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Acceptance and Commitment Therapy (ACT)

Acceptance Commitment Therapy (ACT)

Acceptance and Commitment Therapy (ACT) is a third-wave cognitive behavioural approach that evolved from traditional CBT. While rooted in the same evidence-based tradition, ACT shifts the focus from challenging thoughts to changing our relationship with them. Rather than trying to eliminate distressing thoughts or feelings, ACT helps individuals accept them as a natural part of life, using mindfulness and values-based strategies to build psychological flexibility. The aim is to support clients in living a meaningful, purpose-driven life—even in the presence of discomfort or uncertainty.

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Acceptance and Commitment Therapy (ACT) – Frequently Asked Questions
1. What is Acceptance and Commitment Therapy (ACT)?

ACT is a third-wave behavioural therapy focused on helping individuals increase psychological flexibility—the ability to be present, open up to experience, and take action aligned with personal values. ACT encourages acceptance of difficult emotions and thoughts, rather than trying to avoid or eliminate them.

Reference: Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2012).

2. What conditions does ACT treat effectively?

ACT has been shown to be effective for a wide range of clinical issues, including:

    • Depression
    • Generalized Anxiety Disorder (GAD)
    • Social Anxiety
    • Obsessive-Compulsive Disorder (OCD)
    • Chronic pain
    • PTSD and trauma
    • Substance use disorders
    • Eating disorders
    • Psychosis
    • Workplace and performance stress
    • Medical conditions (e.g., diabetes, cancer-related distress)

Reference: A-Tjak et al. (2015)

3. What are the core components of ACT?

ACT is built around six core processes that promote psychological flexibility:

    1. Cognitive Defusion – Learning to observe thoughts rather than be dominated by them
    2. Acceptance – Allowing unpleasant feelings to be present without struggling with them
    3. Present Moment Awareness – Practicing mindfulness and grounded attention
    4. Self-as-Context – Developing a flexible sense of self
    5. Values – Clarifying what truly matters to the person
    6. Committed Action – Taking steps guided by values, even in the face of discomfort

These processes are often visualised as the hexaflex model and are taught through metaphors, experiential exercises, and mindfulness practices.

Reference: Hayes et al., 2012

4. How long does ACT take?

ACT interventions vary based on the setting and condition, but typically:

    • 8 to 16 sessions is standard for common issues like anxiety or depression
    • Chronic or complex presentations may benefit from ongoing ACT over months

Source: Twohig & Levin, 2017

5. Is ACT effective?

Yes. ACT is classified as an empirically supported treatment by the APA Division 12 through its inclusion in the Unified Protocol and other outcome trials. Research has shown that ACT:

    • Reduces symptoms of anxiety, depression, and stress
    • Improves functioning and quality of life
    • Enhances emotional openness and behavioural flexibility
    • Matches or outperforms CBT in several studies

APA Division 12 recognition: https://div12.org/treatment/acceptance-and-commitment-therapy-act/

6. How does ACT differ from CBT?

ACT is commonly used with many psychological challenges that can also be treated with CBT (or with individuals that have previously tried CBT). So many people ask what is the difference between the two:

CBT

ACT

Change thoughts to feel better

Accept thoughts and focus on values

Skills-based

Mindfulness and values-based

Structured around symptom reduction

Focused on meaningful living

ACT emphasizes living a meaningful life, even in the presence of pain, rather than fixing or eliminating emotional discomfort.

7. Is ACT suitable for everyone?

ACT is especially effective for people who:

    • Struggle with avoidance of difficult emotions
    • Feel “stuck” in patterns of self-criticism or overthinking
    • Want to clarify their values and direction in life
    • Experience chronic stress, illness, or emotional numbness
References

A-Tjak, J. G. L., Davis, M. L., Morina, N., Powers, M. B., Smits, J. A. J., & Emmelkamp, P. M. G. (2015). A meta-analysis of the efficacy of acceptance and commitment therapy for clinically relevant mental and physical health problems. Psychotherapy and Psychosomatics, 84(1), 30–36. https://doi.org/10.1159/000365764

Gloster, A. T., Walder, N., Levin, M. E., Twohig, M. P., & Karekla, M. (2020). The empirical status of acceptance and commitment therapy: A review of meta-analyses. Journal of Contextual Behavioral Science, 18, 181–192. https://doi.org/10.1016/j.jcbs.2020.08.003

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2012). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). Guilford Press.

Twohig, M. P., & Levin, M. E. (2017). Acceptance and commitment therapy as a treatment for anxiety and depression: A review. Psychiatric Clinics of North America, 40(4), 751–770. https://doi.org/10.1016/j.psc.2017.08.009

Society of Clinical Psychology, APA Division 12. (n.d.). Acceptance and Commitment Therapy (ACT). Retrieved from https://div12.org/treatment/acceptance-and-commitment-therapy-act/