Acceptance And Commitment Therapy: What It Is And How It’s Used

Acceptance and commitment therapy (ACT) is a form of behavioral therapy that focuses on accepting oneself and others and commitment to self-improvement and positive behavior changes. This type of therapy is based on clients making specific actions toward their goals rather than being passive participants in therapy. Learning more about ACT can help you decide if it's the proper form of therapy for you.

What is acceptance and commitment therapy?

The Society of Clinical Psychology describes acceptance and commitment therapy (ACT) as an action-based behavioral therapy that concentrates on positive change and acceptance of thoughts, feelings, memories, and sensations. It’s an evidence-based type of therapy that’s modeled on the principles of evolutionary and behavioral science. Clients can expect to be constant participants inside and outside therapy by learning real-life skills that can be used in their daily lives.

The ACT method uses six primary principles. Although the basis for acceptance and commitment therapy is acceptance and commitment to change, there are also four other crucial "rules" that ACT therapists use to treat clients, including: 

• Cognitive defusion
• Being present
• Self as context
• Values 

Acceptance and commitment therapy is often used to treat toxic stress, depression, anxiety and the psychological elements of chronic pain. However, acceptance and commitment therapy may also benefit other diagnoses and mental health challenges. If you're considering this technique, seek a professional opinion before pursuing this path. According to the Association for Contextual Behavioral Science, there have been nearly 2000 randomized controlled trials on ACT. One such randomized controlled trial, published in 2020, found that ACT is as effective as CBT for the treatment of depression in inpatient populations. Additionally, meta-analyses tend to support ACT, with one meta-analysis finding that ACT can help clients manage chronic pain. However, the authors note that most studies fail to provide sufficient information.

What can you expect from an ACT session?

As an acceptance and mindfulness based therapy, clients may be asked to review thoughts, feelings, and experiences carefully and take note of anything that they're avoiding or have discarded as "irrelevant," "unimportant," or otherwise "unacceptable." After identifying thoughts, feelings, and behaviors, the client may be encouraged to accept them as appropriate and necessary. Then, they can identify the changes they need to make moving forward and commit to them.

During an acceptance and commitment therapy session, the therapist works with the client on various concepts. For example, an emphasis may be placed on examining self-talk or beliefs about feelings, thoughts, personality, physical characteristics, life situations, relationships, and other areas of importance. The examination of this self-talk is later used to assess goals for change. 

Acceptance and commitment therapy is based on the therapy, cognitive therapy and cognitive-behavioral therapy (CBT). Unlike cognitive behavioral therapy, which focuses on reframing negative thought patterns, ACT focuses on meta-thought (thinking about thinking) and achieving psychological flexibility—psychological flexibility refers to an awareness of the present moment and an ability to act in accordance with long-term values and goals instead of impulse or instinct.

How long does ACT take? 

ACT can last as long as the client wants to continue sessions. Some people may require more sessions to discuss their challenges, while others might need a few months to see results. The duration of the therapy is often determined by the client and therapist together.

ACT can also be customized, and clients can choose to meet with their therapist as many or as little as they want, as long as the therapist is available and willing. In addition, many therapists only offer 30 to 60-minute sessions. 

Six core processes of acceptance and commitment therapy

ACT uses six basic principles known as core processes. The six principles work together; one is not more important than another. Below is more information about these six principles:

Acceptance 

Acceptance is an active and involved process in ACT. Clients are asked to fully experience and interact with thoughts, and feelings to understand their mind's inner landscapes. When some degree of understanding is achieved, the client is given tools that they can use to accept their situation and feelings while understanding that they can be separated from their reactions and behaviors. 

Cognitive diffusion 

The second principle of acceptance and commitment therapy is reframing how a client interacts with a thought or emotion. Behavioral therapies like ACT focus on how unwanted feelings, thoughts, and experiences relate to undesirable behaviors or "functions." Cognitive diffusion aims to help the client observe and realign negative influences without judgment to produce more desirable functions.

Being present 

This acceptance and commitment therapy principle encourages the client to become aware of the present moment. Many clients may feel concerned with past events or possible future events. By staying focused on the "now," they can better observe themselves and the world around them from a calm, non-judgmental perspective. 

Instead of only being aware of the present moment outside themselves, clients are also taught to explore their inner thoughts, emotions, and outward reactions. Certain undesirable behaviors may be identified through this process, as well as the causes of these behaviors. Clients can then start to accept and commit to change.

Self-as-context

The "self-as-context" principle of acceptance and commitment therapy involves helping the client learn to understand themselves as individuals. This understanding is gained through the exploration of their experiences in life and their relationships with others. The "self-in-context" relates to exploring how clients see themselves (and their situation) compared to other people or situations. Through this, the client is eventually encouraged to see themselves as a whole person with an identity of their own.

Values 

Clients can explore their goals, dreams, and ideals during acceptance and commitment therapy. One of the keys in the values principle of ACT is that clients must actively explore and accept to identify a genuinely individualized future for themselves and their relationships with others. Their choices can benefit from being based on solid ideals unrelated to avoidance. 

Committed action

Committed action is the "commitment" aspect of acceptance and commitment therapy. Clients are asked to commit to acting and making changes using the discoveries and realizations spurred by the other ACT principles. Like other forms of behavioral therapy, there are certain action-oriented activities that clients can participate in as a symbol of their commitment to change. For example, learning a new skill, experiencing an event they're nervous about, or setting a goal are some techniques that acceptance and commitment therapy clients might use.

How is acceptance and commitment therapy used?

Acceptance and commitment therapy can be used in a variety of contexts. It holds value in treating and managing various challenges, but there are some specific situations in which it may be particularly useful or recommended.

Specifically, acceptance and commitment therapy is often an appropriate type of therapy for anxiety disorders and stress. Social anxiety, work-related stress, test-taking anxiety, or generalized anxiety disorder can be managed using this therapeutic method. Other anxiety disorders, like obsessive-compulsive disorder (OCD), can show change through the careful use of acceptance and commitment techniques.

Clients with depression and psychosis have also in mental health and quality of life when receiving acceptance and commitment therapy. Substance use disorders, diabetes, chronic pain, ulcers, and Crohn's disease may also benefit from this therapy. Because high levels of anxiety and stress can cause physical health problems, acceptance, and commitment therapy may help people living with chronic illnesses. 

If you are struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources. Support is available 24/7.

Counseling options 

ACT is a modern approach to traditional behavior therapy integrating modern ideologies into research-backed methods. People work differently, so acceptance and commitment therapy may not be best for everyone. However, if you're living with anxiety, disorders, eating disorders, depressive disorders, or another mental health concern, talk to a therapist to learn more about this option. 

If you face any barriers to meeting with an in-person ACT therapist, you can also find providers practicing this form of support online. Many clients prefer online treatment due to its lower cost, flexible hours, and bonus features. For example, through a platform like BetterHelp for individuals or Regain for couples, you can utilize, webinars, and journaling features through an app or website in addition to phone, video, or live chat sessions. 

Studies also prove the efficacy of online treatment options. One study on internet-based acceptance and commitment therapy found it as effective as in-person methods for treating chronic pain symptoms. In addition, the American Psychological Association (APA) endorses telehealth therapy as a promising option for therapeutic care. In addition to helping people manage their symptoms, ACT may help people live a more satisfying and meaningful life.