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What is Acceptance and Commitment Therapy (ACT)?

By The Science of Mindfulness

Acceptance and Commitment Therapy (ACT)

Acceptance and Commitment Therapy, said as one word, “act,” was developed by Steven Hayes, Kelly Strosahl, and Kirk Wilson as a behavioral therapy that draws on mindfulness and acceptance1. Rather than trying to reduce or control difficult thoughts and feelings, ACT helps people change how they relate to them and move toward the kind of life they value. The overall goal is psychological flexibility: the ability to stay in contact with the present moment and to act in line with one’s values, even when discomfort is present2.

Course Format: ACT is organized around six core processes. Four of them are mindfulness and acceptance processes: acceptance (making room for painful experiences), cognitive defusion (stepping back from thoughts rather than being ruled by them), contact with the present moment, and self-as-context (a stable observing perspective). The remaining two are commitment and behavior-change processes: clarifying values and taking committed action in their direction2. There is no single fixed protocol length. ACT is delivered one-to-one, in groups, and in brief workshop and digital formats, and the number of sessions varies with the problem being treated.

Instructor Requirements: ACT is usually delivered by licensed mental health professionals who have completed ACT-specific training. The Association for Contextual Behavioral Science, the professional community around ACT, shares training resources and a directory of peer-reviewed trainers.

Course Outcomes: A meta-analysis of 39 randomized controlled trials including 1,821 patients with mental disorders or physical health problems found that ACT outperformed control conditions on primary outcomes at the end of treatment and at follow-up (Hedges’ g = 0.57). ACT was superior to waitlist (g = 0.82), to a psychological placebo (g = 0.51), and to treatment as usual (g = 0.64). Compared with established treatments such as cognitive behavioral therapy, there was no significant difference3. The authors concluded that ACT may be as effective as established psychological interventions for anxiety disorders, depression, addiction, and somatic health problems, and called for more research on quality of life and on the processes of change.

Clinical Populations: ACT has been studied in people with anxiety, depression, substance use, chronic pain and other physical health conditions3. Its flexible structure makes it easy to adapt, which also means that what is delivered under the name “ACT” can vary from one setting to another.

Learn More: The Association for Contextual Behavioral Science hosts introductory materials, training events, and research. For a therapy that shares ACT’s emphasis on acceptance, see Dialectical Behavior Therapy (DBT).

This page is for general education and is not medical advice. Please speak with a qualified health professional about treatment options.

References

  1. Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2012). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). Guilford Press.
  2. Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and Commitment Therapy: Model, processes and outcomes. Behaviour Research and Therapy, 44(1), 1-25. https://doi.org/10.1016/j.brat.2005.06.006
  3. A-Tjak, J. G., Davis, M. L., Morina, N., Powers, M. B., Smits, J. A., & Emmelkamp, P. M. (2014). A Meta-Analysis of the Efficacy of Acceptance and Commitment Therapy for Clinically Relevant Mental and Physical Health Problems. Psychotherapy and Psychosomatics, 84(1), 30-36. https://doi.org/10.1159/000365764

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