Acceptance and Commitment Therapy (ACT) is a mindfully oriented behavioral therapy that uses an eclectic and humanistic approach to help people accept and move on from negative experiences.
Unlike other modes of psychology that primarily operate on the concept of healthy normality, ACT therapy accepts the so-called “abnormality” as part of the human psyche and lays more emphasis on change through acceptance.
The myriad of ACT techniques and interventions develop psychological flexibility and mental plasticity resulting in positive actions and life choices.
In this article, we will try to gain a deep understanding of the core concepts of ACT therapy, how it works, and its benefits.
The activities and exercises you find below can be a practical guide and your starting point to uncovering the benefits of ACT for a healthier, happier, and utterly aware life.
Before you continue, we thought you might like to download our three Positive CBT Exercises for free. These science-based exercises will provide you with detailed insight into Positive CBT and give you the tools to apply it in your therapy or coaching.
This Article Contains:
- What Is Acceptance and Commitment Therapy?
- Who Can Benefit from ACT?
- A Look at the Theory and Core Processes
- Benefits of ACT in Group Therapy
- Benefits of ACT for Anxiety, Depression, OCD & Trauma
- 3 Exercises, Activities, and Interventions
- 6 Useful ACT Worksheets (Incl. PDF), Exercises & Workbooks
- Training Options and Certification Courses (Inc. Online Options)
- A Take-Home Message
What Is Acceptance and Commitment Therapy?
Acceptance and Commitment Therapy (ACT) is a type of psychotherapy that is tied in with complete psychological flexibility and adjustment. The name itself suggests that there are two essential counterparts of ACT:
- Acceptance – of miseries, failures, and ailments.
- Commitment – to changing for the better and following a purposeful life.
In its most basic form, the theory being ACT therapy is rooted in helping people accept their difficulties and move on, leaving negativities behind. Many practitioners associate ACT with mindfulness and cognitive restructuring, considering the way it allows us to develop positive thoughts and stick to goal-oriented actions.
The principal goal of ACT is to teach the necessary skills to overcome painful thoughts and emotions, and gain meaningful insight into what truly matters to us. ACT is goal oriented, solution focused, and follows a systematic step-by-step approach in helping clients reach their target in life.
Who Can Benefit from ACT?
ACT therapy can help people of all ages and backgrounds.
Whether used alone or in combination with other forms of psychotherapy, ACT can be particularly suitable for:
- People with depression, melancholy, or other mood disorders (Hayes et al., 1996).
- People who have recently experienced a stressful life event such as losing a job, going bankrupt, losing a loved one, divorce.
- Patients with problems such as hallucinations, affective impairment, and severe melancholia (Gaudiano & Herbert, 2006).
- Individuals with self-doubt and low self-esteem.
- People experiencing social phobia, obsessions, communication barriers, destructive self-thoughts, and limiting beliefs (Twohig, Hayes, & Masuda, 2006).
- Professionals who are looking for a shift of mindset for increasing their productivity at work.
- Couples who are struggling to regain the balance in their marital life (Jacobson & Christensen, 1996).
A Look at the Theory and Core Processes
The theoretical framework of ACT addresses the basic human needs of happiness and pleasure. Letting individuals accept their flaws and training them to outgrow unwanted feelings are the main ideas behind ACT counseling theory.
The core concept of ACT is to promote psychological flexibility by following six major (interconnected and often overlapping) principles. Together they aim to increase mental flexibility in given capacities and make us more aware of ourselves and others (Harris, 2006).
The 6 core processes of ACT
Acceptance involves full recognition and awareness of our feelings, without trying to change them. For example learns to accept their obsessive thoughts as things that exist in their mind, acknowledging they are unreasonable and painful.
Instead of trying to control or forcefully change our thoughts, ACT therapy allows us to accept them and consciously replace painful feelings with positive and uplifting ones.
