What Is Acceptance and Commitment Therapy (ACT)?
Acceptance and Commitment Therapy, usually shortened to ACT and spoken as the word “act” rather than the three letters, is a form of cognitive behavioural therapy. It works on changing your relationship with difficult thoughts and feelings rather than on getting rid of them, alongside building a life that reflects what matters to you. It’s used for anxiety, depression, chronic stress, chronic pain and a range of other presentations. This article covers what ACT involves, the six processes it works with, what a session can look like, and where it differs from traditional CBT.
The idea ACT starts from
Most of us have been taught that unpleasant thoughts and feelings are problems to be solved. You feel anxious, so you try to stop feeling anxious. A thought turns up, so you argue with it, distract yourself, or push it away.
That works reasonably well for a while. The difficulty is that the effort grows over time, and the strategies that bring short-term relief often shrink your life. Avoiding the situations that make you anxious means doing less of what you care about. Arguing with a thought keeps your attention fixed on it.
ACT starts somewhere else. Rather than treating the thought or the feeling as the problem, it treats the struggle with it as the problem. It works on two things at the same time. The first is reducing what that struggle costs you. The second is getting clear on what you want your life to be about, so there’s something worth the discomfort.
The six core processes
ACT is built on six processes, usually drawn as a hexagon. They aren’t stages to work through in order, and most sessions touch several at once.
Acceptance. Making room for uncomfortable feelings instead of fighting them. This isn’t resignation or approval. It’s dropping a struggle that isn’t working.
Cognitive defusion. Stepping back from thoughts so you can see them as thoughts rather than as facts about the world. There are a lot of small exercises for this, and they can feel strange the first few times.
Present moment contact. Paying attention to what’s actually happening now, rather than to a rehearsal of the future or a review of the past.
Self as context. Noticing that you’re the one having the experience, and that you aren’t the same thing as the content of your thoughts.
Values. Working out what matters to you, described in your own words rather than borrowed ones.
Committed action. Doing things that move you toward those values, including when it’s uncomfortable.
Taken together these are described as psychological flexibility, which is the ability to stay in contact with the present, notice what’s showing up, and still act in a way that fits your values.
What a session can look like
ACT is more experiential than a purely conversational therapy. Alongside discussion, expect short exercises done in the session itself, metaphors used to make an abstract idea concrete, and some work between sessions.
A first session usually covers what’s brought you in, what you’ve already tried, and what the cost of those strategies has been. That last part matters more than it sounds. Working out what avoidance has taken from you is often what makes the rest of the work worth doing.
Values work can come early. Some people find it the most useful part and others find it uncomfortable, particularly if they’ve spent a long time meeting other people’s expectations. Both reactions are common, and there’s no right or wrong way to approach it.
Sessions are usually 50 to 60 minutes, and ACT is generally a shorter-term therapy than open-ended approaches, though how long varies. There’s more on that in how many therapy sessions you might need.
Where ACT differs from traditional CBT
ACT sits inside the cognitive behavioural family and shares a lot with traditional CBT. Both are structured, active, and focused on what you do between sessions rather than only on what’s discussed inside them.
The main difference is what happens with a difficult thought. Traditional CBT often examines the thought, tests it against the evidence, and works toward a more balanced or accurate version. ACT usually doesn’t dispute the content at all. It works on how tightly you’re holding the thought and whether it’s dictating what you do.
Neither approach is better than the other. They suit different people and different problems, and plenty of clinicians draw on both depending on what’s in front of them.
What ACT is used for
ACT has been studied across anxiety disorders, depression, chronic pain, substance use, and psychological distress associated with physical health conditions. The Association for Contextual Behavioral Science maintains the research base and a public description of the model, and the Australian Psychological Society includes it among the psychological interventions with evidence behind them.
The evidence is stronger in some areas than others, and no approach suits everyone. If you’ve tried ACT before and it didn’t fit, that’s worth saying early rather than working through it again by default.
ACT also works reasonably well by video, since most of it is conversation and exercises rather than anything requiring physical presence. There’s more on format in online versus in-person therapy.
Frequently asked questions
Is ACT the same as CBT?
No, though they’re related. ACT is part of the cognitive behavioural family and shares its structured, active approach. The difference is that traditional CBT often works on changing the content of unhelpful thoughts, while ACT works on changing your relationship with them without disputing whether they’re true.
How long does ACT therapy take?
It varies with what you’re working on. ACT is generally a shorter-term approach than open-ended therapy, and many people work in blocks of six to twelve sessions with a review, though some need more and some fewer.
Can ACT therapy be done online?
Yes. ACT is mostly conversation and short experiential exercises, both of which work by video. Telehealth also widens your choice of psychologist beyond your immediate area.
Does acceptance mean I have to be okay with what happened?
No. Acceptance in ACT means making room for a feeling rather than spending energy fighting it. It isn’t approval, resignation, or deciding that something was acceptable. It’s a practical move about where your effort goes.
Is ACT suitable for anxiety?
It’s commonly used for anxiety, and the avoidance patterns that maintain anxiety are a direct target of the model. Whether it suits you specifically is worth discussing with your psychologist.
Working with Veronica
If you’re considering therapy and want to understand how ACT might apply to what you’re dealing with, you can read more about therapy with Veronica or get in touch to ask. Veronica works with adults and adolescents across Australia by telehealth, and also draws on approaches for anxiety and other presentations depending on what fits.
About the author
Veronica West is a registered psychologist (BPsychSc(Hons), MPH, MPsych) and Board-approved supervisor based on the Sunshine Coast, Queensland. She works with adults and adolescents across Australia by telehealth and provides clinical supervision to provisional psychologists, registrars and fully registered psychologists. More about Veronica.