Time to ACT? What is ACT & why is it important?
17th April 2025
Dr Laura Meader, Clinical Neuropsychologist, April 2025
‘ACT’ has been used as a talking therapy approach for several decades, and research findings suggest it can provide benefit for a wide variety of mental and physical health conditions that people experience. The ACT approach is considered a more modern form of the better-known Cognitive Behavioural Therapy (CBT), as it too focuses on making changes to people’s behaviour by exploring associated thoughts and feelings. It also shares features of Mindfulness-based therapies.
Photo by Marcel Strauß on Unsplash
As ACT has a reputation for being rather complex to understand and jargon-heavy, this article aims to offer a brief outline of some of the core principles of ACT, with a clinical example at the end to help illustrate how the approach may be used in practice. There are many excellent books and journal articles about ACT, should you wish to explore this approach further. A selection of these has been added to the bottom of this piece.
Psychological flexibility
The idea of “psychological flexibility” is central to the ACT model. This is about being aware (or “mindful”) of your own feelings, thoughts and beliefs, and behaving in a way that will lead to better mental health and quality of life. Life brings with it many obstacles to achieving good mental health, and the ACT approach allows people to examine their thoughts, feelings, and behaviours in a way that helps them identify and overcome such obstacles. In doing so, the person can gain greater control over their own mind and behaviour, which should then lead to improved mental wellbeing.
Values
The concept of “values” is another key feature of the ACT approach. The idea behind this is that when people behave in accordance with what is most meaningful to them, then this will create better mental wellbeing. If you are beginning therapy with an ACT focus, your therapist will ask you about your values and may ask you to complete a questionnaire to help you both gain a better understanding of the values that are most important to you personally. You will then work together to see how learning about your values can help you make sure you are leading your life in accordance with these principles.
Metaphors
Metaphors are often used within ACT as a therapeutic tool. This way of helping people understand and explore their own thoughts, beliefs, and behaviours can be quite powerful. It can be particularly helpful if a person finds it difficult to put into words what they are experiencing, or for example if they find it difficult to understand things following a brain injury or stroke. To use some simple examples, this might be about imagining your thoughts as clouds in the sky, or different behaviours as opening or closing cupboard doors. Metaphors can be quite detailed and specific. The most important thing here is that they are meaningful to your experiences and difficulties.
Where does “Acceptance” and “Commitment” come in?
The “acceptance” part of ACT is about working towards accepting our thoughts, feelings, and individual situations. This draws upon the ideas above. The “commitment” part is about using this acceptance to guide you towards a commitment to behaving in a way that is true to your values and goals. These will be specific to you and your life, and you will explore with your therapist the things that are holding you back from achieving these aims.
Clinical example*:
Sarah was 32 and a keen rugby player. Six months ago, she sustained a concussion after being hit on the head with a rugby ball during practise. She had since become anxious about returning to playing rugby, and found herself feeling more irritable and struggling to sleep. As being a rugby player was an important part of her identity, her avoidance of playing was making her start to feel low in mood.
Using an ACT approach, Sarah was encouraged to “open up” about the thoughts and feelings that came up for her when rugby came to her mind, such as when her friends asked her about returning to practise. She developed an understanding of how avoiding playing rugby was making her feel as if she would never be able to play again. Working towards greater acceptance of her worries about playing rugby, noticing these thoughts but allowing them to pass by (using an analogy of fish swimming in a river), helped Sarah’s sleep improve as she was no longer avoiding the thoughts by actively pushing them away. In doing this, Sarah gained confidence to try rugby again, with realistic goals around the frequency and intensity of her practise. She became committed to returning to practise a sport that she truly valued.
In time, with continued use of ACT strategies, Sarah was able to return to practising rugby at a similar level to that before her concussion. She found that her improved sleep and committed action towards her sport, underpinned by a better ability to live with any unhelpful thoughts, reduced her anxiety and improved her mood and overall quality of life significantly. Importantly, she was able to regain her identity as a rugby player, which was particularly meaningful for her.
*This example is fictitious but based broadly on clinical experience.
Suggested reading:
Books
Curvis, W., & Methley, A. (Eds.). (2021). Acceptance and Commitment Therapy and Brain Injury: A Practical Guide for Clinicians (1st ed.). Routledge. https://doi.org/10.4324/9781003024408
Harris, R. (2019). ACT made simple: An easy-to-read primer on acceptance and commitment therapy (2nd ed.). New Harbinger Publications.
Hayes, S. C., & Smith, S. X. (2005). Get out of your mind & into your life: the new acceptance & commitment therapy. New Harbinger Publications.
Journal articles
Hayes, S. C., Levin, M. E., Plumb-Vilardaga, J., Villatte, J. L., & Pistorello, J. (2013). Acceptance and commitment therapy and contextual behavioral science: examining the progress of a distinctive model of behavioral and cognitive therapy. Behavior therapy, 44(2), 180–198. https://doi.org/10.1016/j.beth.2009.08.002
Sander, A. M., Clark, A. N., Arciniegas, D. B., Tran, K., Leon-Novelo, L., Ngan, E., … Walser, R. (2020). A randomized controlled trial of acceptance and commitment therapy for psychological distress among persons with traumatic brain injury. Neuropsychological Rehabilitation, 31(7), 1105–1129. https://doi.org/10.1080/09602011.2020.1762670
Websites and webpages
Home – Steven C. Hayes, PhD – founder of ACT, Dr Steven Hayes.
Acceptance and Commitment Therapy | ACT Mindfully – Dr Russ Harris’ website
ACT for the Public | Association for Contextual Behavioral Science