Acceptance and Commitment Therapy

About

Acceptance and Commitment Therapy

What is acceptance and commitment therapy?

Acceptance and commitment therapy (ACT) teaches patients how to reconceptualize the feelings, memories, and physical sensations that they avoid or fear. When patients learn how to stop avoiding, denying and struggling with their inner emotions, they can begin to accept that these deeper feelings are appropriate responses to certain situations. However, those feelings should not prevent them from moving forward in their lives. By practicing being present in the moment and accepting otherwise negative emotions, issues and hardships, patients can become more flexible in their thinking and reduce their distress.  

It’s not the goal of ACT to reduce symptoms. A symptom is, by definition, something to struggle against and try to get rid of. ACT works to transform your relationship with negative thoughts and behaviors so you don’t think of them as symptoms. Instead, you learn to perceive them as harmless and transient events. By not giving symptoms any power over you, they are reduced. Symptom reduction is a by-product of the therapy, not its goal.

ACT believes that it’s not only ineffective, but often counterproductive, to spend time and energy trying to control painful emotions or psychological experiences. Suppression of these feelings ultimately leads to more distress. Anxiety disorders are a good example. Anxiety is a normal emotion. An anxiety disorder can cause you to be preoccupied with trying to avoid anxiety. Unfortunately, the more importance you place on avoiding anxiety, the more anxiety you develop. A panic attack is anxiety about anxiety.

Life inevitably brings us some discomfort. The more you struggle with difficult feelings and try to control them, the more they overwhelm you, quickly increasing your discomfort. We use strategies to control our emotions and help manage how we feel. While these strategies may work in the short term, they can be self-destructive in the long term. For example, a depressed person may withdraw from social situations to avoid negative emotions such as anxiety or fear of rejection. Their thought process might include things like “I have nothing to say,” “I won’t know anyone there,” or “I’m a burden.” However, avoiding social situations only increases social isolation and depression. 

ACT teaches patients to reduce the influence of unwanted thoughts through mindfulness. Instead of fighting with your private thoughts and experiences, you open up to those that are beyond your personal control. Unwanted thoughts are allowed to come and go without struggling against them or making any effort to control them. Patients learn to examine the strategies they’ve used in the past to avoid negative thoughts. The therapist may ask about each strategy: “Did this reduce your symptoms in the long term?” “What did this strategy cost you in terms of time, energy and relationships?” “Did it move you closer to the life you want?”  

The second part of ACT is to commit to and take action toward making behavior changes to help you live the life you want, based on your values. 

What is acceptance and commitment therapy used to treat?

ACT has been used effectively to help treat stress, anxiety, depression, social anxiety disorder, obsessive-compulsive disorder, post-traumatic stress disorder, anorexia, schizophrenia, psychosis-related disorders, and medical conditions such as chronic pain, diabetes, addiction and substance misuse. It can be used with individuals, couples or groups, either as brief therapy or long-term therapy.

Anyone experiencing distress related to negative thoughts and emotions can benefit from the techniques used in ACT. This therapy does not treat symptoms as a primary target. Instead, it refocuses on being aware and accepting of the things you can or cannot change, and allowing movement in the direction of positive change in behavior and thoughts.

How does acceptance and commitment therapy work?

ACT encourages you to embrace your thoughts and feelings rather than fear or avoid them. With the help of a therapist, you commit to facing your issues head-on, and learn to listen to your own self-talk. 

As a mindfulness-based behavioral therapy, ACT uses a mix of skills, experiential exercises, and behavioral interventions that are guided by the patient’s values. Mindfulness helps reduce the impact and influence of unwanted thoughts and feelings. Mindfulness is bringing your attention and awareness to the current situation, and engaging fully in what you’re doing rather than getting lost in your thoughts. You allow your feelings to come and go as they are, without trying to control them. 

The therapist guides you to examine the way you talk to yourself about traumatic events, problem relationships, negative thoughts, or fearful situations. You decide if an issue requires immediate action or change, or if you can accept it. You become aware of what you cannot control. You learn to stop wasting energy on uncontrollable facts of life, and redirect your energy to actions that can enrich your life. 

By examining what did not work for you in the past, the therapist helps you stop repeating thought patterns and behaviors that aren’t helping but are causing more distress. You make a commitment to stop repeating your past and start practicing more confident and optimistic behavior.

Who created acceptance and commitment therapy?

ACT was developed in1982 by a clinical psychologist named Steven C. Hayes. 

Is acceptance and commitment therapy an evidence-based practice?

ACT has substantial evidence and strong research support for chronic pain, and modest research support for anxiety disorders, depression, and psychosis. The American Psychological Association maintains a frequently updated list of evidence-based practice guidelines for treatment and diagnosis, that can be found at https://div12.org/treatments/

Is acceptance and commitment therapy a form of cognitive behavioral therapy (CBT)?

ACT is considered an extension of CBT and it includes traditional behavior therapy. ACT holds that pain and distress are facts or life to be accepted. It teaches the patient how to accept their thoughts, even the bad ones, rather than trying to reduce or eliminate them. In contrast, CBT focuses on identifying and changing negative thoughts. 

How many sessions does acceptance and commitment therapy take?

This therapy will typically last between eight to 16 sessions for an effective response, depending on your diagnosis.

With Insurance

Therapy

Your copay
Depending on insurance

Without Insurance

Therapy

$99

Initial Visit

$99

Follow Up

References

Psychology Today. (n.d.) Acceptance and Commitment Therapy. Retrieved 3-1-22, {https://www.psychologytoday.com/us/therapy-types/acceptance-and-commitment-therapy}
Harris, R. (n.d.) Embracing Your Demons: An Overview of Acceptance and Commitment Therapy. Psychotherapy.net. Retrieved 3-1-22, {https://www.psychotherapy.net/article/Acceptance-and-Commitment-Therapy-ACT}
Ackerman, C.E. (2017, March) How Does Acceptance and Commitment Therapy Work? PositivePsychology.com. Retrieved 3-1-22, {https://positivepsychology.com/act-acceptance-and-commitment-therapy/}

Information

Medically reviewed by:

Dr Roy Kedem, MD

Dr Roy Kedem started his premedical studies at Harvard, and research in genetics and gene sequencing at Harvard, Beth Israel. He attended medical school in the UK at the Cambridge Overseas Medical Program in 1998. Dr Kedem then completed his residency in Internal Medicine at Columbia College of Physicians and Surgeons in Stamford, Connecticut and his fellowship in Hospital Medicine at the Cleveland Clinic in Cleveland, Ohio.

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Affordable –
with or without insurance

With Insurance

Therapy

Your copay
Depending on insurance

Without Insurance

Therapy

$99

Initial Visit

$99

Follow Up