ACT (Acceptance and Commitment Therapy) Therapy

What Is Acceptance and Commitment Therapy?

Acceptance and Commitment Therapy, usually called ACT, is a practical form of psychotherapy that helps people respond more flexibly to difficult thoughts, feelings, memories and body sensations. It was developed by psychologist Steven C. Hayes and is grounded in behavioral science, relational frame theory and functional contextualism. ACT is often called part of the third wave of cognitive behaviour therapy. It builds on earlier behaviour therapy and cognitive behaviour therapy. It focuses more on acceptance, mindfulness, values, and committed action. Rather than trying to remove all negative thoughts, ACT helps people change their relationship with them. A person learns to notice painful inner experiences, reduce experiential avoidance and take values-driven actions even when anxiety, sadness, shame, uncertainty or automatic thoughts are present.[1][2][3]

1. The Main Aim of ACT: Psychological Flexibility

The central aim of ACT is psychological flexibility. This means being able to stay in contact with the present moment, open up to difficult inner experiences and choose behaviour that serves valued ends. In everyday life, people often become stuck because they treat thoughts and feelings as problems that must be solved before they can act. Someone may wait for confidence before applying for a job, calmness before attending a social event or motivation before rebuilding routines during depression. ACT takes a different approach. It asks whether the struggle to control inner life has become part of the problem. When people spend all their energy trying to suppress anxiety, panic attacks, cravings or negative thoughts, their world can become smaller. ACT helps them make room for discomfort while moving toward what matters.[1][2]

This does not mean ACT teaches people to tolerate harmful situations or ignore real problems. Acceptance in ACT is not resignation, approval or passivity. It means recognising when fighting internal experiences is no longer workable. A therapist might help a person notice how avoidance has shaped their life: avoiding conversations, decisions, relationships, physical activity, work tasks or memories. This process is sometimes linked to creative hopelessness, where people compassionately examine whether their old coping strategies have delivered the life they want. From there, ACT shifts the focus to values clarity. Instead of asking only, “How do I get rid of this feeling?” the person asks, “What kind of person do I want to be here, and what action would reflect that?”[1][2]

2. Cognitive Defusion, Cognitive Fusion and Being Present

One of ACT’s most important ideas is cognitive fusion. Cognitive fusion happens when a person becomes so entangled with thoughts that the thoughts seem like facts, commands or threats. A thought such as “I will fail,” “I can’t cope,” or “Everyone will judge me” may begin to control behaviour as though it were reality. ACT uses cognitive defusion to create distance from these thoughts. Some people informally describe this as metacognitive defusion, because it involves noticing the mind from a more observing perspective. More commonly, ACT literature refers to cognitive defusion, cognitive distancing or distancing techniques. These methods do not require people to argue with every thought. Instead, they help people recognise, “I am having the thought that I will fail,” and then choose what to do next.[1][2]

Being Present is another core ACT process. It involves returning attention to what is happening now rather than being pulled endlessly into past regrets, future worries or mental problem-solving. ACT shares some territory with mindfulness-based cognitive therapy, because both approaches use mindfulness to help people observe thoughts and feelings with less reactivity. However, ACT is especially focused on whether behaviour is moving a person toward or away from their values. A therapist may guide the person to notice the breath, sounds, posture, emotions or urges, then practise responding with awareness rather than automatic avoidance. This can be useful for anxiety disorders, panic attacks, depression, cravings, chronic pain and stress, where automatic thoughts and body sensations often trigger unhelpful coping patterns.[2][4]

3. Values Clarity and Values-Driven Actions

Values are central to ACT. They are not the same as goals. A goal can be completed, such as finishing a course, making an appointment or running a race. A value is an ongoing direction, such as courage, honesty, learning, compassion, family, contribution or health. Values clarity helps people identify what they want their life to stand for, especially when fear or emotional pain has narrowed their choices. Russ Harris, one of the best-known ACT educators and author of popular ACT books such as The Happiness Trap, often explains ACT in very practical terms: open up, be present and do what matters. This is a useful summary because ACT is not only about feeling better. It is about living better, even when difficult feelings remain.[5]

Values-driven actions are the behavioural expression of ACT. Once a person has clarified what matters, the work becomes practical. Someone who values connection might send a message despite social anxiety. Someone who values health might attend physiotherapy despite frustration about chronic pain. Someone who values parenting might pause during anger and choose a more caring response. These actions do not need to be dramatic. ACT often begins with small, repeatable steps that gradually rebuild trust in one’s own behaviour. Committed action can include planning, facing fears, forming habits, solving problems, speaking assertively, or returning to meaningful activities. The key question is not whether the action removes discomfort immediately. The key question is whether it moves life in a valued direction.[1][2]

