Acceptance and Commitment Therapy (ACT) Basics

Acceptance and Commitment Therapy (ACT), developed by Steven C. Hayes and others in the late 20th century, represents a significant evolution in the cognitive-behavioural tradition of psychotherapy. Grounded in empirical research and theoretical innovation, ACT emphasises psychological flexibility through acceptance, mindfulness, and commitment to values-based actions. This article briefly explores the theoretical foundations and core principles of ACT, highlighting its relevance and application in professional mental health practice. I LOVE to work with ACT, as I find it’s a “real” therapy. It is down-to-earth, grounded in what is happening in the here and now for clients. Which is also where the seeds for change lie!!

Theoretical Foundations

At its core, ACT is underpinned by Relational Frame Theory (RFT), a psychological theory of human language, behaviour and cognition. The linguaphile in me loves RFT, too. RFT posits that the human ability to relate events arbitrarily through language is a fundamental feature of cognition, but also a source of psychological distress. We nearly literally talk ourselves into problems. This relational process can entangle individuals in ineffective cognitive patterns, often manifesting as experiential avoidance and cognitive fusion (i.e. thinking that our thoughts are ‘truth’, and need to be either obeyed or avoided).

Experiential Avoidance refers to the attempt to avoid or escape from unwanted internal experiences (e.g., thoughts, feelings, memories; mental images). Such avoidance, though natural, can paradoxically amplify distress and reduce overall functioning. 

Cognitive Fusion involves becoming so entangled with one’s thoughts that they dominate behaviour and decision-making processes, often leading to rigid and maladaptive patterns of living.

ACT seeks to counter these processes by promoting what it calls psychological flexibility—the ability to contact the present moment fully and without defence, while pursuing values-driven behaviour.

Core Principles

ACT is structured around six interrelated processes, each contributing to the enhancement of psychological flexibility:

1. Acceptance: In ACT, acceptance is the active and open embracing of all internal experiences, including those that are unpleasant or distressing. Rather than attempting to alter or avoid these experiences, clients are encouraged to acknowledge and make room for them, thus reducing the struggle against them. I love the “it is what it is” statement, and often use this with clients.
2. Cognitive Defusion: Cognitive defusion techniques aim to alter the way individuals interact with their thoughts, diminishing their literal impact. By viewing thoughts as transient mental events rather than truths, clients can reduce their influence on behaviour. Techniques such as observing thoughts as passing clouds or repeating words until they lose meaning are common defusion strategies.
3. Contact with the Present Moment: Mindfulness, or present-moment awareness, is a cornerstone of ACT. Clients are trained to engage fully with the here and now, fostering a non-judgmental awareness of internal and external experiences. This strengthens the ability to respond adaptively rather than reactively.
4. Self-as-Context: This principle involves recognising a transcendent sense of self, distinct from one’s thoughts, feelings, and experiences. It’s a way of relating differently to our ‘stories’, our conceptualised selves. By developing a perspective of the self as an observer of experiences rather than an entity and reactor, individuals can cultivate a sense of stability and flexibility in the face of psychological distress.
5. Values: ACT emphasises the identification and clarification of personal values, which are intrinsic qualities that define what is truly meaningful to an individual. Values provide direction and motivation for behaviour, offering a compass for life decisions.
6. Committed Action: The final process involves taking concrete steps guided by these identified values. Committed action is about behaving in ways that are congruent with one’s values, even in the presence of difficult or painful experiences. Goals definitely play a role in this, but only if there is a proper ‘compass heading’.

Application in Practice

The application of ACT in clinical practice involves integrating these principles into a cohesive therapeutic approach. I use a variety of experiential exercises, metaphors, and mindfulness practices to help clients develop psychological flexibility. For example, I might use the “passengers on the bus” metaphor to illustrate how clients can move forward with their values-driven goals despite the presence of troubling thoughts and feelings.

Empirical evidence supports the efficacy of ACT across a range of mental health issues, including anxiety, depression, chronic pain, and substance use disorders. Its transdiagnostic nature and focus on enhancing life quality make it a versatile and actually quite easy-to-understand therapeutic option.

Conclusion

Acceptance and Commitment Therapy offers a compelling and evidence-based approach to psychotherapy, emphasising acceptance, mindfulness, and value-based living. By fostering psychological flexibility, ACT helps individuals navigate the complexities of human experience with greater adaptability and resilience. For mental health professionals, integrating ACT principles into practice can enhance therapeutic outcomes and support clients in leading more fulfilling lives.

If you’d like to hear more about ACT, or the way I work with ACT in my counselling practice, contact me! I’m happy to chat.