Acceptance and Commitment Therapy (ACT) for Mental Health Treatment
ACT was developed in the late 1980s by Steven C. Hayes, along with colleagues, as part of what later became known as the “third wave” of behavioral therapies.1 These approaches expanded CBT through mindfulness, acceptance, and behavior change strategies. It has been studied for many mental health and physical health concerns, including anxiety, depression, trauma, addiction, chronic pain, and long-term medical conditions.
If you’re curious to know how ACT could benefit your mental well-being, the team at Mission Connection can talk you through its suitability for your needs.
This page can also help by covering everything you need to know about ACT, including:
What ACT is- How it works
- The core components of ACT
- Who it typically works for
- ACT’s benefits and limitations
- What to expect from therapy
What Exactly Is Acceptance and Commitment Therapy?
The principle of ACT is psychological flexibility. This means thoroughly understanding your feelings and emotions, and then choosing actions that move you toward the kind of person you want to be.2
A common misunderstanding about ACT is the word “acceptance.” But, in ACT, acceptance does not mean resigning ourselves to misery and giving up. Rather, it means making room for the reality that if you’ve been through a bad incident, you don’t succumb to an additional layer of suffering through shame, guilt, fear, or self-sabotaging thoughts.
It is human nature to spend your energy trying to control these unwanted emotions. ACT teaches you to shift past them.
The Effectiveness of ACT
Dialectical behavior therapy- Mindfulness-based cognitive therapy
- Compassion-focused therapy
- Schema therapy
For a long time, third-wave therapies were seen mainly as options for people who did not benefit from the standard CBT. But, research over the past two decades shows that ACT is effective in its own right and can be used as a first-line treatment for some people. In fact, a study found that it worked better than usual care or waitlist conditions in anxiety disorders, depression, and addiction.3
Another large review validated it against anxiety, obsessive compulsive symptoms, depression, substance use, and chronic pain in a population size of over 12,000.4
The Core Components of ACT
Acceptance- Cognitive defusion
- Being present in the moment
- Viewing self as context rather than content
- Values clarification
- Committed action
We discuss each of these pillars in turn in the sections below.
1. Acceptance
Acceptance means learning how to stop fighting your inner experiences and start making space for them.
Our thoughts, feelings, memories, urges, and body sensations typically show up whether we invite them or not, and most of us respond by trying to push them away. This is called “experiential avoidance.”
The problem with this innate response, however, is that the harder we try to get rid of inner pain, the more it often sticks around. For this reason, experiential avoidance is known to contribute to many mental health conditions.5
Acceptance teaches you to act in your best interest when these uncomfortable feelings come along for the ride. For example, you let anxiety sit in your chest and still show up to your appointment, or notice a self-critical thought and let it pass without arguing back in your head.
2. Cognitive Defusion
Cognitive defusion means learning how to step back from your thoughts so they have less control over what you do. Most of us do not realize that we treat our thoughts as facts. If, for example, the mind says, I’m not good enough, we act as if that statement is objectively true.
In mental health conditions, thoughts and behaviors are “fused.” So, if you think you’ll embarrass yourself in a public setting, you may avoid any social situations entirely.
The concept of cognitive defusion is to realize that your thoughts are merely words and images produced by the mind, not reality. And so, your behaviors can go against them. For instance, you can still attend public events even when your mind says that you’ll likely embarrass yourself.
There are research studies where people practiced defusion techniques, and their belief in the negative thought went down. For example, in a study on Chinese college students, ACT using cognitive defusion led to an improved body image among students.6
3. Being Present
Paying attention to what is happening to you in the moment, on purpose, is known as “being present.”
It is common for us to spend a huge amount of time either worrying about the future or replaying the past. A core aspect of ACT is to bring you back to the current moment as it is. When you’re in the present moment, you’re more able to notice choices. For example, you can feel anxiety and still hear the other person talking to you.
Present-moment awareness overlaps with what research often calls “mindfulness.” It is documented in research that mindfulness practices reduce psychological distress and improve well-being.7
4. Self as Context
The idea of self can be approached in two different ways:
Self-as-content- Self-as-context
Self-as-content means defining yourself by your thoughts, emotions, memories, labels, and personal stories. The problem here is that your thoughts and feelings are unstable and can change at any time.
But self-as-context means to recognize that you are the one who notices thoughts and feelings, not defining yourself as your thoughts and feelings. You can observe your anxiety, shame, guilt, fear, or self-criticism without letting these experiences characterize you.
The concept of self-as-context is measurable and can change with intervention. For instance, the Self-as-Context Scale can be used to understand how you relate to yourself.
When studied for chronic pain, changes in self-as-context over time through ACT therapy were associated with better functioning and less interference from pain in everyday life.8
5. Values Clarification
Values are directions for living. They include what you want to stand for in how you live, how you treat others, and how you show up in the world.
