What is acceptance and commitment therapy (ACT)?

Acceptance and commitment therapy (ACT) is a type of psychotherapy that assists individuals in developing psychological flexibility by accepting stubborn thoughts and feelings rather than avoiding or fighting them.

It is rooted in mindfulness, behavioral change strategies, and commitment to value-based living.

ACT is part of the “third wave” of cognitive-behavioral therapies, which focus on mindfulness, acceptance, and behavioral activation rather than direct cognitive restructuring.

What is the goal of acceptance and commitment therapy?

The purpose is to help individuals productively adapt to challenges in life by developing psychological flexibility due to the ability to stay present, accept difficult thoughts and emotions, and act in accordance with personal values.

Why is ACT effective in treating depression?

It’s helpful to treat depression because it targets psychological inflexibility, which is at the core of many mental health issues.

Rather than trying to eliminate distressing thoughts or emotions, ACT teaches individuals how to coexist with them while still engaging in meaningful activities.

Research suggests that ACT is beneficial for a variety of psychological disorders, including depression, anxiety, chronic pain, and substance abuse.

How effective is ACT in managing depression?

Numerous studies have shown that ACT is successful for treating depression, particularly for those who struggle with chronic, treatment-resistant, or comorbid conditions.

• Meta-analyses and systematic reviews

• • A 2016 meta-analysis (A-Tjak et al.) reviewed 39 randomized controlled trials (RCTs) and found that ACT notably reduces symptoms of depression and has comparable effects to Cognitive Behavioral Therapy (CBT).
  • A 2020 systematic review (Gloster et al.) discovered that ACT improves psychological flexibility, which is key in managing depressive symptoms.

• Comparison with CBT

• • Studies suggest that ACT and CBT show similar effectiveness in reducing depression, but ACT may have an edge in promoting long-term acceptance and psychological flexibility, reducing relapse rates.

• Long-term benefits

• • Unlike traditional therapies that focus on symptom reduction, ACT helps build sustained toughness by teaching to accept distress and commit to important actions despite the symptoms.

The main reasons why it works include:

1. Mindfulness and acceptance: Help individuals stay present instead of being plagued by past regrets or future worries.
   
2. Defusion from pessimistic thoughts: Teaches to detach from unhelpful thoughts rather than believing or avoiding them.
3. Values-based living: Encourages individuals to act according to their core values instead of short-term avoidance of discomfort.
4. Behavioral commitment: Promotes taking action, even in the presence of distress, leading to meaningful life changes.

Below are some additional reasons why it’s so useful:

5. Reduces experiential avoidance: Many mental health issues stem from avoiding difficult emotions, thoughts, or sensations. ACT helps to stop avoiding and start accepting, which leads to long-term psychological resilience.
6. Enhances psychological flexibility: Unlike traditional cognitive therapies that focus on changing thoughts, ACT teaches people how to relate to opinions differently, making them less rigid and more adaptable.
7. Applicable to everyday life: ACT techniques are practical and can be used in various situations, ranging from handling stress at work to managing personal relationships.
8. Encourages long-term behavior change: Instead of directing attention to symptom relief alone, ACT helps people build a life that lines up with their principles, leading to sustained improvements in well-being.
   
9. Works even when symptoms persist: Traditional therapies aim to eliminate symptoms, but ACT aids individuals in functioning well even when uncomfortable feelings or notions remain present.
10. Reduces overidentification with thoughts: Many people struggle because they believe their thoughts define them. ACT helps create distance between thoughts and identity, allowing people to see opinions as temporary mental events rather than absolute truths.
11. Works for people who are resistant to traditional cognitive therapies: Some find cognitive restructuring (challenging negative thoughts) difficult or unhelpful. ACT offers an alternative approach by teaching people to accept thoughts rather than debate them.
12. Encourages a growth mindset: Instead of labeling emotions or experiences as “good” or “bad,” ACT promotes learning from challenges and taking actions according to their values, which advances resilience.
13. Enhances emotional regulation without suppression: ACT helps people build tolerance and resistance rather than avoiding or suppressing emotions. This makes them less likely to engage in unhealthy coping mechanisms.
14. Addresses rumination and overthinking: It aids individuals in breaking free from cycles of worry and overanalyzing by teaching present-moment awareness and defusion from thoughts.

How does ACT work?