2. Cognitive defusion
Cognitive defusion alters the way our thoughts affect us. By using this component, ACT reduces the impact of undesirable and limiting beliefs that cause stress. For example, ACT facilitators may encourage their clients to practice methods like speaking thoughts out loud, naming them, and labeling them until they seem to be ineffective.
ACT counseling theory asserts that rather than changing what we think, it is more natural and more effective to change the way we feel about what we believe.
Acceptance, which is the basis of ACT, lies in being present and alert to what is happening in the moment.
The goal of ACT is to promote mindful awareness in individuals by making their thoughts and actions more consistent and aligned with the present.
4. Self as context, concept, and process
ACT sees the self from three dimensions:
- Self as context – our sense of self in relation with other people, situations, or time.
- Self as a concept – existential and deep-rooted beliefs about who we are.
- Self as a process – evolving ideas about the self in the present, past, and future.
Acceptance and Commitment Therapy aims to create a balance between all the aspects of self.
When we are aware of our experiences and can look at them from an objective viewpoint, we can handle the flow of emotions with more efficacy.
Personal values and judgment constitute a crucial component of ACT. The therapy incorporates a variety of practices and self-help tools that allow individuals to choose their life goals while understanding the underlying value systems that guide their choices.
6. Committed actions
Much like the traditional behavioral therapies, ACT therapy involves acquiring desirable traits, skills, and knowledge. It emphasizes consistent and goal-oriented behavior.
The methods and practices of ACT aim to change maladaptive behavior patterns that create psychological barriers. The interventions focus on training participants to consistently follow actions that enhance feelings of positivity (Hayes, Pistorello, & Levin, 2012).
Benefits of ACT for Group Therapy
For many people, group therapy presents a cost-effective, efficient counseling option.
ACT practices have gained immense popularity as a group intervention for promoting mental health and wellbeing at all levels. ACT interventions in group practices foster accountability and allow participants to take charge of their lives.
Group interventions in ACT create space for emotional catharsis and support. Listening to others and learning from different viewpoints give clients a better understanding of their problems. Psychologists believe that when we commit to an action in public, we are more likely to stick to it (Gaudiano, 2009).
Group rules and group conformity
Most group sessions in ACT begin with a clear explanation of the norms. Whether participants undergo talk therapy, mindful meditation, or group games and metaphors, they have a clear understanding of the group’s expectations.
A structured and solution-focused format
Most group therapy interventions follow a logical and step-by-step format, with all questions and exercises predefined, to save time and increase the likelihood of getting positive responses.
The systematic approach of group ACT is one reason why it is valid for such a significant variation of the population across cultures and backgrounds.
Experiential exercises such as situational role-play or guided imagery help individuals understand how others see and react to the same situation in a wholly different way. Open discussion can build empathy and openness.
Benefits of ACT for Anxiety, Depression, OCD & Trauma
Third-wave positive psychology treatment lines, such as ACT and Dialectical Behavior Therapy, combine behavioral and cognitive principles in a way that reduces symptoms and offers a permanent solution for people with a variety of mental health concerns.
Benefits of ACT for anxiety and depression
By reinforcing mindfulness and self-awareness, ACT interventions aim to rebuild self-perception, which can be particularly beneficial for people with depression and anxiety.
ACT counseling therapy uses cognitive and behavioral measures to change the way we look at adversity. Studies have shown that ACT, both as primary and secondary lines of therapy, works well for uplifting mood and self-worth (Hayes et al., 1996).
ACT group interventions have also shown to reduce symptoms of anxiety and depression (Ferreira et al., 2022).
The mindfulness part of ACT helps in overcoming the negative self-doubts and beliefs that come with depression. As a result, clients are more proactive in bringing about the desired changes and recover sooner (Hayes, 2005).
ACT therapy for OCD
Acceptance and Commitment Therapy is by and large a top-down approach that targets thought process, affective components, and behavior management at all levels.
For treating Obsessive Compulsive Disorder (OCD), ACT aims to defuse the negative thoughts and behavior patterns.
