Acceptance and commitment therapy (ACT)

What is ACT?

Acceptance and commitment therapy, or ACT, is a talking therapy that helps people change how they relate to difficult thoughts and feelings, rather than trying to eliminate them, so they can act on what matters to them. It combines mindfulness-based skills with values-focused action, and is used for anxiety, low mood, chronic pain and stress in adults.

Traditional approaches often aim to reduce or remove unwanted thoughts and feelings directly. ACT works differently. It teaches people to notice difficult inner experiences without being controlled by them, while building a life around personally chosen values. The name reflects the two central aims: accepting what is outside a person’s control, and committing to action that reflects what they care about.

The six core skills of ACT

ACT is built around six interlinked skills, sometimes called the six core processes. A therapist will usually draw on several of these within a single session, adapting the mix to the person and the difficulty they are working with.

Cognitive defusion

Cognitive defusion means learning to see thoughts as mental events rather than literal truths or instructions to be obeyed. A person might practise noticing a thought such as “I am not good enough” as a passing piece of mental activity, rather than treating it as fact. This creates some distance between a person and their thinking, which often reduces the thought’s grip.

Acceptance

Acceptance in ACT means making room for difficult feelings, sensations or urges rather than struggling against them, without requiring resignation or approval of those feelings. It means being willing to experience discomfort when doing so serves a valued goal, such as feeling anxious before giving a presentation that matters to someone.

Present-moment awareness

This skill involves paying deliberate attention to what is happening now, inside and outside the body, rather than being pulled into rumination about the past or worry about the future. Short mindfulness exercises are often used to build this capacity, though ACT does not require formal meditation practice.

Self-as-context

Self-as-context is the idea that a person is more than any single thought, feeling or role they hold. ACT helps people connect with a stable sense of self that can observe changing thoughts and feelings without being defined by them, which can be steadying during periods of anxiety or low mood.

Values

Values work identifies what genuinely matters to a person, across areas such as relationships, work, health and community. These are treated as ongoing directions rather than fixed targets, and they give therapy a clear sense of purpose beyond symptom reduction alone.

Committed action

Committed action means setting specific, workable goals that move a person towards their values, then following through even when difficult thoughts or feelings show up. This often includes practical, gradual steps agreed between client and therapist.

When ACT can help

ACT has been used with adults experiencing anxiety, depression, obsessive-compulsive difficulties, chronic pain, long-term health conditions, stress and burnout. It can be useful when a person has spent a long time trying to control or avoid difficult thoughts and feelings, and where that struggle has started to narrow their life. It also suits people who want a practical, values-based framework rather than a purely symptom-focused approach.

ACT can be offered as the main approach or alongside other support a person is already receiving, such as medication management with a GP. It does not require a formal diagnosis, and many people begin after noticing that avoidance or a struggle with certain thoughts and feelings has started to limit their choices, at work, in relationships or in daily routines.

What to expect from ACT therapy

Sessions usually begin with a discussion of what has brought a person to therapy and what they would like their life to look like if difficult thoughts and feelings mattered less. From there, a therapist introduces the core skills gradually, often through short exercises, metaphors and structured conversation, alongside between-session practice. The pace and focus are shaped around the individual, since some people need more work on acceptance and defusion before values and committed action feel possible, while others move through the skills more quickly.

Between sessions, many people practise short exercises linked to the skills covered that week, such as noticing and naming thoughts, brief mindfulness practice, or identifying one small values-based action to try. These exercises are optional and adapted to what feels manageable, and progress is reviewed together at the start of each session.

The evidence for ACT

ACT has a substantial evidence base across a range of conditions. NICE guidance on chronic primary pain (NG193) recommends ACT as one of the psychological therapies that can be offered to adults managing long-term pain. Research also supports its use for anxiety, depression and stress-related difficulties, generally showing outcomes comparable to other established talking therapies such as cognitive behavioural therapy.

Evidence quality varies by condition, and research continues to develop, particularly for how ACT compares with other therapies over the longer term. As with any talking therapy, how well ACT works for a particular person depends on the fit between the approach and their difficulties, and on their engagement with the skills between sessions.

ACT compared with CBT

ACT and cognitive behavioural therapy share a research tradition and some techniques, but they take different routes. CBT typically works to identify and restructure unhelpful thoughts, testing their accuracy and replacing them with more balanced alternatives. ACT works on a person’s relationship with a thought, using defusion and acceptance so the thought carries less weight, rather than working directly on the thought’s content. Values and committed action then provide a clear sense of direction for what to do next. Many therapists draw on both approaches depending on what a person finds most useful.

Online ACT therapy for Bromley and south east London

This service offers ACT to adults in Bromley and the surrounding area, including Beckenham, Chislehurst, Shortlands, Bickley, Hayes and Petts Wood, working online with clinical psychologists. Sessions take place by video call, which suits people commuting from Bromley South or Bromley North into central London, as well as anyone who would rather fit therapy around work and family life without travelling to an appointment. At the moment all our sessions are online.