Acceptance and Commitment Therapy (ACT)

BY: SABRINA BRADY, ASHLEY CAMPBELL, MIKYLA CLEARY, & KELLY O'NEILL

ACT History & Purpose

Acceptance and Commitment Therapy (ACT) was created by Stephen C. Hayes in 1986, following his interest
in how language and thought influence our experiences. ACT is based upon relational frame theory (RFT) and
is considered a third-wave behaviour therapy that emphasizes acceptance, mindfulness, and compassion, in
addition to traditional behavioural interventions.

"The aim of ACT is to maximize human potential for a rich and meaningful life, while effectively handling
the pain that inevitably goes with it" (Harris, 2019, p. 3).

The ACT Hexaflex: The Six Core Processes of ACT

ACT is a nonlinear model of Contact with the

therapy, which provides the Present Moment
therapist flexibility to address Be Here Now
the six core processes in an
order that makes sense for 
each unique client.
Acceptance Values
Contact with the present Open Up Know What Matters
moment and defusion are
typically the easiest pillars to
work on, while self-as-context
Psychological
and acceptance are the trickiest. Flexibility
Be Present, Open Up,
and Do What Matters
The therapeutic relationship is
an essential component of
ACT, without it, interventions
will fail, backfire, or invalidate Defusion Committed Action
Watch Your Thinking Do What It Takes
the client (Harris, 2019).

The therapist and client work

together as a team to establish Self-as-Context
and achieve goals. The Noticing Self

Who Is ACT Suitable For?

ACT is still a young discipline, but has shown to be beneficial with a diverse range of client populations and
presenting problems, such as anxiety, depression, obsessive-compulsive disorder, social phobia, generalized
anxiety disorder, schizophrenia, borderline personality disorder, trauma, workplace stress, chronic pain,
smoking cessation and drug use, psychological adjustment to cancer, epilepsy, weight control, and diabetes
management (Harris, 2019; McLean & Follette, 2016).

Research using ACT with multicultural populations, and children and adolescents is promising, though limited
(Fuchs et al., 2013; Smith et al., 2020; Swain et al., 2015).
 Tips & Cautions

ACT is an active therapy that requires extensive effort from the client, including the completion of homework.
Cultivating a meaningful life can be powerful, but it takes work!
The collaborative, non-hierarchical approach of ACT might not be a fit for certain clients.
ACT may be of limited use to those with significant deficits in language, such as individuals with severe autism,
acquired brain injury, or other disabilities (Harris, 2019).
Metaphors are an important aspect of ACT. The overuse of metaphors is a common pitfall for new therapists.
Therapists need to be sensitive to the context of the session, picking and choosing metaphors most likely to
resonate with the client (Hayes et al., 2012).
A cultural consideration to be cognizant of is differences in the significance of values, as some values may be
more or less important in certain cultures.

Dropping Anchor Exploring Values

Dropping anchor is a core mindfulness Values-based work is challenging stuff. It can be

technique used in ACT. This simple tool can be beneficial for some clients to explore values at
taught as a skill or used to help ground clients the onset of therapy, while others may need to
who are feeling overwhelmed. The mnemonic, focus on the other components of ACT first.
ACE, is a useful way to remember the steps. Following are two valuable techniques.

A - Acknowledge your inner experience Ten years from now, looking back
Put your thoughts and feelings into words, e.g., I spent too much time worrying about...
"I'm noticing painful memories," "I'm having a I did not spend enough time doing things such as...
feeling of anger," "Here's anxiety." If I could go back in time, what I'd do differently is...

C - Come back into your body Your mistakenly held funeral

Regain control through your physical actions: If you were lost on a desert island and a funeral was
stretch, change posture, alter your breathe, etc. held for you back home, what would you want to
hear people say about:
E - Engage with the world the sort of person you were?
Expand your awareness: notice where you are, your greatest strengths and qualities?
what you can hear, touch, taste, and smell. the way you treated them?

Helpful Resources

Books Podcast
Psychologists off the Clock - Dr. Jill Stoddard
https://www.offtheclockpsych.com/podcast/acceptance-
commitment-therapy

Website 
ACT Mindfully - Russ Harris
Free worksheets, videos, audio clips, & book chapters
https://www.actmindfully.com.au/free-stuff/worksheets-
handouts-book-chapters/

References
Fuchs, C., Lee, J. K., Roemer, L., & Orsillo, S. M. (2013). Using mindfulness – and acceptance – based treatments with clients from nondominant cultural and /or marginalized backgrounds: Clinical
considerations, meta-analysis findings, and introduction to the special series. Cognitive and Behavioral Practice, 20(1), 1-12. http://doi.org/10.1016/j.cbpra.2011.12.004
Harris, R. (2019). ACT made simple: An easy-to-read primer on acceptance and commitment therapy (2nd ed). New Harbinger.
Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2012). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). Guilford Press.
McLean, C., & Follette., V. M., (2016). Acceptance and commitment therapy as a nonpathologizing intervention approach for survivors of trauma. Journal of Trauma & Dissociation, 17(2), 138-150.
https://doi.org/10.1080/15299732.2016.1103111
Smith, K. J., Oxman, L. N., & Hayes, L. (2020). ACT for adolescents: Impact of a pilot group intervention on psychological wellbeing. Journal of Psychologists and Counsellors in Schools, 1-7.
http://doi.org/10.1017/jgc.2019.33
Swain, J., Hancock, K., Dixon, A., & Bowman, J. (2015). Acceptance and commitment therapy for children: A systematic review of intervention studies. Journal of Contextual Behavioral Science, 4, 73-85.
http://dx.doi.org/10.1016/j.jcbs.2015.02.001