ACT (Acceptance and Commitment Therapy) Reviews and Experiences

ACT (acceptance and commitment therapy) is a behavioral therapy promoted at the highest levels of academia by psychologists who have lots of influence in the NIH/VA. It does not seem this behavioral approach rose to the spotlight because of patient advocacy. Rather psychologists lobbied the NIH to get ACT where it is today. The actual people suffering did not influence this process.

ACT's core principle and assumption is to separate pain (noxious stimuli) from suffering (behavior/mental aspect) as well as teach the sufferer aspects of CBT and positive goal oriented behavior. There is nothing wrong with CBT in principle, but this ignores the role of suffering in the person's life, it seems to just be focused on disciplining the person that suffering is irrelevant.

In my opinion ACT's core arguments are based on bad reasoning, the power of persuasion and economics (to take people off disability who need it). Just because ACT is recommended by doctors, therapist and everyone in authority, doesn't mean it's good. Bad ideas can infiltrate at the highest level of academia and it takes brave people to stand against them. Tinnitus Talk represents brave lay people who want biological sciences to advance so we can one day see progress in the field of tinnitus, noise induced pain, hearing loss and distorted hearing.

Why can't patients choose a grant goes towards biomedical research or to the 20th century behaviorist? If patients could VOTE whether grants go to funds biomedical research or more of the same ad nausea behaviorist, I think they'd choose the biologist. Arm chair psychologists shouldn't be competing with serious biomedical scientist and that seems to be the case.

I hope this post makes a constructive discussion on ACT and what role it plays in the tinnitus sufferers' life.

 

It's the cart before the horse. Without subjecting research subjects unduly, you need to identify more broadly over different frequencies and amplitude and duration, how much sound at a given frequency and amplitude is easily, or less easily, or not easily handled. If you can create an approximation of a general measure and know its variance of acceptability than understanding any indirect treatment that involves acceptance of a condition would be much more reasonable.

Certainly anything that works is good. I'm all for that. Science needs generalizations, and psychology labs at universities have been working for decades in the arena of science. Of course psychology of an individual human brain is even better than social interactions, e.g. economics, because brains have evolved to a fairly specific organism. Human brains in general have a lot in common.

OK, that's just my take. My expertise is limited. My work in a psychology labs was as a programmer while I was a graduate student.

 

"ACT's core principle and assumption is to separate pain (noxious stimuli) from suffering (behavior/mental aspect) as well as teach the sufferer aspects of CBT and positive goal oriented behavior."

Is that even possible?

 

Psychologists outnumber biomedical researchers by a long shot. It seems there is a lot more "research" on CBT and ACT, then regenerative medicine or understanding deep biological sciences. It only makes sense the larger community (psychologists) is better at lobbying for grants. It is also much cheaper and holds clinical value unlike research in a lab on mice that doesn't have clinical applications (yet).

A highly specialized scientist holding a Ph.D in biomedicine, biochemistry, or another biomedical specialty is going to be a very rare discipline. That's the literal definition of an highly specialized scientific discipline that meets the qualifications of the word "elite". I don't know the statistics, but it's obvious psychologists outnumber them by a long shot. No one can accuse me of being a conspiracy theorist because it's obvious the higher skill ceiling career is going to be rarer.

ACT and TRT originated from 20th century behaviorist. CBT has a mixed origin coming from both Eastern traditions and behaviorist. Biomedical sciences are one of the youngest of all scientific disciplines. We find ourselves in a crude part of human history where medical science has not yet advanced and psychologist following the 20th century behaviorist ideas of B.F Skinner sit at the highest levels of academia acting like they have it all figured out. It feels like people suffering with tinnitus, neuropathy, fibromyalgia or whatever horrible affliction are treated like human cattle on their farm. They lobby for grants while lay people are completely ignorant of this fact.

https://grantome.com/search?q=cbt+pain
https://grantome.com/search?q=trt tinnitus
https://grantome.com/search?q=acceptance and commitment therapy
https://grantome.com/search?q=behavioral pain management

Someone smarter than me needs to do the research and find out how much money is spent on biomedical sciences compared to behavioral therapies, for every health problem (tinnitus, nerve pain, IBS) individually and for every era (1990, 2000s, 2010s, 2020s) and see if my criticisms hold valid. I can say with confidence tinnitus "research" had been clowned on by the behaviorist but I don't know if it's the case for every disease.

I just want to be healthy again, if I was healthy I would not be freaking out over the fact that biomedical sciences are in their infancy and elite psychologists fill in the niche. I'll never be able to start classes, get a career or make friends in this damaged shitty biological prison I am forced to live in.

 

I'm amazed The Tinnitus Clinic make the claims they do. Levo, Desyncra, hearing aids, stress reduction. Fair enough, but when you read their website some people will believe they get silence and they an't offer that for sure.

