Introduction

The Basics

What is Acceptance and Commitment Therapy (ACT)?

The core philosophy of Acceptance and Commitment Therapy (ACT) is to accept what is out of your personal control while committing to actions that improve and enrich your life. The goal isn’t eliminating difficult feelings, but learning to peacefully coexist with them. Unlike other therapeutic approaches that may focus on reducing symptoms, ACT emphasizes building a rich, full, and meaningful life while accepting the pain that inevitably comes with it.

Goal

What is the goal of Acceptance and Commitment Therapy (ACT)?

The fundamental goal of Acceptance and Commitment Therapy (ACT) is to increase psychological flexibility. This allows you to act in alignment with your values, even when life is painful or uncertain. Rather than aiming to eliminate distress, ACT teaches you to relate to your experiences in a new way, creating space for action guided by your deepest priorities. For example, someone who fears public speaking might still give a presentation because it aligns with their value of sharing knowledge. They don’t allow anxiety to control their behavior, nor do they pretend that their anxiety doesn’t exist.

Uses

What does Acceptance and Commitment Therapy (ACT) treat?

Acceptance and Commitment Therapy (ACT) is effective for treating a wide range of mental health concerns. It is supported by research in the treatment of:

• Anxiety disorders
• Depression
• Obsessive-Compulsive Disorder (OCD)
• Post-Traumatic Stress Disorder (PTSD)
• Substance use and other addictive behaviors
• Disordered eating
• Schizophrenia spectrum and other psychotic disorders
• Borderline Personality Disorder
• Work-related stress and burnout
• General well-being and performance enhancement

ACT is also used in managing chronic illness, chronic pain, and life challenges where ongoing discomfort is part of the experience.

Subtypes

Are there any subtypes of Acceptance and Commitment Therapy (ACT)?

While Acceptance and Commitment Therapy (ACT) maintains a consistent theoretical foundation, several adaptations have emerged to suit specific settings and populations:

• Brief ACT: Designed for use in time-limited settings such as primary care, schools, or short-term counseling. It focuses on quickly introducing core ACT processes like defusion and values-based action.
• ACT for Chronic Pain (ACT-CP): Adapted for individuals living with chronic pain conditions. This version emphasizes pain acceptance, reducing avoidance behaviors, and improving function and quality of life despite ongoing symptoms.
• Group ACT: Delivered in group therapy settings, providing a space for shared learning, peer support, and collective exploration of values and mindful awareness.
• ACT for Workplace Settings: Used in corporate and organizational environments to address burnout, stress, and disengagement. This adaptation often includes values clarification for leadership and employee development.
• ACT for Specific Populations: Tailored versions of ACT have been created for adolescents, couples, veterans, and individuals with autism or substance use disorders.
• Digital and Self-Help ACT Programs: ACT is also offered via mobile apps, online courses, and guided self-help workbooks. These tools allow individuals to practice ACT techniques independently or alongside therapy.

These adaptations maintain ACT’s core principles while enhancing accessibility and relevance.

Effectiveness

Origins

Who developed Acceptance and Commitment Therapy (ACT) and when?

Acceptance and Commitment Therapy (ACT) was developed by Steven C. Hayes, an American clinical psychologist, and his colleagues in the late 1980s. Its foundations emerged from Hayes’ work on Relational Frame Theory (RFT), a psychological theory about how human language and cognition work. The approach was formally introduced in 1999 through Hayes’ book Acceptance and Commitment Therapy: An Experiential Approach to Behavior Change.

Evidence Base

Is Acceptance and Commitment Therapy (ACT) evidence-based?

Yes, Acceptance and Commitment Therapy (ACT) has accumulated a substantial and growing evidence base. Multiple studies have demonstrated its effectiveness across various conditions. The approach has particularly strong evidence for treating anxiety, depression, chronic pain, and workplace stress. Importantly, research supports that ACT works through its intended mechanisms—especially by increasing psychological flexibility—which adds strength to its theoretical foundation.

