Acceptance and Commitment Therapy (ACT) encourages people to embrace their thoughts and feelings rather than fighting or feeling guilty for them.
It may seem confusing at first, but ACT paired with mindfulness-based therapy offers clinically effective treatment. After all:
Running away from any problem only increases the distance from the solution. The easiest way to escape from the problem is to solve it.
Medical conditions such as anxiety, depression, OCD, addictions, and substance abuse can all benefit from ACT and Mindfulness-Based Cognitive Therapy (MBCT).
ACT develops psychological flexibility and is a form of behavioral therapy that combines mindfulness skills with the practice of self-acceptance. When aiming to be more accepting of your thoughts and feelings, commitment plays a key role. In the case of ACT, you commit to facing the problem head-on rather than avoiding your stresses. Imagine committing to actions that help you facilitate your experience and embrace any challenge.
As you will see later in this piece, ACT is effective for a wide range of psychological disorders, and it is also effective as a life-affirming and inspirational perspective of self-determination.
What if you could accept and allow yourself to feel what you feel, even if it’s negative?
Before you start reading this article, I recommend you to download our 3 Mindfulness Exercises Pack for free. With this package, you will not just be able to understand mindfulness on a theoretical level, but you’ll also have the tools to apply mindfulness in your work with clients or students.
This article contains:
- What is Acceptance and Commitment Therapy (ACT)? Definitions and Core Processes
- Steven C. Hayes and ACT
- The Role of ACT in Psychology and Mindfulness
- 10 Worksheets, PDF’s, PPT’s and ACT Resources
- 7 Useful ACT Exercises, Technique, and Metaphors
- 8 ACT Training, Courses, and Workshops
- 4 Acceptance Therapy Books (+ ACT for Dummies)
- ACT for Treating Disorders
- Applying ACT in Group Therapy
- 4 Helpful YouTube Videos
- ACT Apps That Can Help
- A Take-Home Message
What is Acceptance and Commitment Therapy (ACT)? Definitions and Core Processes
The website www.actmindfully.com.au explains ACT in simple terms: it is a type of therapy that aims to help patients accept what is out of their control, and commit instead to actions that enrichen their lives (Harris, 2013).
According to the Association for Contextual Behavioral Science (ACBS), ACT is:
“a unique empirically based psychological intervention that uses acceptance and mindfulness strategies, together with commitment and behavior change strategies, to increase psychological flexibility.”
The ACBS views ACT as a therapy based on the concept that suffering is a natural and inevitable condition for humans. We have an instinct to control our experiences, but this instinct does not always serve us.
The founder of ACT has also offered a definition of ACT in terms familiar to the psychology field:
“a psychological intervention based on modern behavioral psychology, including Relational Frame Theory, that applies mindfulness and acceptance processes, and commitment and behavior change processes, to the creation of psychological flexibility” (Hayes, “The Six Core Processes of ACT”).
To put it in less clinical terms, Dr. Russell Harris (2011) has defined ACT as “a mindfulness-based behavioral therapy that challenges the ground rules of most Western psychology.” Its unique goal is to help patients create a rich and meaningful life and develop mindfulness skills alongside the existence of pain and suffering.
Six core processes of ACT guide patients through therapy and provide a framework for developing psychological flexibility (Harris, 2011). These six core processes of ACT include the following:
- Cognitive Defusion;
- Being Present;
- Self as Context;
- Committed Action.
Acceptance is an alternative to our instinct to avoid thinking about negative—or potentially negative—experiences. It is the active choice to allow unpleasant experiences to exist, without trying to deny or change them.
Acceptance is not a goal of ACT, but a method of encouraging action that will lead to positive results.
Cognitive Defusion refers to the techniques intended to change how an individual reacts to their thoughts and feelings. Acceptance and Commitment Therapy does not intend to limit our exposure to negative experiences, but rather to face them and come out the other side with a decreased fixation on these experiences.
Being Present can be understood as the practice of being aware of the present moment, without judgment the experience. In other words, it involves experiencing what is happening without trying to predict or change the experience.
Self as Context is the idea that an individual is not simply the sum of their experiences, thoughts, or emotions. The “self as context” process offers the alternative concept that there is a self outside of the current experience.
We are not only what happens to us. We are the ones experiencing what happens to us.
