What is acceptance and commitment therapy (ACT) and how does it work? Learn the six processes of psychological flexibility, exercises and who it suits.
Have you been trying for years to get rid of your anxiety without ever managing to? Have you noticed that the harder you try to suppress negative thoughts, the stronger they become? Perhaps you have spent a large part of your life waiting, thinking, "I'll feel better first, and then I'll start living." Acceptance and commitment therapy looks at this cycle from a different place. Instead of fighting difficult feelings and thoughts, it suggests making room for them while taking steps towards what truly matters to you. Also known by its initials, ACT (Acceptance and Commitment Therapy), this approach belongs to the "third wave" of cognitive behavioural therapies. In this article we look at the core idea of ACT, its six core processes, exercises you can try in daily life and who this approach may suit.
What Is Acceptance and Commitment Therapy?
Acceptance and commitment therapy is a psychotherapy approach developed by the psychologist Steven C. Hayes and colleagues, rooted in the behavioural tradition. At its foundation lies "Relational Frame Theory", which tries to explain how human language and thought work.
The main aim of ACT is to build "psychological flexibility". Psychological flexibility is the ability to be in full contact with the present moment, accept difficult thoughts and feelings as they are, and continue or change our behaviour in line with our values.
This approach rests on an assumption that may seem surprising at first: pain is a natural part of being human. Losses, disappointments, worries and difficult memories are part of all our lives. What magnifies the distress is often not the pain itself but the endless struggle we put up to get rid of it. ACT looks at this second layer as "unnecessary suffering" or "the price of avoidance".
The two words in its name sum up the essence of the approach:
- Acceptance: Developing an open and willing stance towards inner experiences (thoughts, feelings, bodily sensations, memories) that we cannot control.
- Commitment: Staying committed to taking concrete steps in line with our values.
Why is ACT different? The trap of trying to control
When most of us come across an uncomfortable thought or feeling, we try to make it go away. In the outer world this strategy often works: if the room is cold, we turn on the heating; if a shoe pinches, we change it. But when we apply the same strategy to our inner world, things go differently.
Let's try a simple experiment: for the next thirty seconds, try not to think of a pink elephant. Chances are a pink elephant appeared in your mind. Trying to suppress thoughts can make them more noticeable.
ACT calls this "experiential avoidance". Experiential avoidance is the effort to escape, suppress or change unwanted inner experiences. It may bring relief in the short term; but in the long term it narrows a person's life.
Suppose someone avoids speaking up in work meetings because they feel anxious speaking in public. Each act of avoidance reduces the anxiety at that moment. But over time they miss promotion opportunities, get no satisfaction from their work because they cannot share their ideas, and feel more and more inadequate. The struggle to get rid of anxiety has stood in the way of living a life the person values.
At this point, instead of asking "How can we get rid of your anxiety?", ACT asks, "Can you do what matters to you even while you have anxiety?"
The Six Core Processes of Psychological Flexibility
In ACT, psychological flexibility is approached through six processes. These processes are not separate from one another; they are interwoven skills.
1. Acceptance
Acceptance does not mean approving of, liking or surrendering to difficult feelings and thoughts. It is more a matter of putting down the fight with them and making room for them. For example, when anxiety arrives, rather than "This feeling has to go away, I must do something right now", being able to say, "Anxiety is here. There is a tightness in my chest. I can make a little room for it."
2. Cognitive defusion
Cognitive defusion is putting some distance between ourselves and our thoughts. Our mind constantly produces thoughts, and we often take these thoughts to be reality itself. When the thought "I am a failure" comes, being able to see it not as a fact but as a sentence the mind has produced reduces the thought's power over us. This is different from trying to change or refute the thought; the aim is not to be "fused" with it.
3. Contact with the present moment
Our mind often travels to the past or the future: regrets, worries, scenarios. Contact with the present moment is being able to bring attention flexibly to the here and now. This process is closely related to mindfulness practices. We covered the subject in detail in our article on what mindfulness is.
4. The observing self (self-as-context)
In all of us there is an "observer" side that notices thoughts, feelings and experiences. Thoughts and feelings come and go, but the you that notices them remains the same. In a metaphor often used in ACT: you are the sky, and your thoughts and feelings are the weather. However fierce the storm, the sky is not harmed.
5. Values
Values are the directions you choose about what matters in your life and what kind of person you want to be. They are different from goals. "Getting married" is a goal, whereas "being a loving and attentive partner" is a value. A goal is reached and finished; a value, like a compass, always gives direction.
6. Committed action
Committed action is taking concrete and sustainable steps in line with your values. Difficult feelings may arise during these steps; committed action means being able to stay on the path even while these feelings are present.
A metaphor: the passengers on the bus
One of the metaphors often used in ACT goes like this: imagine you are driving your life as the driver of a bus. Along the way, frightening, critical, mocking passengers get on the bus; these are your difficult thoughts and feelings. The passengers shout: "Turn right, or bad things will happen!", "You can't go this way, you'll never manage it!" To silence them, you either stop and fight with them or turn in the direction they want. Either way, you do not reach where you wanted to go. ACT suggests turning the steering wheel in the direction your values point, without trying to throw the passengers off the bus, while they carry on talking in the back.
The essence of ACT can be summed up in a single sentence: accept what you cannot control, stay committed to your values and take action.
ACT Exercises You Can Try in Daily Life
The following exercises can help you experience the core processes of ACT. They are not a substitute for therapy, but they offer a starting point for noticing your relationship with your own inner world.