4. What ACT May Help With

ACT has been studied across a range of mental health and physical health problems, including anxiety disorders, depression, substance use disorders, chronic pain and stress-related difficulties. Studies show ACT can work better than usual treatment or placebo for some important problems. It may be about as effective as other well-known psychological treatments for several conditions. However, the evidence is not identical for every problem, and ACT should not be presented as a universal cure. Its strength is that it targets processes common to many forms of suffering: experiential avoidance, cognitive fusion, disconnection from values and rigid behaviour. For this reason, ACT is often described as a transdiagnostic therapy rather than a treatment designed for only one diagnosis.[6][7]

For panic attacks and anxiety, ACT helps people change their response to fear sensations and catastrophic thoughts. For depression, it can help people reconnect with meaningful routines when motivation is low. For chronic pain, ACT does not claim that pain is imaginary or that people should simply endure it. Instead, it helps people reduce the degree to which pain dominates identity, behaviour and quality of life. NICE guidance for chronic primary pain includes psychological therapies such as ACT or CBT when delivered by trained professionals. ACT may also be used alongside other care for trauma-related symptoms, eating problems or substance use disorders, but people with severe trauma, suicidal behaviour, domestic violence or immediate safety risks need appropriately specialised and urgent support.[8][9]

5. What Happens in ACT Therapy?

ACT sessions are usually active, collaborative and experiential. A therapist may ask what the person has been struggling with, what they have tried so far and whether those strategies have worked in the long term. Sessions may include mindfulness exercises, clarifying values, cognitive defusion, metaphors, behavioural experiments, and planning committed actions. For example, the therapist may ask the person to repeat a difficult thought slowly, write it down, sing it, label it as a thought, or imagine it as background noise. These distancing techniques are not intended to make light of suffering. They are designed to reduce the dominance of language so the person can act with more freedom. ACT can be used in individual therapy, group therapy, health settings, workplaces and guided self-help programs.[1][2][10]

ACT is best understood as a practical framework rather than a single script. It can be used with other proven methods. These include cognitive behaviour therapy, mindfulness-based cognitive therapy, trauma-focused therapies, medication, pain management programs, and lifestyle changes. A qualified psychologist, counsellor or other trained health professional can help decide whether ACT is appropriate for a person’s needs. Its appeal is that it offers a realistic form of hope. It does not promise a life without pain, uncertainty or difficult emotions. Instead, it teaches people to notice thoughts, open up to feelings, clarify values and take workable action. In that sense, ACT asks a deeply human question: “Given that life is difficult, how can I still move toward what matters?”[1][3][4]

Key Footnotes on Acceptance and Commitment Therapy Concepts

[1] Hayes, S. C., Strosahl, K. D. & Wilson, K. G. Acceptance and Commitment Therapy: The Process and Practice of Mindful Change. This is a foundational ACT text explaining psychological flexibility, acceptance, defusion, values and committed action.

[2] Hayes, S. C. et al. “Acceptance and Commitment Therapy and Contextual Behavioral Science: Examining the Progress of a Distinctive Model of Behavioral and Cognitive Therapy.” This peer-reviewed article outlines ACT’s six processes and its contextual behavioral science foundations.

[3] Smout, M. “Acceptance and commitment therapy – pathways for general practitioners.” Royal Australian College of General Practitioners. This is a useful Australian clinical overview of ACT for primary care and health professionals.

[4] NICE. Depression in adults: treatment and management. This guideline talks about mindfulness-based cognitive therapy. It is a structured mindfulness-informed treatment for depression..

[5] Harris, R. The Happiness Trap and ACT Made Simple. Russ Harris is one of the most widely read ACT educators, especially for practical explanations of values, defusion and committed action.

[6] A-Tjak, J. G. L. et al. “A meta-analysis of the efficacy of acceptance and commitment therapy for clinically relevant mental and physical health problems.” Psychotherapy and Psychosomatics. This meta-analysis supports ACT’s efficacy compared with treatment as usual or placebo for several clinical problems.

[7] Powers, M. B., Zum Vörde Sive Vörding, M. B. & Emmelkamp, P. M. G. “Acceptance and commitment therapy: a meta-analytic review.” This review found ACT more effective than control conditions, while noting that it was not clearly superior to established treatments.

[8] NICE. Chronic pain primary and secondary in over 16s: assessment of all chronic pain and management of chronic primary pain. This guideline includes psychological therapies such as ACT and CBT as options for chronic primary pain.

[9] World Health Organization. Doing What Matters in Times of Stress: An Illustrated Guide. This WHO stress-management resource is informed by ACT principles and designed for practical coping with adversity.

[10] Lifeline Australia. “Acceptance and commitment therapy.” This consumer-facing Australian resource explains ACT in accessible language, including acceptance, mindfulness and values-based action.