I'm going to speak with Steve Hayes about how a panic attack inspired him to develop acceptance

and commitment therapy, one of the most widely used therapies in practice today.

Welcome to the Carlatte Psychiatry podcast.

I'm Chris Aiken, the editor-in-chief of the Carlat Psychiatry Report, and our co-host, Kelly Newsome, is out today.

In 1999, Guilford Press released acceptance and commitment therapy, an experiential approach to behavior change.

The 300-page book by Steve Hayes, Kirk Strosol, and Kelly

Wilson presents an approach to psychotherapy that was 20 years in the making, carefully constructed

from lab-tested ideas. Ideas like psychiatric disorders are not driven by negative thoughts,

but by our relationship to those thoughts, whether we

accept or avoid them, and how closely we identify with them. Are we tied down by the excruciating

logic of our minds? Or can we step back and watch our thoughts flow by like boats on a river, sometimes entertaining,

sometimes alarming, but rarely carrying the truth.

Acceptance and commitment therapy, or act, spread quickly after the book's release.

Around a million therapists have trained an act, and the books have sold over 13 million

copies translated into 28 languages and supported by about a thousand trials. Act has a wide reach,

and its origins are broad as well. Although it challenged some of the ideas of cognitive behavior

therapy, Act also built upon CBT. Act has roots in a theory of language that Steve Hayes developed

in the 1980s, a theory that proposes that children learn words through associations, and from those associations, they build abstract systems

that allow us to solve problems, make plans and rules,

and navigate our way through the world.

The problem is, we also have a stubborn tendency

to cling to these abstract rules,

...