# Acceptance and Commitment Therapy (ACT) > An overview of Acceptance and Commitment Therapy (ACT), its origins, six core processes and evidence, and how Jess Chadakorn uses it in Melbourne. Source: https://jess.ac/approaches/act/ Acceptance and Commitment Therapy, or ACT (said like the word act), is a psychological therapy that draws on mindfulness and personal values. It aims to build psychological flexibility, the capacity to stay open to difficult thoughts and feelings while acting on what matters to you. ## Where ACT comes from ACT was developed by the American psychologist Steven C. Hayes and colleagues. An early version, comprehensive distancing, took shape in his research group in the early 1980s, and the first full book on ACT, by Hayes, Kirk Strosahl and Kelly Wilson, appeared in 1999. ACT and dialectical behaviour therapy (DBT) are usually grouped among the third-wave cognitive behavioural therapies, which brought mindfulness and acceptance into behaviour therapy. ACT rests on contextual behavioural science, including relational frame theory, a research program on how people learn language and link ideas. The same verbal abilities that let us plan and solve problems also let us replay an awkward conversation from years ago or worry about events that may never happen. ACT regards this as an ordinary part of being human. ## Psychological flexibility and values ACT describes six processes that together build psychological flexibility, often drawn as a six-sided diagram known as the hexaflex (shown on this page). ACT often begins by examining how much effort goes into avoiding or controlling uncomfortable thoughts and feelings, and what that costs. Someone who feels anxious in groups might skip catch-ups with friends. The anxiety eases that evening, but over time they see less of their friends and the worry can grow. ACT offers another option, noticing the anxiety with curiosity and making room for it while doing what matters. Values, the qualities you want to bring to your life, guide those choices. ## What sessions involve ACT sessions are conversational and practical, and often use metaphor for ideas that are hard to explain directly. A well-known example compares struggling with difficult feelings to a tug-of-war with a monster across a pit. The harder you pull, the harder it pulls back. Dropping the rope is also an option. The monster is still there, and your hands are free for other things. Sessions also include brief experiential exercises, such as saying a sticky thought aloud slowly and noticing whether it sounds different. Values work means clarifying what matters to you in areas such as relationships, work and health, then choosing small, realistic steps in that direction. Exercises are offered as experiments, and you can say when one does not suit you. Some people practise between sessions, and others keep the work within sessions. ## What the research says ACT's main international research society keeps a running list of randomised controlled trials, which by 2026 included more than 1,500. A 2020 review of 20 meta-analyses found support for ACT across a range of concerns, including anxiety, depression, substance use and chronic pain, with results broadly similar to CBT where the two were compared. Some researchers have questioned the quality of certain studies and which components of ACT matter most, and that work continues. ACT is one of several evidence-based therapies, and whether it suits you is considered in assessment and treatment planning. ## ACT with children and young people ACT ideas are often shared with children and teenagers through stories, drawing and movement, and parents and carers can learn them too for use at home. DNA-V, a model developed in Australia by Joseph Ciarrochi, Louise Hayes and Ann Bailey, adapts ACT for young people. D, N and A stand for discoverer (trying new things and learning from experience), noticer (attending to feelings and the body) and advisor (the inner voice that judges and predicts, sometimes usefully and sometimes not), and V for the young person's values and vitality. For neurodivergent children and teenagers, ACT can be used in a neurodiversity-affirming way, focused on the young person's own values and wellbeing with no aim of changing who they are. Trust and a sense of safety come first, and the ideas are then shaped around how each young person thinks and communicates, for example through pictures or a favourite interest. ## Key ideas - **Being present.** Paying flexible attention to what is happening now, inside you and around you, so you are less caught up in the past or the future. - **Acceptance.** Making room for uncomfortable feelings and sensations and easing the struggle against them. In ACT, acceptance sits alongside working towards change in your life. - **Defusion.** Stepping back from thoughts to see them as words and images passing through the mind, which can loosen the hold unhelpful thoughts have on what you do. - **Self-as-context.** A sense of yourself as the one who notices thoughts and feelings, sometimes called the observing self. ACT often compares it to the sky, which stays while the weather passes through. - **Values.** The qualities you want to bring to how you live, such as honesty or playfulness. A goal, like finishing a course, can be completed. A value is a direction you keep heading in. - **Committed action.** Taking steps guided by your values, often small ones, and returning to them after setbacks, even when difficult feelings are present. ## A short defusion exercise This ACT exercise takes about two minutes and is designed to create some distance from a sticky thought. Practise with a mild thought, and leave anything heavy or upsetting for another time. 1. Sit comfortably and take a couple of slow breaths, or notice your feet on the floor. 2. Bring to mind a mild, unhelpful thought about yourself, such as "I'm bad at this", and notice how it feels. 3. Silently repeat it with a phrase in front, "I'm having the thought that I'm bad at this." 4. Add one more layer, "I'm noticing I'm having the thought that I'm bad at this." 5. Notice whether anything has shifted. The thought may still be there, with more room around it. 6. Finish by noticing a few sounds and bringing your attention back to the room. _This is general information and not a substitute for individual care; stop if the exercise becomes distressing._ ## How Jess uses ACT Jess often draws on ACT when the struggle with difficult thoughts or feelings has come to dominate daily life, or when someone wants to clarify their values. It is widely used in pain management, and her registrar program included a rotation in a hospital Pain Management Unit. Often used for: Anxiety and worry; Depression and low mood; Living with chronic pain; Adjusting to health conditions; Stress and life changes; Clarifying personal values. ## Questions ### How is ACT different from CBT? ACT and CBT belong to the same family of behavioural therapies, and both are practical. Classic CBT often examines whether a thought is accurate or helpful and works on changing it. ACT focuses more on how you relate to thoughts, noticing them and making room for them while you act on your values. With a thought like "I always mess things up", CBT might test it against the evidence, while ACT might help you notice it as a thought and carry on. Jess draws on both. ### Does acceptance mean putting up with things? In ACT, acceptance applies to inner experiences such as thoughts, feelings, memories and physical sensations. It means making room for them so that less energy goes into fighting them. Accepting a feeling differs from accepting unfair treatment or a situation you want to change, and ACT places considerable weight on action. ### Do I need meditation experience to try ACT? No. Mindfulness in ACT is usually brief and practical, such as a minute of noticing your breath, and most exercises can be done with your eyes open. ## Further reading - [Going with the flow: exploring Acceptance and Commitment Therapy](https://psychology.org.au/insights/exploring-acceptance-and-commitment-therapy) (Australian Psychological Society) - [The six core processes of ACT](https://contextualscience.org/the_six_core_processes_of_act) (ACBS (contextualscience.org)) - [Acceptance and commitment therapy with neurodivergent children and teens](https://psychology.org.au/insights/acceptance-and-commitment-therapy-with-neurodiverg) (Australian Psychological Society)