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Acceptance and Commitment Therapy (ACT): What It Is &

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Meera Patel How It Works
DO
Published: June 1, 2020 Updated: April 5, 2023

Core Concepts of ACT Acceptance and Commitment Therapy (also called ACT) is a form of psychotherapy that utilizes mindfulness and
What Can ACT Therapy Help With? behavioral strategies to help people struggling with issues like depression, anxiety, or addiction. Unlike other
treatments, the goal of ACT is not to reduce symptoms but to encourage people to act in ways that are meaningful to
Common ACT Techniques
them, even when doing so results in difficult thoughts and feelings.
ACT Examples
Although ACT is a newer form of therapy, studies show that it is effective in treating issues like anxiety and depression.
How to Find an ACT Therapist
Sessions for ACT typically last an hour, and treatment can last anywhere from eight to sixteen weeks, or longer
What to Expect at Your First depending on the needs of the client. As a relatively new form of therapy, research has primarily focused on using ACT
Appointment
with adults, although there is some early research to suggest it can also be helpful for teens.1
Is ACT Effective?

How Is ACT Different from CBT or DBT?

Acceptance and Commitment Therapy is a popular type of therapy that many therapists practice. BetterHelp has
History of ACT Therapy
over 20,000 licensed therapists who provide convenient and affordable online therapy. BetterHelp starts at $60 per
Additional Resources week. Complete a brief questionnaire and get matched with the right therapist for you.

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Core Concepts of ACT

Acceptance and Commitment Therapy assumes that pain and suffering are inevitable parts of life. Instead of trying to
control or avoid pain and suffering, ACT therapists encourage people to accept and make room for these experiences.
The ultimate goal of ACT therapy is not to be happier, but to develop “psychological flexibility” and to live a full and
meaningful life.

Psychological flexibility is defined as a state of openness that allows people to be fully present in their experiences
(even when these experiences are painful or upsetting) and to make choices based on their personal values.

There are 6 core processes in ACT therapy that help clients develop psychological flexibility:

1. Contact with the Present Moment

See more Crisis Hotlines Mindfulness is the practice of being fully aware and engaged in the present in a nonjudgmental way. Mindfulness can
be used to be fully engaged with a person’s external circumstances like where they are and what they are doing, or to
get in touch with inner thoughts and feelings. Mindfulness in ACT is encouraged even when inner or outer experiences
are painful or difficult.

2. Cognitive Defusion

Cognitive defusion is the practice of distancing oneself from one’s thoughts. Cognitive defusion is also accomplished
through the use of mindfulness skills. These skills teach people to observe their thoughts in a detached way, as
opposed to getting involved in them.

3. Acceptance

Acceptance of difficult thoughts and feelings is another core component of ACT. While the general instinctive response
to psychological pain is to try to stop it or avoid it, ACT encourages people to instead open up and invite them in. In
doing so, people tend to experience that these thoughts and feelings are only temporary, and dissipate on their own.

4. Self as Context

ACT therapists believe that most people get too wrapped up and involved in their own thoughts. Most thoughts come in
first person “I” language and ACT believes this language keeps people stuck and fused in unhelpful thoughts. Instead,
ACT encourages people to use an “observing” part of their mind to notice the thoughts that come and go. For instance,
a person might describe, “I’m noticing thoughts about not being good enough” vs “I’m not good enough.”

5. Values

Personal values are another central concept in ACT. Highly individualized, personal values are principles and activities
that give meaning and purpose to a person’s life. ACT therapists believe that people are most satisfied when they are
acting according to their values. Part of ACT therapy is usually for a person to identify their core values and assess the
degree to which they are demonstrating each value in their day to day lives.

6. Committed Action
 Committed action describes following through with acting in accordance with one’s personal values. This might
sometimes mean that a person has to open themselves up to the possibility of being hurt, scared or disappointed as
they work to build a life that is meaningful.
MENTAL HEALTH THERAPY TECHNIQUES TYPES OF THERAPISTS STARTING THERAPY FAQ ABOUT US THERAPIST DIRECTORY
ACT therapists guide clients through the 6 processes of ACT, which are each essential parts of developing
psychological flexibility.

Acceptance and Commitment Therapy can be summarized using the acronym ACT, which can also stand for:

Accept thoughts and feelings and be present

Choose a valued direction
Take action

What Can ACT Therapy Help With?

Acceptance and Commitment therapy is used to treat a variety of mental health and substance use disorders, as well
other non-clinical issues that sometimes bring people into counseling (like stress, grief, commitment issues, or
improving work/life balance). ACT is a relatively new type of therapy that utilizes some of the same techniques used in
experiential therapy. Research is ongoing to identify which conditions it can effectively treat.