ACT operates through six core processes that help develop psychological flexibility:

1. Cognitive defusion: Learning to see thoughts as just words or images rather than absolute truths.
   • Example: Instead of thinking “I’m a failure,” a person learns to say, “I’m having the idea that I’m a failure.”
2. Acceptance: Allowing emotions and thoughts to be as they are, rather than struggling with them.
3. Present moment awareness: Staying engaged with the present instead of dwelling on the past or future.
4. Self-as-context: Recognizing that thoughts and emotions are separate from the self; you are more than your thoughts.
5. Values clarification: Identifying what truly matters in life, such as relationships and personal growth.
6. Committed action: Taking purposeful action despite discomfort.
   

Supplementary to the six core processes of ACT (defusion, acceptance, present moment awareness, self-as-context, values, and committed action), ACT also works by:

• Reframing struggles as part of the human experience: Acceptance and commitment therapy normalizes difficult emotions and thoughts, helping individuals see that struggling with discomfort is natural and not a personal failure.
• Using metaphors to reinforce learning: It often employs metaphors to illustrate concepts.
  • Example: The “Passengers on the Bus” metaphor teaches that difficult thoughts and emotions are like noisy passengers on a bus. You can still drive toward your destination (values) even if they are there.
• Focusing on meaning rather than comfort: ACT emphasizes leading a fulfilling life based on deeply held principles instead of seeking happiness as an end goal.
• Encouraging openness to discomfort: ACT helps people open up to discomfort while still engaging in meaningful actions rather than fighting distressing thoughts.
  
• Values-based decision-making: ACT teaches people to base decisions on their long-term values instead of fear or avoidance, leading to more fulfilling lives.
• Building a more compassionate inner dialogue: It encourages individuals to treat themselves with kindness rather than self-criticism through mindfulness and acceptance.
• Using experiential exercises: It often involves real-life exercises to practice psychological flexibility. Think of training tasks such as mindfulness meditations, role-playing, and exposure to feared situations.
• Bridging the gap between thoughts and actions: Many people struggle with acting because they get stuck in their heads. ACT helps them act according to their values despite discomfort.

When is ACT helpful?

ACT is beneficial for a wide range of conditions, including:

1. Depression.
2. Anxiety disorders (GAD, OCD, PTSD, Social Anxiety).
3. Chronic pain and illness management.
4. Substance use disorders.
5. Eating disorders.
6. Workplace stress and burnout.

It’s also advantageous for those who may not have a diagnosed mental health condition but struggle with life dissatisfaction, stress, or emotional avoidance.

For instance:

• People with low self-esteem or self-doubt: Assists clients in seeing their self-critical thoughts without letting them dictate behavior.
  
• Caregivers and healthcare workers: Helps professionals manage compassion fatigue and burnout.
• Athletes and performers: Aids with mental resilience by teaching them to accept performance anxiety and stay focused on their goals.
• Individuals facing major life transitions: Whether dealing with grief, job loss, or a breakup, ACT helps them navigate uncertainty while staying true to their values.
• Parents and educators: Support mindful parenting and teaching by promoting emotional flexibility and presence.
  
• People with trauma histories: Helps trauma survivors detach from painful memories without avoiding them, allowing them to reclaim their lives.
• Veterans and first responders: Helps process trauma and build emotional strength without suppressing emotions.
• Individuals with ADHD: Supports managing impulsiveness, frustration tolerance, and values-driven decision-making.
  
• People with sleep disorders: Aids in reducing anxiety about sleep by moving focus away from controlling sleep toward accepting discomfort.
• Individuals coping with aging or terminal illness: Promotes acceptance and living meaningfully in the face of life’s uncertainties.
• People struggling with social media addiction: Encourages mindfulness and behaving according to one’s principles to reduce compulsive social media use.

Who is a good candidate?

Ask yourself:

• Am I willing to try new ways of relating to my thoughts and feelings?
• Am I open to exploring my values and taking meaningful action?
• Do I struggle with avoiding or controlling my emotions instead of accepting them?
• Am I looking for a long-term strategy rather than just symptom relief?

If you answered yes to these questions, ACT may be an excellent fit for you!

ACT might not be the best approach if you:

• Prefer highly structured, logic-based therapy like CBT.
• Want a quick fix for your issues.
• Need immediate symptom reduction due to a crisis.

What are the benefits of ACT?

It helps develop psychological flexibility, allowing people to handle difficult thoughts and emotions while pursuing a meaningful life.

Here are some of its key benefits:

1. Reduces anxiety, depression, and stress
   

• • ACT helps individuals accept negative emotions instead of trying to control or suppress them.
  • Studies show ACT is as effective as cognitive behavioral therapy (CBT) for treating depression and anxiety.
  • Encourages a healthier relationship with thoughts, reducing rumination and worry.

