A teenage girl is in acceptance and commitment therapy.

What to Know About Acceptance and Commitment Therapy

6 min.

Instead of trying to change or eliminate distorted thoughts or feelings, acceptance and commitment therapy (ACT) helps people mindfully notice them and take action to live a meaningful life.

By: Charlie Health Editorial Team

Clinically Reviewed By: Dr. Don Gasparini

Updated: November 23, 2023

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Table of Contents

As its name suggests, acceptance and commitment therapy (ACT) is a mindfulness-based therapy focused on acceptance. Developed in the late 1980s by psychologists Steven C. Hayes, Dr. Kelly G. Wilson, and Kirk Strosahl, ACT aims to help people non-judgmentally accept unwanted thoughts and feelings with self-compassion while taking steps to live a meaningful life. 

This approach is different from many behavioral therapy techniques, like cognitive behavioral therapy (CBT), that try to change or eliminate distorted thoughts. From an ACT perspective, resisting difficult thoughts and feelings can create “psychological inflexibility,” making it hard to act in line with our core values. With ACT, the goal is to boost “psychological flexibility” by mindfully noticing unwanted thoughts or sensations—helping people be more present and enabling them to take actions based on personal values. Here, we delve further into the philosophy of ACT, how it works, what conditions it treats, and more. 

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How does acceptance and commitment therapy work?

As mentioned, ACT works by helping people develop psychological flexibility—the ability to be open, adapt, and take effective action in the presence of difficult thoughts and emotions. Its approach can be broken down into six core processes that help people become more flexible in their thinking, making it easier to handle life’s challenges and live a meaningful and values-based life. The six core processes of ACT are as follows:

Acceptance

Acceptance in ACT involves acknowledging and allowing one’s thoughts and feelings without judgment. It’s about being open to experiencing the full range of emotions and thoughts, even those that are uncomfortable or distressing. Instead of resisting anxious thoughts, accepting them means recognizing them without trying to push them away.

Cognitive defusion

Cognitive defusion is the process of changing the way people relate to their thoughts. It involves creating distance from thoughts, seeing them as passing events rather than absolute truths. Instead of saying, “I am a failure,” one might say, “I notice the thought that I am a failure.”

Present moment awareness

This process involves cultivating mindfulness—being fully present in the current moment. It encourages people to engage in their experiences without being overly influenced or distracted by past or future concerns. For instance, this could be a small mindfulness exercise like paying full attention to the sights, sounds, and sensations in the current moment without getting caught up in thoughts about the past or future.

Self-as-context

Self-as-context involves seeing oneself from a broader perspective. It’s recognizing that one’s identity is not solely defined by thoughts and emotions but extends beyond them. This could look like understanding that personal worth is not determined solely by success or failure in a specific situation.

Values clarification

This process involves identifying and clarifying one’s core values—what is truly important and meaningful in life. It provides a foundation for making choices and decisions that align with these values. For example, identifying that honesty and compassion are fundamental values and striving to live in accordance with them.

Committed action

Committed action is about taking purposeful and values-driven actions, even in the presence of unhelpful thoughts or emotions. It involves setting goals and making behavioral choices aligned with one’s values. For instance, this could look like taking steps to engage in social activities if connection and relationships are valued despite feeling anxious.

In an ACT session, people work with a therapist to tackle their challenges and boost mental flexibility. In ACT, people discuss their concerns without judgment, and the therapist introduces concepts like acceptance and mindfulness. The therapist guides the person to set goals based on their values and plan actions aligned with these values. Throughout the session, there’s talk about progress, and individuals might have homework (like a mindfulness exercise) to practice what they’ve learned.

What conditions can acceptance and commitment therapy treat?

ACT has been found to be effective in treating a wide range of mental health conditions and psychological issues. However, while ACT can be beneficial for many people, its effectiveness may vary from person to person. Also, ACT is often used in conjunction with other therapeutic approaches, like CBT or dialectical behavior therapy (DBT), as part of a comprehensive treatment plan. Some of the mental health conditions that ACT has been used to address include:

Anxiety disorders

ACT can help people with various anxiety disorders, such as generalized anxiety disorder (GAD), social anxiety disorder, and specific phobias. It focuses on accepting anxious thoughts and feelings while encouraging individuals to take actions aligned with their values, even in the presence of anxiety.

Depression

ACT provides tools to help people manage and alleviate symptoms of depression by changing their relationship with difficult thoughts and emotions. It emphasizes accepting these depressive thoughts and emotions without judgment, allowing people to instead focus on how to take meaningful actions in their lives.

Obsessive-compulsive disorder (OCD)

ACT complements traditional treatments for OCD by addressing the distressing thoughts and behaviors associated with the disorder. It helps people develop a more accepting and flexible relationship with obsessive thoughts.

Post-traumatic stress disorder (PTSD)

ACT can be part of a comprehensive approach to treating PTSD. It helps people in managing trauma-related thoughts and emotions, fostering acceptance, and promoting values-based living.

Eating disorders

ACT is integrated into the treatment of eating disorders by helping individuals accept difficult emotions related to body image and food. It encourages actions that are consistent with long-term values and well-being.

Substance use disorders (SUD)

In substance use disorder treatment, ACT addresses cravings, triggers, and the behavioral patterns associated with substance abuse. It promotes acceptance of urges while encouraging committed actions toward substance abuse recovery.

Chronic pain

For those dealing with chronic pain, ACT focuses on accepting the pain rather than trying to control or eliminate it. It encourages people to pursue actions that are consistent with their values, even in the presence of pain.

Workplace stress and burnout

In organizational settings, ACT is applied to help individuals manage work-related stress and prevent burnout. It equips individuals with tools for coping with stressors while maintaining focus on meaningful work.

A young male is experiencing workplace stress and burnout and could benefit from acceptance and commitment therapy.

How effective is acceptance and commitment therapy?

As mentioned, ACT has been proven effective for various mental health issues, offering positive outcomes in treating many conditions. For instance, one piece of research that analyzed 133 studies with 12,477 total participants found ACT effective (meaning it showed positive effects) for a broad range of people. ACT is versatile and beneficial for diverse populations, but multiple studies have found it to be particularly effective (as effective as CBT, for instance) in the treatment of anxiety, depression, and somatic health problems (like chronic pain and stress). While its effectiveness may vary from person to person, the evidence supports ACT as a valuable option for addressing mental health concerns. 

Acceptance and commitment therapy at Charlie Health 

If unhelpful thoughts or feelings are keeping you from living life to its fullest in alignment with your personal values, Charlie Health is here to help. 

Charlie Health’s virtual Intensive Outpatient Program (IOP) combines group sessions, individual counseling, and family therapy to provide more than once-weekly support for young people with complex mental health conditions and their families. Our expert clinicians are skilled in a range of therapeutic modalities, including cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), and acceptance and commitment therapy (ACT), and work with each client to come up with a personalized treatment plan. 

If you think Charlie Health may be a fit for yourself or a loved one, fill out this free, short form to get started today.

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