Currently, there is evidence to support that ACT is effective in treating the following disorders:2
Depression
Anxiety
Chronic Pain
Obsessive Compulsive Disorder
Psychosis
Substance Use Disorders3

Acceptance and Commitment Therapy is also used to help people who are struggling with stress, life transitions, or
general discontent in some area of their lives. While there is not clear evidence to support the use of ACT for each issue
listed below, many ACT therapists describe success in using the treatment for other issues as well.

These include:

Grief or bereavement
Divorce or separation
Burn-out or work/life imbalance
Interpersonal conflicts
Chronic illness
Parenting difficulty

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Common ACT Techniques

Counselors who use Acceptance and Commitment Therapy have an array of techniques and strategies they use to
help clients. Early on in treatment, ACT therapists may focus on providing education to help clients better understand
ACT theory. ACT therapists then help clients evaluate their current ways of coping with and responding to difficult
thoughts and feelings.

Often, this evaluation reveals that the client has been using ineffective, or even counterproductive, methods of coping.
In these cases, ACT therapists teach clients more effective ways to respond to difficult thoughts and feelings. Finally,
ACT therapists help clients identify their core values and make changes to their behavior that result in more consistent
demonstration of their values.

ACT Metaphors to Teach ACT Theory

Early in treatment, ACT therapists use metaphors to teach clients new ways of understanding their emotions and how
to best respond to them.

Common ACT metaphors include:

Drivers vs Passengers
ACT therapists help clients understand that difficult emotions can either be drivers or passengers. When difficult
emotions like anger or fear are permitted to drive, they often become destructive forces that cause problems in a
person’s life and keep them from getting where they need and want to go. ACT therapists encourage clients to get and
stay in the driver’s seat and to have difficult emotions be the passengers. While they may be unpleasant passengers,
not allowing them to drive is key to reducing the impact they can have on a person’s life and choices.
 Beach Ball Under Water
ACT therapists teach clients that efforts to stop or control difficult thoughts and feelings can be exhausting and
ineffective. To illustrate this, they sometimes use the metaphor of emotional control being like trying to push a beach
MENTAL HEALTH THERAPY TECHNIQUES TYPES OF THERAPISTS STARTING THERAPY FAQ ABOUT US THERAPIST DIRECTORY
ball under water; it takes a lot of effort and energy and ultimately isn’t effective. While it might provide temporary
relief, the difficult thoughts and feelings tend to “pop back up” later on.

Quicksand
Another metaphor ACT therapists use to help clients understand the ways that trying to resist or control emotions is
ineffective is a metaphor of quicksand. When people stuck in quicksand try to struggle free, they ultimately end up
getting more stuck. Instead, working to relax, breathe, and move slowly and deliberately is the way to get free from
quicksand, and also the way to get unstuck from difficult thoughts and feelings.

Experiential Techniques to Teach ACT Theory

Therapists who provide ACT treatment also utilize experiential techniques that help to demonstrate key concepts of the
theory. When a client becomes upset, angry, or anxious in session, the therapist may welcome this as an opportunity to
practice mindfulness and acceptance.

The therapist might encourage the client to sit with the feeling, try to open up around it and give it space. The therapist
might get the client to become curious about the emotion by asking questions about specific sensations or descriptions
of the emotion they are experiencing.

Other experiential techniques an ACT therapist might utilize are those designed to illustrate the counterproductive
nature of control or avoidance strategies.

Evaluating Control and Avoidance Strategies

ACT posits that most of the time, psychological suffering is caused or made worse by control and avoidance
strategies. Control and avoidance strategies include anything a person does to attempt to change, stop, fix, or avoid
difficult thoughts and feelings.

Some common control and avoidance strategies include:

Distraction
Distraction techniques are any activity or mental task that people engage in to temporarily distract themselves from
specific unwanted thoughts and feelings. These might include watching TV, going online, or even just staying
constantly busy with tasks at work or at home.

Opting Out
Opting out includes all of the ways that people may avoid, quit, or withdraw from situations that might result in
unwanted thoughts and feelings. Opting out could include canceling plans with friends, backing out of a project at
work, or avoiding doing new things because of a fear of failure or rejection.

Thinking
Overthinking or overanalyzing is another common way that people try to control unwanted thoughts and feelings.
Overthinking includes obsessively reviewing the problem, finding blame, trying to problem solve or predict outcomes,
self-criticizing, or any other mental task aimed at stopping or fixing a feeling or thought.

Substances/Self-Harm
Some people engage in self-destructive behaviors like self-harm (i.e. cutting), substance use, or other risky behaviors.
These behaviors can be both a way of expressing pain and a way of coping with pain.