Example: Instead of fighting the thought “I am not good enough,” ACT teaches you to notice it, accept it, and take meaningful action despite it.

2. Improves psychological flexibility
   
   

• • The ability to adapt to life’s challenges and move forward even in difficult situations.
  • Helps people respond to emotions and thoughts in a more balanced way rather than being controlled by them.

Example: If you experience anxiety before public speaking, ACT helps you acknowledge the anxiety without letting it stop you from presenting.

3. Encourages mindfulness and present-moment awareness
   

• • Helps individuals stay focused on the here and now rather than being stuck in the past or future.
  • Teaches mindfulness exercises that improve emotional regulation and stress management.

Example: “Leaves on a stream” is a common ACT exercise where you imagine placing thoughts on leaves and watching them float away, helping to observe thoughts instead of being consumed by them.

4. Decreases emotional avoidance
   
   

• • ACT teaches you to accept and coexist with painful emotions instead of running away from them.
  • Eases the struggle with feelings and increases tolerance for discomfort.

Example: A person with social anxiety learns to attend events despite feeling nervous, realizing they don’t have to eliminate anxiety to engage in social life.

5. Strengthens one’s sense of self and identity

• • ACT promotes self-as-context, the idea that you are more than your thoughts and emotions.
  • Assists in detaching from negative self-judgments.

Example: Instead of identifying with the thought “I am a failure,” ACT teaches you to say, “I notice I am having the thought that I am a failure,” creating space between you and your opinions.

6. Helps clarify personal values and goals
   
   

• • Encourages people to identify their core values and associate their actions with what truly matters.
  • Promotes living a values-driven existence rather than one controlled by fleeting emotions.

Example: If family and connection are core values, ACT aids in taking steps toward building deep relationships, even when facing fear or discomfort.

7. Promotes long-term behavior change

• • ACT is about lasting transformation instead of just symptom relief alone.
  • Encourages committed action by taking small, important steps toward your goals despite obstacles.

Example: A person struggling with procrastination due to perfectionism learns to take action despite fear of failure, leading to increased productivity and fulfillment.

8. Can be used for many conditions and situations

• • Depression: Reducing negative thought attachment and increasing important behavior.
  • Anxiety disorders: Teaching acceptance of uncertainty and worry.
  • Chronic pain: Helping people live fully despite discomfort.
  • PTSD and trauma: Supporting emotional processing and acceptance.
  • OCD and phobias: Reducing the need for avoidance and compulsion.
  • Addiction and substance use: Advancing mindfulness and choices based on principles.
  • Workplace stress and burnout: Supporting mental resilience and balance.

What are the limitations, downsides, or potential risks?

While it is an effective and evidence-based approach, it is not a one-size-fits-all solution.

Like any therapy, it has limitations, downsides, and potential risks that should be considered.

1. Requires a willingness to experience discomfort
   

• • Not for those looking for quick symptom relief since ACT concentrates on accepting distress rather than eliminating it.
  • Some people may resist accepting painful emotions and struggle with the concept of “letting go of control.”

Example: Someone with severe anxiety might feel exhausted when asked to “sit with” their discomfort instead of using coping strategies like avoidance or distraction.

2. Can be challenging for highly rational or analytical thinkers
   
   

• • ACT involves mindfulness, experiential exercises, and metaphors, which some may find too abstract.
  • Those who prefer structured and logical approaches (like CBT) may struggle with ACT’s emphasis on psychological flexibility rather than problem-solving.

Example: A person with OCD who wants a step-by-step method for eliminating obsessive thoughts may feel frustrated by ACT’s approach of accepting thoughts rather than changing them.

3. Less focus on symptom reduction
   

• • ACT does not directly aim to reduce symptoms of depression, anxiety, or other disorders, unlike traditional therapies (such as CBT).
  • This might discourage individuals who expect therapy to provide direct relief from suffering.

Example: Someone with depression looking for strategies to boost happiness might struggle with ACT’s approach, which aims at living a profound life despite depression rather than making the disorder go away.

4. May not be suitable for crises or severe mental illness
   
   ACT may not be effective for individuals in crisis, such as those with:

• • Severe suicidal ideation.
  • Active psychosis.
  • Manic episodes (in bipolar disorder).

Individuals in severe distress may need stabilization first (medication, crisis intervention) before ACT is helpful!

Example: Someone experiencing hallucinations or delusions may not benefit from mindfulness-based defusion exercises because they may struggle to differentiate reality from thoughts.

