Acceptance and Commitment Therapy (ACT): What Is It?

Acceptance and Commitment Therapy (ACT) is an evidence-based psychotherapy designed to help people respond differently to difficult thoughts and emotions. Instead of trying to eliminate anxiety, sadness, or intrusive thoughts, ACT teaches skills that help you live a meaningful life even when those experiences show up.

A Different Way of Relating to Thoughts and Emotions

ACT is considered part of the “third wave” of behavioral therapies. [2,4] Traditional cognitive-behavioral therapy (CBT) often focuses on identifying and changing distorted or unhelpful thoughts. ACT, by contrast, focuses on changing your relationship to those thoughts.

ACT is grounded in Relational Frame Theory, a behavioral science model that explains how language shapes human suffering. [2,4] Humans are uniquely capable of using language to imagine worst-case scenarios, relive past mistakes, or judge themselves harshly. While that ability can be useful, it can also amplify distress.

ACT introduces the concept of psychological flexibility – the ability to stay present and engaged in valued actions even when thoughts and feelings are uncomfortable. [1,2] Rather than asking, “How do I get rid of anxiety?” ACT asks, “How can I move toward what matters to me, even when anxiety is here?”

This doesn’t mean ignoring symptoms. It means reducing the struggle with them.

The Six Core Processes of ACT

ACT works through six interconnected processes that build psychological flexibility. [1,2,5]

These include:

• Present-moment awareness (mindfulness skills to anchor attention in the here and now)
• Acceptance (making space for uncomfortable internal experiences)
• Cognitive defusion (learning to see thoughts as mental events, not literal truths)
• Self-as-context (developing a stable observing sense of self)
• Values clarification (identifying what truly matters to you)
• Committed action (taking steps aligned with those values)

Instead of debating whether a thought is accurate, ACT might help you notice the thought, label it, and decide whether acting on it moves you closer to your values.

For example, someone with social anxiety might notice the thought, “I’ll embarrass myself,” practice defusion (“I’m having the thought that I’ll embarrass myself”), and still attend a meaningful event because connection matters to them.

Over time, research suggests that improvements in psychological flexibility are linked to symptom reduction – supporting ACT’s proposed mechanism of change. [6,7]

What Does the Research Say?

ACT has been studied across a wide range of psychiatric and medical conditions. It is considered a transdiagnostic intervention, meaning it applies to multiple diagnoses rather than a single disorder. [3] Systematic reviews examining anxiety and depression have concluded that ACT produces meaningful symptom improvements and functions through its core processes. [6,7]

In short, ACT is not a fringe therapy. It is a well-established, research-supported approach that continues to evolve with modern delivery formats.

ACT Compared to Traditional CBT

ACT and traditional CBT are both evidence-based and widely used. They differ more in emphasis than effectiveness.

CBT often works by identifying cognitive distortions and replacing them with more balanced thoughts. ACT focuses on helping individuals step back from thoughts altogether and choose behavior guided by values.

Research suggests that outcomes for ACT and CBT are typically similar in magnitude for common conditions like anxiety and depression. [6,7] For some individuals, ACT’s acceptance-based model feels more intuitive – especially if they’ve tried to “think their way out” of distress without success.

The right approach depends on individual needs, therapist expertise, and clinical context.

ACT in Digital and Online Therapy

One of ACT’s strengths is flexibility in delivery. It can be provided through individual therapy, groups, self-help programs, and digital platforms. [1,5]

Recent research highlights the effectiveness of digital ACT programs for depression, with promising results for guided online formats. [1] As telehealth expands, ACT’s structured exercises and experiential techniques translate well to video-based online therapy and app-supported programs.

For people juggling work, caregiving, or other responsibilities, virtual formats can reduce barriers to care.

If you’re wondering what to expect from online therapy sessions using ACT, sessions often include mindfulness exercises, experiential metaphors, structured worksheets, and practical behavior plans tied to your values.

When ACT May Be a Good Fit

ACT may be especially helpful if:

• You feel stuck fighting your thoughts
• Avoidance has started limiting your life
• You want a skills-based, practical approach
• You care deeply about certain values but feel blocked by fear, sadness, or self-doubt

Because ACT targets psychological inflexibility, it can be useful across diagnoses. [2,7] It focuses less on labeling symptoms and more on helping you move toward meaningful living.

If symptoms are interfering with daily functioning, relationships, or work, scheduling an evaluation with a psychiatric provider can clarify next steps.

When to Seek Immediate Care

Seek urgent help if you or someone you know experiences:

• Suicidal thoughts or intent
• Thoughts of harming others
• Severe mood swings with unsafe behavior
• Hallucinations or delusional thinking

In the U.S., you can call or text 988 for the Suicide & Crisis Lifeline.

Moving Forward

Acceptance and Commitment Therapy (ACT) is a research-supported, flexible psychotherapy that helps people build psychological flexibility. Instead of eliminating difficult thoughts and feelings, it teaches acceptance, mindfulness, and values-based action.

Across depression, anxiety, and other conditions, ACT shows outcomes comparable to traditional CBT and continues to demonstrate effectiveness in digital formats. [1,2,6,7]

If your symptoms are persistent or interfering with your quality of life, connecting with a psychiatric provider can help you explore medication, therapy, or a combination approach.

Disclaimer: This article is for educational purposes only and is not medical advice. It does not replace evaluation or treatment by a qualified healthcare professional. Do not share personal health information in public comments. For personal medical decisions, consult a licensed psychiatric provider.