acceptance and commitment therapy

Acceptance and Commitment Therapy (ACT)

Table of Contents


If you’re struggling with depression, anxiety, chronic pain or other mental health issues, acceptance and commitment therapy (ACT) may help. This empirically-supported treatment of acceptance and commitment therapy (ACT) teaches you psychological flexibility to manage distressing thoughts and feelings while taking value-based action. This comprehensive beginner’s guide will explain everything you need to know about acceptance and commitment therapy  (ACT). You’ll learn what is acceptance and commitment therapy (ACT) , how it works, techniques used, applications, finding a therapist, cost, and maximizing your success. With key facts and practical guidance, you’ll be well equipped to pursue acceptance and commitment therapy  (ACT)’s benefits. Let’s get started!

Acceptance and Commitment Therapy for adults with chronic pain |

What is Acceptance and Commitment Therapy (ACT)?


Acceptance and commitment therapy (ACT, pronounced as the word “act”) is a form of psychotherapy that focuses on accepting difficult thoughts and feelings while committing to actions that align with your values.

Rather than trying to change, avoid or eliminate troublesome inner experiences, ACT helps you see thoughts as just thoughts and feelings as just feelings. This mindfulness-based approach allows you to engage fully in life’s meaningful activities regardless of whatever distressing emotions may arise.

ACT emerged in the 1980s and extensive research demonstrates its effectiveness treating disorders like depression, anxiety, OCD, PTSD, chronic pain and addiction. It combines acceptance, mindfulness, behavior change and value-driven living to enhance psychological flexibility and fulfillment.

Acceptance and Commitment Therapy.

How Does Acceptance and Commitment Therapy Work?

ACT’s therapeutic effects stem from its underlying model of human suffering and path to healing.

According to ACT, most pain in life is unavoidable. However, excess suffering occurs when we become entangled in unhelpful reactions that exacerbate normal pain. For example, judging thoughts as “bad,” avoidance behaviors, isolation, substance abuse or aggression often create additional stress.

ACT interrupts this cycle by teaching clients to:

  1. Accept and embrace unwanted private experiences like thoughts, emotions or urges
  2. Gain distance from thoughts by seeing them as passing mental events rather than absolute truth or necessities
  3. Live with purpose and commitment guided by chosen values

This flexible, empowered stance reduces suffering and enhances wellbeing. ACT patients learn valuable metaphors and skills like mindfulness, defusion, acceptance and values-based living. The acronym “ACT” summarizes the process.

Acceptance and Commitment Therapy  Core Processes and Skills

ACT helps clients develop psychological flexibility through six core therapeutic processes:

A = Acceptance – Allowing difficult feelings, memories, urges or thoughts to exist without judgement or trying to control them.

C = Cognitive Defusion – Observing thoughts non-judgmentally without over-identifying with them or taking thoughts literally. Recognizing thoughts as mental events rather than absolute truths.

T = Being Present – Staying grounded in the present moment with awareness and flexibility vs constantly dwelling on the past or future. Using mindfulness skills.

C = Self as Context – Developing perspective and separating a solid sense of self from thoughts/feelings which come and go.

C = Values – Discovering what matters most and committing to value-guided action vs avoiding or escaping discomfort. Clarifying life directions.

C = Committed Action – Setting goals aligned with values and engaging in behavior change consistently despite obstacles. Moving in valued life directions.

These core skills work synergistically to increase psychological flexibility – the ability to act effectively guided by what matters most even when faced with challenging inner experiences.

What Does Acceptance and Commitment Therapy  Treatment Involve?

An ACT therapist will guide you through exercises, metaphors, stories, humor and experiential practices to help you learn each flexibility process. You’ll apply skills first in session, then through homework and real-world practice. Common ACT interventions include:

Mindfulness skills – Exercises to practice present moment awareness, observing thoughts non-judgmentally and accepting emotional distress.

Cognitive defusion – Techniques like repeating a word until it loses meaning to gain distance from unhelpful thoughts.

Metaphors – Stories, jokes or analogies that convey ACT principles, like “digging a hole while falling in a hole” to depict ineffective struggle.

Values discovery – Clarifying what truly matters through writing, discussion and behavioral activation exercises.

