Acceptance and Commitment Therapy (ACT) is a type of psychotherapy that helps people accept difficult thoughts and feelings, and commit to taking values-based actions that enrich their lives.
The goal is not to eliminate anxiety, but to develop psychological flexibility – the ability to be fully present and take meaningful action even in the face of unwanted thoughts and emotions.
ACT relies on six core processes to build psychological flexibility: acceptance, cognitive defusion, being present, self as context, values, and committed action.
ACT is based on the idea that fighting anxiety often makes it worse. When we struggle against difficult inner experiences, we get caught in a vicious cycle that actually increases our distress.
Instead, ACT teaches mindfulness skills to observe thoughts and feelings from a distance, make room for them, and focus our energy on what really matters.
How Can ACT Help Someone with Anxiety?
ACT can be helpful for many anxiety disorders such as generalized anxiety disorder (GAD), social anxiety disorder (SAD), and obsessive-compulsive disorder (OCD).
From an ACT perspective, anxiety disorders involve excessive attempts to suppress, control, or avoid anxiety-related thoughts and feelings.
While this is a natural response, research shows that in the long-run, avoidance actually increases anxiety and narrows our lives.
ACT helps people shift their relationship with anxiety by:
- Teaching acceptance and willingness to feel anxiety, rather than fighting it
- Defusing from anxious thoughts and worries, seeing them as just mental activity
- Contacting the present moment instead of getting stuck in anxiety about the past or future
- Distinguishing the observing self from anxiety (I am more than my anxiety)
- Clarifying valued life directions
- Taking committed action toward those values, with anxiety along for the ride
Ultimately, the goal is to embrace a full, vibrant life, even with anxiety present. Instead of waiting for anxiety to go away before pursuing what matters, ACT helps people “drop the rope” in the tug-of-war with anxiety, and refocus that energy on values-consistent living.
ACT Techniques for Anxiety
ACT uses various tools to build acceptance, defusion, present-moment awareness, self-as-context, values, and committed action.
Here are some techniques to try:
Name the Story
Anxiety often shows up as a well-rehearsed story like “I can’t handle this” or “Something bad will happen.” When you notice an anxiety story showing up, acknowledge it by saying “I’m having the Anxiety Story” or giving it a silly name like “The Impending Doom Story.”
This starts to create distance between you and the thoughts.
Thank Your Mind
When your mind starts catastrophizing or churning out “what ifs”, try saying “Thanks mind! I know you’re trying to protect me.”
Respond to your anxious mind as you would a well-intentioned but over-active friend. Acknowledge the thoughts without getting hooked by them.
Dropping anchor
This centering exercise can help you to unhook from anxious thoughts and feelings and ground yourself in the present.
The steps are:
(1) Acknowledge your thoughts and feelings. Observe what you’re experiencing with curiosity and openness.
(2) Come back into your body. Notice your body sensations. Feel your feet on the ground, move your body, or take some deep breaths.
(3) Engage in what you’re doing. Notice what’s happening around you. Engage your five senses to connect with the present.
Leaves on a Stream
This exercise helps people practice defusion – seeing thoughts as just thoughts rather than literal truths. The goal is to observe the thoughts from a distance without holding onto them.
Imagine sitting beside a stream, with leaves gently floating by. For each thought or feeling that arises, imagine placing it on a leaf and watching it drift downstream.
Allow each leaf to pass at its own pace, without trying to speed it up or slow it down. If your mind wanders, simply notice that and return to the exercise.
Expansion
When anxiety shows up as tension, heaviness or restlessness in the body, try breathing into it and creating space around it rather than fighting it.
Observe the sensations with curiosity. Imagine making room for them, softening and opening up around them.
Anxiety Willingness Diary
This tool can help to practice openness to anxiety in daily life.
Each time you feel anxious, write down:
(1) the situation,
(2) your anxious thoughts/feelings,
(3) what you typically do to control the anxiety,
(4) a willingness statement expressing openness to the anxiety, and
(5) an action you will take to live out your values.
Over time this builds acceptance, defusion, and valued living.
Notice 5 Things
Ground yourself in the present by tuning into your five senses:
- notice 5 things you can see
- 4 things you can touch
- 3 things you can hear
- 2 things you can smell
- 1 thing you can taste
This shifts focus from anxious thoughts to direct experience.
