Acceptance and Commitment Therapy (ACT):
What is it and who can benefit from it?

Updated: 26/11/24

Written by Dr Sara Tookey, Clinical Psychologist​​

 

Acceptance and Commitment Therapy (ACT) is - Embracing Psychological Flexibility

 

Acceptance and Commitment Therapy (ACT, pronounced as one word "act") is an evidence-based approach that helps people accept what is outside their control while committing to actions that enrich their lives. Developed by Steven Hayes and colleagues in the late 1980s, ACT uses mindfulness strategies combined with behavioral changes to increase psychological flexibility.​

 

ACT is built on the fundamental idea that psychological suffering often comes from our attempts to control or avoid difficult thoughts and feelings. Rather than trying to change or eliminate challenging experiences, ACT teaches us to develop a new relationship with them while moving toward what matters most to us.

 

 

The Science Behind ACT

 

Research demonstrates that psychological flexibility - the core process in ACT - is associated with:

 

• Better mental health outcomes (Gloster et al., 2020)

• Improved quality of life (Hayes et al., 2017)

• Enhanced ability to cope with chronic pain (Hughes et al., 2017)

• Greater workplace functioning (Bond & Bunce, 2003)

 

 

The Six Core Processes of ACT

 

ACT works through six interconnected processes, often visualised as the "ACT Hexaflex":

​

1.  Acceptance

• Embracing thoughts and feelings without trying to change them

• Alternative to experiential avoidance

​

2.  Cognitive Defusion

• Learning to step back from thoughts

• Seeing thoughts as mental events rather than literal truths

 

3.  Being Present

• Maintaining non-judgmental contact with psychological and environmental events

• Mindful awareness of the here-and-now

 

4.  Self-as-Context

• Accessing a transcendent sense of self

• Experiencing oneself as the context where experiences occur

 

5.  Values

• Identifying what truly matters to you

• Clarifying desired life directions

 

6.  Committed Action

• Taking effective action guided by values

• Building patterns of effective behaviour

​

​

Who Can Benefit from ACT?

 

ACT has shown effectiveness for:

 

• Anxiety disorders (Twohig et al., 2018)

• Depression (A-Tjak et al., 2021)

• Chronic pain (Hughes et al., 2017)

• Substance use disorders (Lee et al., 2015)

• Work-related stress (Bond & Bunce, 2003)

• OCD and psychosis (Bluett et al., 2014)

 

 

What to Expect in ACT Sessions

 

ACT therapy typically involves:

 

1. Learning mindfulness skills

2. Clarifying personal values

3. Practicing acceptance strategies

4. Developing psychological flexibility

5. Creating action plans aligned with values

 

 

Key ACT Techniques

 

Mindfulness Exercises

• Present moment awareness

• Mindful breathing

• Body scan meditations

 

Metaphors and Experiential Exercises

• "Passengers on the Bus" metaphor

• "Leaves on a Stream" exercise

• "Chess Board" metaphor

 

Values Work

• Values clarification exercises

• Values-based goal setting

• Committed action planning

 

 

The Evidence Base

 

ACT's effectiveness is supported by substantial research.

 

A comprehensive meta-analysis by A-Tjak et al. (2021) found that ACT was:

 

• Significantly effective for anxiety and depression

• Comparable or superior to established treatments

• Associated with maintained improvements at follow-up

 

Studies have shown ACT to be particularly effective for:

 

• Chronic pain management (Hughes et al., 2017)

• Anxiety disorders (Twohig et al., 2018)

• Work-related stress (Bond & Bunce, 2003)

 

 

 

 

​