What is Acceptance and Commitment Therapy (ACT)?

What if you could learn to:

  • Live a life based on your values and what you find meaningful and purposeful.
  • Be willing to experience and manage difficult emotions, not just push them away.
  • Respond rather than react to challenging thoughts, feelings, situations, and memories.
  • Become mindful of and find peace in the present moment.
  • Allow for and accept life’s challenges as a part of the shared human condition.

Acceptance and Commitment Therapy, known as “ACT” (pronounced as the word act), is an empirically supported, cognitive behavioral intervention that is designed to help individuals increase their psychological flexibility.  Instead of aiming to push away, ignore, resist, or eliminate distressing thoughts or emotions, ACT focuses on changing the relationship one has with their thoughts. Rather than challenging or disputing negative thoughts, ACT teaches individuals to accept them while committing to behaviors aligned with their values.

Developed in the 1980s by psychologist Steven C. Hayes, ACT has over 3000 published studies and has gained significant stature as an evidence-based practice that can be utilized across a wide range of psychological conditions (see appendix A for a description of conditions and links to the research).  

The basis of ACT is grounded in Relational Frame Theory (RFT), a behavioral theory that explains how the language we choose to use with ourselves and others, as well as our cognitive reasoning, contribute to our overall emotional and psychological health.

ACT is also a type of Exposure Therapy.  What this means is that in some sessions we may directly explore some of the painful thoughts, feelings, memories, sensations and urges you experience in your daily life so that you can practice using the new tools you are learning in a safe and supportive environment.  Because of this therapy may be very challenging at times.  However, we will work together to ensure you feel safe, grounded, and supported. 

ACT starts from the premise that we may feel stuck, but we are not broken.

The reality is, we often find ourselves trying to move away from our pain, only to create more suffering inside of us. There is an old adage from the renowned psychologist Carl Jung that says, “what you resist not only persists, but will grow in size.”  What he means by this is that the more you resist, or push down, the painful things in life, rather than learning how to be with them and manage them, the more you bring them to you, often with even greater intensity.

Have you ever found yourself trying to avoid or dismiss a difficult thought or feeling, only to find that you brain just won’t let it go? This is often a common human reaction to pain, uncertainty, and anxiety.

The Beachball Metaphor: 

You are playing in the ocean, and everyone is having a great time, but there is this big, ugly beach ball that is floating around and distracting you. At first, you just try to ignore it but, it keeps bumping into you.  You become irritated so you push it under the water to get rid of it, but each time you try to walk away it just pops back up.  So, you push it down again, and again until you realize that you are spending all of your time and energy keeping this ball under water and you are too distracted and exhausted to do anything else.

What would happen if you were to just let go and allow it to float on its own? Sure, it may come back to you from time to time, but if you let it be, it will drift off again. Detached from it, you notice that your relationship to it has changed.  You may find that you are not so annoyed or distracted by it and you can begin to re-engage with the life around you.

Our beachball may be made up of anxiety, depression, anger, stress, rumination, intrusive thoughts, toxic relationships, toxic work environments, etc.  We may respond by trying to push it away through isolation, ignoring feelings of overwhelm or burnout, avoidance.  We may also use other maladaptive coping strategies like food, substances, social media, or video games to distract us so that we can avoid feeling the discomfort of our life experiences. These strategies may work for a while… until they don’t.  And then they can create long-term negative consequences for us. 

For example, an individual who experiences fear and anxiety around the thought that everybody is always judging them may try to control the resulting feelings of inadequacy by avoiding being around people.  Although on the surface this looks like a good strategy to get rid of those difficult thoughts and feelings in the moment, it leads to the even more painful feeling of social isolation in the long term, reinforces the thought that “I am not good enough” or “I am not of value to anyone.”

