If you feel trapped by emotional pain, ACT can help you accept it and work toward a more fulfilling life
- Acceptance and commitment therapy (ACT) can treat anxiety, depression, eating disorders, and more.
- According to ACT theory, choosing actions that reflect your values can help you tolerate distress.
Avoiding, suppressing, or otherwise trying to control your thoughts and feelings can have a negative impact on your behavior, according to the philosophy behind acceptance and commitment therapy, or ACT (pronounced "act").
When clinical psychologist Steven C. Hayes developed ACT in the early 1980s, he based it on two concepts:
- His Relational Frame Theory (RFT), or the idea that human language is all about relating one concept to another.
- Cognitive behavioral therapy (CBT), which focuses on challenging unhelpful or unwanted thought patterns.
As its name suggests, ACT is based on two ideas, according to Jessica Brohmer, a licensed marriage and family therapist in private practice who uses ACT in her sessions.
These two ideas include:
- Acceptance of your thoughts and feelings without judgment
- Commitment to constructive actions that align with your values
Unfortunate or distressing life events can trigger a spiral of negative thoughts that cause secondary pain — especially when you react out of avoidance, according to Brohmer.
"ACT helps you learn to tolerate the primary pain, without creating any more unnecessary pain, by choosing to act according to your values," Brohmer says.
Below, learn the potential benefits of ACT and how to get started with this approach.
Who can benefit?
Hayes originally developed ACT in an effort to treat his own panic attacks, but this approach to therapy can treat a wide range of mental health conditions.
ACT may be a good fit if you live with:
A 2020 review found that ACT significantly reduced symptoms of depression, particularly for adults and people with mild depression. These effects proved especially noticeable at a three-month follow-up.
For example, say you believe that anger makes you a "bad" person. You might then avoid anger-provoking situations out of anxiety that expressing your anger will "ruin" your relationships with people.
ACT can address this by helping you notice and accept your anger in the moment without judgment — instead of suppressing or avoiding it.
ACT could help because of the way it focuses on building psychological flexibility, or the ability to cultivate and maintain an awareness of your thoughts and feelings as they arise.
With this increased awareness, you may be less likely to use unhelpful coping mechanisms like restricting, binge eating, purging, and overexercising.
A small 2020 study found that women who participated in 12 ACT sessions experienced greater reductions in eating disorder symptoms and body image concerns than those who didn't. What's more, the benefits of ACT may last a long time — researchers also found these effects still held at follow-up two years later.
- Significant improvements in pain acceptance
- Greater psychological flexibility
- Reduced anxiety and depression
- Improved functioning
Perhaps you abandon hobbies or avoid social events you'd usually enjoy out of fear that your pain will flare up — when those very activities and events could:
- Improve your mood
- Relieve stress
- Offer a sense of control over your life
- Take your mind off the pain
ACT can't take your pain away — but it can help you accept it, along with any related fear and distress you experience, and live a meaningful life in spite of that discomfort.
Substance use disorders
Very often, substance use serves as a coping mechanism for avoiding uncomfortable thoughts and feelings.
In teaching you how to accept and tolerate emotional distress and commit to other actions that better serve you and your goals, ACT may help reduce urges to use substances.
In a 2020 review of ACT for substance use disorders, most studies showed significant reductions in substance use, both immediately following treatment and at follow-ups three and six months later.
What to expect
According to Brohmer, the number of sessions you'll attend depends largely on the severity of your symptoms, as well as your commitment to work on yourself between sessions. That said, research suggests most people do well with 12-16 sessions.
1. Acceptance: This involves embracing your inner thoughts and feelings without trying to ignore or change them. For example, if you're nervous about an upcoming date, your therapist may ask you to scan your body to take note of the physical sensations arising out of that anxiety. If you notice a lump in your throat, they might suggest breathing into the lump, making room for it, and allowing it to exist — not engaging with it or resisting it.
2. Cognitive defusion: This involves detaching yourself from your own thoughts and feelings and learning to use language as a tool to describe internal experiences nonjudgmentally. For example, you might label a negative thought out loud by saying, "I'm having a thought that [XYZ]," which can strip it of its significance and power.
