What is ACT therapy?
Acceptance and commitment therapy (ACT) can be used to treat several health conditions, including anxiety and chronic pain. But how does ACT work? Here, I explain what acceptance and commitment therapy is, what it aims to do, and how it can help.
What is acceptance and commitment therapy (ACT)?
Acceptance and commitment therapy (ACT) is a type of talking therapy. The main goal of ACT is to help you improve your ‘psychological flexibility’. A therapist helps you learn skills to manage thoughts, feelings, and sensations that you avoid and are fearful of.
Is ACT different from CBT?
CBT is a talking therapy that focuses on helping you change how you think and respond to your problems. CBT is used for a range of mental health conditions, including depression, anxiety, post-traumatic stress disorder, and obsessive-compulsive disorder (OCD).
ACT uses the principles of CBT but blends them with newer approaches and concepts such as mindfulness and acceptance.
What is ACT used for?
Research has found that the ACT model of 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.
What are the six processes of ACT?
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 to be 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 defusion
Defusion 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. Defusion 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.
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?
What do you want your life to be about? Your values will be very personal and individual to you.
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 your thoughts and feelings change and you 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.
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. You’ll be able to get mental health advice and support usually without the need for a GP referral. Learn more today.
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Sources Sources
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- Kelson J, Rollin A, Ridout B, et al. Internet-Delivered Acceptance and Commitment Therapy for Anxiety Treatment: Systematic Review. J Med Internet Res 2019;21:e12530. DOI: 10.2196/12530
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- Cognitive and behavioural therapies. Patient. patient.info/doctor, last updated December 2022
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- Chronic pain (primary and secondary) in over 16s: assessment of all chronic pain and management of chronic primary pain. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published April 2021
- Guidelines on the management of chronic pain in children. World Health Organization. who.int, published 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;20:300. DOI: 10.1186/s12883-020-01883-1
- State of the ACT evidence. Association for Contextual Behavioural Science. contextualscience.org, accessed February 2024
- The six core processes of ACT. Association of Contextual Behavioural Science. https://contextualscience.org/the_six_core_processes_of_act, accessed February 2024
- Russ Harris MD. ACT made simple. 2009. https://www.actmindfully.com.au/upimages/ACT_Made_Simple_Introduction_and_first_two_chapters.pdf, New Harbinger Publications Inc
- Zhang C-Q, Leeming E, Smith P, et al. Acceptance and Commitment Therapy for Health Behavior Change: A Contextually-Driven Approach. Front Psychol 2017;8:2350. DOI:10.3389/fpsyg.2017.02350. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5769281/
- Psychotherapy and its uses. Patient. patient.info/doctor, last updated September 2023
- British Association for Counselling and Psychotherapists. bacp.co.uk, accessed March 2024
- British Association for Behavioural & Cognitive Psychotherapies. babcp.com, accessed March 2024
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