Navigation

What is ACT therapy?

Specialist Nurse Adviser for Mental Health, Bupa UK
15 April 2021

ACT therapy has recently been recommended as a treatment for helping people who have chronic pain. But what is it, and how does it work? Here I explain what ACT therapy is, what it aims to do and how it can help.

What does ACT therapy mean?

ACT stands for act and commitment therapy and it’s an extension of cognitive behavioural therapy (CBT).

CBT is a talking therapy that focuses on helping you change how you think and respond to your problems. CBT is one of the most researched therapies around the world and is used successfully for a range of health conditions. ACT therapy uses the principles of CBT but blends them with newer approaches and concepts such as mindfulness and acceptance.

The main goal of ACT therapy is to help you improve your ‘psychological flexibility’. A therapist helps you learn skills that help you manage thoughts, feelings and sensations that you avoid and are fearful of.

What is ACT therapy good for?

Research has found that ACT therapy can be helpful for a range of health conditions and problems. These include chronic primary pain, sleep and mental health conditions such as depression, anxiety and OCD.

How does ACT therapy work?

There are six core areas or processes to ACT. It can be helpful to think of them as positive skills that you can learn.

Acceptance

Acceptance is about opening up and actively embracing the thoughts, feelings and sensations that you might otherwise try to avoid. Rather than struggling or fighting against them, the idea is to make room for them. This doesn’t mean you have to like them, but you are able and willing to let them exist and to be what they are. Learning this skill helps you with the other processes of ACT.

Cognitive diffusion

Diffusion is being able to detach from thoughts, memories and feelings. Instead of getting caught up in them, you can take a step back and watch your thinking. Think of them as clouds in the sky – just passing by. It’s about being able to let go of the thought rather than getting tied up in knots by it.

You can take the power out of a thought or feeling. Rather than thinking ‘I am no good’, you thank your mind for coming up with an interesting thought and then label it as: ‘I am having the thought that I am no good.’ This creates distance.

Another example is giving a sensation a shape, size and colour, as though it were something outside of yourself that you were watching across the street. In this way, ACT therapy can be quite playful. Diffusion helps you to decrease your attachment to the thought or feeling and make it less believable.

Being present

This refers to mindfulness – being in the here and now. In the present moment, you’re not thinking about the past or the future, just what is immediately in your awareness. This helps us step out of ‘being on auto pilot’, which can cause us to lose touch with ourselves and the world around us. It’s about paying attention to what is happening for you moment by moment.

Being present lets you experience the world directly in a non-judgemental way, and in turn, lets you be more flexible with how you then behave. You can then take actions that are aligned with your values (which I talk about below).

Self as context (the observing self)

The mind has two elements – the thinking self and the observing self. The thinking self is the element where we think and feel – we know it well! The observing self is the aspect of our mind that is aware of this thinking self. This is the essence of ‘you’ that never changes even as you change and get older. This is the self that allows you to accept and observe rather than become overwhelmed and swallowed by thoughts, feelings and sensations. You can observe what’s happening without becoming attached.

Values

Values are about connecting with what really matters to you in life. They are your guiding beliefs that help you consistently take action in a clear and meaningful direction. When you feel lost, your values can help you get back on track and move forward again. Values can also be called ‘life directions’. They are activities that give your life purpose. A helpful way to think about them is to ask yourself: Who do you want to be? And what do you want your life to be about? Your values will be very personal and individual to you.

Committed action

Taking action reinforced by your values means that you can take steps to live a rich and meaningful life, even when the road gets rocky. It’s not about avoiding or never having bad thoughts or experiences. It’s about staying committed to taking action to live by your values. These can take the shape of short, medium and long-term goals. There are lots of ways you might do this such as learning to be more assertive or to self-soothe. You might learn skills to problem solve or manage your time more effectively.

How can these skills help me?

These six processes all support each other. When changing your behaviour and actions, you’ll no doubt come up against stressors and barriers – but these processes can help you deal with them along the way so you can continue onwards.

ACT is one type of psychological therapy – there are many more. What works for one person might not work for another.

How can I access ACT therapy?

Accessing ACT therapy will depend on what condition you’re having it for. This will affect whether it’s something you can have through the NHS or privately. For example, if you have chronic pain, your doctor may be able to refer you for ACT therapy. Talk to your GP for advice and more information.

You may also be able to get ACT therapy through having private therapy. Websites allowing you to search for therapists in your area include the British Association for Counselling and Psychotherapists and the British Association for Behavioural & Cognitive Psychotherapies.


If you’re worried about your mental health, our direct access service aims to provide you with the advice, support and treatment you need as quickly as possible. If you’re covered by your health insurance, you’ll be able to get mental health advice and support usually without the need for a GP referral. Learn more today.

Caroline Harper
Specialist Nurse Adviser for Mental Health, Bupa UK

    • Acceptance and Commitment Therapy (ACT). British Association for Behavioural and Cognitive Psychotherapies. babcp.com, accessed 9 April 2021
    • About ACT. Association for Contextual Behavioural Science. contextualscience.org, accessed 7 April 2021
    • Hayes SC, Hofmann SG. The third wave of cognitive behavioral therapy and the rise of process-based care. World Psychiatry. 2017;16(3):245-246. doi:10.1002/wps.20442
    • NICE recommends range of effective treatments for people with chronic primary pain and calls on healthcare professionals to recognise and treat a person’s pain as valid and unique to them. www.nice.org.uk, published 7 April 2021
    • Chronic pain (primary and secondary) in over 16s: assessment of all chronic pain and management of chronic primary pain. National Institute for Health and Care Excellence (NICE). www.nice.org.uk, published 7 April 2021
    • Guidelines on the management of chronic pain in children. World Health Organization. www.who.int, published 22 December 2020
    • Salari N, Khazaie H, Hosseinian-Far A, et al. The effect of acceptance and commitment therapy on insomnia and sleep quality: A systematic review. BMC Neurol. 2020 Aug 13;20(1):300. doi:10.1186/s12883-020-01883-1
    • State of the ACT evidence. Association of Contextual Behavioural Science contextualscience.org, accessed 9 April 2021
    • Kelson J, Rollin A, Ridout B, Campbell A. Internet-Delivered Acceptance and Commitment Therapy for Anxiety Treatment: Systematic Review. J Med Internet Res. 2019 Jan 29;21(1):e12530. doi:10.2196/12530
    • The six core processes of ACT. Association of Contextual Behavioural Science. contextualscience.org, accessed 7 April 2021
    • Russ Harris MD. Act made simple. 2009. New Harbinger Publications Inc
    • Therapists. British Association for Counselling and Psychotherapists (BACP). www.bacp.co.uk, accessed 9 April 2021
    • British Association for Behavioural & Cognitive Psychotherapies (BABCP). www.babcp.com, accessed 9 April 2021

Did you find our advice helpful?

We’d love to hear what you think. Our short survey takes just a few minutes to complete and helps us to keep improving our healthy lifestyle articles.

ajax-loader