Values in this context are the qualities we choose to work towards in any given moment. We all hold values, consciously or unconsciously, that direct our steps. In ACT, we use tools that help us live our lives in accordance with the values that we hold dear.
Finally, ACT aims to help patients commit to actions that will assist in their long-term goals and live a life consistent with their values. Positive behavior changes cannot occur without awareness of how a given behavior affects us.
ACT is not all that different from other behavioral-based therapies; it just emphasizes acceptance instead of avoidance, and in that way, differs from many other forms of therapy. This departure from most mainstream treatment can be traced back to the background of ACT’s founder, Stephen C. Hayes.
Steven C. Hayes and ACT
Steven C. Hayes, a psychology professor at the University of Nevada, developed ACT in 1986 (Harris, 2011). His work began with how language and thought influence our internal experiences and laid the foundation for ACT.
Hayes disagreed that suffering and pain are to be avoided and buffered whenever possible. He saw suffering as an inevitable and essential part of being human, as well as a source of fulfillment when we do not flee from what scares us.
Steven Hayes makes a compelling case for acceptance and self-compassion based on his own experiences with pain. His TED Talk on psychological flexibility explains the foundation for his psychological exploration of ACT.
The Role of ACT in Psychology and Mindfulness
Acceptance and Commitment Therapy is built on the Relational Frame Theory, a theory based on the idea the human ability to relate is the foundation of language and cognition.
Relating involves noting the dimensions along which relation exists. For example, we may associate an apple with an orange, but our ability of relating allows us to understand that although they have a similar shape (round) and function (to be eaten), they have different colors and textures.
Humans, unlike most other animals, have an uncanny ability to relate even neutral events, as well as seemingly unrelated words and ideas.
While this is an advantageous ability, it also facilitates negative thoughts and judgment about ourselves. If we can relate the word “cookie” to the experience of eating a cookie, then we can also relate the word “worthless” to feeling that we are worthless.
Our ability to form relational networks (e.g., I relate the words “orange”, “apple”, and “pear” to the concept of “fruit”) can be a destructive ability when anxiety and depression impact us.
For example, we might relate “worthless” to an ability to perform my job and, by extension, relate the word “worthless” to my life. ACT is built on Relational Frame Theory.
We often form relational networks that are not complimentary or life-giving, but we can also change those relations when we apply mindfulness to accept our feelings and change how we react and relate to them, instead of trying to avoid them.
For a more detailed explanation of Relational Frame Theory, you can check out this PDF from Act Mindfully, a web resource revolving around principles of ACT.
10 Worksheets, PDF’s, PPT’s and ACT Resources
Are you ready to use ACT as a way to improve your life or the life of your clients? If so, read on for excellent resources to apply the science of Acceptance and Commitment Therapy to your work.
Many of these are made available by the organization ACT Mindfully, which is a great resource.
Follow this link for a PDF that includes several worksheets and lots of information on how to guide a client through them.
1. Triggers, Behaviors, and Payoffs (page 7)
This worksheet is a fillable matrix on page 6 with one column for writing down triggers (situations, thoughts, or feeling that immediately precede a certain behavior), behaviors (what you actually do), and payoffs (the immediate outcomes of the behavior that encourage the behavior to continue).
This worksheet can help you or your clients identify self-defeating behaviors with the motivation behind them, which can be a first step to recognizing and modifying problematic behavior.
2. Bull’s Eye: Clarifying Your Values (page 9)
Another worksheet presents the Values Bull’s Eye, or a set of concentric circles that are separated into four quadrants: work/education, leisure, personal growth/health, and relationships.
The exercise involves placing an “X” on the circle that most closely represents how you feel in the present moment.
The closer to the middle the X is, the more you feel you are behaving like the person you want to be. The further out the X is, the less you feel like the person you want to be. This worksheet can be found in the PDF above on page 11 or individually here.
3. The ‘Triflex’ Psychological Flexibility Assessment Tool (pages 14-15)
The final pages in the PDF from ACT Mindfully help you estimate your psychological flexibility based on three factors:
- Ability to open up
- Ability to be present
- Ability to do what matters
Here you will find a visual representation of psychological flexibility, an explanation of each of these three factors, and a method of estimating your abilities in these areas at this moment.
