The 6 core pathological processes of ACT, shown above, are fusion, experiential avoidance, inflexible action, remoteness from values. unworkable action, and fusion with self concept. All, or a combination of some of these processes can be used to develop psychological rigidity, which are basically the "flip side" of psychological flexibility. Throughout going through these processes, there will be examples of people with clinical depression to visualize each process.
Fusion
Fusion refers to a condition where our thoughts exert excessive influence over our physical actions and awareness, often to a problematic degree. For instance, during periods of depression, individuals may become fused with various unhelpful thoughts such as "I am inherently bad," "I don't deserve anything better," "Change is impossible for me," or "I am too exhausted to accomplish anything." Additionally, they frequently become fused with painful recollections of rejection, disappointment, failure, or abuse.
In clinical depression, this is often seen through things like worrying, ruminating, or negative commentary: "Everyone else is having a good time here, while I'd just be in bed. I'm not wanted here."
Experiential Avoidance
Experiential avoidance, which involves continuously trying to avoid private experiences like thoughts, emotions, and memories, is the opposite of acceptance. People with depression tend to try very hard to avoid / get rid of painful feelings like anxiety and anger. An example would be the feeling of social withdrawal before going to a friends birthday party. You may have thoughts like I'm boring, I don't have anything to say, I have no energy to go. You then call your friend and tell them you can go because you have the flu. The instant relief of not having to go is there: but that relief doesn't last long, as that relief is soon replaced by hatred: I'm such a loser, I can't even go my friends party. However, that instant relief reinforces the chance of future social withdrawal.
Fusion and avoidance are usually seen together, as people tend to fuse with painful cognitions (ruminate, worry, self criticize) while trying to avoid or get of them (through things like overeating, excessive sleeping, alcohol).
Inflexible Attention
Flexible attention means the ability to consciously contact both your inner and out worlds, calm down, figure out what's important and sustain your focus towards it. On the other hand, inflexible attention refers to having trouble achieving inflexible attention, through the "three D's": distractibility. disengagement, and disconnection.
Distractibility pertains to the challenge of maintaining focus on a particular task or activity, as attention easily shifts to different things. The more distracted we become during any task, the poorer our performance and the less satisfying the experience.
Disengagement involves various ways in which we lose conscious interest or engagement in our experiences: going through motions, acting mindlessly or on autopilot, or displaying boredom, disinterest, or absentmindedness.
Disconnection refers to a lack of conscious awareness of our own thoughts and feelings. When we fail to notice our thoughts or emotions, we lack self-awareness, making it difficult to modify our behavior in adaptive ways. This can lead to emotional dysregulation and impulsive or reactive behavior.
These three elements—distractibility, disengagement, and disconnection from thoughts and feelings—are commonly observed not only in clients with depression but also across various clinical issues.
Remoteness from Values
As our behavior becomes more driven by fusion and experiential avoidance, our values often become overlooked, neglected, or forgotten. When we're unclear about our values or unable to connect with them, we cannot effectively use them as a guiding force for our actions. For instance, individuals who are experiencing depression may lose sight of values related to compassion, connection, contribution, productivity, self-care, playfulness, intimacy, reliability, and more.
In ACT, our goal is to align behavior more closely with our values rather than with fusion or avoidance. Let's consider the distinctions between going to work under these three conditions:
Motivated by fusion with beliefs such as "I have to do this job. It's all I'm capable of."
Motivated by experiential avoidance, aiming to evade feelings of failure or escape unpleasant emotions stemming from marital tension at home.
Motivated by values such as caring, connection, and contribution.
Which form of motivation would bring the greatest sense of purpose or meaning?
Unworkable Action
The term "unworkable action," also known as "away moves," refers to behavior patterns that lead us away from living mindfully and in alignment with our values. This manifests as impulsive, reactive, or automatic actions rather than mindful, deliberate, or purposeful ones. It also includes actions driven by fusion or experiential avoidance rather than by our values, as well as instances of inaction or procrastination when effective action is needed. Common examples of unworkable action in cases of depression (and other disorders) include excessive drug or alcohol use, social withdrawal, discontinuing previously enjoyable activities, excessive sleeping, excessive TV or gaming consumption, and suicidal attempts.
Fusion with Self Concept
We all have a story on who we are; this story being complex and having multiple layers, as well as facts about ourself (name, age), descriptions on the roles we play, the things we enjoy and dislike, and many more. If we have a flexible mindset with this story, it can help define who we are and our goals in life.
When we become fused with our self-concept, it feels as though all those thoughts describing ourselves are the very essence of our identity. We lose the ability to detach and recognize this self-concept as simply a complex cognitive construct—a mixture of words and images. This fusion is often termed "self-as-content".
In depression, individuals typically fuse with a highly negative self-concept, perceiving themselves as bad, worthless, hopeless, unlovable, and so forth. However, "positive" elements may also be present, such as believing oneself to be strong or good. Despite these positive aspects, individuals may question why they're experiencing certain emotions or situations, further adding to their distress.