5. Effectiveness can depend on the therapist
   

• • Some therapists may not be properly trained in ACT, leading to ineffective treatment.
  • A poor explanation of the core principles may cause misinterpretation of concepts like acceptance (believing it means passive resignation instead of active engagement).

Example: A therapist who doesn’t clarify ACT principles may leave a client believing they should “just accept” an abusive relationship rather than take action to leave it.

6. Some exercises may be emotionally intense
   
   

• • ACT frequently involves exposing oneself to uncomfortable thoughts and feelings, which can initially feel devastating.
  • This may be challenging for those with severe trauma, PTSD, or unresolved emotional pain.

Example: A person with PTSD may struggle with exercises that push them to sit with painful emotions, potentially leading to emotional upset if not guided properly.

7. Less emphasis on changing negative thought patterns
   

• • Unlike cognitive behavioral therapy (CBT), ACT does not focus on challenging or restructuring negative thoughts.
  • Some people may prefer a more proactive approach to altering their thinking patterns rather than just observing them.

Example: A person with severe self-criticism might feel that simply “acknowledging” their thoughts isn’t enough. They might prefer a CBT-based approach that challenges and reframes self-judgmental beliefs.

8. Limited research for some populations and conditions
   
   While ACT is well-supported for depression, anxiety, chronic pain, and stress, research is still emerging for:

• • ADHD
  • Eating disorders
  • Personality disorders

More studies are needed to confirm its long-term effectiveness for certain disorders and age groups.

Example: ACT has shown promise for eating disorders, but CBT-E (cognitive behavioral therapy for eating disorders) remains the gold standard.

How long do I need to go to acceptance and commitment therapy?

The length of time you’ll need to attend acceptance and commitment therapy (ACT) depends on several factors, including your goals, mental health condition, therapist’s approach, and commitment to practice outside of sessions.

1. Typical duration of ACT therapy
   

• • Short-term (6–12 sessions):

• • • Many ACT programs are structured as brief interventions, lasting 6–12 weekly sessions (1–3 months).
    • Effective for mild-to-moderate anxiety, depression, stress, or life challenges.

• • Medium-term (3–6 months):

• • • Some individuals may need 12–24 sessions (3–6 months) to see lasting benefits.
    • Common for people working through chronic stress, relationship issues, or major life changes.

• • Long-term (6+ months to ongoing):

• • • For those with chronic conditions (long-term depression, PTSD, OCD, or chronic pain), therapy may last 6 months to a year or more.
    • Some people choose to continue ACT as maintenance therapy for persistent growth.

Example: Someone with generalized anxiety might attend weekly sessions for 3 months, then biweekly or monthly sessions as they become more independent in using ACT skills.

2. Factors that influence ACT duration
   

• • Severity of your condition: More sessions may be needed if symptoms are severe.
  • Your personal goals: Therapy may be shorter if you have a specific goal, such as managing work stress.
  • How often you attend therapy: Weekly sessions may lead to faster progress than biweekly or monthly ones.
  • Your willingness to practice ACT skills: ACT is skill-based, which means the more you practice outside of therapy, the quicker you’ll see results.
  • Therapist’s approach: Some therapists use structured ACT programs, like 8-session models, while others offer open-ended support.

Can ACT be done as a self-help approach?

Yes! If you don’t want long-term therapy, you can:

• Read ACT books (The Happiness Trap by Dr. Russ Harris).
• Use ACT-based apps (ACT Companion, Unwinding Anxiety).
• Try ACT worksheets & exercises (defusion techniques, values clarification).
• Listen to ACT-based podcasts or guided mindfulness exercises.

Many people find that combining self-help with therapy speeds up progress!

How will I know when to stop ACT?

You may reduce or stop therapy when you:

• Feel more in control of your thoughts and emotions.
• Can apply ACT techniques (like mindfulness and defusion) autonomously.
• Are taking action based on your values.
• No longer feel therapy is essential for progress.

Some people return for booster sessions as needed, especially during stressful times.

How much does acceptance and commitment therapy (ACT) cost?

The cost varies based on factors such as the therapist’s location, experience, session length, and whether you use insurance or self-pay.

1. Average cost of ACT therapy
   

• • In-person therapy:

• • • $100–$250 per session (standard rate in the U.S.).
    • Therapists in large cities, such as New York or Los Angeles, may charge $200+ per session.
    • Sliding-scale fees may be available for lower-income clients.

• • Online ACT therapy:

• • • $60–$150 per session (sometimes lower than in-person therapy).
    • Subscription-based platforms (like BetterHelp, Talkspace) charge $240–$400 per month for unlimited messaging and weekly video sessions.

• • Group ACT therapy:
    

• • • $30–$75 per session (often more affordable than individual therapy).
    • Offered through community centers, hospitals, or online support groups.

• • ACT-based self-help options (more affordable):

• • • ACT Books: The Happiness Trap by Russ Harris ($15–$25).
    • ACT Apps: ACT Companion, Unwinding Anxiety ($5–$20/month).
    • Free online ACT worksheets and exercises: Available through mental health websites or at the end of this article!

2. Does insurance cover ACT therapy?
   

• • Yes, if the therapist is in-network with your insurance provider.
  • Many insurance plans cover ACT as part of general mental health treatment.

• • Check with your insurance provider:

• • • Ask if they cover “mental health counseling” or “psychotherapy.”
    • Confirm the copay (usually $20–$50 per session) or deductible (some require you to pay out of pocket up to a certain amount).
      • Medicaid/Medicare: Coverage varies by state, but some programs include ACT under behavioral therapy.
    • If the therapist is out-of-network:
      • You may need to pay upfront and get reimbursement later (if your insurance offers out-of-network benefits).

3. How to reduce the cost of ACT therapy
   
   

• • Look for sliding-scale fees: Several therapists adjust pricing based on income.
  • Find low-cost community clinics: Some offer therapy for $30–$60 per session.
  • Check for university counseling centers: Many provide ACT therapy at reduced rates (or free) by supervised graduate students.
  • Try online therapy platforms: More affordable than traditional therapy.
  • Use self-help ACT resources: Books, apps, and worksheets can supplement therapy or be used alone.

ACT therapy can cost anywhere from $60–$250 per session, depending on whether it’s in-person, online, or covered by insurance.

Consider sliding-scale therapists, group therapy, or self-help options if affordability is a concern.

How to get started?

Whether you’re working with a therapist or exploring ACT on your own, getting started involves learning its core principles, practicing exercises, and applying them in daily life.

Try following this step-by-step guide:

1. Understand the basics of ACT
   ACT is based on six core processes that promote psychological flexibility:

• • Cognitive defusion: Learning to detach from negative thoughts instead of getting caught in them.
  • Acceptance: Allowing difficult emotions and experiences instead of resisting them.
  • Present-moment awareness (mindfulness): Staying engaged with the here and now.
  • Self-as-context: Seeing yourself as more than your thoughts and feelings.
  • Values clarification: Recognizing what truly matters to you in life.
  • Committed action: Taking significant steps in alignment with your values.

Get started: Read books like The Happiness Trap by Russ Harris or ACT Made Simple.

2. Practice important ACT exercises
   Try these beginner-friendly ACT exercises to build psychological flexibility:

• • Cognitive defusion exercise:
    

• • • Write down a negative thought you often have (“I’m not good enough”).
    • Say it out loud in a silly voice or sing it to the tune of “Happy Birthday.”
    • Notice how it feels less powerful when you don’t take it so seriously.

• • Leaves on a stream (mindfulness exercise):

• • • Close your eyes and imagine your thoughts as leaves floating down a river.
    • Whenever a new thought appears, place it on a leaf and let it drift away.
    • This helps you observe thoughts instead of getting caught in them.

• • Values exploration:

• • • Write down what truly matters to you in key areas of life (relationships, career, health, personal growth).
    • Ask: Am I living according to these values?
    • Choose one small deed you can take today to move toward something important.

Get started: Use printable ACT worksheets to guide your exercises. (These are included at the end of the article!)

3. Apply ACT in daily life
   
   

• • Notice when you’re struggling with difficult thoughts or emotions.
  • Practice mindfulness by bringing your attention back to the present moment.
  • Use acceptance instead of fighting distress. Remind yourself, “It’s okay to feel this way.”
  • Take values-based action even if you don’t feel motivated, such as calling a friend even when depressed.

Get started: Keep a journal to track your thoughts, feelings, and minor daily actions that align with your values.

4. Consider working with an ACT therapist
   
   Working with a therapist trained in ACT can be helpful if you want guidance. They can aid you:

• • Identify and challenge unhelpful thinking patterns.
    
  • Work through emotional avoidance.
    
  • Take steps toward a values-driven life.

• • Find an ACT therapist:

• • • Use online directories like Psychology Today or ACT therapist listings.
    • Ask therapists if they use acceptance and commitment therapy in their practice.

5. Explore ACT books, courses, and apps
   

• • Recommended books:

• • • The Happiness Trap – Russ Harris (great for beginners).
    • ACT Made Simple – Russ Harris (for deeper learning).
    • A Liberated Mind – Steven Hayes (founder of ACT).