4. “The Happiness Trap” Worksheets
The Cost of Avoidance Worksheet (pages 4-5)
This worksheet present four sentences for you to complete:
- The thoughts I’d most like to get rid of are:
- The feelings I’d most like to get rid of are:
- The sensations I’d most like to get rid of are:
- The memories I’d most like to get rid of are:
Next, you are asked to write a list of everything you have done to try to avoid or get rid of these thoughts, feelings, sensations, and memories. Distracting yourself from these, avoiding activities, or using substances to self-medicate are a few examples of avoidance techniques.
Then you are asked to consider these questions for each item:
- Did this action get rid of my painful thoughts and feelings in the long term?
- Did it bring me closer to a rich, full, and meaningful life?
- If the answer to question 2 is “no,” then what did this action cost me in terms of time, energy, money, health, relationships, and vitality?
This worksheet can help you become aware of your own avoidance strategies, and whether they are producing the results you want.
5. Informal Mindfulness Exercises (page 9)
This page introduces two simple mindfulness exercises for any typical day:
- Mindfulness in Your Morning Routine: This exercise encourages you to notice the sensations while getting ready in the morning, such as the taste of your toothpaste, the smell of your face wash, or the feel of hot water on your body in the shower.
- Mindfulness of Domestic Chores: This exercise is one you can practice by simply being aware of the sensations you experience as you sweep the floors, do a load of laundry, or make dinner. Since you “always” have to do the dishes, why not take the time to do it mindfully? It’s good for your brain.
This worksheet allows space for you to imagine some informal mindfulness exercises to add to your day, such as while waiting in traffic or while walking from your car to your door. Maybe it’s as little as “no-phone” time while you grocery shop or wait in line.
6. Values Assessment Rating Form (page 12)
The Values Assessment Rating Form provides a matrix with 10 life domains (e.g., couples/intimate relationships, parenting, employment, etc.) and 4 columns to fill out:
- Valued direction (a brief summary of your goal for each domain)
- Importance of this value in your life
- Success in living this value
- Rank in order of importance you place on working on this domain right now
The Values Assessment Rating Form can help you identify where you are falling short of your goals and where you are meeting your goals, as well as aiding the prioritization of meeting these goals going forward.
7. Goal Setting Worksheet (page 16)
This worksheet guides the reader through the values that underlie their goals and how to make sure these goals are SMART goals. SMART is an acronym for goals that are Specific, Meaningful, Adaptive, Realistic, and Time-bound.
This activity will help you understand how to set goals that you can meet, rather than lofty ideas that are not backed by concrete actions.
8. What To Do in a Crisis (page 20)
This informational page offers a practical and useful response for when you face a crisis.
This response is called STOP:
- Slow your breathing: enter into a quick and simple mindfulness practice.
- Take note: noticing what you are experiencing in the present moment.
- Open up: allow yourself to feel without judgment or avoidance.
- Pursue your values: decide what the best course of action is based on your most important values.
Here is a list of things to consider during this exercise:
- Consider if you need assistance or support, and who could provide you with the assistance or support you need.
- Think about whether you have experienced anything similar before, and how you responded to it then.
- Consider ways to improve the situation, even in the smallest way, whether it’s in the next few minutes or the next few days.
- Be willing to practice acceptance if you cannot improve your situation, and commit to spending your time and energy in a constructive way.
- Ask yourself what the best way is to deal with this situation or, as the metaphor goes, how to play the game with the cards you have been dealt.
- Remember to practice self-compassion; if you need inspiration, imagine a friend or loved one was going through your experience right now, and tell yourself whatever you imagine telling them.
9. Psychological Inflexibility
For therapists and other mental health professionals, this PDF from The HappinessTrap aligns with ACT principles as well. It provides questions for you to assess your clients for their psychological inflexibility.
Psychological inflexibility is the extent to which anyone has trouble practicing the six core processes. The questions map to the opposite of the six core processes as follows:
- The dominance of the conceptualized past or future; limited self-knowledge (vs. acceptance)
- Fusion (vs. defusion)
- Experiential avoidance (vs. being present)
- Attachment to the conceptualized self (vs. self as context)
- Lack of values clarity/contact (vs. values)
- Unworkable action (vs. committed action)
This set of questions can be a great tool to help your clients ascertain where to focus their energy. This is a critical step to embracing their experiences and act according to their deepest values.
10. Applying Mindfulness to Your Therapeutic Practice
If you’re looking for a visual resource on how to apply ACT in your practice, check out this slide presentation on acceptance and mindfulness as therapeutic tools.
