Acceptance and Commitment Therapy (ACT): Definition, Principles & Techniques
A practical guide to ACT's six core processes, in-session techniques, and how it compares to CBT and DBT for behavioral health clinicians.
Acceptance and Commitment Therapy (ACT) is a form of psychotherapy that combines acceptance and mindfulness strategies with commitment and behavior-change techniques to increase psychological flexibility. Rather than trying to eliminate negative thoughts and feelings, acceptance and commitment therapy teaches clients to accept them as a normal part of the human experience — and to commit to actions that align with their personal values, even when those thoughts and feelings are present.
What you'll learn
- What Acceptance and Commitment Therapy (ACT) is and how it supports psychological flexibility
- The six core processes of ACT and how they work together in treatment
- Practical ACT exercises and techniques you can use with clients
- How ACT compares with CBT and DBT in focus, approach, and application
- How therapists can use ACT to support values-based behavior change and client progress
Patients who experience anxiety, depression or emotional distress often try to avoid painful feelings or experiences. Though this is sometimes a knee-jerk reaction, distressing experiences and negative emotions are a part of life. As a psychologist, counselor or other mental health professional, you can use ACT interventions to help your clients accept the reality of their experiences and modify their behaviors to live a more productive, meaningful life.
Using a combination of mindfulness and behavioral change techniques, your patients may be able to achieve better mental well-being. In this guide, we'll examine what acceptance and commitment therapy is, its six core processes, techniques you can use in session, how it compares to other therapeutic approaches, and how you can apply it in your practice.
Who Founded ACT? A Brief History for Mental Health Professionals
ACT was developed and founded by Dr. Steven C. Hayes over two decades ago. This technique was partly inspired by his own history of panic attacks and the desire to accept himself and his experience. His goal was to improve psychological flexibility through mindful practices and acceptance of negative emotions and experiences. Dr. Hayes used relational frame theory (RFT) as a theoretical foundation for ACT, which focuses on the connections between cognition and human language.
RFT, also known as framing, is a modern technique derived from behavior analysis that refers to how people create connections between concepts using words. RFT can be used as an approach to alter functional patterns of relational framing, which requires learning how new relations emerge in the absence of direct reinforcement.
When connecting RFT to ACT, the transformation of stimulus function is essential. For instance, suppose you are treating a client with anxiety. You might suggest that they set a goal to attend one social event, resulting in them becoming avoidant or defensive. In that case, the verbal stimulus of a “social event” could trigger an avoidance or defensive function.
The goal of ACT as a treatment method is to enhance an individual's ability to actively overcome such unwanted or painful emotions by being more aware of and fully connected to their own abilities. Additionally, ACT emphasizes modifying behaviors to help individuals:
- Achieve established goals.
- Accept unwanted experiences.
- Understand their reactions to unwanted thinking.
- Establish value-driven behavior change.
Research Insights: The Efficacy of ACT in Treating Various Conditions
ACT has been proven to effectively manage symptoms and treat a range of conditions, including:
- Depression
- Mixed anxiety
- Obsessive-compulsive disorder (OCD)
- Eating disorders
- Substance abuse
- Chronic pain
- Occupational stress
- Psychosis
- Autism spectrum disorder (ASD)
Eight-session ACT protocols have produced significant reductions in OCD symptom severity in clinical research — including a 68% decrease in symptoms immediately post-treatment in the first controlled study of this protocol, with gains maintained at follow-up (Twohig et al., 2006). A more recent case study likewise found eight sessions of ACT produced a significant decrease in obsessive-compulsive symptoms and distress, alongside an increase in psychological flexibility (Philip & Cherian, 2022).
Patients with social anxiety can also benefit from ACT interventions, though head-to-head randomized trials show it performs comparably to — rather than more effectively than — traditional cognitive behavioral therapy (Craske et al., 2014). Similarly, ACT has been shown to produce improvements in depression and anxiety that are statistically equivalent to those achieved with cognitive therapy, though the two approaches appear to work through different underlying mechanisms (Forman et al., 2007). Across multiple studies, patients who receive ACT treatment report significant improvements in quality of life (Forman et al., 2007; Pahnke et al., 2023).