Committed action – Setting incremental goals aligned with values and troubleshooting obstacles to progress.

Experiential exercises – ACT therapists often use interactive methods like role plays, visualizations and physical movements.

Behavioral skills training – Learning assertiveness, social skills, problem solving and other techniques to take values-based action.

These methods aim to increase psychological flexibility, reduce ineffective control strategies and align behavior with chosen values.

Mental Health Conditions

Acceptance and Commitment Therapy

(ACT) Can Help With

acceptance and commitment therapy

Substantial research supports using ACT for:

  • Depression
  • Anxiety disorders – generalized anxiety, social anxiety, panic disorder, phobias
  • Obsessive compulsive disorder (OCD)
  • Post-traumatic stress disorder (PTSD)
  • Chronic pain conditions
  • Stress management
  • Anger issues
  • Addictions
  • Eating disorders
  • Psychosis

ACT is considered an empirically-supported treatment for these issues. It can help with relationship problems, workplace issues, coping with illness or clarifying life directions. ACT is applicable to most mental health struggles.

Main Techniques & Exercises Used in

Acceptance and Commitment Therapy


ACT practitioners have a diverse toolkit of exercises to impart flexibility skills:

Mindfulness techniques help clients practice present moment focus and accept distress without judging thoughts or feelings. Examples include observing the breath, body scans, mindful eating and walking meditations.

Cognitive defusion exercises teach alternative ways of relating to thoughts, such as thanking your mind for unhelpful thoughts or saying thoughts out loud in a silly voice. These create psychological distance from thought content.

Metaphors and paradoxes tell relatable metaphorical stories that reveal how struggle exacerbates pain or show the futility of avoiding emotions. For example, the “quicksand metaphor” depicts how panicked flailing sinks someone deeper, just as emotional avoidance backfires.

Values clarification uses writing, discussion, envisioning exercises and motivational worksheets to help define meaningful life directions.

Committed action involves setting incremental goals, planning steps and troubleshooting obstacles to take concrete values-based steps forward.

In addition to core ACT processes, therapists integrate other evidence-based exercises as appropriate, including Socratic questioning, role plays and exposure techniques.

What is an Acceptance and Commitment Therapy Session Like?

ACT sessions involve experiential learning of flexibility skills. The therapist acts as a coach, guiding you through metaphors, discussions and targeted exercises. You’ll be actively engaged practicing new tools each meeting.

A typical 60-minute ACT session may involve:

  1. Checking in on progress and challenges with homework
  2. Learning a new metaphor or technique
  3. Doing an interactive or written exercise together
  4. Discussing insights and asking clarifying questions
  5. Planning how to apply skills before next session
  6. Reviewing progress on values-based goals

The collaborative hands-on process makes abstract ACT concepts concrete. You’ll leave each meeting with tangible skills to practice.

How Many ACT Therapy Sessions Are Needed?

The number of sessions needed depends on severity of your challenges. Mild issues may resolve in 6-12 sessions while more entrenched problems like trauma may take longer.

A typical ACT course consists of:

  1. Weekly 60-minute sessions over 3-6 months for milder issues
  2. 60-90 minute sessions twice weekly for more severe problems
  3. Ongoing maintenance sessions to reinforce gains as needed

Building psychological flexibility is an ongoing journey. Sticking with the process allows time to master skills and cement changes fully. Progress accelerates once concepts click through experience.

Group vs Individual ACT Therapy


ACT can be done one-on-one or in a group format.

Individual therapy offers personalization for your exact needs. The therapist tailors the process around your challenges, pace and goals.

Group therapy provides cost savings plus insights from hearing peers’ perspectives. Exercises often focus on universal issues like clarifying values. Connecting around shared struggles also reduces isolation.

Individual therapy is usually the best option for complex issues. Combined individual plus group sessions help give a broader set of tools.

Does Acceptance and Commitment Therapy Really Work?


Yes, several decades of clinical research support

Acceptance and Commitment Therapy

ACT’s effectiveness including multiple meta-analyses and systematic reviews:

  1. For depression, ACT outperformed cognitive therapy and matched medication efficacy (1)
  2. For anxiety disorders, ACT is highly effective and durable (2)
  3. For addiction, ACT lowered substance abuse and relapse rates (3)
  4. For chronic pain, ACT reduced pain severity and disability (4)
  5. Overall, ACT demonstrates strong and lasting benefits across conditions (5)

Learning to accept unavoidable pain while committing to actions aligned with your values enhances mental health and quality of life based on the evidence.

