the value of the various treatment components in the ACT model are left open to question, with the role of the acceptance-based practices often representing a point of focus in the debate (Arch & Craske, 2008). With respect to negative thoughts, ACT emphasizes cognitive defusion (Hayes, 2004). In cognitive defusion no attempt is made to change the content or frequency of negative thoughts. Instead, the focus is on changing how the individual relates to his/her thoughts, such that thoughts are not taken literally, as statements of truth or fact, but rather simply represent verbal activity. For instance, if "I'm a loser" is taken literally it will likely have undesirable functions, such as eliciting emotional discomfort, decreasing motivation to engage in approach behavior and promoting avoidance behavior (e.g., "Why call anyone, no one wants to hang out with a loser"), and occasion other negative self-talk that further emphasizes the importance of cognitive content (e.g., "Only real losers have the thought 'I'm a loser'") or validates belief in the original cognitive content (e.g., "Here I am sitting home on a Friday night, what a loser"). However, if "I'm a loser" can be experienced as what it is (i.e., a thought) and not what it is says it is (a statement of fact about the self) the unhelpful functions of the thought may be reduced without any attempt to alter the frequency or content. It is not that the individual no longer has the thought, but when it occurs its negative inhibitory functions are reduced, promoting increased psychological flexibility, the general goal of all the ACT strategies (Hayes et al., 2006). Defusion is a part of all ACT interventions and a number of successful protocols emphasize defusion (see Bach & Hayes, 2002). Top-down dismantling studies, demonstrating that defusion is an active component in successful ACT interventions, have yet to be conducted. Dismantling studies require large samples and substantial resources to conduct. As such, studies working from the bottom-up, examining whether specified techniques produce predicted changes can help fill the gap. This bottom-up approach is consistent with calls for identifying evidence-based techniques or "kernels"--specific procedures that are shown to influence a variable of interest (Embry & Biglan, 2008; O'Donohue & Fisher, 2008). According to the ACT model, cognitive defusion techniques should influence psychological flexibility (Hayes et al., 2006). ACT offers a wide range of strategies for defusing from negative thoughts (see Hayes et al., 1999; Hayes & Smith, 2005). The strategy with the most empirical support is Titchener's repetition, one of the vocalizing techniques, which involves saying a word aloud over and over again with increasing rapidity for a period of about 20-30 seconds. …

Cognitive defusion for psychological distress, dysphoria, and low self-esteem: A randomized technique evaluation trial of vocalizing strategies.