What Is Acceptance and Commitment Therapy?
Acceptance and commitment therapy (ACT) is a type of psychotherapy that emphasizes acceptance as a way to deal with negative thoughts, feelings, symptoms, or circumstances. It also encourages increased commitment to healthy, constructive activities that uphold your values or goals.
ACT therapists operate under a theory that suggests that increasing acceptance can lead to increased psychological flexibility. This approach carries a host of benefits, and it may help people stop habitually avoiding certain thoughts or emotional experiences, which can lead to further problems.
Techniques
Unlike cognitive behavioral therapy (CBT), the goal of ACT is not to reduce the frequency or severity of unpleasant internal experiences like upsetting cognitive distortions, emotions, or urges. Rather, the goal is to reduce your struggle to control or eliminate these experiences while simultaneously increasing your involvement in meaningful life activities (i.e., those activities that are consistent with your personal values).
This process involves six components:
- Acceptance: This means allowing your inner thoughts and feelings to occur without trying to change them or ignore them. Acceptance is an active process.
- Cognitive defusion: Cognitive defusion is the process of separating yourself from your inner experiences. This allows you to see thoughts simply as thoughts, stripped of the importance that your mind adds to them.
- Self as context: This involves learning to see your thoughts about yourself as separate from your actions.
- Being present: ACT encourages you to stay mindful of your surroundings and learn to shift your attention away from internal thoughts and feelings.
- Values: These are the areas of your life that are important enough to you to motivate action.
- Commitment: This process involves changing your behavior based on principles covered in therapy.
During ACT, your therapist will help you learn how to apply these concepts to your life. They may teach you how to practice acceptance and cognitive defusion, or they may help you develop a different sense of yourself that’s distinct from your thoughts and feelings.
Sessions can also include mindfulness exercises designed to foster nonjudgmental, healthy awareness of thoughts, feelings, sensations, and memories that you have otherwise avoided. Your therapist may also help highlight moments when your actions didn’t fit your values while helping you understand which behaviors would fit.
Your therapist may assign homework to practice between sessions, such as mindfulness, cognitive, or values clarification exercises. The homework is agreed upon between you and your therapist and can be modified to make it as personal and useful as possible.
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What ACT Can Help With
ACT may be effective in treating:
Research has shown that ACT can improve symptoms for people with generalized anxiety disorder (GAD), and it may also be a particularly good fit for older adults with the condition.
Benefits of ACT
One core benefit of ACT is the impact it has on psychological flexibility. Psychological flexibility is the ability to embrace your thoughts and feelings when they are useful and to set them aside when they are not. This allows you to thoughtfully respond to your inner experience and avoid short-term, impulsive actions, focusing instead on living a meaningful life.
Psychological flexibility can improve your ability to accept and function with symptoms of conditions like anxiety or depression. Often, those symptoms may lessen significantly as a result of this increase in psychological flexibility.
Effectiveness
ACT is sometimes referred to as a “third wave” or “new wave” psychotherapy. The term “third wave” treatment refers to a broad spectrum of psychotherapies that also includes:
Historically, third-wave treatments were seen as particularly appropriate for people who were not benefiting from pre-existing treatments like classical CBT. However, it is now believed that for some individuals, a third-wave therapy option may make sense as a first-line treatment.
Research shows ACT to be effective at treating a wide range of conditions, including some that span several diagnoses. ACT also appears to improve quality of life, and it may help people deal with physical conditions and chronic pain.
Things to Consider
While ACT is an effective treatment for a variety of conditions, research shows that it may be about as helpful as other available forms of therapy, such as CBT. These findings suggest that someone who benefits from ACT may have also benefited from another treatment.
ACT has also faced criticism for its similarity to other forms of therapy. Some proponents of CBT claim that ACT, like other third-wave therapies, doesn’t represent a significantly different approach.
How to Get Started
Several types of mental health professionals may offer ACT, including psychiatrists, psychologists, social workers, or mental health counselors. If you are interested in learning more about this approach, you might ask about your treatment provider’s training background with it or seek out an experienced ACT practitioner.
You may also try referral sources such as the Association for Contextual Behavioral Science (ACBS) or the Association for Behavioral and Cognitive Therapies (ABCT). The ACBS also provides free resources about ACT in the form of videos, audio clips, and mindfulness exercises.
A therapist specifically trained in ACT will be both an active, empathic listener and an active guide, encouraging deeper exploration and non-judgmental awareness during the sessions.
ACT sessions tend to be hands-on, often including psychological exercises or mindfulness training, as well as homework after the session is done. Completing these exercises is an important part of ACT, as this is the way you can learn new skills and improve your psychological flexibility.
