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What Is Acceptance and Commitment Therapy (ACT)? How It Works, What It Helps With, and the Evidence

What is acceptance and commitment therapy?

Acceptance and commitment therapy (ACT) is a psychotherapy that builds psychological flexibility through six processes. What it is, what it helps with, the evidence, and where coaching differs.

Acceptance and commitment therapy, usually shortened to ACT (said as the word "act"), is a form of psychotherapy that does not make getting rid of difficult thoughts and feelings its first goal. It aims instead at what its developers call psychological flexibility: being in contact with the present moment and, depending on what the situation allows, changing or persisting in behavior in the service of the values you have chosen. The idea is that a person can feel anxious, sad or ashamed and still do what matters to them. ACT's developers argue that fighting the feeling is often what shrinks a life.

This page explains where ACT came from, the six processes it works through, what it has been used for, and what the research says, including where it did no better than older treatments. It also says plainly, in the middle of the page, that ACT is delivered by licensed clinicians and that coaching is not a replacement for it.

Where ACT comes from

ACT was developed by the psychologist Steven C. Hayes, working with Kirk Strosahl and Kelly Wilson, who together wrote the standard clinician's text, Acceptance and Commitment Therapy: The Process and Practice of Mindful Change (second edition, 2011). It is often discussed alongside cognitive behavioral therapy (CBT), the other widely studied talk therapy it is compared with in the research below.

ACT is linked to a research program on human language and thought called relational frame theory. In a 2006 paper describing the ACT model, Hayes and colleagues state that link directly. The rough idea is that language lets us predict, evaluate and worry, which is useful for solving problems in the outside world and much less useful when turned on our own feelings, because the mind can produce a painful thought faster than we can argue with it. Relational frame theory is a theory, and this page does not treat it as settled fact; the point here is only that it is the framework ACT's developers use to explain why the six processes below are chosen.

The six processes, in plain terms

ACT is often drawn as a six-sided figure, because it treats these six processes as parts of one skill, psychological flexibility, rather than as a sequence of steps.

Acceptance means making room for unwanted feelings and sensations instead of struggling to remove them. It is not approval or resignation. It is closer to willingness: if a feeling is going to be there anyway, the question becomes what you can do with it present.

Cognitive defusion means changing your relationship to a thought rather than arguing with its content. "I am going to fail" is treated as a sentence your mind is producing, which you can notice, instead of a fact you must obey. A common exercise is to restate it as "I am having the thought that I am going to fail."

Contact with the present moment means flexible attention to what is happening now, as opposed to being pulled into replaying the past or rehearsing the future. This overlaps with mindfulness but is one of six processes, not the whole model.

Self-as-context, sometimes called the observing self, is the sense of being the one who notices thoughts and feelings rather than being identical to them.

Values are the directions you want your life to point in, such as being a caring partner or a curious learner. They differ from goals, which can be completed or lost. Values clarification is the work of finding out which ones are really yours rather than inherited "shoulds."

Committed action means taking concrete, repeatable steps in the direction of those values, with the discomfort coming along. The first three processes are mostly about loosening the grip of inner experience; values and committed action point the freed-up effort somewhere.

Explore: cognitive defusion · self as context · values clarification · committed action · psychological flexibility

What ACT is used for

In a 2020 review of 20 meta-analyses, which together reported 100 controlled effect sizes from 12,477 participants, Gloster and colleagues concluded that ACT can be efficacious for the conditions examined, including anxiety, depression, substance use, pain and groups defined by symptoms across diagnoses. A-Tjak and colleagues' earlier 2015 meta-analysis pooled 39 randomized trials with 1,821 patients who had mental disorders or physical health problems.

In practice, ACT is delivered by a trained therapist in sessions, and the conditions in those reviews (anxiety, depression, substance use and pain among them) are conditions where a diagnosis and a treatment plan matter, which is why the line between therapy and coaching, covered below, matters.

Explore: acceptance commitment therapy

What the evidence shows, and what it does not

The A-Tjak 2015 meta-analysis found that ACT outperformed control conditions overall (Hedges' g = 0.57), and was better than waitlist (g = 0.82), psychological placebo (g = 0.51) and treatment as usual (g = 0.64). Those are comparisons against doing nothing or against ordinary care, where a treatment is expected to win. Against established treatments, mainly CBT, the same analysis found no significant difference (p = 0.140). Its authors concluded that ACT appears about as effective as established psychological interventions for anxiety disorders, depression, addiction and physical health problems, and called for more research on quality of life and on how the therapy works.