One technique is called Exposure and Response Prevention (ERP), a strategy that introduces clients to the anxiety-provoking stimulus and lets them realize the unreasonableness of their obsessive ruminations.
Studies have shown that ACT helps treat behaviors associated with OCD, such as like picking, hoarding, and repeated hand washing (Twohig & Woods, 2004). When used to treat OCD, ACT helps create a harmonious relationship with the client’s innermost feelings and build a secure connection to reality (Hayes et al., 1996).
Using ACT for Trauma
ACT has been shown to be beneficial when treating survivors of trauma (McLean & Follette, 2016) and for posttraumatic stress (Woidneck et al., 2014). On that basis, practitioners using Trauma-focused Acceptance and Commitment Therapy (TACT) aim to help people overcome severe trauma and posttraumatic mental disorders. It is usually a long intervention that lasts for a few weeks and follows an acceptance and mindful-awareness approach for healing.
ACT techniques for trauma management include:
- Metaphors and icebreakers.
- Group discussions where each member is encouraged to share their story and listen to others nonjudgmentally.
- Flashback and reminiscence therapy for extreme cases of trauma-induced depression and stress disorder.
- Role-play and role reversals between client and therapist or other members in a group session.
3 Exercises, Activities, and Interventions
ACT interventions and activities help:
- Build self-awareness.
- Create self-control and self-acceptance.
- Boost sensitivity to emotions of the self and others.
- Learn mindfulness skills.
There is a vast variety of ACT interventions and techniques psychotherapists use today, each with benefits that can help individuals address issues like depression, stress, obsessive behaviors, and anxiety. Here are some ACT exercises that are useful for regaining lost meaning and zeal in life (Harris, 2007).
1. Self-as-context exercises
This activity consists of three sets of questions, the answers to which reflect the different aspects of self-context (Harris, 2007).
Who are you?
The therapist asks this question repeatedly to the client. Initially, the individual attempts to answer descriptively by talking about their professional identity, personal details, etc. The therapist listens to the answers and repeats the same question.
This continues until the client understands that all the self-descriptions they have given so far are meaningless. Their real identity lies in the realization of their existence before anything else.
The therapist prompts the clients to notice:
- Their feet touching the ground.
- Their eyes seeing the therapist.
- Their breath flowing in and out.
- Thoughts passing through their mind.
- The smell of the room.
The therapist instructs the client to take a moment and notice themself as a professional, as a sufferer, and their ideal self. Then, the therapist gently guides the client into thinking that they are letting all these selves walk away. The feeling of letting go brings a sense of peace and transcendence, which in turn cultivates unconditional self-acceptance.
2. Obsessive compulsive disorder exercise
During the practice, the therapist helps the client to imagine obsessive thoughts as waves that rise and fall. Throughout the training, the clients learn how to ride their impulses rather than react to them.
The method shows them that by letting the urges flow and dissipate, they can study the thoughts objectively and realize how extremely harmful they can be.
3. Values exercise
The values exercise is an introspective ACT intervention, suitable for group administration or as a one-on-one practice.
The method is systematic and includes four steps:
- Step 1 – List all the values in ten life categories (e.g., family, health, work, social life, community).
- Step 2 – Score each value in the second column of the table, on a scale of 1-10, based on how important it is to the respondent (1 is ‘not important’ and 10 is ‘very important’).
- Step 3 – Score each value in the fourth column of the table, based on the degree to which the respondent applies them in their present lifestyle (1 is ‘not at all,’ and 10 is ‘fully’).
- Step 4 – At the final stage of the exercise, the therapist urges the clients to examine what their scores imply and how they reflect the clients’ value systems.
6 Useful ACT Worksheets (Incl. PDF), Exercises & Workbooks
Here are six excellent tools to help ACT practitioners.
1. Problem dissection
This exercise starts with making a list of all the life situations that we think are responsible for our unhappiness. It aims to examine the four primary elements that contribute to life difficulties.
