According to the ACT model disability is not primarily an aggregated result of symptom burden, distress and limitations in the environment, but heavily relies on the individuals course of action in relation to symptoms, distress and the life they want for themselves. In this model the capacity to live a rich and rewarding life is not dependent on the absence or reduction of tinnitus symptoms or distress (Wicksell, 2009). The model suggests that a primary source of human suffering is the way verbal and rule-‐‑governed behaviour interact with direct contingencies to produce psychological inflexibility (Hayes et al., 2006). This is the case when behaviour is guided by derived verbal rules (cognitive fusion) such as ”In order to be happy I must get rid of my tinnitus” narrowing down the behavioural repertoire by promoting behaviours devoted to control, diminish or abolish tinnitus (experiential avoidance). Further, as ”getting rid of tinnitus” for most people is not possible today, following the logic of the verbal rule, this means that ”being happy” is not possible. Through cognitive fusion and experiential avoidance controlling tinnitus can become a superior goal to living a valued life. As a result people may become so caught up with their tinnitus that they are no longer as committed to moving towards valued ends. In the ACT-‐‑model the individual’s level of functioning refers to their ability to act effectively despite the presence of tinnitus and negative thoughts and emotions (Wicksell, 2009). This ability is asserted in ACT through practicing acceptance of tinnitus and related reactions, finding ways of undermining fusion with hindering tinnitus related thoughts (defusion), identifying and stating important personal values and life goals, and having the patient commit to taking steps in the outlined direction. The treatment outcome in ACT is thought to be achieved through the processes of acceptance, defusion and values based action.
Linköping Studies in Arts and Science No. 547
Studies from the Swedish Institute for Disability Research No. 40 Linköping University
Department of Behavioural Sciences and Learning Linköping 2011