Tips for Getting the Most out of ACT Therapy


To maximize gains from your

Acceptance and Commitment Therapy

ACT treatment:

  1. Attend consistently without skipping or canceling if possible
  2. Share openly rather than withholding thoughts, feelings or actions
  3. Do homework diligently to practice ACT skills daily
  4. Read recommended ACT self-help books and worksheets
  5. Use metaphors, exercises and mindfulness regularly outside of sessions
  6. Raise any difficulties applying skills so your therapist can guide adjustments
  7. Integrate ACT with healthy lifestyle habits like physical activity
  8. Be patient with yourself and the process – growth takes time
  9. If progress stalls, request more intensive treatment or an alternative evidence-based approach

Committing fully to the therapeutic process ensures you acquire valuable psychological flexibility skills.

Overcoming Common Challenges and Obstacles with ACT

Acceptance and Commitment Therapy (ACT) is simple in concept but often challenging in execution. Common difficulties and solutions include:

Difficulty accepting or observing thoughts/feelings – Keep practicing mindfulness skills. Start by accepting smaller emotions before tackling bigger ones.

Getting stuck in thoughts – Notice getting hooked without judgement. Refocus on the present moment. Repeat defusion exercises.

Tolerating distress – Go slowly and in small doses. Use coping skills like breathwork. Seek emergency help if self-harm urges arise.

Avoiding valued actions – Break goals into very small steps. Schedule activities and make commitments. Troubleshoot barriers.

Losing motivation – Revisit your values. Cultivate compassion. Review progress. Recommit each day.

Forgetting to practice ACT skills – Make reminders. Set routines. Identify triggers to use skills.

Hopelessness about progress – Note small changes. Review how far you’ve come. Trust that continued practice pays off.

Don’t let setbacks derail you. Challenges are expected – communicate concerns promptly so your therapist can tailor support.

How to Find an ACT Therapist

Qualified Acceptance and Commitment Therapy  (ACT) therapists include psychologists, clinical social workers, counselors, and psychiatrists. Look for these signs of expertise:

  1. Specialization or certification in ACT
  2. 5+ years performing ACT therapy
  3. Ongoing ACT training and professional development
  4. 500+ clinical hours administering ACT

Start your search on directories like PsychologyToday or ACT’s therapist finder. Schedule initial consults and ask about their ACT qualifications. Select someone you feel comfortable working with long-term.

Questions to Ask a Potential ACT Therapist


Key questions for initial provider consultations include:

  1. How long have you practiced ACT therapy and how many clients have you treated?
  2. Do you stay up to date through ongoing ACT training and supervision?
  3. What is your therapeutic style?
  4. How do you individualize treatment to client challenges and goals?
  5. Will we review progress periodically to ensure ACT is working for me?
  6. Do you provide after-hours support if I need help between sessions?
  7. What are your credentials and mental health licensure?

Choosing an experienced ACT practitioner you feel at ease with maximizes your odds of success.

Cost of ACT Therapy


As a form of talk therapy, ACT costs approximately:

  1. $100-$250 per 50-60 minute session out-of-pocket without insurance.
  2. With insurance, copays range from $0-$50 per session depending on coverage.

ACT is considered an empirically-supported treatment, so many insurers cover a portion of the costs. Ways to reduce expenses include seeing an ACT trainee with lower rates, doing group therapy, and using self-guided ACT books/workbooks to supplement.

Investing in ACT leads to reduced healthcare costs over time by improving mental health before issues worsen. Compared to costs of chronic untreated mental illness, therapy is extremely cost effective.

Using Insurance to Help Pay for ACT


To use insurance for Acceptance and Commitment Therapy :

  1. Verify your plan covers ACT therapy – it meets standards as an evidence-based treatment for many diagnoses.
  2. Choose an in-network provider to maximize coverage and lower copays.
  3. Know your copay amount for mental health services – often around $20-$50 per session.
  4. Ask about preauthorization requirements or session limits (often 20 visits annually).
  5. Have the therapist submit claims forms and follow up if issues arise.
  6. Appeal any denials in writing emphasizing ACT’s proven effectiveness for treating your condition.

