What Is Acceptance and Commitment Therapy (ACT)?

Table of ContentsView AllTable of ContentsACT Therapy TechniquesWhat to ExpectUsesBenefitsEfficacyThings to ConsiderHow to Get Started

Table of ContentsView All

View All

Table of Contents

ACT Therapy Techniques

What to Expect

Uses

Benefits

Efficacy

Things to Consider

How to Get Started

Close

Acceptance and commitment therapy (ACT) is a type ofpsychotherapythat emphasizes acceptance to deal with negative thoughts, feelings, symptoms, or circumstances. ACT therapy encourages increased commitment to healthy, constructive activities that uphold your values or goals.

“Acceptance and Commitment Therapy (ACT) is a third-wave cognitive-behavioral therapy approach that focuses on helping people accept difficult thoughts, feelings, sensations, and internal experiences while guiding them to commit to values-based actions,” explainsAvigail Lev, PsyD, a licensed clinical psychologist who specializes in acceptance-based treatments.

ACT therapists operate under a theory that suggests that increasing acceptance can lead to increasedpsychological flexibility.This approach carries a host of benefits, and it may help people stophabitually avoidingspecific thoughts or emotional experiences, which can lead to further problems.

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How to Embrace Radical Acceptance

Unlikecognitive behavioral therapy (CBT), the goal of ACT is not to reduce the frequency or severity of unpleasant internal experiences like upsettingcognitive distortions, emotions, or urges. Rather, the goal is to reduce your struggle to control or eliminate these experiences while increasing your involvement in meaningful life activities (i.e., those that are consistent with your personal values).

“ACT (Acceptance and Commitment Therapy) utilizes six processes to help people create psychological flexibility, meaning the freedom to choose our actions regardless of our internal experiences, " Lev explains. She describes the six processes of ACT therapy as:

Identifying Values

These are the areas of your life that are important enough to you to motivate action. It is about recognizing what you want to be about and stand for.

Commitment to Action

This process involves changing your behavior based on principles covered in therapy. These specific actions can either move us closer or further toward our values.

Self as Context or Self as Observer

This involves learning to see your thoughts about yourself as separate from your actions. By doing so, people can make space for their thoughts and feelings without becoming entangled with them, Lev says.

One metaphor asks the client to think of themselves as the sky and their thoughts and feelings as weather patterns. While the weather can shift from clear to stormy, the sky remains the same despite the fleeting nature of the weather.

Cognitive Defusion Skills

Cognitive defusionis separating yourself from your inner experiences. This allows you to see thoughts simply as thoughts, stripped of the importance that your mind adds to them.

Exercises that can help with this include imagining your thoughts on clouds and then watching them drift away, making connections between thoughts and values, or singing thoughts in silly voices.

Acceptance

This means allowing your inner thoughts and feelings to occur without trying to change or ignore them. Acceptance is an active process.

Specific skills that are used in ACT therapy to help clients learn acceptance include:

Instead of trying to change your thoughts, Lev says, the goal is to create a non-judgemental relationship with them.

Present Moment Contact

ACT therapy encourages you tostay mindful of your surroundingsand learn to shift your attention away from internal thoughts and feelings. This involves a conscious and deliberate effort to focus on the world around you in the moment.

Staying engaged with the present can help you build greater awareness and prevent past experiences, memories, and conditioning from negatively affecting your interactions in the here and now.

Incorporating all six ACT processes helps people develop psychological flexibility and the freedom to choose their actions, even in the face of very difficult thoughts, feelings, sensations, and urges. These no longer have to be barriers to moving towards values.—AVIGAIL LEV, PSYD, LICENSED CLINICAL PSYCHOLOGIST

Incorporating all six ACT processes helps people develop psychological flexibility and the freedom to choose their actions, even in the face of very difficult thoughts, feelings, sensations, and urges. These no longer have to be barriers to moving towards values.

—AVIGAIL LEV, PSYD, LICENSED CLINICAL PSYCHOLOGIST

What to Expect in ACT Therapy

The first sessions of ACT therapy focus on clarify values with a client, Lev explains. Subsequent sessions then focus on helping people connect to those values and apply them in their lives.

