Most therapy approaches that people have heard of focus on changing something. Changing your thoughts, changing your behaviour, changing your reactions. Acceptance and Commitment Therapy, usually shortened to ACT, takes a different starting point. The work is less about changing what is showing up inside you, and more about changing your relationship with it.
I am Dr Raminta Petrauskaite, an HCPC-registered Clinical Psychologist working with adults across Bournemouth, Christchurch, Poole, and the wider Dorset area. ACT is one of the approaches I use most often, particularly with the people I see who have already tried therapy and felt it did not quite reach the heart of what was keeping them stuck. This article looks at what ACT is, how it differs from CBT, and who it tends to suit.
The basic idea behind ACT
ACT was developed by Steven Hayes and colleagues in the late 1980s, and has been studied extensively since. It draws on mindfulness, behavioural science, and a body of research called Relational Frame Theory. The clinical version of all that complexity is fairly simple to describe.
Difficult thoughts, feelings, and memories are part of being human. Trying to get rid of them often makes them louder, or shrinks the life you can live around them. ACT teaches a different response. You learn to let difficult experiences exist without fighting them, while choosing actions that move you toward what genuinely matters to you. The capacity to do this is called psychological flexibility, and it is what ACT is really aiming for.
The six processes that make up ACT
ACT is often described through six interlinked processes. They sound abstract on the page. In a session, they show up as small experiments and conversations.
Acceptance
Acceptance is the practice of allowing difficult feelings to be there, rather than fighting them. It is not resignation, and it is not pretending you do not mind. It is a quieter willingness to feel what is already being felt, instead of spending energy holding it down.
Cognitive defusion
A thought such as “I am not good enough” can feel like a fact. Defusion helps you notice it as a thought passing through, rather than something you have to act on. Small techniques, such as naming the thought as a thought, often make a surprising difference to how much weight it carries.
Being present
Much of human suffering happens in the past or the future. Being present is the practice of bringing your attention back to what is actually happening now, with curiosity rather than judgement. This is where ACT overlaps with mindfulness (Kabat-Zinn, 2003).
Self-as-context
You are not your thoughts. You are also not your emotions. ACT helps you connect with a steadier part of yourself, sometimes called the observing self, which has been there through every version of you so far. Recognising this can take some of the weight out of difficult internal experiences.
Values
Values are not goals. A goal is something you tick off. A value is a direction you keep choosing, such as being a present parent, doing meaningful work, or living with integrity. Most people have not paused to articulate theirs in any clear way. ACT spends real time on this, because the values are what give the work its compass.
Committed action
Once you know what matters, committed action is taking small, concrete steps toward it, even when difficult feelings are present. The change is not waiting until you feel ready. It is acting in line with your values now, and letting the feelings come along for the ride.
How ACT differs from CBT
CBT often works by examining unhelpful thoughts and testing whether they are accurate or balanced. It is one of the most evidence based therapies available, and for many difficulties it is the first thing I would consider.
ACT comes at things differently. The goal is not to dispute or change the thought. The goal is to change your relationship with it, so that it has less power over what you do. For some of the people I see, this turns out to fit better, particularly where the difficulty has been around for a long time, where values and meaning feel tangled, or where the harder they have tried to fight an experience, the more it has grown.
In practice, I often draw on both, because the question is rarely which therapy is best in the abstract. It is which approach fits this person, this difficulty, at this point in their life.
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What an ACT session looks like in practice
Sessions are quieter than people often expect. There is conversation, of course, although there is also room for short mindfulness exercises, written reflection, and metaphors that help loosen difficult ideas. ACT uses a lot of imagery, because images often reach places that words alone cannot.
A typical piece of work might involve identifying what really matters to you in a particular area of your life, noticing the thoughts and feelings that have been getting in the way, practising small ways of holding those experiences differently, and agreeing concrete steps that align with the values you have named. Progress in ACT is often measured less by how much pain has reduced, and more by how much of your life you are now living.
What ACT can help with
There is now a strong evidence base behind ACT for a range of presentations, including anxiety, depression, chronic pain, long term physical health conditions, work related stress, and post traumatic stress (A-Tjak et al., 2015; Powers et al., 2009). It is also widely used for difficulties that do not fit neatly into a diagnostic category, such as identity transitions, perfectionism, and a sense of being stuck.
ACT tends to fit particularly well where someone has been trying to think their way out of something for a long time, and the thinking has become part of the problem. The shift in approach often comes as a relief.
Frequently asked questions
Is ACT recognised by the NHS?
Yes. ACT is one of the recognised psychological therapies in the UK and has a growing evidence base across a range of conditions. NICE references it within wider guidance on therapies for chronic pain and some other long-term conditions.
How is ACT different from mindfulness?
Mindfulness is one part of ACT, not the whole of it. ACT pairs mindfulness with values and action, which is where its distinctive shape comes from.
How many ACT sessions are typical?
For focused work, eight to twelve sessions is often enough. For more complex or long-standing patterns, longer pieces of work are common, and that is something we would agree together.
Do you offer ACT online?
Yes. ACT works well online and is available to people across the UK who would prefer that format.
Final thoughts
ACT is not for everyone, and it is not always the first place to start. When it does fit, it tends to offer something that feels both grounded and freeing. You stop spending your energy trying to feel differently, and start spending it on the life you actually want to live.
Reach out for support
If you would like to talk through whether ACT might suit your situation with a Clinical Psychologist at Fortitudo Therapy, I offer a free twenty minute consultation by phone or video call. You can get in touch through the contact page, book online, or arrange a free 20-minute consultation first. There is no obligation to book afterwards.
Related reading
- Why Do I Overthink Everything? — How ACT helps when overthinking has become its own problem.
- What is EMDR? — A trauma-focused alternative or companion to ACT, recommended by NICE for PTSD.
- Setting Goals: Balancing Vision, Realism, and Action — Using values to set goals that align with how you want to live.
References
A-Tjak, J. G., Davis, M. L., Morina, N., Powers, M. B., Smits, J. A., and Emmelkamp, P. M. (2015). Meta-analysis of the efficacy of acceptance and commitment therapy for clinically relevant mental and physical health problems. Psychotherapy and Psychosomatics, 84(1), 30-36.
Harris, R. (2019). ACT made simple: An easy-to-read primer on acceptance and commitment therapy. New Harbinger.
Hayes, S. C., Strosahl, K. D., and Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change. Guilford Press.
Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., and Lillis, J. (2006). Acceptance and commitment therapy: Model, processes, and outcomes. Behaviour Research and Therapy, 44(1), 1-25.
Kabat-Zinn, J. (2003). Mindfulness-based interventions in context. Clinical Psychology: Science and Practice, 10(2), 144-156.
Powers, M. B., Zörndig, V., and Emmelkamp, P. M. G. (2009). Acceptance and commitment therapy: A meta-analytic review. Psychotherapy and Psychosomatics, 78(2), 73-80.