Teaching Acceptance, Mindfulness, and Defusion Skills

Usually, evaluating current methods of control and avoidance leads to an agreement that these tactics have only been
partially effective or in some cases, may have been ineffective or even made things worse. While ACT therapists
encourage the client to not use control and avoidance strategies, they also recognize the need for more effective ways
to cope and respond to difficult thoughts and feelings.

Some of the skills that ACT therapists teach include:

Acceptance Skills
Acceptance of difficult thoughts, feelings and experiences is central to Acceptance and Commitment Therapy. Clients
are taught to expand, or open up, around difficult and painful experiences, rather than to try to stop or control them.
Acceptance does not mean that a person likes or wants the difficult thoughts and feelings, only that they are willing to
tolerate them and not waste time and energy trying to control them.

Mindfulness Skills
Mindfulness is the practice of being fully present, open, aware, and engaged in the here and now. Mindfulness can be
used to focus on a narrow aspect of one’s current experience (like on one’s breathing) or to expand to a broader field
of awareness (like what a person can see, hear, feel, and smell). Using mindfulness, people practice being present in
whatever their current experience is.

Defusion Skills
Defusion (also called cognitive defusion) is a skill that helps people distance themselves from their thoughts. Defusion
helps people understand that they are separate from difficult thoughts and feelings and encourages people to become
observers of these thoughts, almost like they are watching words and images on a screen. Defusion does not mean
getting rid of or changing thoughts, it just means recognizing that those thoughts are not always true or important.

Identifying Values and Committing to Action

 A central part of ACT treatment involves identifying values and encouraging clients to act in ways that align with these
values. Values represent what matters most to people: the activities that bring them joy, the principles they stand for,
the impact they want to make on the world, and the things that make life full and meaningful. Usually, a client will work
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Using these core values, a therapist will then help the client evaluate the extent to which their actions demonstrate
each of these core values. ACT therapists believe that acting in accordance with values, instead of in reaction to
emotions, is the key to a full and meaningful life. Clients will be encouraged to identify ways that they can change their
behavior to be more aligned with their core values.

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ACT Examples
Clients of ACT therapists might be initially surprised that the focus of treatment is not centered around reducing their
symptoms. While other treatment approaches see difficult thoughts and feelings as indicators of mental illness, ACT
therapists are more likely to see these inner experiences as a normal part of life. In ACT, the focus is typically on a
client’s response to these inner experiences, rather than on the inner experiences themselves.

For example, a client who is coming to therapy for depression might cite symptoms like sadness, fatigue, and a lack of
interest and motivation as the problems they want to solve in therapy. An ACT therapist is more likely to dig deeper to
find out what the client does when these symptoms arise. Do they stay in bed, isolate themselves, cancel plans? Do
they ruminate on sad things that have happened in the past or on negative thoughts about the future? If so, these
responses would be targeted as a focus of treatment.

An ACT therapist would spend time helping the client explore how these behaviors have affected their experience of
symptoms and their overall quality of life. They would encourage the client to try out different responses to these
symptoms. Instead of ruminating on negative and sad thought thoughts, the client might be encouraged to use
defusion or mindfulness to observe these thoughts from a distance. Instead of staying in bed, isolating themselves, and
canceling plans, the therapist might work to understand what activities and relationships are important and
meaningful to the client, and to encourage them to engage in these even when they experience symptoms.

Throughout the course of ACT therapy, a client learns new ways of thinking about, experiencing, and responding to
difficult thoughts and feelings. ACT therapists emphasize that living lives that are full and meaningful also means being
willing to accept and experience difficult and painful thoughts and feelings.

ACT teaches people skills to manage these inner experiences without letting them restrict their ability to function or
enjoy life. While the expressed goal of ACT therapy is not to reduce the client’s symptoms of depression, symptom
reduction is usually a byproduct of the treatment.

How to Find an ACT Therapist

ACT is typically provided by licensed professional counselors, social workers, or psychologists. Usually, ACT therapy
occurs in weekly outpatient sessions lasting about an hour. ACT treatment typically lasts between 8-16 weeks, although
this can vary, depending on the individual needs and goals of each client.

Finding a therapist who specializes in Acceptance and Commitment Therapy is easier than ever before, thanks to the
internet. A good starting place is an online directory to help locate therapists near you. It is usually possible to narrow
down the search to providers who are trained in ACT, and also those who specialize in specific issues like depression,
anxiety, or addiction.

Many people are also interested in finding a therapist who is in-network with their insurance. Contacting your insurance
company is also a good way to find an in-network therapist. Usually, the best way to begin this process is to either call
the number on the back of the insurance card or to use the insurance company’s website to conduct a search for in-
network counselors.