This presentation includes information on how mindfulness and acceptance can benefit people who are struggling. It also explores the theories behind how ACT works, along with suggestions for therapists who want to introduce their clients to mindfulness.
7 Useful ACT Exercises, Techniques, and Metaphors
The section above includes several resources with Acceptance and Commitment Therapy practices, and now we’ll describe the most popular exercises and metaphors in detail=.
Several of these can be found on the Association for Contextual Behavioral Science website, on their ACT exercises page or their ACT metaphors page. For each exercise or metaphor, a link will be provided to the exercise for you to learn more.
Writing Acceptance Exercise by Matthieu Villatte
This is a quick exercise for mental health professionals to help their clients understand how avoidance can be counterproductive. This exercise can be completed in the following steps:
- Give your client a sheet of paper and a pen and ask them if they are ready for written instructions.
- Before the client can write anything, present an obstacle that obstructs the client’s ability to see the paper and pen (e.g., a piece of cardboard, a mask with severely limited vision, etc)
- Ask the client if this bothers them and if they’d rather be able to see as they write. Inform them that the obstacle will stay, but they should still attempt to work around the obstacle in order to write the sentence
- Let them struggle with seeing around the obstacle for 20 to 30 seconds. They probably will not have written anything readable at this point
- Ask the client about their experience (i.e., “How was it? Was it difficult? Were you able to write the sentence? Can we read it?”)
- Propose that the client stop trying to see around the obstacle, but just accept that it is there and write the sentence anyway.
- The sentence they write when focusing on writing (instead of avoiding) will likely be more readable. Point this out to them and help them make the connection between avoiding the physical obstacle and avoiding emotional pain, and the negative consequences of each.
You can find this exercise in more detail here.
Two Sides of the Same Coin by Jenna LeJeune
This exercise can be guided by a therapist or completed on your own. Following these steps can help you or your client understand that suffering is an inevitable part of life; if we eradicated suffering, we would also eliminate joy.
Follow these steps to give this exercise a try:
- Find an activity or relationship that you find valuable, but that you have retreated from recently;
- Take out an index card or piece of paper. On one side, write down what you value about that activity or relationship or what you hope to achieve or become through it;
- On the other side, write down the difficult thoughts and feelings that sometimes happen for you, when you take action towards gaining the value or achievements written on the other side;
- Put the card in your pocket, wallet, or purse. Over the next week, take it out, look at both sides, and ask yourself if you are willing to have that card, with both the good and bad. You can either avoid both the value and the pain, or you can embrace them both.
Mindfulness of Emotions by Carol Vivyan
This is a mindfulness technique that can defuse a strong, negative emotion. Follow the steps to renew your focus on acceptance and positive action toward your values:
- Sit comfortably in a quiet area. Bring your attention to your breath, feeling the sensations of breathing without trying to manipulate your breath;
- Notice the emotion(s) you are feeling, and what it feels like;
- Name the emotion. Identify what it is and what word best describes how you are feeling;
- Accept the emotion as a natural and normal reaction to the circumstances. Don’t condone it or judge it, just let it move through you;
- Investigate the emotion by asking questions like: How intensely am I feeling this emotion? Has my breathing changed? What are the accompanying sensations in my body? How is my posture? Am I experiencing increased tension in my muscles? What is my facial expression at this moment? How does my face feel?
- Notice the thoughts or judgments that arise, but let them pass. If you find yourself dwelling on any of them, gently bring your attention back to your breathing to re-center, then visit the emotion again. This technique may produce the best results when starting small and working your way up to more intense emotions.
To read the entire technique description and try it for yourself, click here.
The Valued Directions Worksheet by John Forsyth and Georg Eifert
This exercise is a great first step for anyone looking to start practicing ACT techniques. Values, as mentioned earlier, are a foundational piece of Acceptance and Commitment Therapy.
The Valued Directions worksheet presents 10 value domains for the reader to consider:
- Intimate relationships;
- Education/learning/personal growth;
- Friends/social life;
- Health/physical self-care;
- Family of origin (or relationships other than marriage or parenting)
- Spirituality Community life/environment/nature;
The exercise then asks the reader to rate the importance of each value domain on a scale of 0 (not at all important) to 2 (very important). There is nothing wrong with valuing some areas more than others.
