What Is Acceptance and Commitment Therapy (ACT)?

Acceptance and commitment therapy (ACT) is a type of psychotherapy that 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," explains Avigail 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 increased psychological flexibility. This approach carries a host of benefits, and it may help people stop habitually avoiding specific thoughts or emotional experiences, which can lead to further problems.

ACT Therapy Techniques

Unlike cognitive behavioral therapy (CBT), the goal of ACT is not to reduce the frequency or severity of unpleasant internal experiences like upsetting cognitive 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.

"This metaphor conveys that thoughts and feelings are transient, and we don’t equal our thoughts or feelings, nor are we defined by them," Lev explains.

Cognitive Defusion Skills

Cognitive defusion is 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.

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:

• Self-compassion meditations
• Emotion exposure
• Physicalizing emotions or thoughts
• Loving-kindness phrases
• Experiential exercises and metaphors

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 to stay mindful of your surroundings and 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.

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:

• Reviewing the previous week and identifying and rewarding behaviors that were consistent with the individual's values
• Examining behaviors that were not in alignment and work to understand the barriers that led to such actions
• Using the six ACT processes to work through barriers so the individual can move toward their values in the future
  

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 different sense of yourself distinct from your thoughts and feelings.

Sessions can also include mindfulness exercises to foster non-judgmental, healthy awareness of thoughts, feelings, sensations, and memories you have otherwise avoided.

Your therapist may assign homework to 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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What ACT Can Help With

ACT may be effective in treating:

• Anxiety
• Depression
• Eating disorders
• Obsessive-compulsive disorder (OCD)
• Stress
• Substance use
• Psychosis

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.

ACT therapy also helps people cultivate greater self-awareness and self-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:

• Dialectical behavioral therapy (DBT)
• Schema therapy
• Mindfulness-based cognitive therapy (MBCT)

"Third-wave behavioral therapy approaches differ from traditional CBT methods because they emphasize acceptance and mindfulness-based strategies rather than cognitive restructuring which 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.

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.

Things to Consider

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.

How to Get Started

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 the Association for Contextual Behavioral Science (ACBS) or the Association for Behavioral and Cognitive Therapies (ABCT). The ACBS also provides free resources about ACT in the form of videos, audio clips, and mindfulness exercises.

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.