What Is Acceptance and Commitment Therapy?

Acceptance and commitment therapy (ACT) is a type of psychotherapy developed in 1982 by psychologist and researcher Steven C. Hayes. Over the last 25 years, ACT has become a widely used and evidence-based behavior therapy and is accepted as an effective technique for treating a variety of physical and mental conditions.

This technique is action-oriented and focuses on mindfulness, staying present, and behavior change without first changing or eliminating uncomfortable thoughts and feelings.

This article will discuss how ACT works, what conditions it can help with, benefits, risks, costs, and more.

What Is ACT?

Acceptance and commitment therapy (ACT) is a type of counseling and psychological intervention that combines mindfulness, acceptance, and behavior change strategies. ACT suggests a person is capable of changing their behaviors without first changing or eliminating their thoughts and feelings. It can be applied to a variety of conditions and is process-focused and flexible to the needs of the person.

ACT operates under the philosophy that change in action can occur before a change in thought patterns. Rather than fighting to control or eliminate unwanted, uncomfortable, or distorted thoughts and feelings, a person can simply observe the thought or feeling, accept what they cannot change, and commit to actions that make their lives better.

In essence, ACT helps people to accept that painful thoughts and feelings can co-exist alongside healthy behavior change and improved quality of life.

How It Works

ACT works by providing a way to live with less pain and suffering by consciously embracing all that life offers, including discomfort, and choosing to live life according to you goals and values. There are six core processes or skills involved with ACT. During ACT, a therapist works with the client using guided exercises and activities based on these principles to help clients develop psychological flexibility.

The six core processes are:

1. Cognitive defusion: The person is aware that their thoughts are just a thought, not necessarily the truth. They do not allow their thoughts to control them and they examine their thoughts from a place of curiosity rather than judgement.
2. Acceptance: The person willingly experiences difficult feelings and emotions, such as anxiety or pain, without struggling against them. They do not avoid these unwanted emotions, feelings, and sensations.
3. Flexible attention to the present moment: The person is able to stay focused on what is happening in the moment internally and externally and adjust their behaviors accordingly, rather than ruminating (contemplating; worrying) on the past or future.
4. Self-as-context: Rather than clinging onto an identity or label a person puts on themselves as absolute (e.g., lazy, useless, dumb, productive), the person is able to shift their perspective to observing the present feelings and thoughts about themselves with the awareness that they are always changing.
5. Values: The person identifies and clarifies what is most important to them, such as fundamental hopes, values, goals (e.g., being there for one's family, pursing meaningful work). These values help provide direction for the person when faced with changing and challenging situations.
6. Committed action: The person cultivates commitment to doing things in line with the values they identified. They may continually revisit their goals and change them, but they will always be working in alignment with their values.

What ACT Can Help With

Research has shown that ACT can help with a variety of mental conditions including:

• Depression
• Anxiety disorders
• Psychosis (losing touch with reality)
• Substance use disorder
• Chronic pain
• Post-traumatic stress disorder (PTSD)
• Obsessive-compulsive disorder (OCD)
• Affective (mood) disorders (mental disorders that primarily affect a person’s emotional state)
• Stress

Techniques

There is not a specific set of techniques used in ACT. Instead, the therapist applies general strategies flexibly using an ACT approach. With an ACT approach, a variety of cognitive and behavioral exercises are used to guide the person to strengthen the six core skills related to psychological flexibility. These may be tailored based on what psychological conditions the person wishes to address, or is tailored to the setting.

For example, ACT protocols can vary from short interventions done in minutes or hours, to those that take many sessions. ACT can also be applied in groups, individual sessions, classroom settings, couples therapy, bibliotherapy, workplace training, and much more.

ACT utilizes clever, creative, and often playful exercises to help a person develop greater awareness of their beliefs, thoughts, and behaviors. It also helps them with determining whether their behaviors are helping to effectively solve the problem and moving one towards their values and goals. Often, metaphors, paradoxes, and experiential exercises are used to apply the six concepts/skills.

Benefits

The goal for ACT is to move from rigid and inflexible thinking to developing psychological flexibility, which is often considered the pinnacle of health and well-being. Research also suggests that developing psychological flexibility leads to many other mental health benefits, healthy behavior changes, and increased adaptability.

The benefits of psychological flexibility includes:

• The ability to stay present and aware of the current moment along with its emotions, sensations, and thoughts
• Be more open and accepting of emotional experiences
• Recognize and adapt to situational demands by shifting their mindset and choosing behaviors accordingly
• Use their mental resources effectively
• Better regulate their emotions
• Balance competing desires, needs, and areas of life
• Rebound from stressful events and difficulties planning and working towards life goals
• Higher quality of life

Efficacy

To date, there are 260 meta-analyses, systematic reviews, and narrative reviews and 860 randomized controlled trials that support the efficacy of ACTs to address mental and physical disorders. A number of national and international organizations have stated that ACT is supported by research including, but not limited to:

• American Psychological Association
• Society of Clinical Psychology
• U.S. Veteran Affairs
• U.S. Department of Health and Human Services
• The World Health Organization
• The UK National Institute for Health and Care Excellence
  

Cost

Unfortunately, the psychotherapy such as ACT can generally be expensive, especially if you are uninsured. A single session can range from $65 to upwards of $200, depending on your state and practitioner's qualifications. You may also seek low-cost services through federally funded health centers, college and university health centers, or inquire if your therapist provides a sliding scale for payment.

Summary

Acceptance and commitment therapy (ACT) is a type of action-oriented psychotherapy. ACT focuses on implementing mindfulness and behavior change before changing or eliminating uncomfortable thoughts and feelings. It operates by six core processes: cognitive defusion, acceptance, flexible attention to the present moment, self-as-context, values, and committed action.

You do not have to be diagnosed with a psychological disorder to benefit from ACT. ACT techniques can be applied to any life problems such as anxiety, depression, PTSD, substance use disorder, chronic pain, psychosis, eating problems, or stress.

ACT can enhance your quality of life by teaching you to live more in the present and provide strategies to cope with difficult situations, feelings, and emotions that may arise. ACT can help you embrace life fully while continuing to work towards your goals and live life according to your values.

A Word From Verywell

Beginning therapy can feel like a daunting task, especially if you are struggling with an illness, mental health concern, or stressful life event. Acceptance and commitment therapy can be a more approachable type of therapy, as it is flexible and has been proven effective for people going through all kinds of experiences.

If you are interested in starting ACT, reach out to your healthcare provider and/or your insurance company. They can assist you in finding a qualified mental health professional that can help you with your journey.