Whether we are distressed due to a physical illness, a mental condition, or a personal loss, it is usually these four aspects that make us unhappy.
By disjoining them and looking at each element objectively, we can gather valuable information about the best ways to deal with them. The worksheet is shown below.
The instructions are clear, and there are no right and wrong answers in it (Forsyth & Eifert, 2016).
- List all the negative thoughts, worries, fears, self-doubts, and self-criticisms that push you down.
- What current actions make you feel worse and are harmful for your future?
- How do you feel about these troubles? Make a list of the emotions that arise.
- List all the events/people/situations that you have avoided or quit due to these unpleasant ruminations.
2. Problems and values worksheet
The ultimate goal of ACT is to increase awareness about happiness and how to attain it. The Problems and Values worksheet is an enriching journal that the therapist can use between sessions to mark progress and drive clients to enhanced self-understanding.
The worksheet, (available, among others, at ACT Mindfully,) is simple and is divided into four parts, as shown below.
- Problematic thoughts – What problematic thoughts is the client experiencing?
- Problematic actions – What problematic actions are troubling the client?
- Values – What matters to the client in the long run?
- Goals – How does the client plan to restore peace?
3. Life Enhancement Worksheet
The Life Enhancement Worksheet was a part of an ACT workshop conducted by John Forsyth and Jamie Forsyth (n.d.) at the University of Albany and incorporates mindfulness into an objective form.
Here is a summary of the exercise. You can also follow the link to learn more about it.
- Select any sensation you just experienced (e.g., breathlessness, fast heartbeat, dizziness, sweating, choking, nausea, heat flush, tingling, etc.).
- Choose an emotion that best describes that feeling (e.g., fear, sadness, worry, etc.)
- Rate the intensity of that emotion (1 is weak; 8 is very intense).
- Where were you when you experienced the sensation?
- What were you doing?
- Did you do anything to manage these feelings? What helped/didn’t help?
4. The Mindfulness and Acceptance Workbook for Anxiety
Forsyth and Eifert (2016) have brought together some of their most significant findings on mindfulness with Acceptance and Commitment Therapy.
The workbook follows a step-by-step approach to help individuals overcome their fears and self-doubts and get started on a journey of fulfillment and complete self-acceptance.
The book continues to be a compelling read for professionals who want to upgrade themselves for a better living.
5. The ACT Deck
The ACT Deck is a compilation of 55 practices that help build a stronger connection to the self. Authors Timothy Gordon and Jessica Borushok have concocted the exercises in fascinating card formats, which makes the piece user friendly and universally applicable.
6. The Little ACT Workbook
Dr. Michael Sinclair and Dr. Matthew Beadman, authors of The Little ACT Workbook, have come up with some great handy tips and exercises on managing stress and negative emotions with Acceptance and Commitment Therapy.
With a robust scientific framework and lots of practical examples, this workbook can be a great self-help tool or a therapeutic adjunct for cultivating resilience and meaningfulness into our lives.
Training Options and Certification Courses (Inc. Online Options)
Below we share three highly recommended training options for practitioners interested in applying ACT.
For more courses, be sure to check out our article Acceptance & Commitment Therapy Training: Top 17 Courses.
1. Acceptance and Commitment Therapy Courses by Dr. Russ Harris
Dr. Russ Harris has developed a series of ACT courses for various target groups. On his website, you can find ACT courses for beginners, adolescents, and professionals.
His classes also cover specific areas of mental health such as depression, anxiety, and trauma. The course structures are friendly and flexible to accommodate irregular daily schedules.
2. ACT Intensive Online Course
The ACT Intensive Online Course from Dr. Steven Hayes and Daniel Moran follows a systematic approach to train therapists how to treat clients with clinical depression and/or anxiety to overcome their negative thoughts and emotions.
Each module of the course addresses a specific plan to enhance client’s acceptance and teach them how to mindfully act under stressful life circumstances.
