Acceptance and Commitment Therapy (ACT) Explained

Acceptance and commitment therapy, usually called ACT, is a form of psychotherapy that encourages people to accept difficult thoughts and feelings rather than fight them, and to take steps toward what matters in their lives. It uses mindfulness and goal setting, together with a commitment to actions in line with a person’s values, to build what practitioners call psychological flexibility. ACT is one of several approaches a therapist might offer, and it is described by the National Institute of Mental Health (NIMH) as an approach used for conditions such as generalized anxiety disorder.

What ACT is and where it fits

ACT is a talk therapy that focuses on how a person relates to their inner experience. Instead of trying to change or remove unwanted thoughts and feelings, ACT encourages nonjudgmental acceptance of them. The aim is to help a person move toward a life that feels meaningful, even when difficult thoughts or feelings are present.

The approach rests on a few key ideas:

• Acceptance: making room for thoughts and feelings without struggling against them.
• Mindfulness: paying attention to the present moment with openness.
• Values: identifying what matters most to the person, such as relationships, work, health or creativity.
• Committed action: taking concrete steps that move toward those values.
• Psychological flexibility: the overall goal — being able to adapt and act in line with values even when uncomfortable thoughts and feelings show up.

ACT is one of many kinds of therapy. A broader look at the options is in types of therapy explained.

How ACT differs from CBT

ACT and cognitive behavioral therapy (CBT) are sometimes confused because both are structured, goal-oriented approaches. But they differ in emphasis. CBT helps people identify and change thinking and behavior patterns that are unhealthy or ineffective. ACT, by contrast, emphasizes accepting thoughts and feelings rather than changing their content, and focuses on values-based action.

For a closer look at CBT, see what is cognitive behavioral therapy?.

What a session looks like

A typical ACT session is a conversation, often with exercises. The therapist may guide the person through mindfulness practices, such as noticing thoughts and feelings without judging them, or through exercises that help clarify values. Sessions may also include setting goals and planning committed actions for the coming week.

ACT can be delivered individually, with couples or families, or in groups. The frequency and length of sessions are usually discussed and agreed between the person and the therapist. As with other therapies, sessions are typically held once every 1-2 weeks for about 30 to 50 minutes.

The therapist and the person work together to set goals and decide how long and how often to meet. Progress may be reviewed along the way, and the approach can be adjusted.

Who ACT was developed for and who offers it

ACT grew out of the work of psychologist Steven C. Hayes and colleagues. NIMH lists ACT as an approach used for generalized anxiety disorder, alongside CBT and other therapies. For more on anxiety treatment, see therapy for anxiety.

ACT can be offered by many licensed mental health professionals, including psychologists, clinical social workers, counselors, marriage and family therapists, psychiatrists and psychiatric nurse practitioners. Training in ACT varies; some therapists have specific training and supervision in the approach, while others may incorporate elements of it into a broader practice. It is reasonable to ask a therapist about their training and experience with ACT.

What to ask a therapist about ACT

When considering ACT, it helps to ask direct questions. NIMH suggests asking about the therapist’s credentials, experience and any specialty; the approach and its rationale; the goals of therapy; whether a time frame or number of sessions is recommended; how progress will be assessed; and fees and insurance. For ACT specifically, you might also ask:

• What does a typical ACT session involve?
• How much of the work is mindfulness practice, and how much is values and goal setting?
• How will we know if this approach is helping?
• Do you have specific training in ACT?
• How do you handle it if this approach doesn’t seem to be a good fit?

Rapport and trust matter. NIMH notes that a person should feel comfortable with the therapist. If therapy has gone on for what feels like a reasonable time without improvement, it makes sense to talk with the therapist and consider other professionals or approaches.

What goes wrong

Some common misunderstandings can get in the way of ACT being useful.

One is the idea that acceptance means giving up or resigning yourself to feeling bad. In ACT, acceptance is about making room for thoughts and feelings without letting them control your actions — not about liking the situation or abandoning change.

Another is expecting ACT to remove difficult feelings quickly. The approach aims to build a different relationship with those feelings, which can take practice. It is not a quick fix, and no therapy works the same way for everyone.

A third is treating ACT as a set of techniques to apply alone. While books and exercises exist, ACT is usually learned with a trained therapist who can guide the process and adjust it.

Finally, some people assume any therapist offers ACT. Training varies, so it is fair to ask about a therapist’s background and whether they use ACT as their main approach or as one tool among several.

Practical points on cost and access

Paying for ACT works the same way as paying for other psychotherapy, and coverage depends on the plan, so check with it. Under the Affordable Care Act, mental health and substance use disorder services are one of the ten essential health benefits that individual and small-group plans must cover, and Marketplace plans cover behavioral health treatment such as psychotherapy and counseling. Medicare Part B covers outpatient mental health care, including psychotherapy, and Medicaid covers mental health services, with benefits that vary by state. Anyone uninsured or not using insurance can ask for a Good Faith Estimate of the cost.

If you are in crisis or having thoughts of suicide, in the US you can call or text 988 (the 988 Suicide & Crisis Lifeline) or call 911 in an emergency.