ACT, short for Acceptance and Commitment Therapy (pronounced as the word “act,” not the initials), is a form of psychotherapy that helps people build what clinicians call psychological flexibility: the ability to respond to difficult situations in ways that move you toward the life you actually want to live. Developed by psychologist Steven Hayes in the 1980s and formally outlined in 1999, ACT takes a different approach from traditional talk therapy. Rather than trying to eliminate painful thoughts and feelings, it teaches you to change your relationship with them so they no longer control your behavior.
Unlike therapies that measure success by how much your symptoms decrease, ACT treats symptom reduction as a byproduct. The primary goal is improving your subjective quality of life, helping you take meaningful action even when uncomfortable thoughts and emotions show up.
How ACT Differs From Traditional CBT
If you’ve heard of cognitive behavioral therapy (CBT), ACT will sound familiar in some ways but diverge sharply in others. CBT focuses on identifying and changing distorted thoughts. If you believe “I’m a failure,” CBT teaches you to challenge that thought, test it against evidence, and replace it with something more balanced. ACT doesn’t ask you to argue with the thought at all. Instead, it helps you notice the thought, recognize it as just a mental event, and choose your next action based on what matters to you rather than what your mind is telling you.
In a randomized clinical trial comparing 12 sessions of ACT to 12 sessions of CBT for anxiety disorders, both treatments produced substantial improvement by the end of treatment. The more interesting findings emerged afterward. At the 12-month follow-up, people who completed ACT showed steeper improvements in their primary anxiety disorder severity, a difference of large effect size. ACT participants also scored higher on psychological flexibility. CBT participants, however, reported higher quality of life at that same follow-up, suggesting each approach has distinct long-term strengths. Overall, the researchers concluded ACT is a “highly viable treatment” for anxiety disorders, performing comparably to CBT on most measures.
The Six Core Processes
ACT is built around six overlapping skills, collectively known as the Hexaflex model. These aren’t sequential steps. They work together, and a single therapy exercise might target several at once.
- Acceptance: Learning to make room for unwanted feelings, urges, and sensations instead of fighting or avoiding them. This doesn’t mean liking or wanting them. It means dropping the struggle so you can redirect your energy.
- Cognitive defusion: Creating distance between you and your thoughts. Techniques might include repeating a distressing word until it loses its emotional charge, or prefacing a thought with “I’m having the thought that…” The goal is to see thoughts as passing mental events, not facts you have to obey.
- Contact with the present moment: Paying attention to what’s happening right now rather than getting lost in worries about the future or regrets about the past. ACT includes mindfulness, but it looks different from traditional meditation (more on that below).
- Self-as-context: Recognizing that you are not your thoughts, feelings, or experiences. You are the awareness observing them. This perspective makes it easier to experience difficult emotions without feeling defined or overwhelmed by them.
- Values: Clarifying what genuinely matters to you, not what society expects or what anxiety dictates. Values in ACT are ongoing directions (being a caring parent, living creatively) rather than goals you check off a list.
- Committed action: Taking concrete steps guided by your values, even when it’s uncomfortable. This is where ACT connects inner work to real-world behavior change.
Together, these six processes build psychological flexibility, which ACT defines as “the tendency to respond to situations in ways that facilitate valued goal pursuit.” It includes staying in touch with the present moment and the feelings it brings, without fighting them unnecessarily.
Mindfulness in ACT vs. Traditional Meditation
ACT uses mindfulness, but it’s not a meditation program. Traditional mindfulness training, like programs based on mindfulness-based stress reduction (MBSR), centers on guided meditation practices that often run 30 minutes or longer per session, with daily home practice encouraged. ACT sessions typically include shorter mindfulness exercises of around 10 minutes, and these are always paired with a values exercise or a metaphor that connects the practice to real-life behavior.
In fact, most systematic reviews of workplace mindfulness research exclude ACT studies entirely, either because ACT doesn’t use meditation as its central component or because it’s considered more therapeutic than standard mindfulness training. The stated purpose of an ACT-based program is typically something like “to learn how to use personal values as a guide to daily behavior,” with mindfulness serving that larger goal rather than being the goal itself.
What Conditions ACT Treats
ACT is considered a transdiagnostic intervention, meaning it works across a wide range of conditions rather than being designed for just one. It has demonstrated effectiveness for anxiety disorders (including generalized anxiety, social anxiety, and public speaking anxiety), depression, PTSD (including among veterans), OCD, chronic pain, anorexia nervosa, trichotillomania, and smoking cessation. It has also been adapted for school-based mental health programs and delivered successfully through videoconferencing for social anxiety disorder.
This breadth makes sense given ACT’s design. Because it targets the underlying processes of getting stuck (rigid thinking, avoidance of discomfort, disconnection from values) rather than the specific content of any one disorder, the same core skills apply whether someone is struggling with intrusive thoughts, chronic pain, or an eating disorder.
What ACT Sessions Look Like
A typical course of ACT involves around 8 to 16 sessions, consistent with the broader pattern in outpatient psychotherapy where the median number of sessions across studies falls around 8, with most manualized protocols using a 16-session format. Some people benefit from fewer sessions, particularly when ACT is delivered in a focused workshop or group format, while others continue longer depending on the complexity of their concerns.
Sessions are active and experiential. Rather than spending the hour analyzing your past or debating your thoughts, you’ll practice exercises and work with metaphors. A therapist might ask you to hold an ice cube while noticing the urge to drop it, as a way to practice sitting with discomfort. Or they might use the “passengers on the bus” metaphor, where your difficult thoughts are unruly passengers shouting directions while you, the driver, choose where to steer based on your values. Homework between sessions often involves practicing defusion techniques in daily life and taking small values-based actions.
ACT Training for Professionals
If you searched “ACT training” because you’re a therapist or counselor looking to learn the approach, the main professional organization is the Association for Contextual Behavioral Science (ACBS). The ACBS oversees a peer-reviewed trainer process, though it’s worth noting this is not a formal certification or accreditation program. There is no single “ACT certification” that determines who can or cannot practice ACT.
To be listed as a peer-reviewed ACT trainer (someone who trains other therapists), you need a terminal degree in a behavioral health field, strong competency both as an ACT therapist and as a trainer, a working knowledge of the underlying science (behavior analysis, relational frame theory, and functional contextualism), and you must pass a peer review process. Professionals from fields like social work, counseling, marriage and family therapy, and health psychology can qualify if their training includes relevant behavioral principles.
For clinicians simply wanting to use ACT with clients (rather than train other therapists), the path is less formal. Most start with ACBS workshops, books by Steven Hayes and other ACT developers, and supervised practice. Many therapists integrate ACT techniques into existing approaches rather than switching entirely, since the skills-based framework lends itself to flexible application.