A Take-Home Message
Training the mind to live with negativity can be overwhelming, especially when we are distressed. Acceptance and Commitment Therapy opens us to the vastness of self-acceptance.
The principles and methods of ACT are simple reminders about how enriching life can be. Through meaningful self-acknowledgment and acceptance, ACT shows us how we can manage our emotions without actually trying to control them.
The mindfulness-based approach of ACT accounts for its effectiveness and practicability and makes it a satisfying experience for both the therapist and the help seeker.
We hope you enjoyed reading this article. For more information, don’t forget to download our three Positive CBT Exercises for free.
- Blackledge, J. T. (2007). Disrupting verbal processes: Cognitive defusion in acceptance and commitment therapy and other mindfulness-based psychotherapies. The Psychological Record, 57(4), 555-576.
- Ferreira, M. G., Mariano, L. I., de Rezende, J. V., Caramelli, P., & Kishita, N. (2022). Effects of group Acceptance and Commitment Therapy (ACT) on anxiety and depressive symptoms in adults: A meta-analysis. Journal of Affective Disorders, 309, 297–308.
- Forsyth, J. P., & Eifert, G. H. (2016). The mindfulness and acceptance workbook for anxiety: A guide to breaking free from anxiety, phobias, and worry using acceptance and commitment therapy. New Harbinger Publications.
- Forsyth, J. P., & Forsyth, J. R. (n.d.). Forms, exercises, & worksheets: Acceptance & commitment therapy for anxiety disorders: Transforming anxious suffering into a more vital life. Author.
- Gaudiano, B. A. (2009). Öst’s (2008) methodological comparison of clinical trials of acceptance and commitment therapy versus cognitive behavior therapy: Matching Apples with Oranges? Behaviour Research and Therapy, 47(12), 1066-1070.
- Gaudiano, B. A., & Herbert, J. D. (2006). Acute treatment of inpatients with psychotic symptoms using Acceptance and Commitment Therapy: Pilot results. Behaviour Research and Therapy, 44(3), 415-437.
- Harris, R. (2006). Embracing your demons: An overview of acceptance and commitment therapy. Psychotherapy in Australia, 12(4).
- Harris, R. (2007). Acceptance and commitment therapy (ACT) introductory workshop handout [Handout]. Psych Med. Retrieved from http://www.actmindfully.com.au/upimages/2007_Introductory_ACT_Workshop_Handout_-__Russ_Harris.pdf
- Harris, R. (2009). The complete set of client handouts and worksheets from ACT books. ACT Mindfully. Retrieved from https://www.actmindfully.com.au/upimages/2016_Complete_Worksheets_for_Russ_Harris_ACT_Books.pdf.
- Harris, R. (2011). The happiness trap: Stop struggling, start living. Exisle.
- Hayes, S. C. (2005). Get out of your mind and into your life: The new acceptance and commitment therapy. New Harbinger Publications.
- Hayes, S. C., Pistorello, J., & Levin, M. E. (2012). Acceptance and commitment therapy as a unified model of behavior change. The Counseling Psychologist, 40(7), 976-1002.
- Hayes, S. C., Wilson, K. G., Gifford, E. V., Follette, V. M., & Strosahl, K. (1996). Experiential avoidance and behavioral disorders: A functional dimensional approach to diagnosis and treatment. Journal of Consulting and Clinical Psychology, 64(6), 1152-1168.
- Jacobson, N. S., & Christensen, A. (1996). Integrative couple therapy: Promoting acceptance and change. WW Norton & Co.
- McLean, C., & Follette, V. (2016). Acceptance and commitment therapy as a nonpathologizing intervention approach for survivors of trauma. Journal of Trauma and Dissociation, 17(2), 138–150.
- 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.
- Twohig, M. P., & Woods, D. W. (2004). A preliminary investigation of acceptance and commitment therapy and habit reversal as a treatment for trichotillomania. Behavior Therapy, 35(4), 803-820.
- Woidneck, M., Morrison, K., & Twohig, M. (2014). Acceptance and commitment therapy for the treatment of posttraumatic stress among adolescents. Behavior Modification, 38(4), 451–476.
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What our readers think
I am a residential care worker in a children’s home. I have recently learned of ACT and have been devouring everything I can find on the subject. I am hoping to use ACT to help the adolescents I work with move past the trauma in their lives and live happier healthier lives. I love the metaphors in ACT they really help make complicated topics easier to understand.
“At some point you have to realize that some people can stay in your heart, but not in your life.”
How a true radical behaviorism gives ACT the boot and makes RFT useless
In 1994, the book ‘Learning and Complex Behavior’ was published by the Skinnerian behaviorists John Donahoe and David Palmer. An entire issue of the Journal of the Experimental Analysis of Behavior, the house organ of the Skinnerian movement, was devoted to its analysis and criticism, which was mainly laudatory. (link to one of these reviews from the JEAB is below) The book attempted to reconcile cognitive psychology with a Skinnerian radical behaviorism and mapped the Skinnerian data language or syntax to micro-behavioral events, in this case neural activity. Two major hypotheses were ventured by the authors. First, that classical and operant conditioning are not distinct processes, but can be derived from higher order models of brain functioning, or neural networks. Secondly, that reinforcement was the result of dopaminergic activity, which governs attentive arousal and neural activation. Both conclusions have been verified in modern bio- behaviorism (see below link to Berridge’s article).
D and P’s interpretation of a radical behaviorism is precisely the same as that which governs science, which insists on strict mapping of data languages (syntax) to real world events (semantics). Think of modern physics or medicine, which precisely map their terminology to real empiric events. The lineage of learning theories, from Thorndike and Pavlov to Bolles and Berridge in modern times, are basically radical behaviorisms, although they usually do not use a Skinnerian data language.
D and P’s analysis did neglect one fact, however. The dopaminergic processes for reinforcement they discussed are affective and are core elements of emotional states. Indeed, positive affective states, as governed by opioid and dopaminergic systems, can be mapped to abstract properties of response contingencies, and can be elicited and sustained without recourse to the linguistic psychodynamics which are core to modern psychotherapies and their rationales, including ACT. In other words, sustained positive affect, or ‘happiness’ is entirely dependent upon the abstract rather than normative properties of simple response contingencies, or how rather than what we think, and can be easily replicated in day to day life, a hypothesis that can be tested with easily falsifiable procedure.
The irony of this is that the metaphors of ‘acceptance’ and ‘commitment’ do apply, though RFT and ACT don’t.
I offer a more detailed theoretical explanation and procedure in pp. 47-52 of my open source book on the neuroscience of resting states, ‘The Book of Rest’, linked below.
This interpretation is based on the work of the distinguished neuroscientist Kent Berridge of the University of Michigan, a leading theorist on emotion and incentive motivation, who was kind to vet the work for accuracy and endorse the finished manuscript.
Berridge’s Site and article on history of reward learning
Shull’s review of D and P and Tonneau’s article on why RFT is so darn incomprehensible
I’m doing an internship with Veteran’s and this is a theory that is used in the interventions.
It’s so interesting all I was trying hard to put together in my work has, been combined in this approach. Would love to know more about it. Thanks, for the great article.
The use of metaphor in thought defussion is succinctly explained and highly useful in utilizing CR more effectively with learning theory. Certainly helpful in thinking outside the box of the usual CBT treatment protocols I’m required to work with.
I am a clinical psychologist and this is the first time I hear of this approach. Your article has made me want to learn more about it, because sometimes i find that CBT can be very cumbersome to some.
This is what I have been looking for since age 8. I am 65 in September and finally found it.
I hope that ACT has continued to help you. This was encouraging to read. I am just about to start ACT therapy this week. I am 62 and am hoping and praying that this will give me a much more peaceful life without me fighting my thoughts the rest of my life.