The difference between values and goals is that goals have an endpoint (for instance, “lose 15 lbs”). In contrast, values are ongoing behaviors you want to keep practicing, over and over.
For instance, values include…
Being a caring parent- Showing up for relationships
- Acting with kindness
- Being curious
The role of values in ACT is that your values pull you toward meaningful actions even when doing so is uncomfortable. Behavior driven by values does not depend on feeling confident, calm, or motivated first. You do it simply because it matters to you.
6. Committed Action
Committed action is planned, purposeful, repeated behavior. ACT uses guided exercises to help you act in line with your values rather than wait for motivation or confidence.
The first four components of ACT (acceptance, cognitive defusion, being present, and self-as-context) all work on your mindset. Once your mind is clear, you clarify your values on how you want to align your actions in the future.
Committed action refers to taking these values-based steps. If your value is being a supportive parent, a committed action can mean showing up to your child’s social event even while you feel anxious.
Actions are not rigid. You can try out different ones and change course when needed. Commitment only means that you stay engaged with your values as you respond to obstacles realistically.
Mental Health Indications for ACT Behavioral Therapy
ACT is used for a range of mental health concerns. It is best used for situations where a person is trapped in cycles of emotional struggles that affect their daily functioning, and they want to fix their actions.
It is not the first-line treatment for some of the conditions listed below, but research has shown great efficacy of ACT as a supplement or add-on to other treatments.
Some of its indications are:
- Anxiety disorders (generalized anxiety disorder, panic disorder, specific phobia, and social anxiety)
- Depression
- Obsessive-compulsive disorder
- Stress-related difficulties and burnout
- Substance use and addiction-related problems
- Alcohol use disorder
- Eating disorders
- Adjustment difficulties and life transitions
ACT is also used for people living with chronic health conditions. These include chronic pain, cancer, autoimmune illness, and neurological conditions. It does not control symptoms in these diseases. But it helps people reduce their emotional suffering and stay engaged in life despite their physical symptoms.
What Conditions Does ACT Not Treat?
ACT is not indicated for certain mental health problems and immediate crisis situations in particular, such as:
- Acute psychosis with active hallucinations or delusions
- Acute manic episodes
- Severe eating disorders that risk medical complications
- Active suicidal crisis
- Trauma-related stress
- Neurodevelopmental disorders like intellectual disability or autism
What to Expect in an Evidence-Based ACT Therapy Session?
In the early ACT sessions, you sit with a therapist and talk about your current struggles, emotional patterns, and the ways you have tried to cope in the past.
As sessions continue, your therapist helps you develop awareness of your thoughts and emotions. You also get to examine how your inner experiences influence your actions.
Each session includes a brief review of the previous week. For instance, you look at the actions that were consistent with your values and acknowledge them, as well as actions that were not. Further, in situations where your behavior did not align with values, you try to understand the barriers to an appropriate response and how to implement it next time.
ACT sessions use the six core processes of the therapy. You practice present-moment mindfulness exercises to build non-judgmental awareness of thoughts, feelings, body sensations, and memories. Between sessions, you are given home practice, which includes:
- Mindfulness exercises
- Noticing your thought patterns
- Values clarification tasks
- Small values-based actions
The Pros and Cons of ACT Therapy for Mental Health
ACT therapy has many benefits.
It helps people organize their thinking process based on the values they decide for themselves. A clear mind makes deliberate and thoughtful decisions instead of reacting impulsively.
ACT is also associated with reduced levels of depression, anxiety, and stress. As people learn new ways to relate to their inner experiences, their emotional distress starts to become manageable, and they are better able to engage in daily activities.
ACT also encourages action guided by personal values. So, in situations when your motivation is not particularly high, you can still intentionally act in alignment with your long-term priorities.
It also leads to greater self-awareness and self-compassion. The mindset shift from self-as-content to self-as-context helps you develop a kinder relationship with yourself. Most people experience an improved quality of life after ACT sessions compared to baseline.
Alongside the benefits, though, there are some challenges that might come with ACT.
For starters, you must be ready for emotional openness and vulnerability when you start ACT. The awareness of difficult thoughts, memories, or emotions when you practice being-present exercises can temporarily increase your emotional discomfort.
Your progress also depends on practicing skills and taking values-based actions outside of sessions. Thus, it requires active participation on your end.
Can Everyone Get ACT?
Older adults, particularly those managing chronic medical conditions, pain, grief, or age-related life changes, are great candidates for the therapy.
On the flip side, ACT is not the primary mode of therapy for children. The core skills of ACT include abstract thinking, self-reflection, perspective-taking, and values clarification, which require cognitive and emotional capacities that develop later in life. There is, however, emerging evidence for the use of ACT in children using play and sensory activities to make it engaging.9
ACT is also not suitable as a standalone treatment for people in acute psychiatric crises.
Acceptance and Commitment Therapy at Mission Connection
If you’re considering ACT and want ethical, evidence-based care, you’re at the right place. Mission Connection Healthcare offers ACT delivered by licensed, credentialed professionals who specialize in modern behavioral therapies.