ACT has two basic goals:

  • The first is to help you create a rich, full, and meaningful life for yourself. To do that, we’ll need to spend some time talking about what you really want out of life.  Based on these insights, you can begin to set some values-based goals and learn a host of new tools that will give you the space to identify and develop a sense of what is truly meaningful and purposeful to you.  Then you can begin to better establish how you want to live your life in accordance with those values.
  • The second is to help you learn how to be in the present moment and utilize evidence-based tools that will allow you to handle painful thoughts and feelings far more effectively, so that you are able to respond rather than react to challenging people and situations.  In a state of mindfulness, painful thoughts and feelings have much less impact or influence on us and we learn to develop a different relationship to them. In a state of mindfulness, we can effectively handle even the most difficult feelings, urges, memories, thoughts, and sensations. This will allow us to identify our self-defeating habits, or destructive patterns of behavior, and finally loosen the grip of our automatic negative thoughts.  The more you practice, the more benefits you’ll gain.

There are six core processes in ACT:

  1. Acceptance means opening up, making room, and allowing for painful thoughts, feelings, and memories. You learn how to drop the struggle with them and let them be there without getting overwhelmed by them. Acceptance is often the first step to long-term healing. “Once we can accept who we are, then we can change” – Carl Rogers, PhD.
  2. Defusion means learning to step back or detach from unhelpful or intrusive thoughts, not just try to push them away (which doesn’t work – remember the beachball metaphor?) Instead of getting caught up in your thoughts, pushed around by them, or wasting time and energy as you struggle to get rid of them, you will learn how to let them come and go. You will learn how to decide what thoughts and feelings are useful in the moment. You will also learn how to take a step back, put a pause in place, and notice your thinking, so you can respond rather than react to challenging situations.
  3. Contacting The Present Moment means being psychologically present: mindfully connecting with whatever is happening right here, right now. It involves having an awareness all your five senses, practicing various forms of meditation, grounding, breathwork, self-care, and self-compassion, just to name a few.
  4. Self as Context (The Observing Self”) is the part of you that is responsible for awareness and attention. We don’t have a specific word for it in our language, so we typically refer to this as our “observing mind.’ There are two sides to mental processes: The first is the “thinking self,” or the part of us that is responsible for all our thoughts, beliefs, memories, judgments, fantasies etc. The second is the “observing self,” which is that part of us that is aware of our thoughts and our feelings from a less attached and non-judgmental perspective. This “observing mind” is a critical component in mindfulness. The more you practice mindfulness skills, the more you’ll notice this part of your mind and will be able to access it when you need it.
  5. Values are the things that guide your spirit towards what is meaningful in your life. They are the things your stand for at your core. This is at the heart of ACT. We can work towards goals but, if we are not working towards goals that are aligned with what your values are and what is meaningful to you, the changes will not stick. As you will learn to identify your values and strengths, you will begin to ask yourself questions like:
    “What kind of person do I want to be as I move through the world?”  
    “How do I want to “show up” in my interactions with others?”
    “Is what I am about to say or do in line with what is truly meaningful to me?”
    “Are my thoughts moving me in the direction of my values and goals?”
  6. Committed Action is the “now what?” part of ACT. It means taking action that is guided by your values and doing what matters, even when it’s difficult or uncomfortable.


All together, these processes help us to develop “psychological flexibility,” which is the ability to be in the present moment, non-judgmentally, with awareness and openness, and to take action that is guided by our values. 

It can be helpful to remember…

  • Pain is a part of being human. Like all thoughts and feelings, pain is information. Without it, we would not know what we need.
  • Although we sometimes feel like we’re the only one struggling, there is a significant number of other people who are struggling with difficult thoughts, feelings, and emotions as well.
  • Our brain tells us that the most logical thing to do when we have a problem is to get rid of it. Although this works well in some situations, our thoughts, feelings, and emotions work differently: we can’t just ‘get rid of them.’
  • Sometimes, our attempts at ‘fixing’ our problems or avoiding them can make things worse.
  • Trying to control negative or intrusive thoughts doesn’t work, but we can control how we respond to those thoughts.
  • NOW is the only time you can BEHAVE in a manner consistent with your values.
  • Psychological flexibility is the ability to adapt to a situation with awareness, openness, focus, and to take effective actions guided by your values. – Dr. Russ Harris
  • Fulfillment does not mean our difficult emotions disappear; it means we change our relationship with them.  – Dr. Russ Harris


