Acceptance and Commitment Therapy (ACT) is a proactive psychotherapy approach derived from traditional behavioral and cognitive therapies. It encourages clients to cease avoidance, denial, and resistance to their internal emotions. Instead, they are guided to acknowledge that these emotions are appropriate reactions to specific circumstances and should not hinder their progress. Dr. Steven C. Hayes, a University of Nevada professor, conceptualized ACT in the 1980s based on his own struggle with panic attacks. Motivated by personal experiences, Hayes resolved to embrace rather than evade the obstacles he faced.
ACT supports clients to grasp the importance of embracing challenges and committing to necessary behavioral changes, irrespective of life circumstances or emotional responses.
How Does Acceptance and Commitment Therapy Work?
Unlike the most well-known behavior therapy – cognitive behavioral therapy (CBT) – ACT supports clients in experiencing and accepting their emotional and behavioral responses without judgment.
ACT helps people with anxiety, depression, eating disorders, and other mental health challenges by focusing on being flexible in how they think and feel. Instead of trying to get rid of anxious or sad feelings, it helps people learn to live with them and still do the things they want to do. It’s like finding a way to function well even when you’re anxious or feeling low.
Concepts and Approaches in ACT
At its core, ACT challenges the idea of controlling or eliminating unwanted thoughts and emotions by emphasizing acceptance and understanding as pivotal steps toward change. It’s about living a meaningful life, even with these challenges.
The therapy introduces several key concepts.
Cognitive defusion involves distancing oneself from thoughts and reducing their influence over behavior. Instead of taking thoughts literally or allowing them to dictate actions, individuals learn to observe and let thoughts come and go without reacting impulsively. By recognizing thoughts as transient mental events, individuals can choose how to respond rather than being controlled by automatic reactions.
Acceptance involves acknowledging and making room for all thoughts, feelings, and sensations, including those that are uncomfortable or distressing. Rather than struggling to eliminate or suppress unpleasant experiences, individuals learn to accept them as part of their reality. This practice reduces the struggle with internal discomfort and enables a more adaptive response to challenging situations.
Present Moment Awareness
Being mindful and fully present in the moment is a fundamental aspect of ACT. It encourages individuals to engage fully in what they are doing without being preoccupied with the past or future. By focusing on the present, individuals can better connect with their experiences, which allows for a more conscious and intentional response to life’s circumstances.
Self-as-context involves perceiving oneself from a broader perspective that extends beyond thoughts, emotions, or roles. It’s recognizing that individuals are more than the sum of their experiences and are capable of evolving. This mental separation allows individuals to create room for their thoughts and emotions without becoming ensnared by them. By understanding themselves in this way, individuals can navigate challenges with a more stable sense of self and a deeper understanding of their values and purpose. A metaphor often used in this context is to envision oneself as the unchanging sky, while thoughts and feelings are likened to passing weather patterns. Just as weather fluctuates, thoughts and feelings are impermanent.
Values clarification involves identifying what truly matters to an individual in different life domains, such as relationships, career, health, and personal growth. It encourages individuals to reflect on their intrinsic values and aspirations and provides a compass to guide actions and decisions. Living in alignment with these values fosters a sense of purpose and fulfillment.
Committed action is the process of taking intentional and purposeful steps toward achieving one’s identified values and goals. It involves planning and executing actions that are consistent with personal values, even when faced with challenges or discomfort. Through committed action, individuals can transform their values into tangible experiences and accomplishments, which leads to a more fulfilling and meaningful life.
By integrating these concepts into daily life, individuals can cultivate psychological flexibility and respond more effectively to various life situations, reduce emotional struggle, and create a life infused with purpose and value-driven actions.
ACT and Psychological Flexibility
Psychological flexibility is a central concept in ACT and represents an individual’s ability to adapt and respond effectively to the ever-changing demands of life. It involves being open, aware, and accepting of one’s thoughts, emotions, and experiences, while still committing to actions that align with personal values. Rather than struggling to eliminate or avoid discomfort, psychological flexibility encourages individuals to embrace these discomforts as part of the human experience.
Structure of Acceptance and Commitment Therapy
ACT is structured around a clear and purposeful process that enhances psychological flexibility. In the initial stages of ACT therapy, the emphasis is on clarifying a client’s values. Subsequent sessions revolve around helping individuals connect with these values and integrate them into their daily lives.
This therapy typically unfolds in six key stages:
Establishing Context and Clarifying Values: Beginning with rapport building, therapists help individuals clarify their values and what truly matters to them in life.
Present Moment Awareness: Clients are guided to be mindful of their thoughts, feelings, and sensations in the present moment without judgment or avoidance in order to promote awareness and self-reflection.
Cognitive Defusion: Techniques are introduced to help individuals detach from and de-literalize their thoughts, thereby reducing their impact and influence on behavior.
Acceptance: Emphasizes accepting inner experiences, including painful thoughts and emotions, as a fundamental step toward well-being and change.
Committed Action: Encourages the formulation of clear, value-based goals and the development of strategies to achieve them, which fosters purposeful action.
Self-as-Context and Values Clarification Integration: Integrating the concepts of self-as-context and values clarification, clients gain a deeper understanding of their values and how to live in harmony with them.
During ACT, the therapist will guide the client toward applying these principles to their life, potentially through techniques like acceptance and cognitive defusion. They might assist in cultivating a distinct self-concept apart from a client’s thoughts and emotions. Additionally, mindfulness exercises can be integrated into sessions to promote non-judgmental awareness of thoughts, emotions, sensations, and memories they might have avoided.
What Can ACT Help With?
ACT can effectively help with various mental health challenges. It has been successful in treating anxiety disorders, depression, stress, trauma, OCD, chronic pain, substance abuse, eating disorders, and even psychosis. Additionally, ACT has been beneficial in enhancing performance and well-being in academic, sports, and workplace settings. Its versatile approach focuses on improving psychological flexibility and encourages individuals to live a meaningful life by aligning actions with their values, regardless of difficult thoughts and emotions. In essence, ACT equips people with practical skills to navigate challenges and enhance their overall quality of life.
 Sandoz, E.K., Wilson, K.G. and DuFrene, T. (2010) Acceptance and commitment therapy for eating disorders, a process-focused guide to treating anorexia and bulimia. Oakland, Calif: New Harbinger Publications, Inc.
 Westrup, D. (2014) Advanced acceptance and commitment therapy : the experienced practitioner’s guide to optimizing delivery. Oakland, California: New Harbinger Publications.
 Luoma, J.B., Hayes, S.C. and Walser, R.D. (2017) Learning ACT: An Acceptance and Commitment Therapy Skills Training Manual for Therapists. 2nd edn. Oakland: Context Press.