BetterHelp has over 20,000 licensed therapists who provide convenient and affordable online therapy. BetterHelp
starts at $60 per week. Complete a brief questionnaire and get matched with the right therapist for you.

Choosing Therapy partners with leading mental health companies and is compensated for marketing by BetterHelp

Visit BetterHelp

What to Expect at Your First Appointment

The first appointment with a therapist is generally reserved for a diagnostic assessment and intake. This appointment
typically lasts 60-90 minutes and involves a counselor getting background information about you and the issues you
wish to address. A lot of questions are asked during this appointment and the information collected is important in
helping the counselor determine a diagnosis, which is normally discussed at the end of the appointment. You will also
be asked to fill out paperwork which involves standard consent forms and other administrative paperwork needed to
establish care.
 Towards the end of the first appointment, the counselor will discuss your diagnosis and options for treatment.
Treatment recommendations will be made by the counselor based on their assessment, but your input is also essential
in determining next steps. If you have questions about your treatment, this is also the time to ask them. If you and the
MENTAL HEALTH THERAPY TECHNIQUES
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than the first appointment. Sometimes,
medication is also recommended in conjunction with therapy.

While the first appointment is focused on getting the needed information and forms, establishing a diagnosis, and
making a treatment recommendation, subsequent sessions tend to be more focused on the issues bringing you in and
the goals you have for treatment. ACT can be helpful for people without a formal mental health diagnosis, but
generally a diagnosis is required for those wanting to have sessions covered by their insurer.

Is ACT Effective?
Acceptance and Commitment Therapy is gaining recognition as an Evidence Based Practice. It is listed as an Evidence
Based Practice on SAMHSA’s national registry and as a research-supported treatment by the APA. ACT has the most
research backing its efficacy in treating depression, psychosis, anxiety, OCD and chronic pain.4

There is emerging evidence to suggest that ACT could also be effective in treating substance use disorders5 and
PTSD,6 although more research is needed in these areas. As a relatively new treatment, ACT is still being studied to
better understand its applications.

How Is ACT Different from CBT or DBT?

All belonging to the family of behavior therapies, ACT, Cognitive Behavioral Therapy (CBT) and Dialectical Behavioral
Therapy (DBT) all share a common foundation of focusing on behavior change. Out of the three treatments, CBT is
most different. In CBT, difficult emotions are thought to be caused or closely linked to specific unhelpful thought
patterns.

CBT therapists encourage clients to reframe or rethink their thoughts in more helpful ways that lead to improvements
in their emotional state and behavior. ACT therapists believe that putting effort into rethinking or changing thoughts is
unhelpful and sometimes can lead to becoming more stuck.

Instead, ACT and DBT recognize thoughts as playing a role in emotional distress but instead of changing them, both
approaches encourage the use of mindfulness to get distance from them. In both approaches, clients are also
encouraged to be willing to accept and experience difficult emotions. The skills in both ACT and DBT are packaged
differently but ultimately are variations of mindfulness skills. The behavioral focus paired with the focus on mindfulness
is what connects both ACT and DBT, placing them in the same category of “third wave” behavior theories.

One aspect of ACT that is unique is the focus on personal values. In ACT, clients are encouraged to identify their
personal values and use these as a compass to guide more effective actions and behaviors. The central focus on
personal values is not found in other therapies in the third wave behavior family (like DBT, Metacognitive Therapy, or
Mindfulness Based Cognitive Therapy).

History of ACT Therapy

Acceptance and Commitment Therapy was developed in 1986 and is credited to the work of psychologist, professor,
and author Dr. Stephen Hayes. Its roots lie in several existing theories including an earlier theory developed by Hayes
called Relational Frame Theory. Other theories that have influenced ACT include 1st and 2nd wave behavior theories,
Existentialism, and Humanistic approaches.

At the time ACT was developed, CBT was the leading treatment of choice. In many ways, ACT emerged as a challenge
to certain fundamental assumptions of the CBT model, including the idea that thoughts and feelings are symptoms
and that they can be controlled. Hayes forwarded the idea that difficult thoughts and feelings are normal but that
many of the techniques people use to try to control or avoid them lead to more suffering. Many of these techniques
were touted by CBT therapists as skills to reduce unwanted symptoms.

Additional Resources
Education is just the first step on our path to improved mental health and emotional wellness. To help our readers take the next step
in their journey, Choosing Therapy has partnered with leaders in mental health and wellness. Choosing Therapy may be
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For Further Reading

15 Best Acceptance and Commitment Therapy Books
Mental Health America
National Alliance on Mental Health
MentalHealth.gov

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