The "I'm having the thought that..." exercise
Choose a thought that bothers you, for example "I'm not good enough." Hold this sentence in your mind for a few seconds and notice how it feels. Now add this to the beginning of the sentence: "I'm having the thought that I'm not good enough." One step further: "I notice my mind is telling me the thought 'you're not good enough'." Many people notice that this small change puts a distance between them and the thought.
Thoughts on leaves
Close your eyes and imagine a slowly flowing stream. Leaves fall onto the stream and drift away with the current. Place each thought that comes to your mind on a leaf and let it float away. Do not try to push the thought away or hold on to it. If your mind wanders, notice it and gently return to the stream. A five-minute practice may be enough.
The values compass
Take a sheet of paper and write down these areas of your life: family, partner relationship, friendship, work or education, personal growth, health, leisure, community. For each area, ask yourself: "What kind of person do I want to be in this area?" Then rate from one to ten how important each area is to you and how closely you are currently living in line with that value. Areas with a high importance score but a low living score are a good starting point for committed action.
A small committed action
Identify a small, concrete step you can take this week for a value you have chosen. For example, if your value is "being an attentive friend", it might be calling a friend you have not spoken to for a long time. As you take this step, notice the feelings that arise, such as embarrassment or anxiety, and complete the step by making room for them.
Making room for a feeling
When a difficult feeling comes, find where you feel it in your body. Chest, throat, stomach? Look at this area with curiosity: what are the shape, size and temperature of the feeling? Imagine directing your breath towards that area and opening up a little space around the feeling. The aim is not to get rid of the feeling but to be able to stay with it.
What Problems Is Acceptance and Commitment Therapy Used For?
ACT is less a method specific to a single diagnosis than a general framework that can be applied to different difficulties. Research shows that this approach can be helpful in many areas. The main areas where it is applied are:
- Anxiety disorders and generalised worry
- Depression
- Obsessive compulsive disorder
- Chronic pain and living with chronic illness
- Work stress and burnout
- Substance use
- Grief and loss
- A sense of meaninglessness arising from living out of line with one's values
ACT can offer a meaningful path especially for people who have to live with conditions that cannot be changed or are hard to change. In the face of a chronic illness, an irreversible loss or external circumstances that cannot be controlled, the question "How can I live a meaningful life while this situation exists?" is at the centre of ACT.
Collective traumas such as the recent earthquakes in Turkey, economic uncertainty and experiences of migration have left many people having to face conditions they cannot control. In such situations, ACT's acceptance- and values-focused outlook can help a person carry on with their life without putting it on hold.
What Is the Difference Between ACT and CBT?
In classical Cognitive Behavioural Therapy (CBT), the main focus is on noticing unhelpful thoughts, examining the evidence for them and developing more balanced thoughts. In ACT, the focus is less on changing the content of the thought than on changing the person's relationship with the thought.
For example, for the thought "Everyone is judging me":
- In the CBT approach: you are asked, "What is the evidence for this thought? Could there be another explanation?"
- In the ACT approach: you are asked, "Can you notice this thought as a thought? Can you do what you value even while this thought is there?"
These two approaches are not rivals. ACT also sits within the cognitive behavioural tradition, and many therapists use the principles of these approaches together according to the client's needs. You can read about the foundations of CBT in our article on what cognitive behavioural therapy is.
When Should You Seek Professional Support?
ACT exercises can be helpful in daily life; but in some situations it is important to work with a specialist:
- If anxiety, unhappiness or anger markedly affects your daily functioning
- If your life is narrowing more and more because of the things you avoid
- If you are finding it hard to cope with a challenging life event such as grief, trauma or chronic illness
- If there are long-term changes in your sleep, appetite and energy levels
- If you have thoughts of harming yourself or ending your life
If the last item applies, seek support without waiting; in an emergency, call 112 (emergency services).
How Are ACT Principles Handled in Therapy?
A therapy process based on ACT generally places the person's own experience at the centre. The therapist and the client explore together which inner experiences the client avoids, what this avoidance costs them in their life and what really matters to them. Metaphors, experiential exercises and mindfulness practices are often used in sessions.
Clinical Psychologist Eda Erkan Alapala completed the four-year Cognitive Behavioural Therapy training at the Association for Cognitive and Behavioural Therapies (KDTD), to EABCT standards. ACT is among the third wave approaches, and its principles of acceptance, values and mindfulness can be reflected in the process, in a way consistent with the cognitive behavioural framework and according to the client's needs. Which methods will be used in the individual therapy process is decided together with the client after the assessment in the first sessions. Sessions can be held face to face or online.
Frequently Asked Questions
Does acceptance mean giving up?
No. In ACT, acceptance does not mean giving up effort on the things you can change. It means putting down the fight with inner experiences you cannot control and directing your energy towards building the life you value. In fact, acceptance paves the way for taking action.
How long does ACT take?
The length varies according to the person's needs and the issue being worked on. Some people benefit from a short piece of work, while in more complex and long-standing difficulties the process may be longer. This is assessed together in the first sessions.
Can I do ACT exercises on my own?
Many ACT exercises can be practised in daily life and can build awareness. However, if you are experiencing intense emotional difficulty or your distress increases during the exercises, working with a specialist is safer and more effective.
Will ACT get rid of my negative thoughts?
The aim of ACT is not to get rid of negative thoughts but to reduce their power to run your life. The thoughts may keep coming; but the goal is that, by getting caught up in them less, you can act in line with your values.
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Eda Erkan Alapala
Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.
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