• • Apps:

• • • ACT Companion (Guided ACT exercises).
    • Happify (Mindfulness and values-based exercises).
    • Mindfulness Coach (Assists with present-moment awareness).

The key is consistent practice. Start small and integrate ACT into your daily routine.

How to find a qualified therapist?

1. Search online therapy directories
   
   Many professional directories allow you to search specifically for therapists who practice ACT.
   These are some reliable options:

• • Psychology Today therapist directory

• • • Enter your location.
    • Use the filter to search for therapists specializing in acceptance and commitment therapy (ACT).

• • Association for Contextual Behavioral Science (ACBS)

• • • ACBS is the professional organization behind ACT.
    • Their therapist directory lists ACT-trained professionals worldwide.

• • GoodTherapy

• • • Search for ACT-based therapy by filtering for “Types of Therapy” and selecting “Acceptance and Commitment Therapy (ACT).”

• • BetterHelp or Talkspace

• • • These platforms offer online ACT therapy with licensed professionals.

2. Look for ACT-certified therapists
   
   Not all therapists are trained in ACT, so you’ll want to ask about their experience.
   Consider asking the following questions when reaching out:

• • Do you specialize in ACT?
  • What training or certifications do you have in ACT?
  • How do you integrate ACT into therapy?

3. Consider teletherapy or online ACT programs
   Think about virtual therapy if you don’t have an ACT therapist nearby:

• • Online ACT therapy: Platforms like BetterHelp, Talkspace, or Thriveworks offer ACT-trained therapists for video sessions.
  • ACT-based apps: Some apps, like ACT Companion or Happify, provide self-guided ACT exercises.

4. Check with your insurance provider
   
   If you’re looking for an ACT therapist covered by insurance:

• • Contact your insurance company and ask for a list of covered mental health providers.
  • Search their database for therapists trained in ACT.
  • Ask the counselor directly if they accept your insurance.

5. Ask for recommendations
   You can also find an ACT therapist through:

• • Your primary care doctor: They might refer you to a specialist.
  • Local mental health clinics: Many suggest ACT-based services.
  • Community groups or support forums: Online groups such as Reddit’s r/ACTtherapy can share personal recommendations.

Final tips

• Try a few sessions to see if the therapist is a good fit.
• Look for a psychotherapist who makes you feel comfortable and understands your needs.
• Consider the cost and accessibility: Many therapists offer sliding scale fees or online options.

What to expect from ACT?

1. Increased psychological flexibility: It teaches you how to adapt to difficult notions and emotions without being controlled by them.
2. Mindfulness practices: You’ll learn mindfulness techniques to stay present and aware, helping you engage more fully in life.
3. Acceptance over avoidance: ACT helps you make space for painful emotions, so they have less power over you instead of struggling against painful emotions.
4. Cognitive defusion: You’ll discover how to detach from negative beliefs rather than believing them or letting them define you.
5. Clarifying values: Exploring what truly matters to you and learning how to align your behaviors with these values.
6. Committed action: The therapy stresses taking meaningful action steps toward your goals, even in the face of discomfort.

Examples of ACT in practice

• ACT for depression
  
  

• • A person feeling stuck in life identifies core values (creativity, kindness) and commits to small daily actions aligned with those values, even when they feel low.

• ACT for anxiety

• • Someone with social anxiety is taught to notice their anxious thoughts (“They’ll think I’m stupid”) without engaging in them. Instead of avoiding social events, they take small, meaningful steps toward connecting with others based on their values.

• ACT for chronic pain

• • Rather than fighting against chronic pain or letting it control their life, a patient learns to accept it while still participating in activities that support their values, such as spending time with loved ones.

• ACT for work stress
  
  

• • An employee struggling with job stress learns to observe self-critical beliefs without judgment and concentrate on actions that ally with their career and personal goals.

• ACT for perfectionism

• • A student struggling with perfectionism learns to accept that mistakes are part of learning rather than trying to eliminate their fear of failure.
    Instead of evading challenging tasks, they take steps aligned with their academic and personal values.

• ACT for relationship issues
  
  

• • Someone struggling with trust issues in a relationship learns to notice their anxious thoughts (“What if they leave me?”) without reacting impulsively.
    Instead, they focus on behaving in ways that side with their ideals (honesty, kindness).

• ACT for obsessive-compulsive disorder (OCD)

• • A person with OCD practices allowing distressing thoughts to exist without engaging in compulsions.
    They commit to actions that support their beliefs, like spending time with loved ones rather than seeking certainty by performing rituals.