Lev explains that a typical ACT therapy session involves:

During ACT, your therapist will help you apply these concepts to your life. They may teach you how to practice acceptance and cognitive defusion or help you develop a differentsense of yourselfdistinct from your thoughts and feelings.

Sessions can also includemindfulness exercisesto foster non-judgmental, healthy awareness of thoughts, feelings, sensations, and memories you have otherwise avoided.

Your therapist may also help highlight moments when your actions didn’t fit your values while helping you understand which behaviors would fit.

Your therapist may assignhomeworkto practice between sessions, such as mindfulness, cognitive, or values clarification exercises. The homework is agreed upon between you and your therapist and can be modified to make it as personal and useful as possible.

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Press Play for Advice On Radical Acceptance

This episode ofThe Verywell Mind Podcastshares how to practice radical acceptance to reduce suffering. Click below to listen now.

What ACT Can Help With

ACT may be effective in treating:

Research has shown that ACT can improve symptoms for people withgeneralized anxiety disorder (GAD), and it may also be a particularly good fit forolder adultswith the condition.

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Benefits of ACT Therapy

One core benefit of ACT is the impact it has on psychological flexibility. Psychological flexibility is the ability to embrace your thoughts and feelings when they are useful and to set them aside when they are not. This allows you to respond thoughtfully to your inner experience and avoid short-term, impulsive actions, focusing instead on living a meaningful life.

Psychological flexibility can improve your ability to accept and function with symptoms like anxiety or depression. Often, those symptoms may lessen significantly due to this increase in psychological flexibility.

ACT therapy also helps people cultivate greaterself-awarenessandself-compassion. “One of the primary benefits of ACT is that it helps individuals build a different relationship with their internal experiences. This means learning to relate to oneself and one’s inner narrator with kindness and gentleness,” Lev says.

How Effective Is ACT Therapy?

ACT is sometimes referred to as a “third wave” or “new wave” psychotherapy. The term “third wave” treatment refers to a broad spectrum of psychotherapies that also includes:

“Third-wave behavioral therapy approaches differ from traditional CBT methods because they emphasize acceptance and mindfulness-based strategies rather thancognitive restructuringwhich involves challenging and changing difficult thoughts and feelings,” Lev explains. “This means they focus more on helping people accept difficult emotions, developing a loving relationship with their emotions, and creating distance from troubling thoughts.”

Historically, third-wave treatments were seen as appropriate for people not benefiting from pre-existing treatments like classical CBT. However, it is now believed that a third-wave therapy option may make sense as a first-line treatment for some individuals.

Recent theories suggest that attempting to resist or change thoughts and feelings can make them stronger. So, instead of challenging them as one would in traditional CBT, ACT takes a different approach.

ACT helps people change their relationship with the mind and with internal experiences so that these have less influence on their behavior. The more willing we are to stay present with difficult thoughts and feelings the more freedom we have to choose our actions and to use our emotions as a compass to help guide our decisions.—AVIGAIL LEV, PSYD, LICENSED CLINICAL PSYCHOLOGIST

ACT helps people change their relationship with the mind and with internal experiences so that these have less influence on their behavior. The more willing we are to stay present with difficult thoughts and feelings the more freedom we have to choose our actions and to use our emotions as a compass to help guide our decisions.

Research shows ACT to be effective at treating a wide range of conditions, including some that span several diagnoses. ACT also appears to improve quality of life and may help people deal with physical conditions and chronic pain.

While ACT is an effective treatment for a variety of conditions, research shows that it may be about as helpful as other available forms of therapy, such as CBT.These findings suggest that someone who benefits from ACT may have also benefited from another treatment.

ACT has also faced criticism for its similarity to other forms of therapy. Some proponents of CBT claim that ACT, like other third-wave therapies, doesn’t represent a significantly different approach.

Several types of mental health professionals may offer ACT, including psychiatrists, psychologists, social workers, or mental health counselors. If you are interested in learning more about this approach, you might ask about your treatment provider’s training background with it or seek out an experienced ACT practitioner.

You may also try referral sources such as theAssociation for Contextual Behavioral Science (ACBS)or theAssociation for Behavioral and Cognitive Therapies (ABCT). The ACBS also providesfree resources about ACTin the form of videos, audio clips, and mindfulness exercises.

