When we’re faced with a negative experience, our natural instinct may often be to struggle with it. Sometimes, we might disengage or avoid it. Other times, we might do the opposite and get caught up in it, dwelling on negative thoughts — from traumatic moments, harsh self-criticism, worrying about the future or the distressing memories, emotions or aftermath associated with them.
The first reaction is called experiential avoidance, a tendency as humans to suppress or distance ourselves from what’s painful. Contrasted with a ruminating mindset, both may seem like opposites but are part of the same mental coping method. And not addressing or giving them the attention they deserve can, over time, lead to larger problems like depression or anxiety.
This internal struggle may also lead to ambivalence or reluctance about making changes in life. Even if you may recognize that certain thought or behavioral patterns are no longer sustainable, another part may remain resistant to facing that pain.
How can you reconcile those thoughts and emotions and promise to move past them? One type of behavioral therapy is called Acceptance and Commitment Therapy, and like its acronym tells us, it can help you to ACT on making room in your life for difficult feelings and resolve them in a way that’s aligned with your values.
Read on to learn more about how Commitment and Acceptance Therapy work, what it treats and how it can help you.
What Is Acceptance and Commitment Therapy (ACT)?
Acceptance and Commitment Therapy is a modern form of psychotherapy and behavioral therapy developed in the 1980s by psychologist Steven C. Hayes. The purpose of ACT, said Hayes in an interview, was “to try to figure out how we can create a psychology, a behavioral science, that’s more adequate to the challenge of the human condition.”
ACT Acceptance and Commitment Therapy teaches us two things:
- It’s OK to accept that negative thoughts, emotions or actions — or avoiding facing how you think and feel — you’ve had were valid responses in past moments.
- You can commit to making changes and make them happen in a way that’s personally valuable to you.
Acceptance and Commitment Therapy embraces the idea that difficult thoughts and emotions are a normal part of life, and that you can change your relationship to those experiences and reframe your mental narrative while staying true to yourself.
In a Psychology Today report, Dr. Hayes elaborates: “We as a culture seem to be dedicated to the idea that ‘negative’ human emotions need to be fixed, managed or changed — not
experienced as part of a whole life. We are treating our own lives as problems to be solved as if we can sort through our experiences for the ones we like and throw out the rest.”
He adds, “Acceptance, mindfulness and values are key psychological tools needed for that transformative shift.“
What Are the Core Principles of ACT?
As you progress through treatment, each of these Acceptance and Commitment Therapy skills are personal achievements for your own self-growth:
The first principle involves making room in your mind and heart for painful feelings or memories, both good and bad, and accepting them for what they are, without judgment, allowing them to come and go without any internal dissonance.
One of the most important Acceptance and Commitment Therapy techniques, “defusion” is the practice of detachment, seeing your thoughts and feelings, no matter how negative, just for what they are — merely passing, fleeting thoughts and feelings — instead of becoming mentally or emotionally entangled in them.
Many of ACT’s principles resemble some of the key tenets of Buddhism. This practice is one of them, to bring your presence and focus into the here and now. By staying aware to each current, waking moment, it allows you to experience the world directly and prevents you from ruminating on the past or worrying about the future.
Holistic means “whole,” as this skill teaches you to perceive yourself fully and completely, with a tangible, vital identity separate from your thoughts, feelings and memories.
In ACT therapy, you decide the changes you want to make in your life according to your own value system. You’ll create a list of what’s most important to you, not influenced by your therapist or other people. What kind of person do you want to be? What gives your life meaning and what do you want to achieve?
The last principle is the second bookend to ACT therapy — staying committed to reaching the goals you set. At this stage, you’ve accepted hurtful feelings and thoughts, detached yourself from them by staying present, seeing yourself for who you and your values are and following through on making tangible changes, even when it’s difficult.
What Does Acceptance and Commitment Therapy Treat?
ACT therapy is widely used as one of many behavioral therapies and cognitive therapies for a range of conditions:
Addiction to substances — from alcohol to illicit or prescription drugs — is also linked to the mind-emotion-behavior connection that ACT treats. Substance abuse is known to make tangible changes to the brain, which can influence further misuse and make it difficult to quit without relapsing. Commitment and Acceptance Therapy helps you to accept the urges and cravings to drink or use drugs. You’ll learn to notice cravings, detach yourself from them and make room for
the discomfort. Most importantly, you’ll understand that substance abuse does not define who you are — but your values do. One of them could be, “Being sober and substance free,” a reachable, realistic goal you can commit to.
Because mental health conditions so often originate from cognitively disordered thinking, studies show that ACT becomes a powerful tool for mental health.
“ACT consistently reduces symptom severity, improves emotional regulation, enhances life satisfaction and increases psychological flexibility,” notes a 2024 report.
