What is acceptance and commitment therapy (ACT)? Six core processes
CareOps editorial team · · 6 min read
Mental wellness information and service guidance published by CareOps.
Translated from our Korean guide. Korean public services, insurance, and helpline numbers refer to South Korea. For urgent help elsewhere, contact local emergency services or a crisis line in your country.
Have you ever noticed that the harder you try to stop worrying, the more stuck you get? Telling yourself not to think about something makes it come back more often, and waiting for anxiety to disappear keeps pushing back the things you wanted to do. Acceptance and commitment therapy is about changing the direction of that struggle.
At a glance
- Acceptance and commitment therapy (ACT) helps you notice difficult thoughts and feelings and make room for them instead of fighting them, while acting in the direction of what matters to you.
- It rests on six core processes: acceptance, cognitive defusion, being present, self as context, values, and committed action. Together they build what is called psychological flexibility.
- A review that pooled 20 meta-analyses (more than 12,000 participants) found ACT effective across many difficulties, including anxiety, depression, and pain.
What is acceptance and commitment therapy (ACT)?
Acceptance and Commitment Therapy is usually shortened to ACT. It was developed by psychologist Steven Hayes of the University of Nevada and his colleagues. Broadly it belongs to the cognitive behavioral family, but instead of checking whether a thought is true, it changes your relationship with your thoughts.
Its goal is psychological flexibility: being fully in touch with the present moment, and changing or continuing what you do when that serves what you care about. You don't have to wait for anxiety to go away before you move. ACT helps you take a step toward where you want to go even while anxiety is there.
How is ACT different from CBT?
| Aspect | Cognitive behavioral therapy (CBT) | Acceptance and commitment therapy (ACT) |
|---|---|---|
| Working with thoughts | Check a thought against the facts and find a balanced one | Step back from thoughts instead of arguing with them |
| Difficult feelings | Change the thoughts and actions that feed them | Make room for them instead of removing them |
| Where it points | Change the loop that keeps a problem going | Do more of what you value |
It's less that one is better and more that they work differently. In a meta-analysis of 39 randomized controlled trials (A-Tjak et al., 2015), comparing ACT directly with CBT showed no significant difference in effect. If you want to know more about CBT, see What is cognitive behavioral therapy?.
What are the six core processes of ACT?
ACT is described through six processes. They aren't steps you climb in order; they connect and grow together.
| Process | What it means | Try this |
|---|---|---|
| Acceptance | Let difficult thoughts and feelings be, without fighting them | When anxiety comes, note "anxiety is here" and pause |
| Cognitive defusion | See a thought as words passing through, not a fact | Read it again as "I'm having the thought that…" |
| Being present | Attend to now, without judgment, instead of past or future | Notice one sound or one object in front of you |
| Self as context | You are also the one noticing your thoughts and feelings | Picture "the me watching the anxiety", not "an anxious me" |
| Values | A direction you keep moving toward, not a goal you finish | Pick one area that matters lately: relationships, health, learning, work, rest |
| Committed action | Take concrete steps toward your values and widen them | Choose one small step for today |
Does ACT work?
In a meta-analysis of 39 randomized controlled trials with 1,821 participants (A-Tjak et al., 2015), ACT worked better than waitlist, psychological placebo, and treatment as usual. As noted above, it did not differ significantly from CBT.
A broader review pooled 20 meta-analyses with 12,477 participants (Gloster et al., 2020). ACT was effective in every area examined: anxiety, depression, substance use, pain, and groups not limited to a single diagnosis.
Is there a three-minute practice I can try on my own?
This practice runs through the six processes once, briefly. A piece of paper or a notes app is enough.
- Write down the sticky thought: write the thought you keep getting caught on in one line. Don't judge whether it's right or wrong.
- Step back: read it again as "I'm having the thought that…".
- Notice the present: notice one thing, a sound, an object in front of you, or a comfortable body sensation.
- Pick what matters: choose one area that matters to you lately, such as close relationships, taking care of your body, learning, your work, or rest.
- Choose a small action: pick one small thing you can do in that direction. Just the first move is fine.
- Bring it along: write down the thoughts or feelings likely to come with that action, and decide whether you'll take them along instead of getting rid of them.
If too many thoughts keep you up or the same thought keeps circling, try the methods in When you think too much as well.
Who might ACT suit?
- People whose worry or anxiety grows the harder they try to get rid of it
- People who keep freezing in front of things they want to do because of too many thoughts
- People living with difficulties they can't simply remove, such as long-lasting pain or illness
- People who feel unsure what all their effort is for
When to get support from a professional
If thoughts and feelings are getting in the way of daily life, or you feel like hurting yourself, reach out directly to a psychiatrist or a counseling center. Diagnosis and medication are decided in clinical care, and you can keep up practices like this while you are in treatment or counseling.
Can you do ACT with an app?
For milder difficulties, practicing with an app can help too. In a meta-analysis of 66 randomized controlled trials of smartphone app-based interventions (Linardon et al., 2019), apps had a small but significant effect on symptoms of depression and anxiety.
CareOps Maeumi is an AI counseling app. Its conversations draw on well-researched approaches including ACT, CBT, behavioral activation, and motivational interviewing, and when you work with ACT, Maeumi walks you through the six steps above one at a time inside the conversation. How these approaches turn into everyday practice is covered in Therapy-informed apps.
Frequently asked questions
- Does "acceptance" in ACT just mean putting up with things?
- No. Acceptance isn't giving up or gritting your teeth. It means dropping the fight to get rid of difficult thoughts and feelings and letting them be, with awareness. ACT then uses the room that creates to choose actions in the direction of what matters to you.
- Is ACT the same as mindfulness?
- They overlap. Mindfulness, noticing the present moment without judgment, resembles some of the six processes. ACT adds values and committed action, so noticing carries on into moving toward what matters.
- How do you practice cognitive defusion?
- The simplest way is to label the thought. If you think "I'm going to fail," try saying "I'm having the thought that I'm going to fail." You aren't erasing the thought; you're making a small gap between the thought and yourself.
- Where can you get ACT?
- Look for psychiatrists or counseling centers that offer ACT. Before booking, ask whether they work with ACT and how many sessions and how much it costs. Counseling costs are covered in How much does counseling cost?.
Sources
- Hayes et al. (2006), Acceptance and Commitment Therapy: Model, processes and outcomes, Behaviour Research and Therapy 44(1), 1–25
- A-Tjak et al. (2015), A Meta-Analysis of the Efficacy of Acceptance and Commitment Therapy for Clinically Relevant Mental and Physical Health Problems, Psychotherapy and Psychosomatics 84(1), 30–36
- Gloster et al. (2020), The empirical status of acceptance and commitment therapy: A review of meta-analyses, Journal of Contextual Behavioral Science 18, 181–192
- Association for Contextual Behavioral Science (ACBS), The Six Core Processes of ACT
- Linardon et al. (2019), The efficacy of app-supported smartphone interventions for mental health problems: a meta-analysis of randomized controlled trials, World Psychiatry 18(3), 325–336
This article shares general mental wellness information. For urgent help, contact local emergency services or a crisis line in your country. In South Korea, the suicide prevention helpline is 109 (24 hours), and the mental health crisis line is 1577-0199.