3. Being present: This involves shifting your attention from internal thoughts and feelings toward your external environment, which can help you stay grounded and present as you react to events. For example, your therapist might encourage you to notice five things you can hear, see, feel, and smell in the room in the present moment.
4. Self as context: This involves learning to distinguish yourself from your thoughts and feelings so you don't overidentify with them. For example, you might bring your attention to a certain emotion, make yourself aware that you're noticing it, and observe how it changes with time but you do not.
5. Values: This involves identifying the areas of your life most important to you that could motivate positive change. Your therapist may ask you to fill out a values questionnaire, which entails ranking your values in 10 different life domains, like education, work, spirituality, romantic relationships, and family.
6. Commitment: This involves setting goals for altering your behavior based on the values you identified. For instance, if you value personal growth, your goal may involve dedicating more time to a specific hobby. Your therapist can help you brainstorm small steps for reaching that goal, tips to address any potential roadblocks that might show up, and potential strategies to overcome them.
Brohmer, like most other ACT therapists, assigns "homework" to complete between sessions. ACT homework aims to help you apply the techniques you learn in therapy to real-life scenarios so you can learn to navigate challenging situations on your own.
For example, your therapist might ask you to keep a record of any time you attempt to avoid or control painful thoughts, feelings, and urges by:
- Distracting yourself
- Numbing the discomfort with substances
- Blaming or criticizing yourself
Over time, this exercise may help you become more aware of the specific strategies you tend to lean on, so you can replace them with more productive alternatives you learn during your sessions.
How to try it yourself
Working with a therapist is usually the best way to reap the benefits of ACT.
Quick tip: There's no official certification for ACT, but the Association for Contextual Behavior Science offers a list of providers who have identified themselves as ACT therapists. You can also search online databases like Psychology Today to find local therapists who offer ACT.
Brohmer says you can also get started with ACT on your own by using self-help worksheets. She recommends trying these ACT techniques:
According to Brohmer, this exercise can help you clarify which life domains you care most about, and where you have room for improvement in those areas.
Here's how to try it:
- Start by writing down what you want to develop in each of these seven life areas: work, education, relationships, personal growth, health, leisure, and recreation.
- Draw or print out a dart board with a segment for each life area.
- Draw an "X" on the dartboard for each life area — closer to the bull's eye if you already live by your values in that area, and farther away if you want to do more to exemplify those values in your daily life.
- Write down any obstacles standing between you and the life you want to live.
- Finally, for each area of your life, list some actions you can take in your daily life that will help you overcome those obstacles and zero in on your values.
This exercise may help you notice your own thoughts in a nonjudgmental way, which can serve as a stepping stone to acceptance.
Here's how to try it:
- Start by setting a timer for 10-15 minutes and sitting in a comfortable position with your eyes gently closed.
- Visualize yourself sitting next to a gently flowing stream with leaves floating along in the water.
- As positive, negative, or neutral thoughts arise over the next several minutes, mentally "place" those thoughts on a leaf and watch them float away.
- Continue watching the stream, allowing your thoughts to come and go at a natural pace.
- When painful or difficult thoughts and feelings come up, acknowledge them, place them on leaves, and watch them pass by.
Important: These exercises may help, but they can't replace therapy with a trained mental health professional. They also may not be enough to address serious or persistent feelings of anxiety, depression, and other mental health symptoms. If you experience ongoing distress, a good next step involves connection with a therapist.
ACT doesn't offer the opportunity to dig into past events, according to Patel. Because of this, Patel says it may not be the best approach for those still trying to come to terms with or navigate the impact of a traumatic experience.
It also may not be ideal if you have:
- A cognitive impairment that makes it difficult to understand language or retain memories
- Acute psychosis with severe delusions or hallucinations
ACT teaches skills to help you recognize and welcome all of your thoughts, sensations, and emotions — even the undesired ones. From there, you can begin to explore ways to shift your everyday choices to support your chosen values.
ACT can prove helpful for a variety of mental health conditions, from depression and anxiety to eating disorders and substance use disorders.
If you can't find a therapist trained in this approach or would prefer to try it on your own first, you can get started at home with ACT self-help exercises.
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