Another study reiterates, “(ACT) teaches … skills to appreciate and observe unfavorable thoughts and feelings just as they are instead of teaching ‘more, different, better’ strategies to change or decrease unwanted thoughts and feelings.”
Here’s what ACT can treat:
- ACT for anxiety: Persistent, intrusive thoughts and worries are all too often symptomatic of anxiety disorders, which go on to affect 40 million adults annually. In the U.S. ACT teaches you to acknowledge your anxieties, step away from them and reframe that mental narrative while also creating a new value-based framework for thinking, feeling and acting.
- ACT for depression: A sense of deep, pervasive sadness, hopelessness, low self-worth and a loss of interest or pleasure in activities you once enjoyed are just some of the ways that depression can conjure a feeling of being “stuck.” “By freeing oneself of the weight of their thoughts and feelings, ACT allows people with depression to take control over their lives,” notes a video on ACT therapy. The goals and values you list become small steps to emerge from depression happier and with a renewed outlook on life.
- ACT for PTSD and trauma: According to the National Council for Behavioral Health, 70% of adults — 223.4 million people — have experienced a traumatic event at some point in their lives. Just one traumatic experience can trigger development of a trauma disorder like Post-Traumatic Stress Disorder (PTSD), often marked by nightmares, flashbacks, disturbing recollections and a constant sense of dread and fear. ACT helps you learn — and set into motion — how to resolve those painful memories and feelings and forgive yourself for any undue self-blame, enabling you to re-engage with yourself in each present moment.
Many people struggle with both a substance use disorder and a mental health condition at the same time. In fact, according to a recent National Survey on Drug Use and Health, 21.5 million people in the U.S. endure this challenge, called a co-occurring disorder. A co-occurring disorder necessitates what’s called a dual diagnosis, where both conditions are treated in unison, not separately. ACT therapy is uniquely poised to treat the underlying cognitive reasons for the co-existence of problems like alcoholism and depression, helping you to understand and make
peace with the triggers that may fuel both addiction and mental illness, become present with your whole self and map out a plan for better well-being and sobriety personal to you.
What Are the Benefits of ACT?
One of the main benefits of ACT therapy is attaining a degree of psychological flexibility, which joins up with ACT’s core principles. According to the Association for Contextual Behavioral Science, it’s the process of “contacting the present moment fully as a conscious human being, and based on what the situation affords, changing or persisting in behavior in the service of chosen values.”
But engaging in Acceptance and Commitment Therapy ACT — from acceptance to commitment and the steps in between — offers numerous other advantages, like:
- A diminishment in symptoms related to anxiety, depression and other mental health issues
- Sharper mental clarity, inner strength and a sense of self-awareness
- The ability to cope with life’s stresses and challenges
- A renewed sense of purpose and direction in life with clear-cut, meaningful goals
- An improved sense of well-being and quality of life
How Effective is ACT?
Studies consistently show that ACT therapy improves that same psychological flexibility in people who seek treatment and alleviates mental health symptoms, particularly for depression and anxiety.
Other research tells us that ACT may be just as effective as Cognitive Behavioral Therapy (CBT) — if not more effective — in treating the same conditions (in addition to addiction and somatic health problems), making both therapies in tandem a purposeful combination for any treatment plan.
How Does ACT Work?
ACT teaches you to stop struggling against painful thoughts and feelings, and instead, to take committed action toward making positive changes guided by your personal values.
Since the ultimate goal of ACT therapy is to gain better psychological flexibility, you and your therapist may engage in a number of different Acceptance and Commitment Therapy exercises.
You’ll first learn to accept your internal experiences with an objective perspective, without suppressing them or blaming yourself for your thoughts or feelings. Your therapist may guide you in using mindfulness to become more present-focused.
Another approach is called cognitive defusion. One exercise is called the Zoom Out method, where you’ll visualize yourself floating high above the earth and far from your worries. An alternate cognitive defusion exercise is called Leaves on a Stream. Imagine standing by a stream. Whenever a habitual, distressing thought comes to mind, take it, place it on a leaf and watch it gently float by, observing it without judgment.
Likewise, you’ll take committed steps to changing your behaviors guided by your personal values list. With your therapist, this might take shape through Acceptance and Commitment Therapy worksheets like the Bull’s Eye, a values assessment where you can identify what’s most important to you on a printed dart board. The closer to the center, the higher its value
What to Expect in ACT
You might wonder, how do you visit all the six core ACT processes as treatment progresses? Therapy sessions are all about addressing issues and identifying goals as you go; sometimes, you may unearth certain memories in the psyche or establish important values a few sessions in. There’s no pressure to predict or know in advance how you’ll evolve during ACT therapy.
Sessions often begin with exercises to ground you in the here and now. You’ll practice reviewing the prior week’s work and bringing awareness to the fore, observing your thoughts and feelings without getting entangled in them. This creates the space needed to choose your response rather than reacting automatically.