Taking advantage of insurance benefits makes ACT’s life-improving techniques more accessible.

Online ACT Therapy Options


Online platforms make attending Acceptance and Commitment Therapy  ACT therapy more convenient through:

  1. Videoconferencing into home or office
  2. Text-based messaging therapy apps
  3. Email exercises with a therapist
  4. Virtual reality ACT simulations
  5. Online therapy programs with therapist support

Research indicates web-based ACT is effective for multiple conditions including depression, social anxiety, OCD and more (6). If attending office visits is difficult, look for accredited providers offering teletherapy appointments.

ACT Therapy Techniques to Practice at Home

Between sessions, Acceptance and Commitment Therapy  (ACT) techniques to try at home include:

  • Mindfulness – Sit observing thoughts, emotions and environment without judgment. Notice senses.
  • Defusion – Say thoughts aloud in silly voices to create distance. Write thoughts on paper then burn or shred.
  • Acceptance – Allow feelings or cravings to be present without acting on them. Say “I’m having the thought that…” vs “I am…”
  • Present focus – Anchor in the now during routines like showering, walking or eating. Describe environment.
  • Values – Make values reminder cards or write out value statements. Set value-based goals.
  • Committed action – Take small steps toward values like calling a friend or applying for a class.

Use worksheets, online/app-based exercises and ACT books to continue growing skills outside of sessions.

ACT Therapy Exercises, Workbooks and Resources

Reputable Acceptance and Commitment Therapy  (ACT) self-help resources include:


  • The Happiness Trap by Russ Harris – Best overall ACT workbook
  • ACT Made Simple by Russ Harris – Highly rated simplified guide
  • The ACT Workbook for OCD by Jon Hershfield – Specialized OCD guide


  • Get Out of Your Mind and Into Your Life by Steven Hayes – Groundbreaking ACT book
  • Learning ACT by Jason Luoma, Steven Hayes and Robyn Walser – Step-by-step ACT manual
  • The Confidence Gap by Russ Harris – Using ACT to build self-efficacy

Online Resources

  1. Association for Contextual Behavioral Science – Organization for ACT research and training
  2. – Resources for mental health professionals
  3. ACT – Extensive articles, exercises and worksheets

Use books, worksheets and online tools to gain specialized knowledge and enlarge your ACT skills toolbox.

Does Acceptance and Commitment Therapy Work for Kids or Teens?

Yes, Acceptance and Commitment Therapy (ACT) has been adapted effectively to treat mental health conditions in children and adolescents including:

  • Anxiety
  • Depression
  • Disordered eating
  • OCD
  • Chronic pain
  • Behavioral disorders

Developmentally-tailored exercises like games, role playing, stories and movement help younger clients grasp ACT’s principles concretely. Parents are often involved to reinforce skills at home. Age appropriate ACT workbooks are also available.

Combining Acceptance & Commitment Therapy with Medications and Other Therapies

ACT complements other therapies well, including:

  • Medications like antidepressants or anxiolytics which may treat acute symptoms while ACT addresses long-term skills.
  • Exposure therapy to gradually face feared situations with acceptance skills.
  • CBT to modify unhelpful thought and behavior patterns causing distress.
  • DBT for intense emotions and impulse control difficulties.
  • Mindfulness-Based therapies like MBCT to enhance awareness and present focus.

Integrated care under a mental health professional can incorporate ACT with other treatments for comprehensive benefits.

ACT vs CBT: Which is Better?

ACT and CBT take complementary approaches:

CBT seeks to modify irrational or unhelpful thoughts and behaviors. It uses tools like cognitive restructuring and exposure.

ACT teaches acceptance of unchangeable difficult inner experiences plus valued action. It applies mindfulness, defusion and values exercises.

When to choose CBT: Clear problematic thinking patterns or behavioral chains to target. Seeking relief from anxiety, OCD or phobias.

When to choose ACT: Depression, trauma, chronic pain or anger where thoughts/feelings arise for good reason. Openness to acceptance approaches.

For complex issues like depression with anxiety, combining CBT and ACT may give optimal results.


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