**1.10. Acceptance and commitment therapy**

The theoretical basis of ACT is a relational frame construct that is a behavior analytic theory of language and cognition [27]. It focuses on understanding behavior through linguistic contexts or frames. It also includes techniques designed to promote mindful awareness of internal experiences. ACT aims to promote namely the improvement of orientation to experience and cognitive defusing that is a shifting of mental contexts by cultivating patient's awareness of awareness to allow them to view thoughts as thoughts and not as facts [27, 28]. Dalrymple and Herbert [48] conducted ACT for SAD patients. Nineteen individuals diagnosed with SAD participated in a 12 weekly 1 h program integrating exposure therapy and ACT. The results revealed that significant improvements occurred in self-reported social anxiety symptoms, yielding large effect size gains (ES = 0.72 on the Liebowitz Social Anxiety Scale-Fear, ES = 1.24 on the Liebowitz Social Anxiety Scale-Avoidance). In another study by Ossman et al. [49], individuals (N = 22) diagnosed with SAD participated in 10 weekly 2 h sessions of ACT. Here, ACT produced significant reductions in self-reported social anxiety symptoms (ES = 0.82 on the Liebowitz Social Anxiety Scale-Fear and ES = 1.71 on the Liebowitz Social Anxiety Scale-Avoidance).
