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Acceptance and Committment Therapy
ACT combines mindfulness and self-acceptance with committed action, helping people accept what they can’t control and build a richer life.
Introduction
The basics
What is Acceptance and Committment Therapy?
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 Committment Therapy?
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 conditions does Acceptance and Committment Therapy 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
What are the subtypes of Acceptance and Committment Therapy?
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 Committment Therapy 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 Committment Therapy 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 Committment Therapy 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 sessions in Acceptance and Committment Therapy?
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 Committment Therapy typically take? Is there any set structure?
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 Committment Therapy?
Alma’s directory has many therapists who specialize in Acceptance and Committment Therapy, including:
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Similar types of therapy
Besides Acceptance and Committment Therapy, what other types of therapy might be right for me?
If after reading this, you’re not sure if Acceptance and Committment Therapy is quite the right fit, here are some other types that might be worth looking into:
Cognitive Behavioral Therapy (CBT): if thought patterns also play a role
CBT examines how thoughts, feelings, and behaviors interact, then uses practical skills to shift unhelpful patterns.
Dialectical Behavioral Therapy (DBT): if emotion regulation skills are a priority
DBT combines mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness skills for people navigating intense emotions or relationship stress.
Mindfulness-Based Stress Reduction (MBSR): if mindfulness tools feel like a fit
MBSR teaches mindfulness practices that help people observe thoughts, emotions, and body sensations with less reactivity.
Compassion Focused Therapy (CFT): if self-criticism is a central concern
CFT builds self-compassion and emotional safety, especially for people who struggle with shame, self-criticism, or threat-based thinking.
This article was written and medically validated by Drs. Jill Krahwinkel-Bower and Jamie Bower.
FAQs
ACT tends to be a good fit if you've spent a lot of energy trying to control, suppress, or eliminate difficult thoughts and feelings — and found that the harder you fight them, the stronger they seem to get. Rather than trying to reduce distress directly, ACT teaches you to change your relationship to it, making room for difficult experiences while still moving toward what matters most to you. It's particularly well-suited to people dealing with anxiety, depression, chronic pain, or burnout, and it's a strong option for anyone who finds that understanding a problem intellectually doesn't seem to shift how they feel about it.
It is. This type of therapy is well-suited for virtual sessions using secure video platforms. The effectiveness of online therapy has been consistently demonstrated, with results matching those of in-person care for a broad range of mental health issues. If you're looking for this type of therapy online, you can use this link to find an ACT therapist who takes your insurance.
Whether ACT is covered for you depends on your individual insurance plan. Most major insurance plans cover therapy when it's provided by a licensed mental health professional, regardless of the type of therapy you choose. What matters more is whether therapy is considered medically necessary given your diagnosis. The best way to find out what you'll pay is to check your plan's explanation of benefits, call the member services number on your insurance card, or use Alma's free cost estimator tool before booking.
Both ACT and CBT work with thoughts — but they approach them very differently. CBT typically asks whether a thought is accurate and helps you replace it with a more balanced one. ACT doesn't focus on changing the content of thoughts at all. Instead, it uses a technique called "cognitive defusion" to help you observe your thoughts as mental events rather than facts, reducing their power without needing to argue with them. ACT also has a stronger emphasis on values-based action: rather than working primarily to reduce symptoms, it asks what kind of life you want to be living and helps you build toward that, even in the presence of discomfort.
ACT is built around six interconnected processes that together build what the approach calls psychological flexibility — the ability to stay present and act in line with your values, even when life is painful. Those processes are: acceptance (making room for difficult experiences rather than fighting them), cognitive defusion (creating distance from unhelpful thoughts), present-moment awareness, self-as-context (developing a stable sense of self that isn't defined by passing thoughts or feelings), values clarification, and committed action. In practice, sessions often involve experiential exercises and metaphors alongside conversation, making ACT feel quite different from traditional talk therapy.
Yes. ACT has a particularly strong evidence base for anxiety disorders, and it's one of the most thoroughly researched approaches for this area. The key insight ACT brings to anxiety is that the effort to avoid or suppress anxious feelings often makes them more persistent — a phenomenon researchers call "experiential avoidance." Rather than teaching you to manage anxiety by reducing it, ACT helps you relate to anxiety differently, so it no longer controls your behavior. People who go through ACT often report that they still experience anxiety, but it has less power over what they do.
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