Then, readers rate their satisfaction with their lives in each area on a scale of 0 (not at all satisfied) to 2 (very satisfied).
Once the ratings have been completed, the exercise asks readers to review any value rated as a 1 or 2 on the importance scale and write their intentions in that area for the foreseeable future. In other words, write down what you want to achieve, maintain, or become in each important value area.
These are not goals that can be completed and “checked off,” but rather they are actionable goals that match how you want to live your life each day.
This exercise can help clarify what is important and needs to be prioritized in your life. It’s best if you have a therapist or qualified professional to discuss the results and actionable goals with. It is still a powerful exercise whether you are currently attending therapy or not.
To give this exercise a try, follow this link.
For more ACT exercises, check out the exercises, techniques, and worksheets on the following sites:
Metaphors also play a key role in Acceptance and Commitment Therapy. They provide clients with a simple way to understand how their feelings and thoughts influence their actions, and thus, allow people to visualize how adjusting our thoughts affects our behaviors.
Here are three of our favorite metaphors relevant to ACT.
The Sailing Boat Metaphor
This metaphor uses the setting of a small sailing boat, with “you” as the sailor. Occasionally, waves send water over the side and into the boat, causing you the inconvenience of wet feet. The boat includes a bailer to bail out this water, and you know how to use it.
So one day, when a particularly big wave breaks over the side and leaves water in your boat, you start bailing. You may start bailing calmly or mindfully, but eventually, you might find yourself bailing desperately or wildly to get rid of all this water.
While you’ve been bailing, have you noticed what is happening to your boat? Where is it headed? Where has it drifted to? Would it be fair to say you’ve been bailing more than sailing?
Now imagine that you take a look at the bailer and see that it is really a sieve, full of holes? What would you do?
The implicit purpose of bailing water here is probably to get your boat back on track—once you rid the boat of the water. But if your tool is not suited to the task, you will find yourself struggling to get rid of any water, let alone guide your boat.
The question is would rather be on a boat that has only a little water in the bottom, but is drifting without direction, or on a boat that may have quite a bit of water in the bottom but is heading in the direction you wish to go?
This metaphor can help you or your clients realize two things:
- The techniques we use to deal with our problematic thoughts and feelings are tools like the bailer and the sieve, and some are better than others.
- Sometimes working desperately to avoid wet feet (or other painful or uncomfortable feelings) gets us so off-track; the distraction and struggle of “wet feet” become our blocks to reaching our goals, not the waves.
To read this metaphor in its entirety, see this link.
The Mind Bully Metaphor
This metaphor is meant for people struggling with a particular emotion or diagnosis, like anger, anxiety, or depression.
In this metaphor, the mind bully is our particular problem: it is an extremely large and strong bully. We are on opposite sides of a pit, tugging back and forth on a rope as the Mind Bully tries to make us fall into the pit.
When we pull on the rope, when we listen and pay attention to or even believe the monster, we are actually feeding it. Like any bully, the Mind Bully can only harm us when we engage with it and believe the negative things it says. In other words, don’t let your mind bully your body.
Instead of pulling on the rope, what do you think would happen if we drop it? The Mind Bully might still be there, hurling its insults and meanness, but it would no longer be able to pull us towards the pit.
The less that we feed the Mind Bully, the smaller and quieter it will get. Maybe eventually, we even will grow empathy for this sad creature and wonder why it says such mean thoughts.
We stop feeding the Mind Bully by noticing and acknowledging it but shifting our attention away from it instead of believing what it says. Engaging in a quick mindfulness exercise can be a great way to do this.
To learn more about the Mind Bully metaphor and read the alternate version of this metaphor, visit this website.
The Quicksand Metaphor
Quicksand is a loose, wet patch of sand that cannot support weight like dry sand can. When you step in quicksand, you start to sink instead of finding a solid footing.
Common knowledge is that struggling against quicksand only increases the rate at which it sucks you down into its depths. When you put more weight on one foot to try to lift the other, it just sinks deeper into the pit. The more you struggle, the deeper you sink. Frightening!
The solution to surviving quicksand is to spread your body weight over a large surface area and move slowly.
Rather than trying to stand and fight the quicksand, ignore your instincts to struggle and lie down on your back instead.
It’s counterintuitive, but the less you struggle and the more you accept your present situation and embrace vulnerability, the easier it is to escape.