Though the primary goal of ACT is improving a patient's ability to live a self-determined life, symptom reduction is a by-product of enhanced psychological flexibility. In some cases, ACT has addressed and managed chronic disease symptoms.
In a randomized controlled pilot study of 20 adults with autism spectrum disorder (Pahnke et al., 2023), researchers noted the following clinical improvements as a result of ACT, compared with a treatment-as-usual control group:
- Autistic mannerism
- Perceived stress and quality of life
- Cognitive and behavioral avoidance
- Cognitive fusion
- Psychological flexibility
These studies support the effectiveness of ACT as a psychological intervention to address various mental health conditions as well as high perceived stress, reduced quality of life and overcoming obstructive thoughts and managing difficult emotions.
Acceptance and Commitment Therapy Principles and Techniques
Using ACT as a method for integrated care across a variety of mental health interventions can help your clients achieve better outcomes. To better understand how ACT works, we've outlined exactly how this type of therapy addresses psychopathology conditions.
Put ACT Into Practice With Ready-to-Use Clinician Worksheets
Support Acceptance and Commitment Therapy sessions with a practical worksheet pack built around ACT’s six core processes. Use the exercises in session or assign them between visits, then track client progress over time with the included session tracker.
- 6 structured worksheets — one for each core ACT process
- Guided, client-friendly exercises you can use in session or as homework
- Clinician notes sections for observations, resistance, and breakthroughs
- Session tracker included to monitor progress across multiple sessions
What Are the Six Core Processes of ACT?
Acceptance and commitment therapy is based on six core therapeutic processes that promote psychological flexibility.
Acceptance
Clients learn to accept negative feelings even though they have no control over them. They open themselves up to make room for unpleasant thoughts, experiences and emotions. Instead of trying to avoid or deny these events, they acknowledge them and break the vicious cycle of worrying.
Cognitive Defusion
The concept of defusion refers to learning how to step back from one's thoughts and change the way one reacts to distressing feelings and thoughts. Clients learn how to lessen the emotional impact of their thoughts to mitigate their harmful effects.
Contacting the Present Moment
An important component of ACT is practicing mindfulness and focusing on the “now” rather than on the past. This principle helps clients use all five of their senses to bring themselves into the present moment and establish skills to ignore distracting thoughts.
Self as Context
Also called the Observing Self, this core process of ACT refers to the concept of distancing oneself from thoughts, sensations, images and memories. This technique enables clients to take a step back and become observers of themselves to understand that they are more than their thoughts. From an outside perspective, negative emotions and experiences may not feel as dangerous or threatening.
Values
Also called value living, this core process describes what an individual cares most about in their lives. Defining personal values can help clients modify their behaviors toward more meaningful outcomes instead of actions that avoid distress or aim to meet other people's expectations. By focusing on what they want to be, your clients may be more willing to experience some anxiety as they welcome the natural stressors that come with behavior adjustments.
Committed Action
An important aspect of any therapeutic intervention is taking effective action toward one's goals. Committed action refers to outlining concrete steps that will bring positive change in an individual's life, such as skill development, goal setting and exposure to difficult thoughts or experiences.
A Deeper Look at the Interconnected Therapeutic Framework
These six principles come together to form a comprehensive framework that addresses basic human needs. With the overlapping principles of ACT, individuals learn to accept their perceived flaws while increasing mental flexibility against future challenges they may experience.
These building blocks of ACT aim to facilitate behavioral change by helping individuals outline and plan effective and realistic behaviors that meet their values. When an individual ignores their long-term values, their quality of life can suffer. This can lead to poor physical and mental health outcomes, such as denial about behavioral risks, medication nonadherence and delaying preventive health care.
Implementation of ACT can improve your client's willingness to experience and accept unpleasant Thoughts, Emotions, Associations, Memories and Sensations (TEAMS). Accepting the negative aspects of life can help them engage in healthier and more meaningful behaviors.
In addition to these six core processes, there are also four properties of psychological flexibility:
- Recognizing and adapting to situational demands
- Shifting perspective when functioning is compromised
- Balancing competing life demands
- Being aware and committed to behaviors that align with personal values
5 Acceptance and Commitment Therapy Exercises and Techniques
Though every individual has different needs and goals, here are some examples of exercises you can build on during your ACT therapy sessions with your clients.
