Acceptance and commitment therapy (ACT)
Acceptance and Commitment Therapy (ACT) is a distinctive form of cognitive behavioral therapy that emphasizes the acceptance of difficult thoughts and emotions rather than attempting to avoid or eliminate them. This therapeutic approach encourages individuals to observe their internal experiences, reframe their meanings, and focus on their present realities. Central to ACT is the concept of psychological flexibility, which involves aligning one's behaviors with personal values while remaining fully engaged in the current moment. The therapy is built upon six key processes: acceptance, cognitive defusion (observing thoughts without attachment), being present, self as context (awareness of oneself), values identification, and committed action.
Originally developed in the 1970s by psychologist Steven C. Hayes, ACT incorporates insights from relational frame theory and has evolved to include various techniques such as mindfulness practices, metaphors, and behavioral exercises. It can be delivered in multiple formats, including individual sessions, group therapy, and workshops. ACT has shown effectiveness in treating a range of psychological issues, including anxiety, depression, and chronic pain, as well as addressing nonclinical challenges like workplace performance and interpersonal issues. Overall, ACT promotes a compassionate and values-driven approach to mental health and well-being.
On this Page
Subject Terms
Acceptance and commitment therapy (ACT)
Acceptance and commitment therapy (ACT) is a cognitive behavioral therapy (CBT) approach that seeks to transform how an individual experiences difficult or unpleasant emotions, thoughts, or physiological feelings, rather than avoid, eliminate, or replace them, as is common in traditional therapies. In ACT, the individual is encouraged to observe and accept such internal events, reevaluate their meanings, focus on present realities, identify core values, and choose behaviors that align with those values.
When used in nonclinical environments, ACT is sometimes referred to as “acceptance and commitment training.” Similar psychological treatment methods include mindfulness-based cognitive therapy and dialectical behavior therapy. ACT is often, though not always, paired with mindfulness techniques.
Overview
ACT largely grew out of psychologist Steven C. Hayes’s work in the 1970s to develop a behavioral approach based on B. F. Skinner’s theories of verbal and rule-governed behavior. Hayes’s approach considered thoughts to be another form of behavior, which, under certain circumstances, elicits other behaviors. That framework later evolved into comprehensive distancing, a contextual approach that encourages an individual to observe self-talk impartially. By the mid-1980s, Hayes and his colleagues had developed the relational frame theory (RFT), which considers language acquisition, the role of language in connecting self and environment, and the influence of experiential contexts on internal events such as thoughts and emotions. Cognitive distancing and RFT laid the theoretical foundations for ACT, which was fully defined by 2000. The early 2000s saw widespread adoption of ACT protocols around the world.
The ultimate goal of ACT is psychological flexibility, or the individual’s ability to be fully present in a given situation and to choose behaviors based on that reality and aligned with their personal values. According to ACT philosophy, six processes—acceptance, cognitive defusion, being present, self as context, values, and committed action—are needed to achieve such psychological flexibility. Acceptance entails acknowledging and allowing room for difficult or unpleasant thoughts, emotions, and feelings. Cognitive defusion involves detaching from and observing such internal events. Being present means bringing cognitive awareness and engagement to current physical and/or mental conditions. “Self as context,” or “pure awareness,” refers to the individual’s ongoing observation of the self throughout life. Values, or “chosen life directions,” represent the ways in which the individual wishes to behave over time to create a meaningful life. Committed action uses the individual’s values to guide goal setting and decision-making that aligns with those values.
ACT treatment is delivered via individual or couples sessions, group therapy, workshops, workplace training, and self-help publications and other media. Dialogue, metaphors and analogies, visualizations, and behavioral homework are among the specific techniques that may be used as part of ACT protocols. Treatment duration varies based on individual needs or practitioner methods.
ACT has been used to treat conditions ranging from phobias, smoking, trichotillomania (hair-pulling disorder), diabetes, and substance abuse to depression, epilepsy, chronic pain, panic disorders, obsessive-compulsive disorder (OCD), and even acute psychosis. Research suggests it may also be beneficial in addressing such nonclinical concerns as prejudice, inability to learn, or work performance.
Bibliography
Bach, Patricia, and Daniel J. Moran. ACT in Practice: Case Conceptualization in Acceptance and Commitment Therapy. New Harbinger, 2008.
Harris, Russ. ACT Made Simple: An Easy-to-Read Primer on Acceptance and Commitment Therapy. Foreword by Steven C. Hayes. New Harbinger, 2009.
Hayes, Steven C., et al. Acceptance and Commitment Therapy: The Process and Practice of Mindful Change. 2nd ed., Guilford, 2011.
"Psychological Inflexibility: An ACT View of Suffering and Failure to Thrive." Association for Contextual Behavioral Science, contextualscience.org/about‗act. Accessed 7 Aug. 2024.
Serani, Deborah. “An Introduction to Acceptance and Commitment Therapy.” Psychology Today, 22 Feb. 2011, www.psychologytoday.com/us/blog/two-takes-on-depression/201102/an-introduction-to-acceptance-and-commitment-therapy. Accessed 13 Sept. 2013.
Twohig, Michael P., et al., editors. The Oxford Handbook of Acceptance and Commitment Therapy. Oxford UP, 2023.
Zettle, Robert D. “The Evolution of a Contextual Approach to Therapy: From Comprehensive Distancing to ACT.” International Journal of Behavioral Consultation and Therapy, vol. 1, no. 2, 2005, pp. 77–89.