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What is Acceptance and Commitment Therapy (ACT)?

by | Aug 17, 2021

Acceptance and Commitment Therapy (ACT)

Leigh Fisher, LMSW primarily utilizes a therapeutic treatment called Acceptance & Commitment Therapy in her work. 

Acceptance and Commitment Therapy, known as “ACT” (pronounced like the word “act”) is a mindfulness-based behavioral therapy that utilizes a mix of metaphor, paradox, and mindfulness skills, along with a wide range of experiential exercises and values-guided behavioral interventions. In research studies, ACT has proven effective with a wide-range of clinical conditions, including depression, anxiety, OCD, workplace stress, chronic pain, the stress of terminal cancer, anxiety, PTSD, anorexia, grief and loss, substance use, and even in severe and persistent disorders such as schizophrenia. 

ACT starts from the premise that we are stuck, NOT broken.

What if you could:

  • Live a life based on what you find meaningful and valuable.
  • Be willing to experience and manage difficult emotions.
  • Respond rather than react to challenging thoughts, feelings, situations, and memories.
  • Become mindful of and find peace in the present moment.
  • Learn how to allow for and accept life’s challenges as a part of the shared human condition.

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 psychologist Dr. Carl Jung that says, “whatever you resist, persists”.  Meaning, 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 increased intensity.  Think of yourself pushing a beach ball down into the ocean over and over again.  Every time you let go, it pops back up again.  You will waste a great deal of time and energy always trying to keep that ball underwater.

We may use food, substances, toxic relationships, isolation, avoidance, anger, and other maladaptive coping strategies to try and not feel the extreme discomfort of our life experiences. 

These strategies work, until they don’t.  And, they can create long-term negative consequences for us.  For example, an individual who thinks that everybody is always judging them (mostly because they are judging themselves!) 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, it leads to social isolation in the long term.

In ACT, the aim is not to try and avoid or change the content of the distressing thoughts, or to ignore the difficult feelings that result; rather, it is to help you create space for your thoughts and feelings and allow yourself the opportunity to understand what you really need in the moment.  This change in perspective, from avoidance to a willingness to allow for difficult thoughts and feelings, can help you begin to live your life in a way that is important to you and put yourself back in the driver’s seat of how you respond and act.  We refer to this moment as a “choice point”.  And fortunately, we have many, many opportunities for choice points throughout the day.

ACT has Two Primary Goals: 

The first is to help you create a rich, full and meaningful life. To do that, we’ll need to spend some time talking about what you really want out of life.  We will figure out what is important and meaningful to you, clarify what your values are, and better understand how you want to present yourself as you move through this life.  Based on these insights, we’ll set goals and learn new tools to allow you the space to identify and develop a sense of meaning and purpose in your life.

 The second is to teach you how to be in the present moment and utilize mindfulness 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 with 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 use identify our self-defeating habits or destructive patterns of behavior and finally loosen the grip of our lifelong automatic negative thoughts.

An important piece of this therapy involves your learning the present moment/mindfulness skills in session, and then taking them home and practicing them “in-vivo” between sessions. The more you practice, the more benefits you’ll get.  

ACT is also a type of exposure therapy.  What this means is that in some sessions we will need to bring up and talk about some of those painful thoughts, feelings, memories, sensations and urges during the session so that you can practice using the present moment/mindfulness techniques.  Because of this, at times this therapy may be very challenging.  However, we will work together to ensure you feel safe, grounded and supported. 

There are six core processes in ACT:

  1. 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, learning to ground ourselves in our bodies, and practicing self-compassion, just to name a few.
  2. Defusion means learning to step back or detach from unhelpful or intrusive thoughts.  Instead of getting caught up in your thoughts, or pushed around by them, or struggling to get rid of them, you learn how to let them come and go.  You will 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. 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.
  4. Self as Context (The Observing Self”) is the part of you that is responsible for awareness and attention. We don’t have a 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 or judgmental perspective. This “observing mind” is a critical component in mindfulness. The more you practice the 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 you find meaningful in your life.  They are the things your stand for at your core.  What kind of person would you like to be in the world, and what would like to be remembered for by the people you love?  Those are your values.
  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.

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.  In other words, it’s the ability to be present, open up, and do what matters.

It can be helpful to remember…

Pain is a part of being human.  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

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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