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Avoiding, suppressing, or otherwise trying to control your thoughts and feelings can have a negative impact on your behavior, according to the philosophy behind acceptance and commitment therapy, or ACT (pronounced "act").
When clinical psychologist Steven C. Hayes developed ACT in the early 1980s, he based it on two concepts:
As its name suggests, ACT is based on two ideas, according to Jessica Brohmer, a licensed marriage and family therapist in private practice who uses ACT in her sessions.
These two ideas include:
Unfortunate or distressing life events can trigger a spiral of negative thoughts that cause secondary pain — especially when you react out of avoidance, according to Brohmer.
"ACT helps you learn to tolerate the primary pain, without creating any more unnecessary pain, by choosing to act according to your values," Brohmer says.
Below, learn the potential benefits of ACT and how to get started with this approach.
Hayes originally developed ACT in an effort to treat his own panic attacks, but this approach to therapy can treat a wide range of mental health conditions.
ACT may be a good fit if you live with:
ACT can help alleviate situational depression by helping you learn how to better accept your thoughts and feelings around stressful and upsetting events.
A 2020 review found that ACT significantly reduced symptoms of depression, particularly for adults and people with mild depression. These effects proved especially noticeable at a three-month follow-up.
In one 2020 review, seven out of 11 studies found ACT appeared effective for treating anxiety.
Anxiety disorders often stem from psychological inflexibility, or a tendency to try and control your thoughts and feelings to avoid distress.
For example, say you believe that anger makes you a "bad" person. You might then avoid anger-provoking situations out of anxiety that expressing your anger will "ruin" your relationships with people.
ACT can address this by helping you notice and accept your anger in the moment without judgment — instead of suppressing or avoiding it.
Difficulty managing and responding to your emotions may, in some cases, contribute to eating disorders.
ACT could help because of the way it focuses on building psychological flexibility, or the ability to cultivate and maintain an awareness of your thoughts and feelings as they arise.
With this increased awareness, you may be less likely to use unhelpful coping mechanisms like restricting, binge eating, purging, and overexercising.
A small 2020 study found that women who participated in 12 ACT sessions experienced greater reductions in eating disorder symptoms and body image concerns than those who didn't. What's more, the benefits of ACT may last a long time — researchers also found these effects still held at follow-up two years later.
One 2017 review found that people with chronic pain who participated in ACT experienced:
Perhaps you abandon hobbies or avoid social events you'd usually enjoy out of fear that your pain will flare up — when those very activities and events could:
ACT can't take your pain away — but it can help you accept it, along with any related fear and distress you experience, and live a meaningful life in spite of that discomfort.
Very often, substance use serves as a coping mechanism for avoiding uncomfortable thoughts and feelings.
In teaching you how to accept and tolerate emotional distress and commit to other actions that better serve you and your goals, ACT may help reduce urges to use substances.
In a 2020 review of ACT for substance use disorders, most studies showed significant reductions in substance use, both immediately following treatment and at follow-ups three and six months later.
According to Brohmer, the number of sessions you'll attend depends largely on the severity of your symptoms, as well as your commitment to work on yourself between sessions. That said, research suggests most people do well with 12-16 sessions.
Reena B. Patel, a licensed psychologist in private practice, says you'll learn ACT's six core processes in these sessions:
1. Acceptance: This involves embracing your inner thoughts and feelings without trying to ignore or change them. For example, if you're nervous about an upcoming date, your therapist may ask you to scan your body to take note of the physical sensations arising out of that anxiety. If you notice a lump in your throat, they might suggest breathing into the lump, making room for it, and allowing it to exist — not engaging with it or resisting it.
2. Cognitive defusion: This involves detaching yourself from your own thoughts and feelings and learning to use language as a tool to describe internal experiences nonjudgmentally. For example, you might label a negative thought out loud by saying, "I'm having a thought that [XYZ]," which can strip it of its significance and power.
3. Being present: This involves shifting your attention from internal thoughts and feelings toward your external environment, which can help you stay grounded and present as you react to events. For example, your therapist might encourage you to notice five things you can hear, see, feel, and smell in the room in the present moment.
4. Self as context: This involves learning to distinguish yourself from your thoughts and feelings so you don't overidentify with them. For example, you might bring your attention to a certain emotion, make yourself aware that you're noticing it, and observe how it changes with time but you do not.
5. Values: This involves identifying the areas of your life most important to you that could motivate positive change. Your therapist may ask you to fill out a values questionnaire, which entails ranking your values in 10 different life domains, like education, work, spirituality, romantic relationships, and family.
6. Commitment: This involves setting goals for altering your behavior based on the values you identified. For instance, if you value personal growth, your goal may involve dedicating more time to a specific hobby. Your therapist can help you brainstorm small steps for reaching that goal, tips to address any potential roadblocks that might show up, and potential strategies to overcome them.
Brohmer, like most other ACT therapists, assigns "homework" to complete between sessions. ACT homework aims to help you apply the techniques you learn in therapy to real-life scenarios so you can learn to navigate challenging situations on your own.
For example, your therapist might ask you to keep a record of any time you attempt to avoid or control painful thoughts, feelings, and urges by:
Over time, this exercise may help you become more aware of the specific strategies you tend to lean on, so you can replace them with more productive alternatives you learn during your sessions.
Working with a therapist is usually the best way to reap the benefits of ACT.
Brohmer says you can also get started with ACT on your own by using self-help worksheets. She recommends trying these ACT techniques:
According to Brohmer, this exercise can help you clarify which life domains you care most about, and where you have room for improvement in those areas.
Here's how to try it:
This exercise may help you notice your own thoughts in a nonjudgmental way, which can serve as a stepping stone to acceptance.
Here's how to try it:
ACT doesn't offer the opportunity to dig into past events, according to Patel. Because of this, Patel says it may not be the best approach for those still trying to come to terms with or navigate the impact of a traumatic experience.
It also may not be ideal if you have:
ACT teaches skills to help you recognize and welcome all of your thoughts, sensations, and emotions — even the undesired ones. From there, you can begin to explore ways to shift your everyday choices to support your chosen values.
ACT can prove helpful for a variety of mental health conditions, from depression and anxiety to eating disorders and substance use disorders.
If you can't find a therapist trained in this approach or would prefer to try it on your own first, you can get started at home with ACT self-help exercises.