What is Acceptance and Commitment Therapy (ACT)?

This blog will explore Acceptance and Commitment Therapy (ACT), an evidence-based approach that is often used by aspiring and trainee psychologists when working with service users. ACT is a therapeutic model that emphasises mindfulness, self-acceptance, and the courage to face life’s challenges head-on. This blog will guide you through ACT’s core principles, the Hexaflex model, and its benefits across a range of clinical issues.

Interested in practical mindfulness applications within ACT, check out this related post on mindfulness.

Read on, to uncover how ACT empowers individuals to live rich, meaningful lives amid life’s complexities.

ACT (pronounced as the word ‘ACT’) was developed in 1968 by Steve Hayes (Harris, 2006). It is one of several ‘third wave’ therapies and emphasises the development of mindfulness skills with the practice of self-acceptance.

ACT focuses firmly on living life alongside the challenges and difficult experiences that can and will arise for most people at some point in their lives. ACT focuses on supporting people to learn ways to be fully present, by practicing ways to ‘defuse’ difficult thoughts and feelings and connect with the things that matter to them (such as their values). It teaches mindfulness skills as an effective way to handle difficult experiences. It is through taking effective action, guided by our values, that ACT helps individuals to create a rich and meaningful life.

The ‘Hexaflex’ is the key model of the ACT framework. It provides six key processes that guide both therapists and service users in navigating challenges. It’s called the “Hexaflex” because it visually represents six interlinked areas of psychological flexibility, helping to simplify complex experiences into manageable parts (Hayes et al., 2006; Prevedini et al., 2011).

Each part of the Hexaflex—Acceptance, Cognitive Defusion, Contact with the Present Moment, Self-as-Context, Values, and Committed Action—provides a distinct approach to dealing with difficult thoughts, emotions, and situations. By breaking things down this way, the model helps service users see where they might feel “stuck” and provides clear steps for moving forward. For example, “Acceptance” teaches ways to make room for uncomfortable feelings, while “Values” encourages service users to identify what matters most in life.

When service users work through these key areas they learn to notice how they are becoming stuck and how to “untie” themselves. As emphasised in this framework, the focus of ACT is to both reduce suffering and promote rich, meaningful, and vibrant lives.

Overall, the Hexaflex helps guide therapy by offering a structured, yet flexible, framework that adapts to each individual’s needs, whether they’re dealing with anxiety, depression, or other life challenges. It empowers people to approach therapy with a clearer focus, grounded in their own values and goals, making it easier to create meaningful change over time.

 

The ‘Hexaflex’ model of ACT for psychological flexibility and inflexibility.

Credit: Prevedini et al. (2011)

The process of practising non-judgmental awareness to internal and external events. Through this practice, individuals recognise that there are somethings that we cannot control and if we accept this, we can make better decisions about the part we have control over – the actions we make.

The process of learning to notice the process of thought, rather than getting caught up in the content. By stepping back and observing the process of thinking, thoughts that may have previously led to significant distress or challenging behaviour weaken.

The process of contacting the ‘observing self’, a part of us that is able to witness thoughts, feelings, and actions at any moment. This part of us allows us to be mindful and in practicing contact with the observing self, it is possible to change previously tightly held beliefs about oneself.

The process of defining what is most important to an individual in their life. In this process of connecting to a deeper sense of what matters, it is possible to define purpose, direction, and the choices we make for a richer and more vibrant future. We can also recognise qualities of behaviour we would like to live in line with.

The process of taking steps towards valued goals while experiencing uncomfortable feelings and thoughts. By doing this an individual learns how committing to the valued action, rather than the outcome, can bring better meaning to life.

The overall therapeutic aim of ACT helps the service user to reach a more general goal of psychological flexibility, meaning that individuals are able to live in the present moment with consciousness and intention, persisting with actions or changing them dependent on individual values (Prevedini et al., 2011).

Aspiring and trainee psychologists using ACT are likely to benefit from its flexibility as it can be used with individuals, couples, and groups as both brief and long-term therapy. Additionally, ACT allows psychologists to create and individualise their own mindfulness techniques, or to co-create them with service users (Harris, 2006).

ACT can support a wide range of clinical populations. It is most often used to support service users experiencing anxiety, depression, obsessive compulsive disorder (OCD), addictions, chronic pain, and those with high levels of self-criticism (Harris, 2006; Prevedini et al., 2011).

Research has demonstrated the benefits and efficacy of ACT. For example, after services users experiencing chronic pain had a brief intervention using ACT (four one-hour individual sessions), their sick-leave from work and medical appointment frequency reduced in comparison to service users who received an intervention including a combination of support and resources but not including ACT (Dahl et al., 2004).Group ACT has also been shown to be effective for reducing anxiety symptoms in those diagnosed with a mental health condition (e.g., anxiety disorders, substance use disorder, personality disorder) or with a physical condition (e.g., musculoskeletal pain, vascular disease, fibromyalgia) (Ferreira et al., 2022). Studies also show that group ACT is effective in treating depressive symptoms in broader populations, including those with physical and mental health conditions and parents of children living with a disability or chronic illness (Ferreira et al., 2022).

As an aspiring clinical psychologist, you are likely to come across individuals who struggle to utilise effective coping skills or connect to themselves fully during difficult moments. It is likely you will become familiar with some of the skills used in ACT, such as mindfulness (staying in the present moment, without judgement), connecting to your own values, and helping others become connected to theirs.

As evidenced, ACT is helpful for psychologists as it draws on a wide range of concepts and skills which can aid service users facing multiple challenges in life such as both mental and physical health difficulties.

As with any therapeutic modality, discuss your cases in supervision and consider the most appropriate approach depending on your service, your skills, and your supervisor’s experience.

And…

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Dahl, J. C., Wilson, K. G., Nilsson, A. (2004). Acceptance and Commitment Therapy and the treatment of persons at risk for long-term disability resulting from stress and pain symptoms: a preliminary randomized trial. Behaviour Therapy, 35(4), 785-801. https://doi.org/10.1016/S0005-7894(04)80020-0

Ferreira, M. G., Mariano, L. I., de Rezende, J. V., Caramelli, P., & Kishita, N. (2022). Effects of group Acceptance and Commitment Therapy (ACT) on anxiety and depressive symptoms in adults: A meta-analysis. Journal of Affective Disorders, 309, 297-308. https://doi.org/10.1016/j.jad.2022.04.134

Harris, R. (2006). Embracing Your Demons: an Overview of Acceptance and Commitment Therapy. Psychotherapy in Australia, 12(4), 2-8.

Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., Lillis, J. (2006). Acceptance and commitment therapy: an experiential approach to behavior change. Behaviour Research Therapy, 44(1), 1-25. https://doi.org/10.1016/j.brat.2005.06.006

Prevedini, A. B., Presti, G., Rabitti, E., Miselli, G., & Moderato, P. (2011). Acceptance and Commitment Therapy (ACT): the foundation of the therapeutic model and an overview of its contribution to the treatment of patients with chronic physical diseases. Giomale Italiano di Medicina del Lavoro ed Ergonomia, 33(1 Suppl A), A53-63.