Written by Dr Sara Tookey
Acceptance and Commitment Therapy (ACT): Embracing Psychological Flexibility
Acceptance and Commitment Therapy (ACT, pronounced as one word "act") is an evidence-based approach that helps people accept what is outside their control while committing to actions that enrich their lives. Developed by Steven Hayes and colleagues in the late 1980s, ACT uses mindfulness strategies combined with behavioral changes to increase psychological flexibility.
What is Acceptance and Commitment Therapy?
ACT is built on the fundamental idea that psychological suffering often comes from our attempts to control or avoid difficult thoughts and feelings. Rather than trying to change or eliminate challenging experiences, ACT teaches us to develop a new relationship with them while moving toward what matters most to us.
The Science Behind ACT
Research demonstrates that psychological flexibility - the core process in ACT - is associated with:
Better mental health outcomes (Gloster et al., 2020)
Improved quality of life (Hayes et al., 2017)
Enhanced ability to cope with chronic pain (Hughes et al., 2017)
Greater workplace functioning (Bond & Bunce, 2003)
The Six Core Processes of ACT
ACT works through six interconnected processes, often visualised as the "ACT Hexaflex":
Acceptance
Embracing thoughts and feelings without trying to change them
Alternative to experiential avoidance
Cognitive Defusion
Learning to step back from thoughts
Seeing thoughts as mental events rather than literal truths
Being Present
Maintaining non-judgmental contact with psychological and environmental events
Mindful awareness of the here-and-now
Self-as-Context
Accessing a transcendent sense of self
Experiencing oneself as the context where experiences occur
Values
Identifying what truly matters to you
Clarifying desired life directions
Committed Action
Taking effective action guided by values
Building patterns of effective behaviour
Who Can Benefit from ACT?
ACT has shown effectiveness for:
Anxiety disorders (Twohig et al., 2018)
Depression (A-Tjak et al., 2021)
Chronic pain (Hughes et al., 2017)
Substance use disorders (Lee et al., 2015)
Work-related stress (Bond & Bunce, 2003)
OCD and psychosis (Bluett et al., 2014)
What to Expect in ACT Sessions
ACT therapy typically involves:
Learning mindfulness skills
Clarifying personal values
Practicing acceptance strategies
Developing psychological flexibility
Creating action plans aligned with values
Key ACT Techniques
Mindfulness Exercises
Present moment awareness
Mindful breathing
Body scan meditations
Metaphors and Experiential Exercises
"Passengers on the Bus" metaphor
"Leaves on a Stream" exercise
"Chess Board" metaphor
Values Work
Values clarification exercises
Values-based goal setting
Committed action planning
The Evidence Base
ACT's effectiveness is supported by substantial research.
A comprehensive meta-analysis by A-Tjak et al. (2021) found that ACT was:
Significantly effective for anxiety and depression
Comparable or superior to established treatments
Associated with maintained improvements at follow-up
Studies have shown ACT to be particularly effective for:
Chronic pain management (Hughes et al., 2017)
Anxiety disorders (Twohig et al., 2018)
Work-related stress (Bond & Bunce, 2003)
Recommended Resources
Books
"Get Out of Your Mind and Into Your Life" by Steven Hayes
"The Happiness Trap" by Russ Harris
"ACT Made Simple" by Russ Harris
Online Resources
Note: This article is for informational purposes only and does not constitute medical advice. Always consult with a qualified mental health professional for personalized guidance.
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References
A-Tjak, J. G., Morina, N., Topper, M., & Emmelkamp, P. M. (2021). A randomized controlled trial in routine clinical practice comparing acceptance and commitment therapy with cognitive behavioral therapy for the treatment of major depressive disorder. Psychotherapy and Psychosomatics, 90(1), 30-40. https://pubmed.ncbi.nlm.nih.gov/29566394/
Bluett, E. J., Homan, K. J., Morrison, K. L., Levin, M. E., & Twohig, M. P. (2014). Acceptance and commitment therapy for anxiety and OCD spectrum disorders: An empirical review. Journal of Anxiety Disorders, 28(6), 612-624. https://anxietyinstitute.com/wp-content/uploads/2021/12/Bluett-et-al.-2014.pdf
Bond, F. W., & Bunce, D. (2003). The role of acceptance and job control in mental health, job satisfaction, and work performance. Journal of Applied Psychology, 88(6), 1057. https://research.gold.ac.uk/id/eprint/47/1/bond_jap2003_preprint_GRO.pdf
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, 181-192. https://edoc.unibas.ch/80055/1/20210204143347_601bf7bb83825.pdf
Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2017). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). Guilford Press. https://awspntest.apa.org/record/2012-00755-000
Hughes, L. S., Clark, J., Colclough, J. A., Dale, E., & McMillan, D. (2017). Acceptance and Commitment Therapy (ACT) for chronic pain. The Clinical Journal of Pain, 33(6), 552-568. https://pureadmin.qub.ac.uk/ws/portalfiles/portal/525980890/ACT_for_CP_Chapter_24.March.2021_R1_kv.pdf
Lee, E. B., An, W., Levin, M. E., & Twohig, M. P. (2015). An initial meta-analysis of Acceptance and Commitment Therapy for treating substance use disorders. Drug and Alcohol Dependence, 155, 1-7. https://www.sciencedirect.com/science/article/abs/pii/S037687161501594X
Twohig, M. P., Abramowitz, J. S., Smith, B. M., Fabricant, L. E., Jacoby, R. J., Morrison, K. L., ... & Ledermann, T. (2018). Adding acceptance and commitment therapy to exposure and response prevention for obsessive-compulsive disorder: A randomized controlled trial. Behaviour Research and Therapy, 108, 1-9. https://jonabram.web.unc.edu/wp-content/uploads/sites/2968/2018/08/Twohig-et-al-2018-ACT-ERP.pdf
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