How It Works

Techniques Used

How does Acceptance and Commitment Therapy (ACT) work?

Acceptance and Commitment Therapy (ACT) helps individuals change their relationship to difficult internal experiences rather than trying to eliminate them. ACT integrates six core processes that create psychological flexibility—the ability to stay present and live meaningfully, even in the face of emotional pain.

The Six Core Processes of Acceptance and Commitment Therapy:

• Acceptance: Learning to embrace uncomfortable thoughts, emotions, and bodily sensations instead of avoiding or resisting them. This process is about making space for what’s already present rather than trying to push it away.
• Cognitive defusion: Gaining distance from unhelpful thoughts by observing them as mental events—not absolute truths. This helps reduce the power and influence of negative or rigid thinking patterns.
• Present moment awareness: Developing mindfulness skills and awareness of current experiences. This process enhances clarity and focus, helping individuals respond consciously instead of reacting automatically.
• Self-as-context: Connecting with a consistent sense of self that’s separate from temporary thoughts and feelings. Rather than being defined by one’s thoughts or emotions, this perspective helps individuals view themselves as the observer of those inner experiences.
• Values clarification: Identifying what truly matters to you on a personal level. Values serve as a compass for intentional living.
• Committed action: Taking value-driven steps toward your values, even in the presence of discomfort. This process emphasizes persistence, flexibility, and behavior change rooted in meaning.

By repeatedly practicing the six core processes, clients build psychological flexibility, which allows them to stay centered and take meaningful action even in the presence of discomfort.

What to Expect in a Session

What can I expect from an Acceptance and Commitment Therapy (ACT) session?

Your therapist will work with you to determine the focus for each session, targeting one or more of the six core processes mentioned above. Beyond talking about concepts, you will engage in experiential learning through a variety of exercises like:

• Mindfulness practices: You may be guided through simple, present-moment awareness exercises to help you tune into your body, breath, or surroundings. These practices develop the ability to observe thoughts and feelings without judgment or avoidance.
• Guided visualizations: Your therapist may use imagery exercises to help you access inner experiences, explore values, or practice acceptance. Visualizations can create emotional insight and deepen your connection to what matters.
• Metaphors and storytelling: ACT often uses creative metaphors (like "Passengers on the Bus" or "Leaves on a Stream") to illustrate abstract ideas and make them easier to apply. These tools help shift perspective on difficult thoughts or emotions.
• Role-playing: Practicing real-life situations in a safe space can help you try out new behaviors, clarify values-driven responses, and build psychological flexibility. This might include handling conflict, setting boundaries, or facing fears.
• Real-life behavior change assignments: Between sessions, you may be invited to take small, values-aligned actions in your everyday life. These “homework” tasks are designed to help you build momentum, reinforce new patterns, and break out of avoidance habits.

You will practice new skills during sessions, address barriers to progress, and be assigned homework in between sessions to promote skill generalization in your daily life. Your therapist will also help you practice new ways of relating to difficult thoughts and feelings while keeping the focus on what matters most to you.

Treatment Length & Structure

How long does Acceptance and Commitment Therapy (ACT) typically take?

Acceptance and Commitment Therapy (ACT) is goal-oriented rather than time-limited, meaning treatment length depends on progress rather than a predetermined schedule. Typically, ACT will occur over 8 to 16 weekly sessions, though the exact duration will vary depending on individual needs and circumstances. Some brief interventions might last 4-8 sessions, while more comprehensive treatment could extend several months.

There is flexibility in the structure of ACT-focused sessions, but therapists will typically follow a pattern of introducing and practicing the core processes while consistently linking them to your values. Each session usually includes experiential exercises and practical applications. Many people continue to practice ACT principles independently after formal therapy ends.

Getting Care

Finding a Therapist

How do I find a therapist who uses Acceptance and Commitment Therapy (ACT)?

Alma’s directory has many therapists who specialize in Acceptance and Commitment Therapy, including: