Approaches / Acceptance and mindfulness
Acceptance and commitment therapy (ACT)
A behavioural approach that works with willingness to experience difficult thoughts and feelings while acting on personal values.
Overview
Acceptance and commitment therapy, usually said as one word, aims to help a person act in line with what matters to them while relating differently to difficult thoughts and feelings. It is often described as part of newer developments in behavioural therapy.
Core ideas
ACT describes six linked processes: acceptance, defusion from thoughts, contact with the present moment, a sense of self as a perspective, values and committed action. Together they are described as building psychological flexibility.
Rather than aiming mainly to change the content of thoughts, ACT focuses on how a person relates to them.
What a session can involve
Sessions may include experiential exercises, metaphors, mindfulness practices, clarifying values and planning small actions linked to them. A practitioner may pick one or two processes at a time rather than cover all six.
Formats and settings
ACT is used individually, in groups, through self-help materials and in digital formats. It has been applied in mental health, health care and other settings.
How it relates to other approaches
ACT shares an acceptance and mindfulness focus with mindfulness-based cognitive therapy and dialectical behaviour therapy, and a behavioural root with cognitive behavioural therapy. Practitioners and researchers disagree about whether it is a distinct approach or a variant of CBT.
Limits and open questions
Debate continues about how distinct its processes are from those in other approaches, and some critics note that much early research came from its developers and close colleagues. Some of its language, such as defusion, may be unfamiliar and not suit everyone.
For people aged 16 and over with chronic primary pain, NICE guidance in England recommends considering ACT or CBT for pain with appropriately trained professionals. Its evidence review and recommendation concern this particular population and should not be generalised to every condition.
History
ACT was developed from the 1980s by Steven Hayes and colleagues, drawing on a behavioural account of language known as relational frame theory. The 1999 book by Hayes, Strosahl and Wilson set out the approach for practitioners.
Values and life directions
In their clinical guide, LeJeune and Luoma distinguish values as qualities of behaviour and directions in life from the broader life areas in which behaviour takes place. This is an account within a particular therapeutic framework, not a claim that all approaches define values in the same way.
Key people
Steven Hayes is the founder of ACT. Kirk Strosahl and Kelly Wilson are co-authors of the founding treatment manual.
Sources and inspection notes
Supports: The developers' account of the ACT model and its processes. It is a primary source, not an independent review.
Supports: Independent NICE evidence review of psychological therapies, including ACT, for chronic primary pain in people aged 16 and over; findings are specific to the reviewed populations and comparisons.
LeJeune, J., & Luoma, J. B. (2019). Values in Therapy. Context Press, pp. 11–12.
Supports: In their clinical guide, LeJeune and Luoma distinguish values as qualities of behaviour and directions in life from the broader life areas. The printed pages were checked in page images by two AI readers; clinical subject review is pending.
Supports: Recommends considering ACT or CBT for pain delivered by appropriately trained professionals for people aged 16 and over with chronic primary pain in England.