Acceptance and Commitment Therapy (ACT) is a relatively new therapeutic approach. ACT was founded in the 1980s by psychologist Steven C. Hayes, who also contributed to the development of relational frame theory (RFT) [1].
RFT theorizes that our thoughts and perspectives are shaped by language, past experiences, and our environments. Over time, these past experiences build a framework that we use to understand the world. If the beliefs and thoughts within that framework are negative, it can lead to low self-esteem, harmful coping strategies, and mental health conditions.
ACT encourages people to separate themselves from their framework of negative thoughts and beliefs. This video by Your ACT Auntie gives a simplified explanation of the relationship between ACT and RFT: Relational Frame Theory (RFT).
People who are in the midst of a difficult situation may cope by denying reality. They may try to push down their negative thoughts or experiences. This can slow or halt emotional healing. ACT helps clients accept their circumstances without judgment or evaluation.
Psychologically inflexible people often have a hard time separating themselves from their thoughts and emotion. They may engage in emotional reasoning, a cognitive distortion where thoughts and feelings are misinterpreted as reality.
Diffusion increases the space between the individual and their thoughts. ACT helps clients understand that feeling hopeless doesn’t mean there are no solutions or that they cannot improve their quality of life.
In the ACT model of suffering, focusing on the negativity of the past or the uncertainty of the future can lead to distress. ACT clients are encouraged to practice mindfulness and remain grounded.
ACT emphasizes that people are not their thoughts nor the set of traits they or others have ascribed to them. Through ACT, clients can go beyond expectations and labels and view themselves as growing and dynamic centers of consciousness. In ACT, this may be described as the self-as-context or the observing self.
ACT therapist Dr. Russ Harris explains the observing self in this short video: The Stageshow Metaphor.
One of the most debilitating side effects of psychological inflexibility is experiential avoidance. By avoiding sources of psychological pain, like emotions or memories, people tend to lose touch with their true selves. They may stay in jobs or relationships that clash with their values.
According to ACT theories, understanding one’s personal values is the path to psychological flexibility. Personal values can serve as a guide for decision-making and lead to a purpose-driven life.
Psychological inflexibility is often characterized by rigid and unhealthy behavior patterns, such as using substances, overworking, or avoiding social interactions. Breaking out of these self-destructive patterns requires deliberate action. ACT helps clients identify and commit to actions that align with their values.
Multiple studies have investigated the efficacy and usefulness of ACT and found several advantages.
Research has shown that ACT is an effective form of treatment for medical and psychological conditions [7]. The American Psychological Association recommends ACT for people with the following conditions:
Depression Eating Disorders Obsessive Compulsive Disorder Chronic pain Substance use disorderACT is also beneficial for patients dually diagnosed with a mental health issue and a medical condition.
Unlike Cognitive Behavioral Therapy (CBT) or other talk therapies, ACT can treat clients with severe forms of mental health conditions.
This is because the goal of ACT is not to reduce or eliminate symptoms. Instead, ACT helps clients reframe their thinking about their condition and circumstances and live life in the most fulfilling way possible [8].
Researchers have found numerous links between stress and pain intensity [9]. When the fight or flight response is activated, the body produces more cortisol, a hormone that can damage brain cells at elevated levels [10]. High cortisol levels can also promote widespread inflammation, which can worsen chronic pain.
Since chronic disease and chronic pain can also increase stress levels, this can create a toxic feedback cycle. People may require stronger or higher doses of medication to manage their pain. This can increase the risk of addiction or contribute to side effects, such as nausea or headaches [11].
ACT therapy introduces cognitive techniques that can effectively manage stress and counter the fight or flight response. For example, remaining present-focused is linked with improved mental health and stress reduction [12].
Several studies have found that ACT can reduce symptoms associated with chronic pain and lower the need for medication [13]. ACT has shown similar results for people facing substance use addiction and depression [14].
Other types of talk therapies, such as cognitive behavioral therapy, place a heavy emphasis on an individual’s interpretation of events rather than the situations themselves.
While this approach may be beneficial for some people, it is not ideal for people living with challenging circumstances, such as chronic pain.
Rather than promoting a lack of negative emotions as the standard for well-being, ACT practitioners encourage a more holistic definition of wellness that includes the acknowledgment and acceptance of negative experiences.
According to ACT founder Steven C. Hayes, ACT counters the normal psychological processes that can prevent us from facing, accepting, and integrating negative emotions. He expands on this idea in this short video: The Catch-All Nature of Acceptance and Commitment Therapy.
When psychological flexibility is increased, instead of avoiding negative experiences and emotions, we can use them as a launchpad for growth and wellness.
While ACT is evidence-based and effective, it isn’t appropriate for everyone.
While ACT does acknowledge how past experiences can influence present mental health, the approach focuses more on what clients can do in the present.
For people with deeply rooted trauma, ACT may not be comprehensive enough to meet their needs. In these cases, therapies that focus more on the root of maladaptive thinking and behavior patterns may be more suitable. This includes schema and psychodynamic therapies.
ACT sessions include a lot of reflection exercises and abstract concepts. This could preclude people with impairments that affect communication or cognition from benefiting from ACT.
Likewise, while ACT can support patients with conditions that feature psychosis, people in an acute state of psychosis would be better served by a different treatment approach.
