Understanding Acceptance and Commitment Therapy (ACT): A Modern Approach to Mental Wellness

How Acceptance and Commitment Therapy (ACT) Functions

Acceptance and Commitment Therapy (ACT) is a progressive form of psychotherapy that centers on embracing negative thoughts, emotions, and life challenges rather than fighting them. This therapeutic approach promotes dedicating oneself to positive, value-aligned behaviors that enhance overall well-being.

Dr. Avigail Lev, a licensed clinical psychologist specializing in acceptance-based therapies, explains that ACT is a third-wave cognitive-behavioral therapy designed to help individuals accept difficult internal experiences and commit to meaningful, values-based actions.

ACT is grounded in the concept that fostering acceptance increases psychological flexibility, which helps prevent avoidance of uncomfortable thoughts or feelings that might otherwise exacerbate distress.

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Key Techniques in ACT Therapy

Distinct from traditional cognitive behavioral therapy (CBT), ACT does not aim to lessen the occurrence or intensity of unpleasant thoughts or emotions. Instead, it focuses on reducing the struggle against these experiences while enhancing engagement in purposeful activities consistent with personal values.

According to Dr. Lev, ACT employs six core processes to cultivate psychological flexibility—the ability to choose actions regardless of internal experiences:

Clarifying Personal Values

This step involves identifying what truly matters to you and motivates your behavior, helping you define the principles you wish to live by.

Commitment to Action

ACT encourages translating values into concrete behaviors that steer you toward your goals, fostering meaningful change.

Self as Context (Observer Self)

This process teaches you to observe your thoughts and feelings as separate from your identity and actions, creating mental space and reducing entanglement with negative experiences.

One helpful metaphor likens the self to the sky and thoughts and feelings to weather patterns—transient and ever-changing, while the sky remains constant.

Cognitive Defusion Techniques

Cognitive defusion helps you detach from unhelpful thoughts by viewing them objectively, diminishing their impact. Techniques include visualizing thoughts as passing clouds or playfully altering their tone.

Acceptance

Acceptance involves actively allowing internal experiences without resistance or avoidance. Techniques such as self-compassion meditation, emotional exposure, and loving-kindness practices support this process.

Present Moment Awareness

ACT promotes mindful engagement with the here and now, helping you focus on your surroundings rather than becoming consumed by internal narratives, enhancing awareness and reducing the influence of past conditioning.

Integrating these six processes empowers individuals with psychological flexibility, enabling them to pursue valued life directions despite difficult internal experiences.

— Avigail Lev, PsyD, Licensed Clinical Psychologist

What to Anticipate in ACT Therapy Sessions

Initial sessions typically focus on identifying your core values. Subsequent therapy work centers on connecting with these values and applying them in daily life.

Therapy sessions often include:

• Reviewing recent behaviors aligned with personal values and reinforcing them
• Analyzing actions that conflict with values and exploring underlying barriers
• Utilizing ACT's six processes to overcome obstacles and promote value-consistent living

Your therapist may guide you through mindfulness exercises, acceptance practices, and cognitive defusion strategies, alongside assigning personalized homework to deepen your skills between sessions.

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Conditions Where ACT Shows Promise

ACT has demonstrated effectiveness in managing a variety of mental health challenges, including:

• Anxiety disorders
• Depression
• Eating disorders
• Obsessive-compulsive disorder (OCD)
• Stress management
• Substance use disorders
• Psychosis

Research highlights ACT’s benefits for generalized anxiety disorder, especially among older adults.

Advantages of Acceptance and Commitment Therapy

A central strength of ACT lies in enhancing psychological flexibility—the capacity to accept thoughts and feelings when helpful and set them aside when they are not. This skill fosters thoughtful responses over impulsive reactions, promoting a meaningful and fulfilling life.

ACT also nurtures self-awareness and self-compassion, helping individuals form kinder, gentler relationships with their inner experiences.

Evaluating the Effectiveness of ACT

As a “third-wave” psychotherapy, ACT emphasizes mindfulness and acceptance rather than challenging thoughts directly, distinguishing it from traditional CBT approaches.

Third-wave therapies, including Dialectical Behavior Therapy (DBT) and Mindfulness-Based Cognitive Therapy (MBCT), focus on embracing emotions and creating distance from distressing thoughts.

Initially considered for cases unresponsive to classic CBT, ACT is increasingly recognized as a viable first-line treatment for many.

New perspectives suggest that resisting unwanted thoughts can intensify them; ACT instead encourages changing one’s relationship with these thoughts, reducing their behavioral influence.

— Avigail Lev, PsyD, Licensed Clinical Psychologist

Extensive research supports ACT’s effectiveness across diverse mental and physical health issues, enhancing quality of life and aiding in chronic pain management.

Important Considerations

While ACT is effective, studies indicate it may offer similar benefits to other therapies like CBT. Some critics argue ACT shares many similarities with existing methods, questioning its distinctiveness.

Starting Your ACT Journey

ACT is offered by various mental health professionals, including psychologists, psychiatrists, social workers, and counselors. When seeking therapy, inquire about your provider’s ACT training or look for specialists through organizations such as the Association for Contextual Behavioral Science (ACBS) or the Association for Behavioral and Cognitive Therapies (ABCT).

ACT therapists typically engage actively with clients, facilitating exploration and mindful awareness through exercises and homework designed to build psychological flexibility.

Discussing personal values is a cornerstone of therapy, guiding your path forward.

For more information, explore resources on conditions like anxiety and generalized anxiety disorder, and learn what to expect during your initial therapy session.

References:

1. Wetherell JL, et al. Acceptance and commitment therapy for generalized anxiety disorder in older adults: A preliminary report. Behav Ther. 2011.
2. Twohig MP, Levin ME. Acceptance and commitment therapy as a treatment for anxiety and depression: A review. Psychiatr Clin N Am. 2017.
3. Gloster AT, et al. The empirical status of acceptance and commitment therapy: A review of meta-analyses. J Contextual Behav Sci. 2020.
4. Öst LG. The efficacy of acceptance and commitment therapy: An updated systematic review and meta-analysis. Behav Res Ther. 2014.
5. Delhom I, et al. Is acceptance and commitment therapy helpful in reducing anxiety symptomatology in people aged 65 or over? Front Psychiatry. 2022.
6. Kahl KG, et al. The third wave of cognitive behavioural therapies: What is new and what is effective? Curr Opin Psychiatry. 2012.
7. A-Tjak JGL, et al. A meta-analysis of the efficacy of acceptance and commitment therapy for clinically relevant mental and physical health problems. Psychother Psychosom. 2015.
8. Gaudiano BA. Evaluating acceptance and commitment therapy: An analysis of a recent critique. Int J Behav Consult Ther. 2011.

Article by Deborah R. Glasofer, PhD, a clinical psychology professor and cognitive behavioral therapy practitioner.

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