1. Ranking Values
Have your client perform a value clarification exercise. Ranking their values by priorities will help you both identify in what areas of their lives they feel unfulfilled or need further development. Instruct your client to rate each life domain according to importance, such as family, finances, relationships or self-care. Next, find their top three value priorities and set goals for meeting them.
2. Anchor Breathing
A key exercise for improving mindfulness is focusing on one's breathing, such as during meditation. When your client feels stressed, instruct them to ground themselves through mindful breathing. In an anchor breathing exercise, they will envision themselves feeling safe and calm in a boat anchored in a place that keeps them happy. Now, tell them to imagine themselves as the anchor, using their body to feel grounded. As they breathe, remind them to bring themselves back to the anchor point if their mind wanders.
3. Defusion Questions
It's common for people with anxiety or OCD to have difficulty identifying negative thought patterns as they occur. Using this defusion exercise, instruct your patient to answer questions that can help strengthen their mindfulness skills. These questions might include “Is this thought helpful?” “What do I gain by buying into this thought?” “Am I going to trust my mind babbling on or my experience?” or “Is this thought going to help me reach my goals?”
4. Write a Future Birthday Speech
A sentimental exercise can help put things into perspective for some clients. Ask your client to imagine that it's their 90th birthday and describe what their dearest friend or significant other would say about their life. What would they like to hear about themselves? What kind of person do they want to be remembered as?
5. Thank Your Mind
When people experience anxiety or stress, their minds tend to amplify it in the form of negative self-talk or thoughts. This exercise involves telling your client to “thank” their mind when a judgmental or self-defeating thought appears, acknowledge it and let it go. For example, if “I'm not good enough” pops into their head, they can thank their mind for the replay of that storyline and let it fade into the background. You can also provide self-esteem worksheets that help your clients build self-compassion and confidence.
Role of Therapists in ACT Outcomes
As a therapist or counselor, your guidance can make all the difference in your client's journey toward mental well-being. The main goal of ACT is to increase psychological flexibility, and practitioners can facilitate this by helping patients be more mindful of the ways they feel and think using various mindfulness exercises.
You want your patients to create lasting behavioral changes, which means committing to new thought patterns, actions and behaviors. Working with your patients to help them learn to accept their TEAMS and evaluating what elements are no longer serving their life goals can promote more positive thoughts and actions.
Your role as a therapist in ACT implementation strategies may also include helping patients:
- Work through painful memories.
- Determine what things they can or cannot change.
- Make peace with the things they cannot control.
- Develop strategies for making necessary changes to meet personal goals.
- Evaluate patterns that have a negative impact on their lives.
- Acknowledge their emotions.
- Learn how to experience discomfort without trying to avoid it.
- Identify interventions that fit their individual needs.
- Address common obstacles as they appear.
- Measure and track their progress.
ACT vs. CBT and DBT: Comparing Therapy Approaches for Therapists and Counselors
There are countless effective interventions that you can use in your practice to address conditions like anxiety, depression and OCD. Let's examine how ACT compares to traditional therapy methods like cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT).
Cognitive Behavioral Therapy (CBT)
ACT and CBT are relatively similar because they both aim to help individuals overcome difficult thoughts and feelings. However, CBT generally focuses on reframing harmful thought patterns, while ACT prioritizes accepting them. The primary goal of CBT is to reduce symptoms, whereas the goal of ACT is to strengthen psychological flexibility.
You may prefer to implement CBT if you want your client to identify and modify negative or destructive thoughts. Alternatively, ACT may be ideal for patients who could benefit from accepting the good and the bad that come with life rather than trying to change them. Finally, ACT is usually a long-term treatment option that clients integrate into their daily lives over time. CBT tends to be more goal-oriented for specific issues.
Dialectical Behavior Therapy (DBT)
ACT and DBT both focus on the importance of acceptance, mindfulness and effectiveness of action. They are both effective psychotherapy methods that aim to help individuals gain control over their thoughts and improve their quality of life. DBT and ACT also help patients face their undesirable or uncomfortable feelings head-on to promote psychological flexibility. However, their underlying theories are quite different. While ACT emphasizes observation and experience to help individuals cope with their conditions, DBT leans more toward an educational approach.