Appendix A – ACT as an Evidence-Based Therapy

The effectiveness of ACT has been widely researched and has a strong base of empirical evidence supporting its use across a wide range of psychological conditions. Below are several key areas where ACT has demonstrated efficacy.

1. Depression

ACT has been shown to be effective in treating depression. A comprehensive meta-analysis conducted by A-Tjak et al. (2015) reviewed 39 randomized controlled trials (RCTs) and concluded that ACT demonstrated moderate-to-large effect sizes in reducing depressive symptoms, comparable to other well-established therapies like Cognitive Behavioral Therapy (CBT).

Another study by Zettle and Hayes (1986) was one of the earliest to compare ACT to CBT in the treatment of depression. Results showed both therapies were effective, but ACT showed more lasting benefits in terms of psychological flexibility and overall well-being.

2. Anxiety Disorders

ACT is also effective for treating anxiety disorders, including Generalized Anxiety Disorder (GAD) and Social Anxiety Disorder (SAD). A randomized controlled trial conducted by Arch et al. (2012) compared ACT to CBT for individuals with anxiety disorders. The study found that both treatments were equally effective at reducing anxiety, but ACT showed a unique advantage in enhancing psychological flexibility, a core aspect of mental health.

A systematic review by Swain et al. (2013) further supports ACT’s effectiveness in treating anxiety disorders. This review found that ACT produced significant reductions in anxiety symptoms across multiple RCTs.

3. Chronic Pain

ACT has shown to be effective in helping individuals cope with chronic pain. A meta-analysis by Veehof et al. (2011) reviewed 22 studies on ACT for chronic pain, finding moderate improvements in pain-related outcomes, including reduced pain interference, depression, and anxiety. ACT’s approach of acceptance, rather than attempting to control pain, was linked to better outcomes than traditional pain management strategies.

The study highlights ACT’s potential to improve quality of life for individuals suffering from chronic pain by reducing the impact of pain on daily functioning, rather than focusing on pain reduction alone.

4. Substance Use Disorders

ACT has been successfully applied to substance use disorders. In a study by Luoma et al. (2012), individuals in recovery from substance use who received ACT showed higher rates of sustained abstinence compared to those in a traditional treatment group. ACT’s focus on values and acceptance helped participants achieve more meaningful, lasting changes in behavior.

This evidence supports ACT as an effective intervention in helping individuals overcome addictive behaviors by addressing underlying psychological distress and promoting values-based living.

5. Psychosis

ACT has also shown promise in helping individuals with psychotic disorders. A randomized controlled trial by Bach and Hayes (2002) applied ACT to individuals experiencing psychotic symptoms and found that those receiving ACT had fewer hospitalizations compared to a control group. ACT helped reduce the distress and believability of psychotic experiences, allowing individuals to engage more fully in their lives.

6. Psychological Flexibility as a Mechanism of Change

ACT’s effectiveness can be largely attributed to its focus on increasing psychological flexibility, which refers to the ability to stay present in the moment and adapt behaviors based on personal values, even in the face of difficult thoughts and emotions. Research by Hayes et al. (2013) highlights the role of psychological flexibility as a key mechanism of change in ACT, mediating the positive outcomes seen in various clinical populations.

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About Leigh | View Profile

Leigh is a psychotherapist who specializes in working with clients who experience a wide range of symptoms associated with anxiety, depression, and trauma.  She utilizes mindfulness-based and evidence-based treatments in her practice, including ACT, MBSR, DBT, CBT, and SFBT.

We offer in-person and virtual services – contact us today to learn more!

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