Acceptance and Commitment Model of Borderline Personality Disorder

Acceptance and commitment therapy (ACT) is one of the novel modalities that was developed as the third wave of cognitive and behavioral therapies, which was built on the traditional behavior analysis and is one of the most documented and experimentally supported psychotherapeutic approaches named contextual therapies. ACT is founded on a pragmatic philosophy of science named functional contextualism, and the preliminary foundation of ACT is based on a relational frame theory. The ACT psychological flexibility model comprises six subprocesses, including acceptance, defusion, flexible attention to the present moment, self-as-context, values, and committed action, as well as being open and active. Since ACT is still a relatively newer treatment approach, less research has been done on its tenets and effectiveness in treating BPD. Experiential avoidance strategies are applied by patients with BPD to change unpleasant internal experiences, encompassing self-injury, denial, distraction, substance or alcohol use, and thoughts and emotion suppression. BPD symptom severity has a significantly stronger association with experiential avoidance compared to emotion dysregulation and/or distress tolerance issues. Patients with BPD experience high rates of cognitive distortions, such as dichotomous thinking and overgeneralization, due to their distress. Furthermore, six core pathological processes contributing to the development of psychological inflexibility include inflexible attention, disruption of chosen values, inaction or impulsivity, attachment to conceptualized self, cognitive fusion, and experiential avoidance. Individuals with BPD use experiential avoidance strategies to avoid acute negative internal experiences, including self-injurious behaviors, denial, distraction, substance or alcohol use, and thoughts and emotion suppression, all of which can result in increasing distress over the long term.