A therapist specifically trained in ACT will be both an active, empathic listener and an active guide, encouraging deeper exploration and non-judgmental awareness during the sessions.

ACT sessions tend to be hands-on, often including psychological exercises or mindfulness training, as well as homework after the session is done. Completing these exercises is an important part of ACT, as this is the way you can learn new skills and improve your psychological flexibility.

Your therapist will also want to discuss your values and goals during therapy. This is another crucial part of treatment, as these values will inform your actions moving forward.

What to Expect During Your First Therapy Session

8 SourcesVerywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Wetherell JL, Afari N, Ayers CR, et al.Acceptance and commitment therapy for generalized anxiety disorder in older adults: A preliminary report.Behav Ther. 2011;42(1):127-34. doi:10.1016/j.beth.2010.07.002Twohig MP, Levin ME.Acceptance and commitment therapy as a treatment for anxiety and depression: A review.Psychiatr Clin N Am. 2017;40(4):751-770. doi:10.1016/j.psc.2017.08.009Gloster AT, Walder N, Levin ME, Twohig MP, Karekla M.The empirical status of acceptance and commitment therapy: A review of meta-analyses.J Contextual Behav Sci. 2020;18:181-192. doi:10.1016/j.jcbs.2020.09.009Öst LG.The efficacy of acceptance and commitment therapy: An updated systematic review and meta-analysis.Behav Res Ther. 2014;61:105-121. doi:10.1016/j.brat.2014.07.018Delhom I, Mateu-Mollá J, Lacomba-Trejo L.Is acceptance and commitment therapy helpful in reducing anxiety symptomatology in people aged 65 or over? A systematic review.Front Psychiatry. 2022;13:976363. doi:10.3389/fpsyt.2022.976363Kahl KG, Winter L, Schweiger U.The third wave of cognitive behavioural therapies: What is new and what is effective?.Curr Opin Psychiatry. 2012;25(6):522-8. doi:10.1097/yco.0b013e328358e531A-Tjak JGL, Davis ML, Morina N, Powers MB, Smits JAJ, Emmelkamp PMG.A meta-analysis of the efficacy of acceptance and commitment therapy for clinically relevant mental and physical health problems.Psychother Psychosom. 2015;84(1):30-36. doi:10.1159/000365764Gaudiano BA.Evaluating acceptance and commitment therapy: An analysis of a recent critique.Int J Behav Consult Ther. 2011;7(1), 54-65. doi:10.1037/h0100927

8 Sources

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Wetherell JL, Afari N, Ayers CR, et al.Acceptance and commitment therapy for generalized anxiety disorder in older adults: A preliminary report.Behav Ther. 2011;42(1):127-34. doi:10.1016/j.beth.2010.07.002Twohig MP, Levin ME.Acceptance and commitment therapy as a treatment for anxiety and depression: A review.Psychiatr Clin N Am. 2017;40(4):751-770. doi:10.1016/j.psc.2017.08.009Gloster AT, Walder N, Levin ME, Twohig MP, Karekla M.The empirical status of acceptance and commitment therapy: A review of meta-analyses.J Contextual Behav Sci. 2020;18:181-192. doi:10.1016/j.jcbs.2020.09.009Öst LG.The efficacy of acceptance and commitment therapy: An updated systematic review and meta-analysis.Behav Res Ther. 2014;61:105-121. doi:10.1016/j.brat.2014.07.018Delhom I, Mateu-Mollá J, Lacomba-Trejo L.Is acceptance and commitment therapy helpful in reducing anxiety symptomatology in people aged 65 or over? A systematic review.Front Psychiatry. 2022;13:976363. doi:10.3389/fpsyt.2022.976363Kahl KG, Winter L, Schweiger U.The third wave of cognitive behavioural therapies: What is new and what is effective?.Curr Opin Psychiatry. 2012;25(6):522-8. doi:10.1097/yco.0b013e328358e531A-Tjak JGL, Davis ML, Morina N, Powers MB, Smits JAJ, Emmelkamp PMG.A meta-analysis of the efficacy of acceptance and commitment therapy for clinically relevant mental and physical health problems.Psychother Psychosom. 2015;84(1):30-36. doi:10.1159/000365764Gaudiano BA.Evaluating acceptance and commitment therapy: An analysis of a recent critique.Int J Behav Consult Ther. 2011;7(1), 54-65. doi:10.1037/h0100927