Your therapist will also want to discuss your values and goals during therapy. This is another crucial part of treatment, as these values will inform your actions moving forward.
Acceptance and Commitment Therapy (ACT) is one of the third wave of mindfulness-based cognitive-behavioral therapies and has accumulated a huge scientific evidence base demonstrating its effectiveness.
ACT was originally devised by Steven C. Hayes when he was seeking relief from his own panic disorder. He tells the moving story of his own suffering and how it led to the development of ACT in the TED Talk below.
Used as an intervention, ACT is beneficial for a range of health problems, including managing chronic pain, addictions, anxiety, depression, obsessive-compulsive disorder, and psychosis (Hayes, 2021).
Want to know more about these incredibly beneficial ACT techniques? We share many interventions and videos below.
Before you continue, we thought you might like to download our three Positive Psychology Exercises for free. These science-based exercises explore fundamental aspects of positive psychology, including strengths, values, and self-compassion, and will give you the tools to enhance the wellbeing of your clients, students, or employees.
6 Acceptance and Commitment Therapy Techniques
ACT is based on a model of six core processes called the hexaflex.
The key objective of ACT is to alleviate suffering by optimizing psychological flexibility. This is achieved through educating clients about the six core processes and supporting the development of new psychological skills, including mindfulness, cognitive defusion, and acceptance.
ACT interventions aim to overcome experiential avoidance using a combination of mindfulness and behavioral change techniques. Each intervention activates at least one of the six core processes, but some interventions activate multiple core processes simultaneously.
Below are six techniques that focus on the core processes of mindful connection and cognitive defusion that are especially helpful for managing anxiety. Feeling anxious when under stress is normal and can help arouse the extra energy required to identify creative solutions to problems.
However, prolonged anxiety can be exhausting and even develop into panic attacks (Smith, 2019). The good news is that the ACT approach was developed by Hayes to help him overcome his own anxiety and panic disorder. For a full update of the state of the evidence (Hayes, 2021), visit the Association of Contextual and Behavioral Science, the professional association for ACT practitioners.
In this TED Talk, Hayes shares the development of his approach:
Many ACT interventions are especially helpful for anxiety, as explained in Hayes’s TED Talk above. We discuss several of the approaches here.
1. Anchor Breathing – Mindful grounding
When you’re stressed, you’re more susceptible to anxiety and overwhelm (Hayes, Strosahl, & Wilson, 1999).
This can even lead to panic attacks when stress is prolonged (Smith, 2019).
When anxiety is aroused, grounding yourself through mindful breathing can help calm you. Try this simple Anchor Breathing exercise to take a mindful stress reduction break.
2. Cognitive defusion from unhelpful thoughts
Cognitive defusion is a technique that uses mindfulness skills to distance and detach yourself from painful thoughts or internal commentary (Hayes & Smith, 2005).
ACT makes use of a lot of metaphors to facilitate defusion from painful thoughts and feelings.
The ACT Defusion Metaphors worksheet contains a list of questions to determine the difference between helpful and unhelpful thoughts (Hayes & Smith, 2005), as well as a list of metaphors to apply during sessions if a client is stuck in a downward spiral of negative self-judgment, harsh self-criticism, or catastrophizing.
Remind the client that their inner commentary only comprises thoughts that are just words and use the ‘thoughts are like’ section of this worksheet to help them defuse from painful thoughts.
3. The struggle switch
Russ Harris (2008) invented the struggle switch ACT metaphor to help his clients defuse from anxiety by choosing to notice it and observe it mindfully, rather than struggling with it.
He explains the metaphor and how to use it in the video below. You can also download Harris’s worksheet on Struggle Strategies for free.
4. Observing Anxiety Mindfully
First, it is essential to help a client understand that experiential avoidance of their anxiety actually intensifies it.
In the following video, Hayes shows a mindfulness exercise that redirects an anxious client to become an observer of their anxiety in the context of a whole person across a lifetime.
This therapy intervention activates four core processes – mindful connection, cognitive defusion, acceptance, and self-as-context – in one intervention. We have adapted the exercise into the free Observing Anxiety Mindfully worksheet.
5. Radio Doom and Gloom
Ever feel like your mind is whirring on in the background like a radio broadcasting the Doom and Gloom Show?
When your mind gets stuck in negative self-commentary or keeps replaying negative events, your thoughts generate painful emotions like fear and anxiety.
In the video below, Russ Harris describes a defusion exercise called “Radio Doom + Gloom,” which helps quiet anxiety-generating thoughts. We have also adapted Harris’s (2008) technique into a free worksheet: Radio Doom and Gloom.