Then, as you and your therapist work on defusion and mindfulness exercises, you’ll also devote time dedicated to discovering and clarifying what is genuinely important to you. What do you want to stand for? What do you want to achieve tomorrow, next week, next month, next year? What are your short- and long-term goals for mental health or sustaining sobriety? You’ll pinpoint and define the personal values that give your life purpose and direction — some of which you may just be discovering now.
At the end of each session, you’ll commit to making manageable actions you can take during the week. At first, it’s OK to start small, especially when you’re new to therapy or facing difficult thoughts or feelings.
How Long is ACT?
The amount of time you spend in ACT therapy can vary from person to person, since everyone has uniquely different needs. Overall, expect to be in sessions once a week for several weeks — generally anywhere from eight to 16 weeks, or two to four months weekly, with each session lasting about an hour. If you’re in an outpatient setting, that means you’re enabled to go to and from treatment on your own and live at home. If an inpatient/residential program suits you better, you might engage in therapy more frequently, part of your daily therapy and activities over a period of one to three months.
Can ACT Help Me?
In a word, yes, ACT can help you or anybody, for any mental health or substance use issue. If you feel that you’ve been stuck in a pattern of painful thoughts, emotional dysregulation or being disconnected or unclear about living according to your values, ACT may be a perfect fit.
Maybe you’ve tried making tangible changes in your mindset and day-to-day behaviors on your own but faltered. That’s exactly what ACT is geared toward — to give you the guidance and tools to take action and make concrete improvements even when thoughts and emotions feel abstract at the moment. It’s designed for anyone — as a standalone treatment or as part of a larger treatment plan — who want to develop present-focused mindfulness, a holistic self-perception and meaningful movements in everything you do.
Tips for Successful Acceptance and Commitment Therapy
If you’re entering ACT for the first time but unsure how therapy may unfold, keep these tips in mind to get the most out of treatment:
- Be open and receptive: ACT may feel different from some other therapies, blending elements of talk-based psychotherapy with holistic therapy. It teaches having an acute receptiveness to your mind’s activity, so aim to be similarly open to new ideas and exercises.
- Practice patience: Learning to cultivate awareness, mindfulness, detachment and self-awareness takes time, but it can be easy to get discouraged. Be patient – but moreover, show compassion and empathy for yourself — throughout your sessions and you’ll begin to notice progress.
- Live what you learn: It’s easy to take the techniques you’ve learned and leave them at your therapist’s office. Rather, see it as an opportunity to give real-world practice to mindfulness, defusion and goal reaching in your daily life, not just in treatment.
- Make your values a priority: If times get tough or you’re feeling triggered or having a challenging day, refer back to the values you’ve identified. Act in accordance and stay true to what matters most to you.
- Be honest with yourself: ACT therapy emboldens you to accept and commit to changing both your inner and outer world. Know that struggle may accompany success — stay strong, stay the course and know that your therapist is your advocate alongside you.
Is ACT Covered by Insurance?
Yes, Commitment and Acceptance Therapy is covered by most health insurance providers. In fact, behavioral health is protected under federal and state laws, requiring it to be including under insurance plans.
We believe that therapy is a right — not a privilege — that should be accessible and available to everyone, and that cost should never be a barrier to obtaining treatment. At Aliya, we accept both in-network and out-of-network plans, and we’re here to help you navigate the insurance maze to make sure that you’re maximizing your insurance and getting the most out of your coverage.
By contacting us today, we can verify your insurance coverage and explain your payment options clearly so you can focus on recovery without the financial burden or stress. Contact us today, either by calling to speak to a specialist (we’re available 24/7/365), emailing us or requesting a call or text back. We can explain the treatment process, behavior therapy, if ACT therapy is right for you and answer any questions you may have.
We’re here to meet you where you are.
Headstuck! What is Experiential Avoidance?
How to Avoid Experiential Avoidance | Psychology Today
Acceptance and Commitment Therapy (ACT): What It Is
Acceptance Commitment Therapy: An Introduction w/ Steven Hayes
Acceptance and Commitment Therapy | Psychology Today
Acceptance and Commitment Therapy (ACT) For Generalized Anxiety Disorder – PMC
Introduction to Acceptance and Commitment Therapy for Depression
Anxiety Disorders – Facts & Statistics
Co-Occurring Disorders and Other Health Conditions | SAMHSA
Psychological Flexibility: ACT skill | Worksheet | Therapist Aid
Thought Defusion: Cognitive distancing techniques | Worksheet | Therapist Aid
Leaves on a Stream | Worksheet | Therapist Aid
Mindfulness Exercises | Worksheet | Therapist Aid
http://www.academicsupport.washington.edu/site/assets/files/2367/values_exercise_bulls_eye.df
Acceptance and Commitment Therapy (ACT): Definition, Techniques, and Efficacy