The 2020 review points the same way. Its abstract reports that ACT was generally superior to inactive controls, treatment as usual and most active comparison treatments, excluding CBT. In other words, the evidence supports ACT as a treatment that can help, and it does not support the claim that ACT beats CBT.

The 2006 model paper by Hayes and colleagues is more cautious still. It reported that the evidence relevant to the ACT model was broadly supportive, and that ACT appears to work through different processes than traditional CBT, but also that there were not enough well-controlled studies at that time to conclude ACT is generally more effective than other active treatments.

There are limits on what this page can say. Meta-analyses combine studies of uneven size and quality, and a pooled number does not tell you what will happen for one person. We did not find, and do not claim, a single trustworthy figure for how many people recover with ACT. We also did not confirm a current evidence rating for ACT from the professional-body listings we checked, so this page does not quote one.

ACT is therapy, and IX Coach is coaching: where the line is

ACT is a psychotherapy. It is delivered by licensed clinicians, such as psychologists, counselors and psychiatrists, who assess what is going on and adapt the work to the person in front of them. IX Coach is coaching, built around reflection and moving from insight to action. It is not therapy, and nothing on this page is a course of ACT.

What coaching can borrow from ACT's ideas is real but limited. Working out what you value, as distinct from what you think you should want, is something many people do outside of therapy. So is choosing one small step in that direction and taking it while still nervous. Noticing a harsh thought as a thought and asking whether acting on it helps you is a self-help practice with a long history. These are skills a person can practice. Practicing them is not the same as treatment.

What coaching cannot replace is treatment for depression, anxiety disorders, post-traumatic stress disorder, obsessive-compulsive disorder, substance use problems, or thoughts of suicide. If your symptoms last for weeks, make it hard to work or look after yourself, or are getting worse, a licensed clinician is the right person to talk to, and ACT may be one option they offer or one among several. If you are not sure which side of the line you are on, there are plain-language guides to telling therapy and coaching apart on this site, linked below.

If you are having thoughts of ending your life or of hurting yourself, you do not have to wait until it feels bad enough. In the United States, you can call or text 988, the 988 Suicide & Crisis Lifeline, or chat at 988lifeline.org; it is free, confidential and available 24/7. If you are somewhere else, findahelpline.com lists verified helplines in more than 175 countries, and if you are in immediate danger, call your local emergency number.

How to find ACT if you want it

If you want to try ACT itself, look for a licensed therapist who says they practice it and ask how they use it with the problem you have. It is reasonable to ask a clinician which format suits your situation. The Association for Contextual Behavioral Science, the professional community around ACT, publishes information about it.

A fair question to ask any therapist about any method is what you should expect to notice, and by when, if it is working. ACT defines its aim as psychological flexibility, meaning flexibility in what you do, so the sign it is aiming for is not that a feeling has gone but that it has less control over your choices.

Common questions

Is ACT the same as mindfulness? No. Mindfulness-style attention is one of six processes. ACT pairs it with values and committed action, so the attention is used to move toward something and not as an end in itself.

Does acceptance mean putting up with a bad situation? As ACT uses the word, acceptance is willingness toward your inner experience, such as feelings, sensations and thoughts. It is not meant as a recommendation to tolerate mistreatment or to stop trying to change circumstances you can change.

Is ACT better than CBT? The evidence above does not show that. The 2015 meta-analysis found no significant difference between them, and the 2020 review reported ACT as generally superior to other comparisons except CBT. Which one suits you may depend on the problem, the therapist and what you respond to.

Can I do ACT on my own? The six processes can be practiced as skills. Whether that is enough depends on what you are dealing with, and for the conditions listed in the section above, a clinician is the safer starting point.

Where IX Coach fits

This page is published by an AI coaching company, and that belongs on the table plainly. IX Coach is an AI coaching system you can talk with directly, designed around reflection, clarity about what matters, and the step from insight to action, and it is available at any hour. It is not an ACT program, and it is not built to be a therapist or a crisis service. If ideas like values or committed action are what you are looking for, a conversation can be one place to explore them, and if what you are dealing with falls in the section above on where the line is, a licensed clinician is the right place to go.

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