Acceptance & Commitment Therapy
(ACT)

Acceptance and Commitment Therapy (ACT, pronounced as the word “act”) is a modern, evidence-based form of psychotherapy that developed within the cognitive behavioral therapy tradition. It grew out of an important scientific observation: much of human suffering is not caused simply by painful thoughts and emotions themselves, but by the exhausting struggle to control, avoid, or eliminate them. This insight led ACT researchers to ask a different question. Rather than focusing primarily on how to feel better, ACT asks how to live better — even when life (inevitably) includes uncertainty, loss, self-doubt, anxiety, sadness, and other difficult experiences. Somewhat paradoxically, research has shown that this shift often makes symptom improvement more likely, not less. To achieve this, ACT helps people develop psychological flexibility: the ability to respond to life’s challenges with greater awareness, openness, and freedom, while continuing to act in ways that reflect what truly matters to them. Instead of becoming trapped by thoughts, emotions, or habitual patterns, people gradually learn to make choices that are guided more by their values than by their discomfort. Today, ACT is one of the most extensively researched modern psychotherapies. It has been shown to be effective for a wide range of psychological difficulties and life challenges, and its principles can be applied across many different situations because they target fundamental psychological processes that are common to all human beings. At its heart, ACT is about changing your relationship with your inner experiences so that they no longer determine how you live your life. The goal is not simply to reduce suffering, but to help you live more freely, purposefully, and fully—and, in doing so, often reduce suffering as well.

Acceptance and Commitment Therapy (ACT) belongs to the broader family of cognitive-behavioral therapies, but it takes a somewhat different approach. Traditional Cognitive-Behavioral Therapy (CBT) often focuses on identifying and challenging unhelpful thoughts in order to reduce emotional distress and improve functioning. ACT, on the other hand, is initially less concerned with whether a thought is objectively true or false, and more interested in whether getting caught up in that thought is helpful in building the life you want. This difference emerged from decades of psychological research suggesting that the struggle to control or eliminate unwanted thoughts and emotions can sometimes make them more persistent or disruptive. Rather than teaching people to “think positively” or suppress difficult experiences, ACT helps them develop a different relationship with those experiences — one that allows them to act more intentionally and in accordance with their own values, even when difficult thoughts or feelings are present. Importantly, this does not mean ACT dismisses thoughts or that CBT and ACT are opposites. Both are evidence-based therapies, and both have been shown to be effective for a wide range of psychological difficulties. In practice, they often overlap considerably. ACT simply places greater emphasis on developing psychological flexibility — the ability to stay present, make room for difficult inner experiences when necessary, and choose actions that move life in a personally meaningful direction.

ACT is considered a transdiagnostic form of psychotherapy. In practical terms, this means that it targets psychological processes that are common across many different conditions, rather than being designed for one specific diagnosis. From an ACT perspective, thoughts, emotions, memories, and bodily sensations are not inherently “bad” or pathological. They become problematic when our relationship with them becomes rigid — for example, when we become entangled in our thoughts, spend increasing amounts of energy trying to avoid or control difficult inner experiences, or gradually lose contact with what genuinely matters to us. Over time, these patterns can contribute to a wide range of psychological problems, regardless of the particular diagnosis. Because ACT focuses on these underlying processes, rather than on symptoms alone, it has been studied across a broad range of conditions. Research supports its use for anxiety disorders, depression, obsessive-compulsive disorder (OCD), chronic stress, burnout, post-traumatic stress disorder (PTSD), chronic pain, substance-use disorders, eating disorders, and adjustment to long-term medical conditions, among others. The strongest evidence suggests that ACT is particularly helpful when people find themselves caught in repetitive struggles with their own thoughts and emotions—for example, excessive worrying, rumination, self-criticism, avoidance, or attempts to control experiences that cannot realistically be controlled. Rather than trying to eliminate these experiences altogether, ACT helps people develop greater psychological flexibility: the ability to respond to difficult thoughts and feelings more openly and effectively, while continuing to move toward a meaningful life. This does not mean that diagnosis is unimportant. Understanding a person’s specific difficulties remains an important part of assessment and treatment planning. However, in ACT, the diagnosis is often only one part of the picture. Equally important is understanding the psychological patterns that are maintaining suffering, and identifying the skills that can help create long-term change.

Probably not what you think. In ACT, acceptance does not mean approving of a painful situation, giving up, resigning yourself to suffering and so forth. If something can and should be changed, ACT encourages taking action. Acceptance becomes relevant when the struggle itself has become the obstacle. More specifically, acceptance refers to developing a greater willingness to experience thoughts, emotions, memories, and bodily sensations without automatically trying to suppress, avoid, or control them. This does not mean liking them. It means allowing them to simply be there in moments where they are already present, so that they no longer hijack our attention and dictate your actions. This approach is supported by decades of psychological research showing that persistent attempts to eliminate unwanted inner experiences can sometimes have the opposite effect — making them more frequent, more intense, or more disruptive. By reducing this internal struggle, many people discover that difficult experiences become easier to carry, even if they do not disappear altogether. In therapy, this is not achieved simply by talking about acceptance or deciding to “accept” something. It is developed through repeated practice. During sessions, we use brief experiential exercises that help you notice thoughts, emotions, and physical sensations as they arise, observe them with greater clarity, and gradually respond to them with more flexibility rather than automatically reacting or avoiding them. Like any psychological skill, this develops over time through experience rather than insight alone. The goal is not to feel better at any cost. The goal is to become less restricted by difficult inner experiences, so that they occupy less space in your decisions and more of your energy can be directed toward the life you want to build.

It means commitment to living in accordance with your values: the qualities you want your actions to express and the kind of person you want to be in your relationships, work, health, and other life domains. Rather than waiting to feel confident, calm, or motivated before taking meaningful action, ACT helps you build a life that reflects what genuinely matters to you, even while difficult thoughts and emotions come and go. This is not simply a philosophical idea. Research suggests that values-guided action is associated with greater psychological flexibility, well-being, life satisfaction, and a higher likelihood of lasting improvement across a wide range of psychological difficulties. One reason is that people often become trapped in a cycle of organizing their lives around avoiding distress. While this can bring short-term relief, it frequently strengthens anxiety, low mood, compulsive behaviors, and other forms of psychological suffering over time. Committed action helps break that cycle by giving behavior a different organizing principle: your personal values rather than your discomfort. Acceptance and committed action are therefore two sides of the same process. Acceptance creates the space to respond more flexibly instead of reacting automatically to difficult inner experiences. Committed action gives that freedom a direction by translating your values into the choices you can make in each moment. Together, the two help people spend less energy struggling with and trying to control their inner world, and more energy building the life they want to live. As a result, many people experience reductions in symptoms such as anxiety, depression, stress, or compulsive behavior. These improvements are important, but in ACT they are generally understood as the byproduct of living more flexibly and consistently with your personal values, rather than the primary goal in themselves.

As its name suggests, ACT is an active form of therapy. Most sessions combine conversation with practical exercises that help develop specific psychological skills. The balance between the two depends on the issues you are bringing to therapy and other individual factors, but sessions typically involve both understanding what’s showing up in the moment and actively practicing new ways of responding to it. Unlike some more traditional forms of psychotherapy, ACT does not require lengthy exploration of the past or detailed disclosure of your most private thoughts and feelings in order to be effective. Those conversations can certainly be valuable, and they sometimes become an important part of therapy. However, ACT is primarily concerned with how you relate to your inner experiences rather than what those experiences are. A central part of the work is learning to notice your own thoughts, emotions, and bodily sensations as they arise, without immediately becoming overwhelmed or pushed around by them. The conversation itself is typically purposeful and guided. Rather than simply listening, I actively help identify patterns, make connections, clarify what is getting in the way, and create opportunities to practice new skills during the session. These exercises are then adapted to your own life and experiences, so that the work remains practical rather than entirely abstract. The therapist’s role in ACT is therefore neither passive nor directive in the sense of telling you how to live your life. Instead, we work together as a team, combining your knowledge of your own life with my psychological training and experience.

Yes. Research over the past two decades has consistently shown that online psychological therapy can be just as effective as face-to-face therapy for many common mental-health difficulties, including anxiety, depression, stress-related problems, and trauma symptoms. This is also true of Acceptance and Commitment Therapy (ACT), which has been successfully delivered online in both individual and group formats across a wide range of populations. Beyond effectiveness, online therapy offers several practical advantages. It makes treatment more accessible, eliminates travel time, allows greater flexibility around work and family commitments, and often makes it easier for people to attend sessions consistently. Many clients also appreciate the additional sense of privacy and discretion that comes with receiving therapy from a location of their own choosing. These findings are one of the reasons I choose to work exclusively online. In my experience, ACT translates particularly well to this format because the work happens in the client’s everyday environment rather than in the artificial setting of a therapist’s office. The skills we develop are practiced where they will actually be used — in your home, your workspace, or wherever life is unfolding. I also find that online sessions create a different therapeutic atmosphere. Rather than feeling as though you’ve stepped into the therapist’s world for an hour, therapy takes place within yours. Many clients experience this as more natural, more equal, and easier to integrate into daily life. Instead of leaving the session and abruptly transitioning back to reality, you’re already there.

ACT is one of the most extensively researched modern psychotherapies. Over the past two decades, hundreds of randomized controlled trials and numerous meta-analyses have found it to be effective for a wide range of psychological difficulties, including anxiety, depression, chronic pain, obsessive-compulsive symptoms, trauma-related difficulties, substance use, stress, and many others. Overall, ACT tends to produce outcomes comparable to other evidence-based therapies, including cognitive behavioral therapy (CBT). Rather than replacing existing approaches, ACT offers a different evidence-based route to meaningful psychological change. As with most forms of psychotherapy, outcomes generally improve with sufficient treatment duration, regular practice between sessions, and active engagement in the therapeutic process. One of ACT’s greatest strengths is that it is transdiagnostic. Instead of requiring a different protocol for every diagnosis, ACT targets a set of psychological processes that research has shown to underlie many forms of psychological suffering. This makes it particularly well suited to people whose difficulties span multiple areas of life or do not fit neatly into a single diagnostic category — a situation that is far more common than many people realize. Research also provides important clues about why ACT works. Studies consistently show that improvements are closely linked to increases in psychological flexibility: the ability to remain open to difficult inner experiences while continuing to act in ways that reflect one’s values. As people become less caught up in unhelpful thoughts, less driven by avoidance, and more engaged in meaningful action, symptoms often improve as well. In fact, changes in psychological flexibility have repeatedly been shown to predict better treatment outcomes across many different conditions. Like all good psychotherapy, ACT is not a quick fix or a guarantee of success. Its effectiveness depends on many factors, including the nature of the problem, the quality of the therapeutic relationship, and the willingness to practice new skills outside of sessions. The evidence suggests, however, that for many people ACT provides a reliable, scientifically supported framework for creating long-term psychological change rather than temporary symptom relief.

ACT is supported by a substantial body of research across a wide range of psychological difficulties, but — as with any form of therapy — its effectiveness depends not only on the approach itself, but also on the person’s willingness to engage with it. ACT is an active form of therapy. Sessions are important, but much of the therapeutic change comes from practicing new skills between sessions and gradually applying them in everyday life. This may include brief exercises, reflection, or experimenting with different ways of responding to difficult thoughts, emotions, or situations. Consistent attendance, openness to trying unfamiliar approaches, and regular practice generally predict better outcomes than insight alone. ACT is not designed as a brief intervention. While some people notice meaningful changes relatively early, lasting psychological change usually develops over time through repeated practice and experience. The appropriate duration depends on the nature and complexity of the difficulties being addressed, but treatment commonly extends over several months, and sometimes longer. Sessions are typically held weekly, and may become less frequent as progress becomes more stable. The same principles apply in couples therapy. Lasting improvements usually depend on both partners attending regularly, practicing new ways of responding to one another between sessions, and remaining engaged even when the work becomes emotionally challenging. Whether ACT is appropriate cannot always be determined in theory. Sometimes it becomes clearer through conversation. The introductory consultation provides an opportunity to discuss the nature of the difficulties, previous experiences with therapy, expectations and goals, and to decide together whether ACT appears to be an appropriate approach.