Acceptance and commitment therapy (ACT)

Acceptance and commitment therapy (ACT) is a talking therapy that helps you live a full life even when pain, worry or sadness are still around. Instead of trying to get rid of hard thoughts and feelings, you learn to hold them more lightly. Then you put your energy into what matters most to you.^1,2

ACT has been tested for long-lasting (chronic) pain, depression, anxiety and other problems. This page explains the main ideas in plain words, what the research shows, and how to use our five free lessons.

The big idea: stop the tug-of-war

Most of us try to push away painful feelings. We avoid places, people or tasks that stir them up. It makes sense in the short run, but over time it can shrink your life. You may stop going out, stop calling friends or give up things you love.

ACT calls this pattern experiential avoidance, which means working hard to escape unwanted thoughts, feelings and body sensations.¹ ACT offers another way. You let the feelings be there, without a fight, and keep moving toward the life you want.^1,2

Think of a tug-of-war with a monster. You can pull harder and harder, or you can drop the rope. The monster is still there, but your hands are free to do other things.

The six skills in plain words

ACT teaches six skills that work together. You do not need to learn them in order.¹

Source for the table: Association for Contextual Behavioral Science.¹

Values are not goals you finish. They are directions, like heading west. Goals are the stops along the way.¹ For example, "being a loving grandparent" is a value. "Calling my grandson on Sunday" is a goal that moves you in that direction.

How ACT is different from CBT

ACT grew out of behavior therapy, like cognitive behavioral therapy (CBT).² Both are active and practical. The main difference is in how they treat thoughts.

ACT also uses a lot of mindfulness, which means paying attention to the present moment on purpose. See our mindfulness section.

What the research shows

Across many problems. A 2015 review pooled 39 trials with 1,821 people. They had anxiety, depression, addiction or physical health problems. ACT did much better than being on a waitlist. It also did moderately better than usual care or a "placebo" talking therapy. When compared directly with CBT, there was no clear difference.³ In daily life, this means ACT is a reasonable choice, but not a magic one. It seems to work about as well as other proven therapies.

Chronic pain. This is where ACT has the most support. ACT for pain usually runs about 8 sessions. The goal shifts from getting rid of pain to living well with it.⁵ A list of research-backed therapies kept by the Society of Clinical Psychology (part of the American Psychological Association) has rated ACT for chronic pain as having "strong" research support.⁵ ACT is not meant to take pain away. Its aim is to help you do more of what matters with the pain you have. See chronic pain and mood.

Depression. ACT for depression usually takes about 12 sessions.⁶ The 2022 VA/DoD depression guideline lists ACT among seven therapies a clinician can offer, along with CBT, behavioral activation, interpersonal therapy and others.⁴ The guideline rates this advice "weak for." That means the benefits seem to outweigh the harms, but the evidence has limits. Moderate evidence Read more about depression treatment.

Anxiety. ACT for mixed anxiety disorders also runs about 12 sessions.⁷ It uses acceptance and mindfulness to cut down on avoidance.⁷ Moderate evidence See treatment for anxiety.

The same psychology society rated ACT for depression and for anxiety as having "modest" support. Its ratings for all three conditions are now marked for re-review.^5,6,7

ACT for older adults

ACT has been tested in later life, though the studies are fewer and smaller.

• Anxiety. A Dutch trial included 314 people aged 55 to 75 with mild to moderate anxiety. Some got ACT that mixed online lessons with counselor visits. Others got face-to-face CBT. Both groups improved a lot, and the gains lasted a year. ACT and CBT worked about the same. People in the ACT group were more satisfied with their care. Most people in the study were well educated and comfortable online, so results may differ for others.⁸
• Chronic pain. A UK study followed 60 adults aged 65 and older in a 2- to 4-week ACT pain program. They improved in daily functioning and mental health by the end. Nine months later, most gains were smaller and no longer clear.⁹ This suggests that practice after treatment matters.

ACT can fit well with the changes of later life, such as illness, loss and new limits. It focuses on what you can still do and care about, not on what is gone. Our depression in later life and anxiety in later life pages say more.

If memory problems make lessons hard to follow, a family member can read them aloud and help write things down. Keep practices short and repeat them.

Is ACT right for you?

ACT may suit you if you:

• Have spent years fighting a feeling, a pain or a worry, and the fight itself has worn you out
• Find that arguing with your thoughts, as in CBT, does not feel helpful
• Are living with an illness or loss that cannot be fixed, and want to live well alongside it
• Want help getting clear on what matters most to you

Five free ACT lessons

These lessons walk you through the core ACT skills one at a time. Try one lesson a week.

The sixth skill, self as context, is woven through all five lessons. You can also pair ACT with short practices like grounding and the body scan.

The World Health Organization offers a free illustrated stress guide called Doing What Matters in Times of Stress. It teaches self-help skills that take a few minutes a day. It comes in dozens of languages, some with audio.¹⁰

Finding an ACT therapist

Psychologists, licensed clinical social workers and licensed counselors may offer ACT. When you contact a therapist, ask:

• Do you use ACT? What training have you had in it?
• Have you worked with people my age, or with my problem?
• How many sessions do you expect, and do you take my insurance?

You can check your insurance plan's list of therapists, and ask about sliding-scale fees based on income.¹¹ Our guides on finding a therapist and paying for therapy have more tips. Medicare details are on what Medicare covers for mental health.

For an overview of every method, see therapies and training.

In this section

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.