Acceptance and Commitment Therapy (ACT)

What is acceptance and commitment therapy?

Acceptance and commitment therapy (ACT) is a type of psychotherapy that helps you move beyond negative thoughts and feelings in a meaningful way by:

• Accepting that your thoughts and emotions are an appropriate response to certain situations.
• Committing to making changes in your life that match your values.

It’s normal to have negative thoughts and emotions. Having them doesn’t make you a bad person. Sometimes, your brain is wired to spend more time brooding in negative thoughts than moving on from them. This can affect your mental and physical health, work or school performance, and social life. Mental health professionals can help you rewire your brain so negative thoughts don’t take over.

Imagine you’re scheduled to give a presentation at work. You might think, “I’m nervous, and I’m going to mess it up.” Feeling nervous before a presentation is a realistic expectation to have. ACT can help you reframe your thoughts to: “I know I feel nervous, and that’s OK. I’m going to practice giving my presentation before the meeting so I feel more confident.”

During acceptance and commitment therapy, you learn to recognize that your emotions are part of the human experience. You’ll practice different ways of thinking to help you meet your individualized goals.

What does acceptance and commitment therapy treat?

Acceptance and commitment therapy may help you manage the following mental health conditions:

• Addiction.
• Alcohol use disorder.
• Anxiety disorders.
• Depression.
• Eating disorders.
• Obsessive-compulsive disorder (OCD).
• Post-traumatic stress disorder (PTSD).
• Social anxiety disorder.
• Stress.
• Substance use disorder.

You might seek this type of treatment to help you cope if you have a chronic or progressive disease or an underlying condition like cancer that may have a significant impact on your day-to-day life and future.

ACT isn’t the first line of treatment for these conditions, but it may be secondary or supplemental to other types of treatments (like medication) that your healthcare provider recommends.

Who is a good candidate for acceptance and commitment therapy?

Anyone can participate in acceptance and commitment therapy. Studies show that this type of therapy is best for teenagers and adults. You’ll need to use abstract thinking (understanding things or ideas that aren’t physical objects or experiences), which may be challenging for children to comprehend.

What happens during acceptance and commitment therapy?

During your first session, you’ll meet with a therapist (like a psychologist). They’ll learn more about who you are and your goals. They’ll give you more information about what you can expect, a planned timeline and what you’ll be working on during each session.

You’ll be given a lot of information at first, which can seem overwhelming. At the start of each session, you’ll review what you went over the week before so you don’t forget it. You’ll also be able to ask questions any time you have them.

Acceptance and commitment therapy focuses on learning more about yourself and your values. Each session is a little different. You’ll practice various exercises and techniques that help you:

• Set and achieve personalized goals.
• Be more mindful.
• Define your values.
• Explore your thoughts and feelings.
• Adjust your behavior.

Acceptance and commitment therapy follows six core processes that you’ll need to incorporate into each exercise. Exercises may include thinking about things in a new way, reevaluating past situations or exploring your values, among others.

What are the six core processes of ACT?

The six core processes of acceptance and commitment therapy are:

1. Acceptance: You accept that you’ll have a range of thoughts or emotions that can be positive, negative or anything in between.
2. Cognitive defusion: You detach or distance yourself from negative thoughts and beliefs. You see a thought as a passing event instead of a truth that drives your actions.
3. Being present: Your focus is on how you feel in the moment. You minimize planning for future “what ifs” so you can see more of what’s happening around you.
4. Self-as-context: You see yourself as a whole person with an identity. You aren’t solely defined by your experiences, thoughts or feelings.
5. Values: You set your own standards that you want to live up to. These values are yours and not driven by the influence of others.
6. Committed action: You make changes that help you meet your goals. These goals should align with your values.

The six processes follow the psychological flexibility model, where your behavior aligns with your values instead of your emotions driving your behavior. You may see other branches of therapy using a similar approach.

It takes time and practice to master these processes, so it’s normal to feel challenged as you work through them. Think of it like juggling. You can start with one ball, tossing it in the air. When you get comfortable, you can add another. Over time, you can keep all six balls moving at the same time. It’s OK if you drop one or need more time to add another. Your therapist will give you tips or help you readjust your form so you can juggle more at once. You’ll also need to practice what you learn during each session at home so the process becomes more second nature.

What are the benefits of acceptance and commitment therapy?

The main benefit of acceptance and commitment therapy (ACT) is psychological flexibility. This means you can recognize how your emotions play a role in your life, but you don’t feel overwhelmed by them. You learn to accept the things within your control and stay true to yourself and your values.

Other benefits of acceptance and commitment therapy may include:

• Mental clarity.
• Reduced symptoms of depression, anxiety and stress.
• A willingness to set and work toward your goals.
• Improved quality of life and functioning.

What are the risks of acceptance and commitment therapy?

Participating in therapy requires a certain level of vulnerability that can make you feel uncomfortable. You’ll need to face and address your thoughts and emotions to move forward from them. Therapy is difficult and requires significant mental effort. For these reasons, it’s normal — and OK — to feel overwhelmed and exhausted from time to time.

You may also be managing underlying mental health conditions where you’re more at risk of thoughts of suicide. Your therapist can help you navigate these thoughts. Outside of therapy, if you’re in a difficult spot, call or text 988, the Suicide & Crisis Lifeline. Someone is available to speak with you 24/7.

How long will I need acceptance and commitment therapy?

Each person has different goals and reasons for participating in therapy, so there isn’t a specific timeline that works for everyone. During your first session, your therapist can give you a rough estimate of what to expect. You’ll usually meet once a week for several weeks.

It’s also important to note that you’ll get out of it what you put into it. Therapy isn’t easy, and results don’t happen overnight. It’s just like playing a sport — you can’t win a game without putting in the practice. You’ll need to work hard and train your brain on new techniques to reach your personalized goals.

Let your therapist know if you feel like you’re falling behind or not meeting your goals. They can help you get back on track or try new techniques that better align with your values.