This same principle applies to pain, suffering, and knowing when to ask for help. The more we struggle and fight against it, rather than accepting our situation, the more we drag ourselves down deeper.
When we accept that the suffering is inevitable, we are more likely to survive and come out the other side more quickly and efficiently.
If you find metaphors to be useful tools in your own life or your clients’ lives, you can read more metaphors in The Big Book of Metaphors: A Practitioner’s Guide to Experiential Exercises and Metaphors in Acceptance and Commitment Therapy by Jill Stoddard, Niloofar Afari, and Steven C. Hayes.
You can also visit these websites for quick and simple descriptions:
We also suggest a couple of videos on ACT metaphors in the YouTube videos section below. Spoiler alert: they include some pretty cute animation.
8 ACT Training, Courses, and Workshops
- The Association for Contextual Behavioral Science (ACBS) provides excellent resources for anyone wanting to learn about Acceptance and Commitment Therapy. They divide their resources by method of learning: on your own, or with a community. Check out this page here for books and articles by Steven Hayes.
- The ACBS also offers occasional training workshops on working with ACT. You can check their events calendar here to see when there will be training in your area.
- If you happen to be in the Portland, Oregon area, Portland Psychotherapy offers several workshops on applying ACT to your practice. These workshops are conducted by Dr. Jason Luoma both on location in the Pacific Northwest and online; they focus on a variety of topics within Acceptance and Commitment Therapy.The next two upcoming workshops will be focused on applying ACT and mindfulness techniques for self-critical and shame-prone clients. You can find more information about these workshops here.
- Dr. Russ Harris offers online training in ACT. His 8-week course for beginners lasts includes animation, video clips of real ACT sessions, audio clips, and more. If you’re interested in this course, find more information here.
- Another course through Dr. Harris focuses on ACT and mindfulness for clients who have experienced trauma. This 8-week course offers an intensive dive into ACT complete with videos, online coursework, and multiple tools and techniques to apply in your practice. You can learn more about this course here.
- If you’re interested in applying ACT in your practice with adolescents, this course can help. It is a 6-week course intended to help you adapt ACT for your younger clients.
- Finally, Dr. Harris also offers a course for treating depression and anxiety disorders with ACT. This course is not active at the moment, but you can share your interest in the course through the website.
All of these courses can be found with more details on timing, course content, and cost at imlearningact.com.
4 Acceptance Therapy Books (+ ACT for Dummies)
- The most essential ACT book may be Hayes’ Get Out of Your Mind and Into Your Life. At one point, this book was a best-seller in the self-help family of American books. This book offers an emphasis on accepting and living with pain, which is a concept largely foreign to the Western perspective on happiness and the avoidance of pain.This book will walk you through the foundations of ACT and help you learn to accept your emotions rather than act in ways that are self-destructive or undermining to your mental health. To read reviews or see purchasing options, check it out here.
- If you’re a therapist or researcher wanting to apply ACT in your practice or research, A Practical Guide to Acceptance and Commitment Therapy is great. This book by Steven C. Hayes and Kirk D. Strosahl establishes the groundwork for integrating ACT into your work. If you’d like to learn more, you can find the book here.
- Another guide for applying ACT to your work is Learning ACT: An Acceptance and Commitment Therapy Skills-Training Manual for Therapists by Jason Luoma, Steven C. Hayes, and Robyn D. Walser.This book garnered numerous positive reviews on Amazon and includes a DVD that features role plays of some of the main ACT processes and techniques. You can check out this book here.
- Finally, a list of books on any topic wouldn’t be complete without the “For Dummies” version. This book on ACT “For Dummies” is no different. It describes what ACT is, how it can be applied to everyday life, and why it works. To see reviews and other information on this book or to purchase it for yourself or your clients, follow this link.
ACT for Treating Disorders
Like the practice of mindfulness, ACT can be applied in any individual’s life and help with general anxiety disorders, chronic pain, depression, OCD, eating disorders, and social anxiety.
General and Social Anxiety Disorders
Many studies showcase the positive effects of this form of therapy for patients struggling with anxiety.
For example, one study showed that college students who received ACT treatment enjoyed less stress in regards to academic concerns, decreased anxiety and depression symptoms, greater general mental health, and improved mindful acceptance (Levin, Haeger, Pierce, & Twohig, 2017).