Silly Voices Technique
When a self-critical or catastrophic thought arises, repeat it slowly in a silly voice (like a cartoon character). Do it again in an even sillier voice. This weakens the impact of the thoughts and creates distance from them.
Kind Observer
Practice observing your thoughts, feelings, and sensations from the compassionate stance of the “kind observer” – that wise, caring aspect of yourself that can notice inner experiences without judgment.
What does the kind observer notice? What compassionate message does it have for the part of you feeling anxious?
Valued Action
Clarify what you value in domains like relationships, work, health, leisure, personal growth. Then brainstorm a small valued action you could take today.
Commit to taking the action, making room for any anxiety that shows up. The goal is to shift your life in meaningful directions, without first needing anxiety to go away.
How Effective is ACT for Anxiety?
Numerous studies support the effectiveness of ACT for anxiety disorders:
- A meta-analysis of 39 randomized controlled trials found ACT to be as effective as cognitive behavioral therapy (CBT) for anxiety disorders.
- Another meta-analysis of 36 laboratory studies found ACT produced large reductions in anxiety even in brief one-session interventions.
- These effects have been found across various anxiety-related concerns including generalized anxiety disorder, social anxiety, panic, phobias, obsessive-compulsive disorder, and anxiety associated with medical problems.
- Research shows the specific processes ACT targets – acceptance, defusion, present moment awareness, self-as-context, values, committed action – are tied to clinically-relevant outcomes.
Overall, ACT appears to be a flexible, transdiagnostic approach for promoting meaningful life changes and reducing the impact of anxiety.
Considerations
While ACT offers a powerful approach, it’s not for everyone. The emphasis on opening up to anxiety can feel counterintuitive or daunting for some. Therefore, it’s crucial that ACT is implemented in a compassionate, guided way in the context of a supportive therapy relationship.
Particularly for people with high anxiety sensitivity, a gentler pace may be required to build clients’ willingness to have anxiety.
Additionally, some may prefer the more structured, thought-challenging approach of CBT over ACT’s focus on mindfulness and acceptance.
Cultural factors and personal preferences are important considerations. An open, collaborative discussion with an ACT therapist can help determine fit.
In sum, ACT offers a well-researched approach to help people transform their relationship with anxiety and build full, value-guided lives.
With its focus on acceptance, mindfulness, and meaningful action, ACT can help people get unstuck from chronic anxiety and live more flexibly and freely.
If you are considering ACT, it is best to seek advice from a mental health professional who can provide guidance.
References
Beygi, Z., Jangali, R. T., Derakhshan, N., Alidadi, M., Javanbakhsh, F., & Mahboobizadeh, M. (2023). An overview of reviews on the effects of acceptance and commitment therapy (ACT) on depression and anxiety. Iranian Journal of Psychiatry, 18(2), 248.
Bluett, E. J., Homan, K. J., Morrison, K. L., Levin, M. E., & Twohig, M. P. (2014). Acceptance and commitment therapy for anxiety and OCD spectrum disorders: An empirical review. Journal of anxiety disorders, 28(6), 612-624. https://doi.org/10.1016/j.janxdis.2014.06.008
Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2011). Acceptance and commitment therapy: The process and practice of mindful change. Guilford press.
Lee, E. B., Pierce, B. G., Twohig, M. P., & Levin, M. E. (2021). Acceptance and commitment therapy. In A. Wenzel (Ed.), Handbook of cognitive behavioral therapy: Overview and approaches (pp. 567–594). American Psychological Association. https://doi.org/10.1037/0000218-019
Levin, M. E., Hildebrandt, M. J., Lillis, J., & Hayes, S. C. (2012). The impact of treatment components suggested by the psychological flexibility model: A meta-analysis of laboratory-based component studies. Behavior therapy, 43(4), 741-756. https://doi.org/10.1016/j.beth.2012.05.003
Thompson, E. M., Destree, L., Albertella, L., & Fontenelle, L. F. (2021). Internet-based acceptance and commitment therapy: a transdiagnostic systematic review and meta-analysis for mental health outcomes. Behavior Therapy, 52(2), 492-507. https://doi.org/10.1016/j.beth.2020.07.002
Twohig, M. P., & Levin, M. E. (2017). Acceptance and commitment therapy as a treatment for anxiety and depression: a review. Psychiatric clinics, 40(4), 751-770. https://doi.org/10.1016/j.psc.2017.08.009