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Wetherell JL, Afari N, Ayers CR, et al.Acceptance and commitment therapy for generalized anxiety disorder in older adults: A preliminary report.Behav Ther. 2011;42(1):127-34. doi:10.1016/j.beth.2010.07.002Twohig MP, Levin ME.Acceptance and commitment therapy as a treatment for anxiety and depression: A review.Psychiatr Clin N Am. 2017;40(4):751-770. doi:10.1016/j.psc.2017.08.009Gloster AT, Walder N, Levin ME, Twohig MP, Karekla M.The empirical status of acceptance and commitment therapy: A review of meta-analyses.J Contextual Behav Sci. 2020;18:181-192. doi:10.1016/j.jcbs.2020.09.009Öst LG.The efficacy of acceptance and commitment therapy: An updated systematic review and meta-analysis.Behav Res Ther. 2014;61:105-121. doi:10.1016/j.brat.2014.07.018Delhom I, Mateu-Mollá J, Lacomba-Trejo L.Is acceptance and commitment therapy helpful in reducing anxiety symptomatology in people aged 65 or over? A systematic review.Front Psychiatry. 2022;13:976363. doi:10.3389/fpsyt.2022.976363Kahl KG, Winter L, Schweiger U.The third wave of cognitive behavioural therapies: What is new and what is effective?.Curr Opin Psychiatry. 2012;25(6):522-8. doi:10.1097/yco.0b013e328358e531A-Tjak JGL, Davis ML, Morina N, Powers MB, Smits JAJ, Emmelkamp PMG.A meta-analysis of the efficacy of acceptance and commitment therapy for clinically relevant mental and physical health problems.Psychother Psychosom. 2015;84(1):30-36. doi:10.1159/000365764Gaudiano BA.Evaluating acceptance and commitment therapy: An analysis of a recent critique.Int J Behav Consult Ther. 2011;7(1), 54-65. doi:10.1037/h0100927

Wetherell JL, Afari N, Ayers CR, et al.Acceptance and commitment therapy for generalized anxiety disorder in older adults: A preliminary report.Behav Ther. 2011;42(1):127-34. doi:10.1016/j.beth.2010.07.002

Twohig MP, Levin ME.Acceptance and commitment therapy as a treatment for anxiety and depression: A review.Psychiatr Clin N Am. 2017;40(4):751-770. doi:10.1016/j.psc.2017.08.009

Gloster AT, Walder N, Levin ME, Twohig MP, Karekla M.The empirical status of acceptance and commitment therapy: A review of meta-analyses.J Contextual Behav Sci. 2020;18:181-192. doi:10.1016/j.jcbs.2020.09.009

Öst LG.The efficacy of acceptance and commitment therapy: An updated systematic review and meta-analysis.Behav Res Ther. 2014;61:105-121. doi:10.1016/j.brat.2014.07.018

Delhom I, Mateu-Mollá J, Lacomba-Trejo L.Is acceptance and commitment therapy helpful in reducing anxiety symptomatology in people aged 65 or over? A systematic review.Front Psychiatry. 2022;13:976363. doi:10.3389/fpsyt.2022.976363

Kahl KG, Winter L, Schweiger U.The third wave of cognitive behavioural therapies: What is new and what is effective?.Curr Opin Psychiatry. 2012;25(6):522-8. doi:10.1097/yco.0b013e328358e531

A-Tjak JGL, Davis ML, Morina N, Powers MB, Smits JAJ, Emmelkamp PMG.A meta-analysis of the efficacy of acceptance and commitment therapy for clinically relevant mental and physical health problems.Psychother Psychosom. 2015;84(1):30-36. doi:10.1159/000365764

Gaudiano BA.Evaluating acceptance and commitment therapy: An analysis of a recent critique.Int J Behav Consult Ther. 2011;7(1), 54-65. doi:10.1037/h0100927

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