We currently offer ACT through both in-person and online therapy sessions in three states: California, Washington, and Virginia. Plus, to reduce financial barriers to treatment, we are in-network with all major insurance providers in the country.
Our clinicians offer weekly individual therapy as well as process-based group therapy. When clinically appropriate, we also provide medication management for a comprehensive approach to treatment.
All our clients receive a custom treatment plan developed in consideration of their symptoms and goals. If you’re ready to get started or simply have some ongoing questions, get in touch today.
Frequently Asked Questions About ACT
How Many Sessions Does ACT Therapy Involve? ACT therapy typically lasts for 12–16 sessions. However, the number of sessions is variable depending on your progress and individual needs.
Is ACT Better Than CBT for OCD? Research shows ACT is an alternative to CBT for OCD, and they are both equally effective. For instance, a recent randomized trial found group ACT to be non-inferior to CBT with exposure and response prevention in reducing OCD symptoms at post-treatment and follow-up.10
Is ACT Cognitive or Behavioral? ACT is a behavioral type of therapy, not cognitive. Cognitive therapies aim to change the content of thoughts, while ACT focuses on your actions and the way you respond despite the presence of distressing thoughts.
References
- Anusuya, S. P., & Gayatridevi, S. (2025). Acceptance and commitment therapy and psychological well-being: A narrative review. Cureus, 17(1), e77705. https://doi.org/10.7759/cureus.77705
- Knudsen, F. M., Donahue, M. L., Klimczak, K. S., Aller, T. B., & Levin, M. E. (2025). Psychological flexibility as a mechanism of change in online ACT among adults living with chronic health conditions. Journal of Behavioral Medicine. https://doi.org/10.1007/s10865-025-00585-8
- A-Tjak, J. G. L., Davis, M. L., Morina, N., Powers, M. B., Smits, J. A. J., & Emmelkamp, P. M. G. (2015). A Meta-Analysis of the Efficacy of Acceptance and Commitment Therapy for Clinically Relevant Mental and Physical Health Problems. Psychotherapy and Psychosomatics, 84(1), 30–36. https://doi.org/10.1159/000365764
- Gloster, A. T., Walder, N., Levin, M. E., Twohig, M. P., & Karekla, M. (2020). The empirical status of acceptance and commitment therapy: A review of meta-analyses. Journal of Contextual Behavioral Science, 18(18), 181–192. https://doi.org/10.1016/j.jcbs.2020.09.009
- Rodríguez‐Rey, R., Guerra Corral, M., Collazo‐Castiñeira, P., Collado, S., Caro‐Carretero, R., Cantizano, A., & Garrido‐Hernansaiz, H. (2024). Predictors of mental health in healthcare workers during the COVID-19 pandemic: The role of experiential avoidance, emotion regulation and resilience. Journal of Advanced Nursing. https://doi.org/10.1111/jan.16122
- Fang, S., Ding, D., Ji, P., Huang, M., & Hu, K. (2022). Cognitive Defusion and Psychological Flexibility Predict Negative Body Image in the Chinese College Students: Evidence from Acceptance and Commitment Therapy. International Journal of Environmental Research and Public Health, 19(24), 16519. https://doi.org/10.3390/ijerph192416519
- Keng, S. L., Smoski, M. J., & Robins, C. J. (2011). Effects of Mindfulness on Psychological health: a Review of Empirical Studies. Clinical Psychology Review, 31(6), 1041–1056. https://doi.org/10.1016/j.cpr.2011.04.006
- Yu, L., Norton, S., & McCracken, L. M. (2017). Change in “Self-as-Context” (“Perspective-Taking”) Occurs in Acceptance and Commitment Therapy for People With Chronic Pain and Is Associated With Improved Functioning. The Journal of Pain, 18(6), 664–672. https://doi.org/10.1016/j.jpain.2017.01.005
- Gooya Tayyebi, Nathera Hussin Alwan, Ameera Fares Hamed, Alhan Abdulhasan Shallal, Thaiba Abdulrazzaq, & Reyhane Khayayi. (2024). Application of Acceptance and Commitment Therapy (ACT) in Children and Adolescents Psychotherapy: An Umbrella Review. Iranian Journal of Psychiatry. https://doi.org/10.18502/ijps.v19i3.15809
- Nielsen, S. K. K., Stuart, A. C., Winding, C., Øllgaard, M., Wolitzky-Taylor, K., Daniel, S. I. F., Vangkilde, S., Rosenberg, N., Hageman, I., & Jørgensen, M. B. (2025). Group Acceptance and Commitment Therapy versus Cognitive Behavioral Therapy/Exposure Response Prevention for Obsessive Compulsive Disorder: A Block Randomized Controlled Trial. Psychotherapy and Psychosomatics, 94(3), 135–146. https://doi.org/10.1159/000544070