ACT involves a combination of talking sessions and self-directed exercises. During the talking sessions, the ACT therapist will help the client notice their automated thought processes and beliefs [15]. In between sessions, the client is expected to complete exercises to improve their psychological flexibility.
This format can be difficult for people who cannot or will not complete exercises on their own. ACT is also not suitable for clients who will have difficulty linking discussions and insights from different sessions [16].
There are no official qualifications for ACT therapists [17]. People looking for ACT therapy will have to do some legwork and contact therapists or mental health clinics directly and ask about their experience.
As ACT is less than a few decades old, ACT therapists are not as numerous as CBT or psychodynamic therapists. Clients may need to work with private practice professionals, who may charge a hundred dollars or more per session. However, ACT can be employed in group therapy formats [18]. This can make sessions more affordable.
ACT is ideal for clients who are ready to make lasting changes in their lives. If you can say yes to the following statements, ACT therapy may work for you:
You can or are willing to learn how to express yourself through emotional language You are open to building a rapport with the therapist You can commit to completing self-directed exercises You are in a safe environment, and accepting your circumstances will not risk your health or safety[1] STEVEN C. HAYES, PH.D. (2012, August 3). ACT and RFT Community. Steven C. Hayes, Ph.D.
[2] Steven Hayes. (n.d.). About ACT | Association for Contextual Behavioral Science. Contextualscience.org. https://contextualscience.org/about_act
[3] Vowles, K.E. & Thompson, Miles. (2011). Acceptance and Commitment Therapy for chronic pain. Mindfulness and Acceptance in Behavioral Medicine: Current Theory and Practice. 31-60.
[4] Ramaci T, Bellini D, Presti G and Santisi G (2019) Psychological Flexibility and Mindfulness as Predictors of Individual Outcomes in Hospital Health Workers. Front. Psychol. 10:1302. doi: 10.3389/fpsyg.2019.01302
[5] Kashdan, T. B., Disabato, D. J., Goodman, F. R., Doorley, J. D., & McKnight, P. E. (2020). Understanding psychological flexibility: A multimethod exploration of pursuing valued goals despite the presence of distress. Psychological Assessment, 32(9), 829–850. https://doi.org/10.1037/pas0000834
[6] Matt Johnson Ph.D. (2021, June 21). The Psychology of Acceptance and Commitment Therapy | Psychology Today. Www.psychologytoday.com. https://www.psychologytoday.com/us/blog/mind-brain-and-value/202106/the-psychology-acceptance-and-commitment-therapy
[7] Steven C. Hayes, Jacqueline Pistorello, & Michael E. Levin. (2021). Acceptance and Commitment Therapy as a Unified Model of Behavior Change. Apa.org. https://www.apa.org/education-career/ce/acceptance-commitment.pdf
[8] Matt Johnson Ph.D. (2021, June 21). The Psychology of Acceptance and Commitment Therapy | Psychology Today. Www.psychologytoday.com. https://www.psychologytoday.com/us/blog/mind-brain-and-value/202106/the-psychology-acceptance-and-commitment-therapy
[10] Kim EJ, Pellman B, Kim JJ. Stress effects on the hippocampus: a critical review. Learn Mem. 2015 Aug 18;22(9):411-6. doi: 10.1101/lm.037291.114. PMID: 26286651; PMCID: PMC4561403.
[11] Martel MO, Finan PH, Dolman AJ, Subramanian S, Edwards RR, Wasan AD, Jamison RN. Self-reports of medication side effects and pain-related activity interference in patients with chronic pain: a longitudinal cohort study. Pain. 2015 Jun;156(6):1092-1100. doi: 10.1097/j.pain.0000000000000154. PMID: 25782367; PMCID: PMC4431924.
[12] Querstret, D., Morison, L., Dickinson, S., Cropley, M., & John, M. (2020). Mindfulness-based stress reduction and mindfulness-based cognitive therapy for psychological health and well-being in nonclinical samples: A systematic review and meta-analysis. International Journal of Stress Management, 27(4), 394–411. https://doi.org/10.1037/str0000165
[13] Baker, P. (2019, June 26). Helping Patients Get Their Life Back Through Acceptance and Commitment Therapy. Southern Pain Society. https://southernpainsociety.org/act-therapy/
[14] Zhenggang Bai, Shiga Luo, Luyao Zhang, Sijie Wu, Iris Chi, Acceptance and Commitment Therapy (ACT) to reduce depression: A systematic review and meta-analysis, Journal of Affective Disorders, Volume 260, 2020, Pages 728-737, ISSN 0165-0327, https://doi.org/10.1016/j.jad.2019.09.040
[16] Practitioners, T. R. A. C. of G. (2012, September 9). RACGP – Acceptance and commitment therapy – pathways for general practitioners. Www.racgp.org.au. https://www.racgp.org.au/afp/2012/September/acceptance-and-commitment-therapy
[17] Douglas Long. (n.d.). ACT Certification | Association for Contextual Behavioral Science. Contextualscience.org. https://contextualscience.org/act_certification
I am a freelance wellness writer passionate about positive psychology and gentle productivity. I enjoy studying personal development and sharing what I’ve learned to help others create a balanced and fulfilling life. When I am not writing, I am tending to my garden.