6. Thank your mind and name the story
Often, when you’re experiencing anxiety, your mind will amplify it by introducing a familiar self-judgmental storyline. When such self-defeating or self-limiting thoughts arise, acknowledge them as the product of your mind and thank your mind for its opinion. You can say it aloud or in your head.
When each repetitive self-defeating storyline appears (for example, “I’m not good enough”), name it the “I’m not good enough” story, acknowledge it, then let it go.
Each time your old self-defeating storyline takes center stage in your mind, thank your mind for the replay of the “I’m not good enough” story and let it play away in the background while focusing on the tasks that will lead you to your goal.
Russ Harris describes thanking your mind and naming the story in the video below.
Further techniques involving other core processes are described in our article 21 ACT Worksheets and Ways to Apply Acceptance & Commitment Therapy.
3 ACT Interventions for Your Sessions
In ACT, we practice something called front-loading the values (Hayes et al., 1999; Hayes & Smith, 2005). In other words, the very first session you have with your client should involve the clarification of their deepest values.
Often, clients mistake goals for values, such as “I want to be happy.” This is a goal, albeit an emotional one. You can use goals to explore the values underpinning them by asking something like, “So when you are happy, what will you do then?”
Another common goal is “I want to be rich.” Again, the same applies. “What will you do when you are rich that you cannot do now, and why?” This kind of exploration can help clients clarify their values.
For example, a common reason for wanting to be rich is freedom. In such a case, the client values freedom, perhaps in many areas of their lives, such as freedom to travel, freedom to work at something they enjoy, or freedom from work to enjoy other pursuits.
The difference between values and goals is explored in this short video by Russ Harris.
ACT practitioners have developed a range of interventions to help clients clarify their values and make a deepening commitment to them. The exercises below provide a map of valued life directions that can help steer a client into a life of greater fulfillment. This is especially helpful when goals are at risk of derailment by experiential avoidance.
Three value clarification interventions are described in the worksheets below.
1. Clarifying your personal values across 10 life domains
Try this exercise to clarify a client’s personal values across 10 valued life domains.
Download our free Personal Values Worksheet and use this simple self-reflection to prioritize those areas of life that are most important to a client or that remain the least fulfilled.
2. Values clarification – Write your own 80th birthday party speech
Ask your client to do this quick exercise from their heart. Ask them to imagine how they would want somebody else to sum up their life as a life well lived. What would they like to hear about themselves at their 80th birthday party?
You can guide your client as follows. “Consider what you want your life to stand for as you approach your later years. What kind of person do you want to be remembered as? An adventurer? A loving parent? A generous and charitable member of your community? A pioneering businessperson?
“Write your own 80th birthday party speech and include what you would most like to hear. You might want to draft the speech according to your most valued life activities.”
This exercise can help clarify values, which are necessary to set realistic, achievable goals.
3. Experiential avoidance – The Clean and Dirty Discomfort Diary
This exercise helps your client track their experiential avoidance strategies that undermine goal achievement and behavioral change (Hayes et al., 1999). It enhances self-awareness and mindfulness of the self-defeating consequences of avoidance.
The exercise helps clients distinguish between the clean discomfort of uncomfortable emotions or thoughts, versus the dirty discomfort of avoidant behaviors such as drinking too much, smoking, overeating, binge-watching TV, and so on.
You can download our free Clean and Dirty Discomfort Diary worksheet adapted from Hayes and Smith (2005).
3 Activities to Try With Your Clients
Overcoming experiential avoidance is crucial for developing psychological flexibility.
A willingness to take committed action despite the inner obstacles that will arise is also essential.
The following three activities follow on from the value clarification exercises above by helping clients to prioritize their values and set action-based goals that steer their life toward greater fulfillment.
1. Ranking Your Values and Finding Your Life Deviation Score
This exercise is best completed after a value clarification exercise. The aim is to prioritize values and areas of your life that remain unfulfilled as those in need of further development.
Each valued life domain is rated in terms of importance and degree of fulfillment to find your life deviation score (Hayes & Smith, 2005). Our free Ranking Your Values and Finding Your Life Deviation Score worksheet adapted from Hayes and Smith (2005) provides a template and explains the exercise in detail.
2. Life Deviation Scores and Goal Setting
Once you have ranked your values and their degree of fulfillment, you will find that the areas of your life that are most in need of attention will have higher life deviation scores.
Use this worksheet to focus on your top three highest-scoring valued life domains and begin setting long- and short-term goals that specify the action you will take to fulfill your deepest values.
Download our free Life Deviation Scores and Goal Setting worksheet adapted from Hayes and Smith (2005) for the exercise instructions and action-planning template.
3. Values-driven action planning
Committed action planning follows on from value clarification and prioritizing exercises. This goal-setting exercise can be completed using our Commitment, Obstacles, and Strategies worksheet.