• ACT for public speaking anxiety

• • A professional who fears public speaking learns to accept their anxiety instead of trying to suppress it. By concentrating on their values (sharing knowledge, helping others), they engage in public speaking despite discomfort.

• ACT for weight management and healthy living
  
  

• • An individual learns to make food choices based on long-term health values in place of short-term emotional avoidance, such as aiming for a rigid diet. They practice self-compassion rather than guilt after setbacks.

• ACT for creative professionals

• • A writer struggling with self-doubt practices defusion techniques by seeing their inner critic as just “background noise” rather than a truth. They continue writing even when feeling uninspired to align their actions with their creative passion.

• ACT for fear of failure among entrepreneurs

• • A business owner struggling with self-doubt learns to defuse thoughts like “I’m not good enough” and instead focuses on merits such as innovation and persistence. They continue pursuing their business goals despite fear.

• ACT for parenting stress
  
  

• • A parent devastated by stress accepts their emotions rather than feeling guilty about them. They practice mindfulness and commit to showing up for their child with love, even on difficult days.

• ACT for recovering from a breakup

• • An individual practices acceptance and aims at principles like self-growth and connection instead of ruminating over a past relationship. This allows them to engage in new, fulfilling activities.

• ACT for procrastination

• • Instead of avoiding work due to fear of failure, a student acknowledges their discomfort and commits to working on assignments in small steps that line up with the significance of learning.

• ACT for managing social media overuse

• • A person struggling with extreme screen time practices mindfulness by noticing urges to check social media and choosing to engage in important matters instead.

ACT exercises and worksheets

You can use the following acceptance and commitment therapy (ACT) exercises and worksheets to develop psychological flexibility and live in alignment with your principles.

1. Cognitive defusion exercises
   
   

Goal: Help separate from unhelpful thoughts so they have less control over your behavior.

Exercise: “Leaves on a stream” visualization

Worksheet:

• • Write down an intrusive or distressing thought.
  • Close your eyes and visualize a gentle stream with leaves floating on the water.
  • Imagine placing each thought onto a leaf and watching it float away.
  • Repeat with other pessimistic notions without trying to change or stop them.

Purpose: Teaches that thoughts come and go, and we don’t have to get stuck in them.

2. Acceptance exercises

Goal: Increase willingness to experience difficult emotions instead of resisting them.

Exercise: “Expansion exercise”

Worksheet:

• • Pen down an emotion you have been struggling with (anxiety, sadness).
  • Notice where you feel it in your body (chest tightness, stomach tension).
  • Breathe into the sensation and imagine making space for it.
  • Describe what it feels like without judging it.

Purpose: Pushes the acceptance of emotions rather than suppression.

3. Present moment awareness (mindfulness) exercises
   
   

Goal: Aids staying grounded in the present rather than getting lost in thoughts.

Exercise: “Five senses grounding”

Worksheet:

• • List:
    • 5 things you can see.
    • 4 things you can touch.
    • 3 things you can hear.
    • 2 things you can smell.
    • 1 thing you can taste.

Purpose: Bringing awareness to the present moment and lowering rumination.

4. Self-as-context exercises

Goal: To recognize that you are not your thoughts or emotions.

Exercise: “Observing your thoughts”

Worksheet:

• • Write down a negative thought you often have about yourself.
  • Ask yourself:

• • • “If this thought were a radio station, what would it be called?”
    • “If this thought were a character in a movie, what kind of character would it be?”
    • “What happens when I take a step back and just notice this thought instead of believing it?”

Purpose: Detaching from thoughts and seeing them as external, not part of your identity.

5. Values clarification exercises

Goal: Identify core personal values to guide behavior.

Exercise: “The 80th birthday speech”

Worksheet:

• • Imagine you are at your 80th birthday party, and someone gives a speech about your life.
  • Write down what you hope they say about you.
  • Identify what values those statements reflect. For example, kindness, perseverance, and honesty.
  • Ask yourself: “Am I currently living in alignment with these values?”

Purpose: Clarifies principles and motivates purposeful action.

6. Committed action exercises
   
   

Goal: Promote action based on importance, despite discomfort.

Exercise: “The one small step”

Worksheet:

• • Identify a meaningful goal based on your principles.
  • Break it down into the smallest possible step you can take today.
  • Write:
    • “If discomfort arises, I will remind myself that this action sides with my values.”
  • After completing the step, reflect:
    • “What did I learn from taking this action?”

Purpose: Helps build momentum and action, even when fear or discomfort is present.