For example, DBT interventions may involve developing logical, hands-on skills and strategies that patients can use in their daily lives. Finally, ACT is generally considered to have a functional contextualism philosophy, whereas DBT maintains a dialectical and analytical philosophy. It's important to note that there are certainly benefits and challenges of each approach depending on your client's needs, symptoms and history of mental health treatment.
| ACT | CBT | DBT | |
|---|---|---|---|
| Primary goal | Strengthen psychological flexibility | Reduce symptoms | Gain control over thoughts and improve quality of life |
| Approach to thoughts | Prioritizes accepting them | Reframing harmful thought patterns | Educational, skills-based approach |
| Philosophy | Functional contextualism | Goal-oriented for specific issues | Dialectical and analytical |
| Typical duration | Usually long-term, integrated over time | More goal-oriented for specific issues | Hands-on skills for daily life |
How ICANotes Support ACT Documentation
Acceptance and Commitment Therapy often involves tracking values, behavioral goals, mindfulness practices, client responses, and progress toward committed action over time. That makes clear, consistent documentation especially important when ACT is part of a client’s treatment plan.
ICANotes is designed specifically for behavioral health professionals, with charting tools that help clinicians document assessments, progress notes, treatment plans, and ongoing client progress in one system. This can make it easier to capture the clinical work happening in ACT sessions while reducing the time spent on repetitive documentation.
With ICANotes, clinicians can more efficiently:
- Document interventions, client responses, and progress toward treatment goals
- Track changes in functioning and behavior over time
- Maintain treatment plans that reflect individualized clinical goals
- Keep assessments, progress notes, and other behavioral health documentation organized in one place
- Spend less time on paperwork and more time focused on client care
Make More Time for the Work That Matters
ACT helps clients build psychological flexibility through mindfulness, acceptance, values, and committed action. ICANotes helps behavioral health clinicians document that work more efficiently with tools designed for behavioral health workflows, so you can stay focused on treatment instead of paperwork.
- Streamline behavioral health documentation
- Track client progress and treatment goals more efficiently
- Access assessments, progress notes, and treatment planning tools in one system
- Reduce time spent on repetitive charting tasks
See how ICANotes can support your clinical workflow. Start your free 30-day trial, no credit card required.
Start Your Free 30-Day Trial
Frequently Asked Questions About ACT
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References
- Craske, M. G., Niles, A. N., Burklund, L. J., Wolitzky-Taylor, K. B., Vilardaga, J. C. P., Arch, J. J., Saxbe, D. E., & Lieberman, M. D. (2014). Randomized controlled trial of cognitive behavioral therapy and acceptance and commitment therapy for social phobia: Outcomes and moderators. Journal of Consulting and Clinical Psychology, 82(6), 1034–1048.
- Forman, E. M., Herbert, J. D., Moitra, E., Yeomans, P. D., & Geller, P. A. (2007). A randomized controlled effectiveness trial of acceptance and commitment therapy and cognitive therapy for anxiety and depression. Behavior Modification, 31(6), 772–799.
- Pahnke, J., Jansson-Fröjmark, M., Andersson, G., Bjureberg, J., Jokinen, J., Bohman, B., & Lundgren, T. (2023). Acceptance and commitment therapy for autistic adults: A randomized controlled pilot study in a psychiatric outpatient setting. Autism, 27(5), 1461–1476.
- Philip, J., & Cherian, V. (2022). Acceptance and commitment therapy in obsessive–compulsive disorder: A case study. Indian Journal of Psychological Medicine, 44(4), 400–403.
- Twohig, M. P., Hayes, S. C., & Masuda, A. (2006). Increasing willingness to experience obsessions: Acceptance and commitment therapy as a treatment for obsessive-compulsive disorder. Behavior Therapy, 37(1), 3–13.
Katie Cox
Katie Cox, MA, LPCC is a Licensed Professional Clinical Counselor with over 10 years of clinical experience working with adolescents and adults. Her areas of expertise include anxiety, depression, OCD, life transitions, self-esteem, career concerns, and women's mental health. Katie utilizes evidence-based, client-centered approaches to help individuals develop practical coping skills, increase emotional awareness, and achieve their personal goals. Through her clinical work and writing, she is committed to making mental health information accessible, practical, and empowering.