 

They are not just putting psychology before biology. It all boils down to economics. ACT and CBT are cheaper then biomedical research. The reason ACT rose to power is because of the opioid epidemic killing people and it looks better than its alternative (opioids).

Source:
https://www.kpwashingtonresearch.or...kpwhri-3-heal-grants-totaling-over-15-million

Obviously they mean well, but the actual problem has to do with a lack of biomedical science. After the opioid shills lost power, the CBT and ACT shills began. No one takes biomedical sciences seriously. So don't expect scientific progress to be made anytime soon. They were all dozing off in biology class but took B.F Skinner's promise of utopia seriously.

I just want my health back, I wouldn't waste my life criticizing elite psychologists if I had my health back. We could close down the forum and get on with our lives.

 

If you raise awareness for tinnitus, neuropathy or whatever horrible disease that happens to have little attention. It's considered uncouth for we (the lay people) obviously lack medical knowledge.

However It's not just a medical topic it's a biological topic, we are biological organisms and we experience defective biological processes that make our lives miserable. It only makes sense people with bad biology end up asking about damaged body parts and why they have damaged body parts. If you are being tortured by bad biology, your goal will be to find a way to solve the problem, not just shut up and live with it. We should have the right to voice how we feel without censorship.

 

Sounds just like another good ole pseudo treatment, which deals with the effect rather than the cause.
It is then much easier (and cheaper) to shift the blame on the sufferer, should this "therapy" fail.

"He/she wasn't doing it right, wasn't disciplined enough, suffers from mental illness, didn't follow the right protocol"...etc.
They will never admit the fact that some people simply will not get used to this, no matter how much Orwellian double-think they get exposed to.

We need real, actual solutions, not any more of this mental quackery hiding under different acronyms.

We have provided a treatment based on our belief that "everyone can habituate" but the patient is not responding to it.

 

My main issue with some TRT treatments. Having used its basics myself, I have no issues with the psychological approach, but don't go badmouth the patient if it does not have the desired effect: continue the diagnosis on physical levels.

Which, btw, should happen in either case. The psychological "treatments" should be used as support bars while finding out the true cause, so that the patient does not fall into depression (or worse) while the real cure is being worked on.

 

I too believe that the basics could be useful for anyone, if only to ease one's distress. But it shouldn't be presented as a cure or even a real treatment - perhaps to the patient to increase the likelihood of a positive outcome, but the medical community needs to stop pretending it's an actual treatment.

Anything that does not diminish the actual problem isn't a treatment. I don't fear my noise at all. When in silence, it doesn't bother me at all, I notice it, that's it. But that doesn't mean I'm not still suffering, worrying about an uncertain future. Only a cure can genuinely take that away.

It's useful to deal with it from day to day, but we deserve better than this, we deserve better than to be blamed if it doesn't work.

 

I did ACT, and it helped massively, but my main issue was OCD with having tinnitus as one of my obsessions. When ACT reduced my OCD I was able to deal with the tinnitus.

I think ACT really can help to deal with the emotional side. Is it a cure? Nope it ain't.

 

To be fair, ACT and CBT shouldn't be put in the same bag as TRT. TRT was created and aimed squarely at tinnitus (and yes, habituating to the issue is absolutely not the same as solving the issue), while most other psychotherapies are aimed first at depression, anxiety, PTSD, OCD, etc...

I personally applied by myself some techniques from ACT for anxiety and insomnia issues and found them far more useful than anything CBT-related. But this is very personal and probably due to the way my brain works, as CBT aims to show why your issues are due to distortions in thinking (compared to a more objective reality), and my over-analytical brain is very adept at researching and coming up with objective studies confirming the object of my anxiety for example.

ACT takes another approach, more like "Ok, maybe you're right, now what?", where it doesn't try to disprove anymore the object of the anxiety, but to create more distance between where the feeling of "I" , the self, is located, and the anxiety/depression/PTSD object. Not in an attempt to suppress the issue, but to to be able to still move towards your personal goals despite the issues. The idea being that some mental issues are like, internet trolls, the less you feed them, the weaker they become.

It's rooted in Skinner and behaviorism yes, but it's actually far more rooted in my opinion in Buddhism. In fact, you could almost say that ACT is basically Buddhism with a more rigorous framework , and maybe more digestible for westerners.

Many have also observed that it is strikingly similar to Morita therapy, a Japanese form of modern therapy rooted in buddhism and developed in the early 1900s by a Japanese therapist named Shoma Morita.

Now, that said, you'll always find practitioners who will throw psychotherapies at anything, from mental issues to purely biological issues. So I'm not surprised to see it thrown at tinnitus. Will it make your tinnitus disappear? Nope, no psychotherapy can, no more than any psychotherapy can make a cancer disappear. Can it help with the psychological despair associated with it? For some people, it can, to various degrees. But the cancer/ulcer/blindness/bone fracture/tinnitus/whatever still remains, and it won't be solved with any other means than biomedical.

