A Brief Overview of Acceptance and Commitment Therapy

Developed by University of Nevada psychology professor Steven C. Hayes in 1986, Acceptance and Commitment Therapy (ACT) encourages people to learn to accept and endure painful experiences, rather than escape or avoid them. Rooted in Hayes’ early work, which focused on the influence of language and thought on internal experience, ACT acknowledges that pain and suffering are not only inevitable, but essential. Instead of trying to avoid what causes fear, he encourages individuals to practice self-compassion.

When confronted with compassion, suffering can become a source of meaning and fulfillment. ACT is essentially a form of behavioral therapy that encourages psychological flexibility, allowing individuals to experience challenges without fear or resistance.

By confronting difficult experiences head-on, practitioners can increase their sense of self-acceptance. Combined with mindfulness-based therapeutic interventions, ACT has proven clinically effective in the treatment of conditions such as depression, anxiety, substance use disorder, and obsessive-compulsive disorder.

ACT aims to empower people to accept events and circumstances that are outside their control while committing to life-enriching actions. The intervention combines acceptance and mindfulness strategies with commitment and behavior change strategies to cultivate psychological flexibility. This strategy runs counter to popular ideas that hard work and right action can help people control their experiences.

The therapeutic framework for ACT involves six core processes. First, individuals must practice acceptance. Instead of denying or avoiding painful emotions, they must choose to allow unpleasant experiences to exist. Acceptance is not a goal, but rather an active choice.

Next, participants engage in cognitive defusion, which aims to decrease fixation on negative thoughts and experiences. By surrendering to what is, they can take away a negative event’s power to dominate their thoughts. The third core process of being present ties into this step, encouraging the person to maintain awareness of the present moment, without judging or trying to change it.

Self as context teaches that an individual’s identity comprises more than what happens to them, and that each person has a “self” outside their current experience. The fifth process (values) invites the person to consider their deepest principles. ACT then provides tools to help them bring their lives into alignment with these values. Finally, the committed action process guides practitioners in taking action. Once they are aware how their behavior choices affect their emotions, they can implement positive changes.

Like other behavior-based therapies, ACT focuses on acceptance instead of avoidance. During an ACT session, a therapist will help a person apply these six core processes to everyday life. For example, the therapist may implement mindfulness exercises that identify unpleasant sensations in the body. Instead of learning to “fix” these problems, the practitioner can spend time observing without judging.

A therapist may also guide a person in noticing where their actions did not align with their values, or may help them separate their sense of self from negative thoughts and feelings. Between sessions, the therapist may assign homework exercises to help individuals develop a healthy, non-judgmental awareness of memories or thoughts.

Because it aims to reduce the struggle to control anxious thoughts and encourages involvement in meaningful activities that align with chosen values, ACT has shown promise in improving the symptoms of generalized anxiety disorder (GAD). ACT has proven particularly beneficial for older adults with GAD.

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