7. “Thank your mind” exercise (cognitive defusion for negative thoughts)

Goal: Reduce the impact of negative self-talk by treating thoughts as separate from reality.

Worksheet:

• • Write down a negative belief you often experience (“I am worthless”).
  • Instead of treating the thought as an absolute truth, say:
    • “Thank you, mind, for that thought.”
    • “I notice I am having the thought that…”
  • Repeat the thought out loud in a silly voice or sing it to the tune of “Happy Birthday.”
  • Reflect: Did the thought lose some of its power?

Purpose: detaching from self-critical thoughts rather than engaging in them.

8. “The struggle switch” exercise (acceptance of emotions)

Goal: Reduce the emotional struggle that fuels depression.

Worksheet:

• • Discover a feeling you have been trying to avoid, like sadness or loneliness.
  • Describe what happens when you fight it (does it get stronger, persist, or drain energy?).
  • Imagine a light switch labeled “struggle.”
  • Visualize what would happen if you turned the struggle switch off. Allow the emotion to just “be” without trying to change it.
  • Commit to allowing emotions to exist without resisting them.

Purpose: Lowering emotional resistance and exhaustion.

9. “What would my best friend say?” (self-compassion exercise)
   
   

Goal: Cultivate self-compassion to counter depressive self-judgment.

Worksheet:

• • Pen down a negative thought you have about yourself, like “I am not good enough”.
  • Imagine a friend feeling this way. What would you say to them?
  • Write down your response as if comforting a friend.
  • Now, read your response to yourself.

Purpose: Shifts self-talk from critical to supportive, reducing depressive self-judgment.

10. “The life compass” (values clarification for motivation)

Goal: Reconnect with your values and find direction.

Worksheet:

• • Draw a compass with four quadrants labeled:
    • Relationships.
    • Personal growth.
    • Health and well-being.
    • Work and contribution.
  • Write down what truly matters to you in each area.
  • Reflect:
    • Are you currently living according to these principles?
    • What small step could you take today to move closer to one value?

Purpose: Assists individuals in regaining a sense of purpose and motivation.

11. “The 5-minute activation challenge” (committed action for behavioral activation)
    
    

Goal: Overcome inaction and take small steps toward positive change.

Worksheet:

• • Choose an activity you used to enjoy or value (taking a walk, painting, calling a friend).
  • Set a timer for 5 minutes. Commit to engaging in the activity for this short time, no matter how you feel.
  • After 5 minutes, reflect:
    • Did it shift your mood, even slightly?
    • Would you like to continue for another 5 minutes?

Purpose: Helps break the cycle of inaction and re-engage with life.

12. “My thoughts are not facts” (defusion from depressive thinking)

Goal: Ease belief in automatic negative thoughts.

Worksheet:

• • Write down a negative thought you frequently have (“I will always be alone”).
  • Ask yourself:
    • “What evidence supports this thought?”
    • “What proof contradicts this thought?”
    • “If a friend had this thought, what would I say to them?”
  • Reframe the thought into a more balanced statement (“Right now, I feel alone, but I have had meaningful connections before and can build them again”).

Purpose: Breaking depressive belief patterns.

13. “Dropping the anchor” (mindfulness for emotional grounding)
    
    

Goal: Decrease crushing and pessimistic thoughts by staying present.

Worksheet:

• • When overwhelmed, pause and concentrate on your breath for a few seconds.
  • Acknowledge thoughts and feelings without judgment.
  • Come back to your physical environment:
    • Press your feet firmly on the ground.
    • Notice your surroundings.
  • Take action toward a small value-aligned step (making tea, stretching).

Purpose: Helps ground oneself in the present instead of getting lost in antagonistic thoughts.

14. “If my depression were a character” (self-as-context perspective-taking)

Goal: Externalize depression to gain perspective.

Worksheet:

• • Imagine your depression as a character and describe it.
    • What does it look like?
    • How does it talk?
    • What are its favorite phrases?
  • Give this character a name (“the critic” or “the cloud”).
  • The next time it appears, recognize it:
    • “Oh, here comes ‘the judge’ telling me I’m worthless again.”

Purpose: To separate oneself from depression, reducing its grip.

• Reflection section
  
  A reflection section after these tasks can also be helpful. Possible reflections could be: “What insights did you gain from these exercises?”, “Which ones resonated with you the most?”, “How can you integrate them into your daily life?”

Final thoughts

ACT is a useful and research-backed approach that helps people live more meaningful lives, even in the presence of distress.

Instead of trying to control thoughts and emotions, ACT pushes individuals to accept them and act based on their importance.

This allows them to focus on what truly matters.