 

Truly outstanding, balanced analysis, Ultra. I'm somewhat envious.

The only reservation I have is quite simply that a tinnitus spike is analogous to real pain, and when a spike of truly astounding levels occurs I have never been able to philosophically remove myself from it's encroaching awareness.

This reminds me of that scene in Kubrick's "Doctor Strangelove", when Jack D. Ripper asks the British Officer Mandrake if he was subjected to torture when he was captured by the Japanese.

"Yes, Indeed I was', he replied.
"Did it break you down", Ripper asks.
"Of course", replies Mandrake, "It did to everyone."

He are some previous observations I posted:

I wonder if the Psychotherapy Community's insistence of the efficacy of TRT and CBT is their last attempt to claim relevance.

Ever since the introduction of Prozac in 1987, their influence and feasibility has shrunken to the point where they are virtually marginalized with so many "methods" discredited.

Several years ago I read that less than 20% of all psychiatrists engage in talking therapy to any degree. (I recall such TRT and CBTish "therapies" as Rational-Emotive, Reality, Client-Centered, Encounter Group, et.al. which have almost no practitioners and are largely historical curiosities).

Before 1987, if you visited a psychiatrist for depression he automatically assumed that your attitude, outlook on life, previous experiences, etc. were the cause of such depression and these factors had to be improved. You were supposed to make a Herculean effort of will to suppress all depressive thoughts, sensations, etc. Clients received such "therapy" for years with no improvement. When the first antidepressant drugs were introduced, many clients had their depressive states lifted within weeks.

This began the demolition of the talking therapy model that was originally instituted by Freud.

In spite of all of the defenders and apologists for TRT and CBT, the one single, galling realization is that they have not yet been rendered as obsolete as in the abovementioned example regarding depression only because no other treatment for tinnitus yet exists.

They resemble squatters who occupy vacant, abandoned buildings and then disappear when a new owner arrives.

The last vacant building for them to occupy is this treatmentless condition.

 

I always compare it a bit with the treatment/training that you can get for arachnophobia. You learn to deal with your anxiety. You learn to face it, and that is the best trick to overcome it.

And again I'm not saying that it works for everyone, although I'm having a spike for a week or something and it's freaking loud at some moments. And yes it causes some 'helpless' feeling, but I just continue my life.

 

To be honest, we have to look at tinnitus as a neurological condition. People who have other neurological conditions, for example Parkinson's or epilepsy, have you seen anybody say it's just a seizure, calm yourself with psychological therapy, or that they are just tremors, you cannot eat nor sleep correctly but you could try CBT... LMAO.

Ain't nobody fooling them around, they receive proper treatment like we should as well

Again another reason why tinnitus is simply often downplayed, because it's just a "noise", isn't it?

I mean sure, for some it is, but for others it can be so debilitating, you can in fact compare tinnitus to Parkinson's or epilepsy. Different severities, different distress/debilitation.

Ridiculous.

 

The other issue going against those with chronic tinnitus is that the majority of cases do get better over time. Google is right about that. Most do have it go away or they have it fade into the background. I have moments where I don’t hear my stuff and when I realize it - it comes right back to remind me that it’s here.

Most get a hiss, and it goes away. My uncle is a drummer. 50 years behind a kit. Finally getting a hiss in his 60s. He’s inconsistent with hearing protection. I’m worse than him right now. I’m only 33. I can be better in a few years. I do think I have one somatic and one acoustic trauma tone each. The somatic is from a straight cervical spine (diagnosed today). The acoustic trauma is a headphones blast I wasn’t ready for.

My cousin had a hiss once. Went away in mere weeks.

My old boss had moderate tinnitus when he was younger that now he never hears unless someone talks about tinnitus. He saw a neurologist about it back when there was no info on it. He’s in his 70s. I made his come to the forefront after a 5 minute talk about the condition. He joked about it. I love that dude. I hope to be like him someday because he’s been through some shit and he’s a saint. I just need the Saint part lol.

Someone I know that I taught a well paying specific skill to him 5 years ago - he had a gun go off in a basement at a party. Horrible tinnitus for “a while.” Didn’t let me know the timeframe and I didn’t want to ask. He said it was horrible twice in the text messages. Only heard it again when he learned I have it when we were texting. He said he just tuned it out over time.

My father has a loud version. Goes to work everyday and never once complains about it. Owns a business. His is age related. I’m teaching him about different types of tinnitus and he gets it. He thought ours were identical.

A lot of people habituate, which reduces the attention to cure this. And a lot of people do get better over time or remit. I’ve dug through some prominent posters history who are gone after a few years - they talk about “I’m getting better” and then a few months later they’re gone. I’m sure being here 24/7 doesn’t help us considering it’s making our limbic system amplify the condition. If you think about it all day it can get louder from stress. When I’m not stressed it’s mild.