Another study reiterated these positive impacts on anxiety and showed that ACT delivered via the internet could be as effective as therapist-delivered ACT (Ivanova et al., 2016).
The participants in this study reported reduced general and social anxiety, whether they were in the “treatment as usual” group or the online ACT group.
To learn more about how to apply Acceptance and Commitment Therapy to anxiety disorders, check out this website that is packed with information on how ACT can help treat anxiety and why it works. This site focuses on important points like mindfulness, commitment, and control paradox, which arises from our expert ability to control our environment paired with our relative inability to control our thoughts and emotions.
If you want to treat anxiety with ACT, we recommend the following book, Acceptance and Commitment Therapy for Anxiety Disorders: A Practitioner’s Treatment Guide to Using Mindfulness, Acceptance, and Values-Based Behavior Change Strategies. This book can be found here.
Georg H. Eifert, John P. Forsyth, and Steven C. Hayes offer real and tangible changes for therapists and clients alike.
Acceptance and Commitment Therapy has been found to improve quality of life—even without affecting the level of pain experienced—for many cases of chronic pain.
One study showed that cancer patients who receive ACT treatment reported significant improvements in the acceptance of their circumstances and finding increased meaning in life, even while still experiencing pain (Datta, Aditya, Chakraborty, Das, & Mukhopadhyay, 2016).
Another study also found that ACT improves psychological flexibility and reduces depressive symptoms, even when chronic pain remains (Scott, Hann, McCracken, 2016).
A different study verified this finding, reporting that physical and emotional functioning improved with ACT, even with no concurrent reduction in pain (Vowles, Witkiewitz, Levell, Sowden, & Ashworth, 2017).
Similarly, ACT has been found to improve symptoms for people suffering from depression. One study found that ACT decreased the severity of depressive symptoms for veterans with depression and suicidal thoughts (Walser, Garvert, Karlin, Trockel, Ryu, & Taylor, 2015).
ACT also reduced psychological inflexibility and distress related to depression and anxiety in older adults, even with only a brief course from a novice ACT therapist (Roberts, 2016).
If you’d like to learn more about using Acceptance and Commitment Therapy to treat depression, give this book a try: ACT for Depression: A Clinician’s Guide to Using Acceptance and Commitment Therapy in Treating Depression, by Robert Zettle. It describes how ACT can contribute to the successful treatment of depression by providing a session-by-session approach.
Obsessive-Compulsive Disorder (OCD)
ACT can also help patients suffering from Obsessive-Compulsive Disorder (OCD).
An overview of the quantitative research conducted in this area showed that ACT treatment for OCD is as effective as the “treatment as usual” approach, including cognitive behavioral therapy (Bluett, Homan, Morrison, Levin, & Twohig, 2014).
For a great explanation of how to apply ACT in the treatment of patients with OCD, check out Michael Twohig’s piece on this subject.
He explains that ACT can be applied to OCD treatment by viewing behaviors as changeable rather than inherent biological responses. He offers ways to focus on clients’ reactions to events, instead of seeing their behaviors as fixed facets of their personality.
Finally, ACT has also been successfully applied to patients with eating disorders. A case-series study on women with Binge Eating Disorder showed that participants improved with the application of ACT (Hill, Masuda, Melcher, Morgan, & Twohig, 2015).
One patient even reached a point where her symptoms no longer met the clinical definition of Binge Eating Disorder, while both displayed increases in their body image flexibility.
In a study on patients with anorexia, participants who received treatment that included ACT were more likely to reach positive outcomes at the end of the study (Parling, Cernvall, Ramklint, Holmgren, & Ghaderi, 2016).
Applying ACT in Group Therapy
Acceptance and Commitment Therapy can be applied on an individual level, but it is also effective when delivered via a treatment group. The Association for Contextual Behavioral Science acknowledges the effectiveness of group ACT treatments for anger, depression and general anxiety, social anxiety, chronic pain, and for struggling adolescents.
The Houston Group Psychotherapy Society reiterates the effectiveness of group ACT therapy, noting that a group setting can provide opportunities for clients to connect and learn from one another, receive the validation they may desperately need, and practice constructive vulnerability.
Set rules for the group (show up to each group ready to make it work, don’t try to “solve” another group member’s feelings, conversations within the group are not expected to continue outside of this context etc.) and make sure group members know they must be followed.
