Acceptance and Commitment Therapy (ACT)

Understanding the Foundation of ACT

Dr. Steven Hayes developed ACT in response to the deficits he found in providing cognitive-behavioral therapy. Hayes had personal struggles with panic attacks and found that his attempts to control or reduce his anxious thoughts often exacerbated them. By learning how to accept himself and his symptoms – and by embracing the moment instead of resisting it – he noticed significant emotional relief. 

At its core, acceptance and commitment therapy is a contextual behavioral science, blending key aspects of clinical psychology, cognitive therapy, mindfulness exercises, and the inherent wisdom of the mind and body. ACT derives from concepts of relational frame theory (RFT), which focuses on how humans identify and connect to the world through complex relational networks. 

This theory creates a framework for discerning individual values. In ACT therapy, clients learn how to accept themselves and their circumstances to improve their overall well-being.

Six ACT Processes 

ACT interventions focus on concepts of emotional regulation, cognitive defusion, values, and learning how to practice acceptance. ACT also emphasizes the notion of experiential avoidance, which refers to how people seek to avoid or escape their negative thoughts, emotions, or memories. While this strategy may provide some initial relief, it can perpetuate a sense of psychological suffering. By facing discomfort – and embracing themes of acceptance – people build more resilience and feel more empowered.

ACT adheres to six crucial elements: 

1) Acceptance: Acceptance refers to acknowledging and identifying the complete spectrum of various emotions, physical sensations, and thoughts. Acceptance isn’t a ‘set destination.’ Rather, it’s a deliberate effort to learn how to sit with discomfort without feeling doomed by it. 

2) Values clarification:  ACT aims to help individuals better align their current lives to their personal values. Clients are encouraged to continuously reflect on what matters most to them, as these priorities shape meaning and purpose. 

3) Being present: ACT principles are rooted in helping people orient themselves to the present moment. Practicing mindfulness can decrease ruminating on the past or obsessing about the future. This, in turn, can promote a deeper sense of inner peace. 

4) Self-as-context: ACT assumes that all people have a full sense of self; they are infinitely more than their past experiences, negative thoughts, or fleeting feelings. Successful treatment entails learning how to ‘observe self’ without getting too caught up in emotional discomfort. 

5) Cognitive defusion: Cognitive defusion focuses on learning how to understand and relate to certain thoughts rather than trying to change them. Strengthening this mindfulness muscle can empower people to mindfully observe how they feel or what they think without panicking or acting in ways they later regret. 

6) Committed action: ACT practitioners help clients choose to engage in proactive choices based on their core values. The idea is that owning a sense of commitment can significantly reduce emotional pain and lead to desired behavioral change. When a client’s goals actually align with their values, they may be more inclined to follow through with them. 

Efficacy of ACT 

Today, mental health professionals use ACT resources to support their clients in building a rich and meaningful life. Moreover, research has consistently shown that ACT can be beneficial in treating some of the following presenting concerns: 

Depression: A significant meta-analysis reviewing 11 studies of nearly 1000 people found that ACT helped decrease depressive symptoms⁽¹⁾.

Anxiety symptoms: A randomized-controlled trial reviewing ACT found that this model can effectively reduce symptoms of generalized anxiety disorder and other anxiety disorders. 

Chronic pain: ACT processes are known to reduce stress and pain symptoms. Furthermore, the World Health Organization (WHO) has deemed ACT as a recommended treatment approach for treating pediatric chronic pain symptoms⁽²⁾. 

Family mental health: ACT training can also support reducing the stigma of serious psychiatric conditions, with research showing that ACT can improve overall family well-being and coping amid mental illness⁽³⁾. When family members were taught the principles of acceptance and mindfulness, they were more involved in their loved one’s treatment and recovery. 

Is ACT Right For You? 

ACT sessions tend to be both collaborative and action-oriented. If you’re looking to make an important behavior change, ACT differs from many Western psychology practices in the sense that it’s not about making you do anything. Instead, it’s about accepting your circumstances, leaning into your values, and creating goals that embody those values. 

With that, the model is relatively flexible, and it may include a range of interventions, including experiential exercises, mindfulness, and behavior change strategies.

You may benefit from acceptance and commitment therapy if you:

• persistently feel stuck in your negative thought patterns
• struggle with indecisiveness or are unable to set meaningful goals in your life 
• feel disconnected from your identity or sense of values 
• resonate with having long-term anxiety or depression symptoms 
• have felt limited by other behavioral therapies 
• want to integrate more mindfulness into your everyday life
• have difficult life circumstances and want support in embracing more acceptance 
• want to engage in meaningful life activities but feel uncertain of what you need

Some practitioners use ACT as a standalone model, but it also balances well with other therapeutic modalities, including cognitive behavior therapy (CBT), dialectical behavior therapy (DBT), psychodynamic therapy, and mindfulness-based cognitive therapy (MBCT).

Final Thoughts 

Acceptance and commitment therapy offers both a gentle but empowering approach to treating a variety of mental health problems. The six ACT processes support people to embrace their current lives and derive a deeper sense of meaning and satisfaction. 

If you’re struggling with your mental health, you don’t need to navigate your symptoms alone. Seeking professional support offers compassion and guidance in helping you make the changes you desire. 

Sources

1. Acceptance and Commitment Therapy: A Meta-Analytic Review (2009). JSTOR. Retrieved from: https://www.jstor.org/stable/48511139. 
2. Acceptance and Commitment Therapy for Pediatric Chronic Pain: Theory and Application (2017). National Library of Medicine. Retrieved from: https://pmc.ncbi.nlm.nih.gov/articles/PMC5332912/. 
3. Investigation the effect of Acceptance and Commitment Therapy (ACT) training on stigma and family functioning in family members of patients with psychiatric disorders: a randomized controlled clinical trial (2024). BMC Psychiatry. Retrieved from: https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-024-06114-2?utm_source=chatgpt.com.