Long winded point is most do get better. Long term conditions aren’t common, but it’s well over represented on this forum for an obvious reason. I want a cure because I can’t be in sports anymore. I lost nearly my entire identity as a person in the past 10 weeks. I’m a somebody in a niche field. And people count on me. They’re all hoping I can get better. They can’t lose me to this. But I also know it might be 5 years. We have no idea. But living is where it’s at regardless of how. If homebound for eternity is my fate - then friends and family can come see me and tell me stories about their lives.

We are, however, fortunate that the therapies to truly help are coming. Regeneration and progenitor therapies will work someday. Gene therapy as well. I bet there are people who have a gene to never get tinnitus. The genetic makeup doesn’t allow for it. We’ll be able to all have it someday.

Cognitive therapy won’t be needed in just a few more decades for this affliction ever again. Medicine will get that good.

 

Well, if you get confronted with diseases like Parkinson's or others that have a major impact on your life, psychosocial therapy is often part of your treatment plan. Just to cope with the distress of getting that message.

The son of a former colleague got diagnosed with MS, and became depressed, so they add psychotherapy and antidepressants to the treatment plan. It didn't cure the MS, but made his quality of life more than good enough to continue it without committing suicide...

 

I have just had a conversation with a friend who is a neurologist. The outcome of this conversation was the best treatment is acceptance, to such degree that it would dramatically improve my life!

He calmly and rationally downplayed any talk of treatment or hair cell regeneration. In fact he said hair cell regeneration is 'miles away' and may start to be realised towards the end of my life. I am 48.

When I optimistically showed him the OTO-313 Phase 1 study, he shook his head and said 'acute' over and over again. He was right.

So that left me with the most effective treatment ACT, which since January I have not been able to achieve, partly because I look at the Research News threads a lot and hang onto hope, when the answers do not lie there within the next 15-20 years!

 

Tell him calmly and rationally to go fuck off. Things are changing faster than ever in the research and science community and, even though things involving ears are so slow-paced, it's reasonable to believe that at least one treatment will emerge in the next 5-10 years, if not sooner.

 

@DimLeb, hmm. I think The Michigan Device will pass through Phase 2 and hit the market in <5 years, more likely ~2 years.

That apart, I can only see some Trobalt like (Sound Pharmaceuticals/Xenon Pharmaceuticals) epilepsy type things that may/may not help within 5 years.

In the 5-10 year (early 2030s) band, it's likely some improved cochlear implants will be available using optical light. Who knows, this may render regeneration trials largely obsolete.

I just think the development of technology will outstrip biology.

So, for now, it is ACT or mood drugs.

 

Did you ask your friend about XEN1101? He may be right about hair cell regeneration, but what about potassium channel modulators and DBS?

Acceptance is not acceptable for some. Some people are literally dead men or women walking. Their lives are ruins and reflections of bygone memories. We wouldn’t tell an epileptic to accept their condition, or someone with chronic migraines, or someone with severe back problems, even. These docs that push acceptance are tone deaf to the realities of true suffering. Someone that has severe noxacusis and tinnitus that causes sensations of pain can’t just accept their conditions. Because acceptance means that the person has to live with the fact that they can’t live basically. Extreme nox and tinnitus make you incompatible with this world, so much so that even performing the bare essentials of life becomes almost impossible. I can guarantee you that your buddy wouldn’t be preaching acceptance if he was in my shoes. Because if he did, he’d have to willingly give up his job as a neurologist, isolate himself from family and friends, and never leave his house. Plus, he’d have to wear protection for large portions of the day and listen to screaming tinnitus that causes sensations of physical pain. He’d have to surrender his pride and manhood, and become something less than human — a shell of the person he once was. He’d have to accept that his remaining days on this earth would be spent mourning the past and dreaming about an impossible future. Does that sound acceptable?

 

I think most people who regularly look at the Research News threads of Tinnitus Talk are in a lot of pain and suffering, myself included.

I understand, tinnitus can be horrible. So all reason goes out the window. I think it’s better we try to just get through as best we can and then, if a treatment comes along, it’s a bonus. It’s not easy to do!

I wake up and before my eyes open, the sound of loud screaming bilateral tinnitus greets me. You can go back over the Research News threads 10 years ago and it’s exactly the same things being said - we will have treatments soon and this will all be cured within the decade. None of it happened. I just feel we can’t live in that world without it affecting our psyche negativity.

 

My friend, brother, you are, unfortunately, very right.

I pray our lives will pass away quickly, or dare I say, what remains of our once existing lives.

 

I agree man. My favorite saying about the medical field is "a cure is just 10 years away" --- every 10 years of course.