This exercise also helps clients identify obstacles to meeting goals and plan strategies for overcoming them.
2 ACT Group Exercises
Here are two excellent group exercises you can use during therapy.
1. Group mindfulness
Mindfulness practice in a group doesn’t have to be confined to breathing exercises or meditation (Westrup & Wright, 2017a). In ACT, traditional sitting meditation is rarely used.
Try this group exercise that cultivates mindfulness by adopting a nonjudgmental mental state and experiencing an awareness of other group members while walking around in silence. You can download our free Silent Connections worksheet for further instructions.
2. Passengers on the bus
The ACT passengers on the bus metaphor (Harris, 2008) can also be conducted as an experiential exercise that activates all the ACT core processes, including a willingness to move toward value life directions, maintaining committed action through mindful connection with the present moment, and defusing from inner events such as negative commentary and self-judgment.
Here’s an educational video illustrating the metaphor created by members of an ACT special interest group.
Here is an example of the exercise, adapted from Westrup and Wright (2017b):
Use chairs to form a “bus” in the middle of the room with four to six “passengers” and one “driver,” depending on the group size. Ask for a volunteer driver, while the rest of the group will be passengers. The driver must think of something they want to achieve but haven’t so far due to negative self-commentary. Next, inform the driver that each passenger represents one of the thoughts getting in their way.
The driver turns to each passenger and assigns each of them a thought, such as “You’re incompetent,” “You’ll never amount to anything,” “You’re not good enough,” and so on.
Next, give the bus driver the following directions: “You’ll drive your bus toward your committed action [e.g., enroll in a new course, get a new job, go on a date, write a book] over there [point to the wall in front of the bus]. But, before you start your journey, you have to pick up your passengers. Look at each of them, listen to what they have to say, and reply, ‘Please get on the bus.’
“Passengers, you sit on one of the seats and keep on commenting on the thought you have been assigned. For example, if your driver assigned you with ‘You’re stupid,’ you can keep going on that theme with related comments. Driver, after all the passengers are on the bus, look straight ahead, and drive your bus toward your committed action.”
Afterward, process this activity by asking questions such as, “What did you want to do, driver?” Typical responses include “I wanted to stop the bus and get off” or “I wanted to turn around to shut them up.” Talk about what happens to your goals if you do any of those things.
Also, process the passengers’ experiences. This can be difficult for them. Group members often say they didn’t like being rude. Also, get feedback from the entire group about what it was like to witness this activity and ask if group members can relate it to their own experiences with their interfering thoughts.
PositivePsychology.com’s Relevant Resources
In addition to the free resources and worksheets provided above, you could try our three Mindfulness Exercises for free.
We also offer an eight-module Mindfulness X training course consisting of the latest science-based mindfulness interventions ready to deliver under your own branding.
More exercises are available in our related article How to Do Acceptance & Commitment Group Therapy: 3 Activities.
If you’re looking for more science-based ways to help others enhance their wellbeing, check out this signature collection of 17 validated positive psychology tools for practitioners. Use them to help others flourish and thrive.
A Take-Home Message
Acceptance and Commitment Therapy continues to accumulate a scientific evidence base showing its efficacy as an intervention for a range of life problems.
New metaphors, exercises, and techniques continue to develop and are shared freely on the internet.
ACT is a short-term psychoeducational intervention that applies a practical approach to cultivating psychological flexibility and overcoming the experiential avoidance that results in chronic suffering.
It remains a vibrant area of research in the broad fields of health, education, and personal development.
We hope you enjoyed reading this article. Don’t forget to download our three Positive Psychology Exercises for free.
References
- Harris, R. (2008). The happiness trap. Robinson.
- Hayes, S. C., Strosahl, K., & Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change. Guilford Press.
- Hayes, S. C., & Smith, S. (2005). Get out of your mind and your life – The new acceptance and commitment therapy. New Harbinger.
- Hayes, S. C. (2021, August). State of the ACT evidence. Association for Contextual and Behavioral Science. Retrieved November 22, 2021, from https://contextualscience.org/state_of_the_act_evidence
- Smith, J. (2019, October 3). How does anxiety spiral into a panic attack? Dr Julie Smith. Retrieved on November 28, 2021 from https://doctorjuliesmith.com/how-does-anxiety-spiral-into-a-panic-attack/
- Westrup, D., & Wright, M. J. (2017a). Learning ACT for group treatment: An acceptance and commitment therapy skills training manual for therapists. New Harbinger.
- Westrup, D. & Wright, M. J. (2017b). Learning ACT for group treatment: Supplemental exercises. New Harbinger.