Group Format and Structure
Decide on whether the group is more general or for a more specific topic like anxiety or depression. Consider starting the group with a mindfulness exercise or keeping a quick mindfulness exercise in your back pocket in case a group member gets off track.
Don’t be afraid to include experiential exercises but be on the lookout for judgment from group members after the exercise.
When conflict arises, which is likely to happen at some point, guide the group member to their inner experience first. Help them bring their thoughts back to making therapy work for them. Be ready to experience discomfort. Avoid the urge to “rescue” group members from their pain. As some therapists say, “don’t steal the struggle,” as it is sometimes a key part of the group’s process of establishing trust for each other.
For more information on applying ACT in groups, see the humorously named The Idiot’s Guide to ACT in Groups. This workbook provides a practical outline for setting up and conducting group ACT therapy and includes models, techniques, exercises, and basic protocols for group ACT.
4 Helpful YouTube Videos
If you learn more efficiently from videos than books, then here are some fantastic ACT videos on YouTube to learn more about ACT techniques.
For a great overview of ACT videos, begin with Dr. Russ Harris’ YouTube channel here. He has several ACT videos for different audiences and techniques. For example, one upload is for specifically for adolescents who want to harness ACT to “stop struggling and start thriving.”
If you’re looking for a short and sweet introduction to Acceptance and Commitment Therapy, the video below comes from the Veterans Health Administration.
If you’d like to learn more about the metaphors applied in Acceptance and Commitment Therapy, this video from Joe Oliver explains the ACT metaphor of passengers on a bus. In this metaphor, we are asked to place ourselves in the role of the bus driver, the person who has control over the speed and direction of the bus, but not the passengers.
Just as we cannot control the passengers who board the bus, we cannot control our own internal experiences, but we can allow them to say their piece while maintaining control over the bus. It’s only five minutes and features engaging animation.
Another great video from Joe Oliver outlines the unwelcome party guest metaphor. This video is just over four minutes and shows how trying to avoid things can backfire. Instead of avoiding the negative experiences that cause us stress or emotional discomfort, allowing ourselves to experience them and learn from them can produce far better results.
What if our depression, or anxiety, was “that unwelcome party guest” we should allow space for at the party?
Our final metaphor video from Joe Oliver images one of the demons on the boat. In this metaphor, we are steering the boat with a horde of angry, aggressive, and intrusive demons in the water below us. If you’re wondering how this translates to helpful ACT tactics, watch the video below.
You may be entertained and surprised.
ACT Apps That Can Help
As technology flourishes, so do the set of treatment options available to us. As with so many other problems, issues, or opportunities, there’s an app for that!
The two most popular apps are described below.
The Happiness Trap App
The ACT companion App, or the Happiness Trap App, is very popular. It is from Dr. Russ Harris and psychologist Anthony Berrick. If you are unfamiliar with Dr. Russ Harris’s project, this video below may inspire you towards applying ACT to your life or practice.[youtube height=”HEIGHT” width=”WIDTH”]PLACE_LINK_HERE[/youtube]
The app that Dr. Russ Harris designed helps you keep your commitment to positive action through mindfulness exercises. One tool measures how well you applied ACT skills to real-life situations, and prompts quick mindful acts.
This app is available through Google Play for $9.99 and the Apple App Store for $14.99. It’s not free, but it is a relatively inexpensive investment for an app that can help you dramatically improve your quality of life.
If you are interested in downloading this app, click here to learn more.
This app is offered through the US Department of Veterans Affairs. It includes tabs such as “Learn,” “Practice Mindfulness,” “Live Your Values,” and “Track Your ACT Moments.”
This app is designed to help veterans live their values in their daily life, even when faced with unpleasant situations and potential PTSD. It is available at no cost through iTunes. You can learn more about this app here.
A Take-Home Message
Acceptance and Commitment Therapy has the potential to produce extremely positive results, and not only for those suffering from psychological disorders.
If you are suffering from the pain inherent in everyday life, or you know clients and other people who do, this form of therapy has been highly successful. With so many resources available online, it’s easier than ever to give ACT a try.
Whether you want to try it yourself or guide your clients through ACT, I hope this piece has provided you with the information and resources you need to get started.
Thanks for reading.
And please, leave a comment below. Have you ever tried Acceptance and Commitment Therapy, for yourself or your clients? We would love to hear more.
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