Acceptance and Commitment Therapy(ACT)
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Overview
Acceptance and Commitment Therapy (ACT, pronounced as a single word) is a behavioural therapy that helps people develop psychological flexibility — the ability to be present with difficult thoughts and feelings without being controlled by them, while moving toward what matters most. Rather than trying to eliminate distressing internal experiences, ACT changes the relationship people have with them.
What this therapy focuses on
ACT helps people move toward meaningful life directions while learning to respond differently to distressing internal experiences. It is built around six core processes (the “hexaflex”): acceptance, cognitive defusion, present-moment awareness, self-as-context, values, and committed action.
What sessions are usually like
Session length: 45–60 minutes
Frequency: Weekly or flexibly scheduled
Time-limited or flexible depending on presentation
Experiential exercises are common — ACT uses metaphors, mindfulness, and in-session exercises rather than purely verbal discussion
Between-session practice encouraged: values-based action plans, mindfulness, defusion exercises
Session profile
Common uses and suitability
What problems it is commonly used for
Who this therapy may suit best
- People interested in mindfulness-based approaches
- Those who have found thought-challenging approaches unhelpful or exhausting
- Individuals seeking meaning-focused therapy
- People who want to live well alongside ongoing difficulties rather than waiting to be “fixed”
When it may need adapting or may not be suitable
- Severe dissociation without stabilisation
- Acute psychosis (adapted approaches exist)
- Where the primary need is for structured behavioural intervention (e.g., severe OCD may benefit from ERP first)
Where this therapy may not be enough
ACT may not be sufficient as a standalone treatment for conditions with strong evidence for specific protocols (e.g., ERP for severe OCD, trauma-focused CBT for PTSD). It may need augmentation for severe and complex presentations.
What happens in therapy
Values Clarification
Exercises to help you identify what truly matters to you — not goals to achieve but directions to move in.
Cognitive Defusion
Techniques to help you step back from unhelpful thoughts so they have less power over you — without having to argue with them.
Mindfulness Exercises
Brief practices to help you notice the present moment with openness and curiosity.
Committed Action
Choosing specific, values-based actions and following through, even when difficult feelings show up.
Acceptance and Willingness
Practising being open to difficult feelings rather than fighting or avoiding them.
Evidence Base
Guideline support
Moderate to strong depending on condition. ACT has a growing evidence base across multiple conditions. It is included in some clinical pathways though less frequently as a standalone NICE recommendation compared to CBT.
Strength of evidence
Moderate to strong. Multiple RCTs and meta-analyses support ACT for chronic pain, depression, anxiety, and mixed presentations. Evidence for ACT in chronic pain is particularly strong.
Limitations
Evidence base is growing but still smaller than CBT for many specific conditions. Some studies have methodological limitations. Process research on mechanisms of change is ongoing.
Evidence claims by condition
ACT helps people live well with chronic pain by changing their relationship with pain-related thoughts and feelings.
ACT can help with depression by building a life focused on what matters rather than trying to eliminate low mood.
Resources & Printables
For Adults
For Children (6–11)
For Teenagers (12–17)
For Parents & Caregivers
Practitioner & Training Notes
Typical professional background
Psychologists, therapists, and mental health professionals with ACT-specific training.
Recognised training routes
ACT training is available through ACBS-affiliated programmes, workshops, and post-qualification courses. Peer-reviewed ACT Trainer designation available through ACBS.
Registration considerations
ACBS provides certification. Practitioners may also be registered with broader bodies (BABCP, BACP, HCPC).
Source Registry
Link and paraphrase.
Last evidence review: January 2026. All sources are verified and checked on a scheduled cadence.