Acceptance & Commitment Therapy (ACT)

ACT takes an unusual stance: the goal isn't to get rid of difficult thoughts and feelings, but to change your relationship with them so you can live by what matters. This guide explains how it works.

13 min read Reviewed July 2026 Plain-language summary

The short version

ACT (said as one word, “act”) aims for psychological flexibility, not symptom elimination — living a meaningful life alongside difficult feelings.
It rests on six processes: acceptance, cognitive defusion, present-moment awareness, self-as-context, values, and committed action.
Acceptance is not resignation or approval — it's dropping the struggle against feelings you can't control so your energy goes to what you can.
ACT has a strong and growing evidence base across anxiety, depression, chronic pain, and more.

What ACT is

Acceptance and Commitment Therapy — pronounced as the word "act," not spelled out — is a modern form of cognitive behavioral therapy developed by Steven Hayes and colleagues. It belongs to what's often called the "third wave" of behavioral therapies, which fold in mindfulness and acceptance rather than focusing only on changing the content of thoughts.

Traditional CBT often works by testing and reshaping unhelpful thoughts. ACT takes a different route: instead of arguing with a painful thought, it helps you change your relationship to it — to hold it more lightly — so it no longer runs the show. The energy that went into fighting or avoiding inner experience gets redirected toward living by your values.

A different goal

ACT starts from the premise that pain is a normal part of a human life and that trying to eliminate every difficult feeling often backfires — the struggle itself becomes the problem. The aim is a rich, meaningful life with pain present, not a life spent waiting for the pain to leave first.

Psychological flexibility: the goal

The central aim of ACT is psychological flexibility: the ability to stay in contact with the present moment — including uncomfortable thoughts and feelings — and to keep choosing actions that serve what you care about. Its opposite, psychological inflexibility, is getting stuck: avoiding, ruminating, being fused to a story about yourself, and drifting from what matters.

All six ACT processes below are simply different angles on building that one capacity.

The six core processes

ACT is often taught through the "hexaflex" — six interlocking processes. They aren't steps in order; they support each other.

AcceptanceMaking room for hard feelings instead of fighting them

DefusionUnhooking from thoughts — seeing them as thoughts, not facts

Present momentContacting the here-and-now with openness

Self-as-contextThe observing self that notices experience

ValuesWhat you want your life to stand for

Committed actionDoing what matters, guided by values

Acceptance

Actively making room for unwanted inner experiences — anxiety, grief, urges — rather than struggling to suppress or escape them. Not because the feelings are pleasant, but because fighting them tends to amplify them and shrink your life.

Cognitive defusion

Learning to step back from thoughts and see them as thoughts— passing mental events — rather than literal truths or commands. A defused person can notice "I'm having the thought that I'll fail" instead of being fused with "I'll fail."

Contact with the present moment

Bringing flexible, open attention to what's happening now — the ACT version of mindfulness — rather than being lost in the past or future.

Self-as-context

Noticing the "observing self" — the stable part of you that has been present through every experience and is bigger than any single thought or feeling. From that vantage point, difficult content feels less threatening.

Values and committed action

If acceptance and defusion clear space, valuessupply the direction. Values are chosen qualities of living — being a caring parent, an honest friend, a curious learner. They're not goals to be completed but directions to keep moving in.

Committed actionis then taking concrete, values-guided steps — and coming back to them again and again, even when discomfort shows up. This is the "commitment" half of ACT, and it's where the behavioral change happens. A person might feel intense social anxiety and still show up to the family dinner because connection matters to them.

Acceptance is not resignation

The most common misunderstanding of ACT is that "acceptance" means giving up, approving of a situation, or gritting your teeth through suffering. It means none of those.

Acceptance is dropping the struggle against what you can't control — your feelings, other people, the past — so your effort goes toward what you cancontrol: your next action. It's the opposite of passive; it frees up energy to change what's changeable.

Importantly, ACT never asks anyone to accept abuse, injustice, or a harmful situation. Acceptance applies to inner experience, not to circumstances you can and should change.

What the evidence shows

ACT is an empirically supported treatment with a large and expanding research base. Meta-analyses find it effective for anxiety, depression, chronic pain, obsessive-compulsive spectrum concerns, and stress, and it performs comparably to traditional CBT for many conditions. It has also been studied in brief and group formats and for physical-health conditions where coping with distress matters.

As with any therapy, fit matters. Some people connect strongly with ACT's emphasis on values and acceptance; others prefer the more structured thought-testing of classic CBT. A good therapist can help you find the approach that works for you.

Find ACT therapy in New Hampshire

Meridian maintains a verified directory of New Hampshire providers, including therapists trained in ACT and other evidence-based approaches.

ACT-trained therapists across New HampshireFind verified providers offering acceptance and commitment therapy by region.

References & further reading

1.Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2012). Acceptance and Commitment Therapy: The Process and Practice of Mindful Change (2nd ed.). Guilford Press.
2.A-Tjak, J. G. L., 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.
3.Gloster, A. T., et al. (2020). The empirical status of acceptance and commitment therapy: A review of meta-analyses. Journal of Contextual Behavioral Science, 18, 181–192.
4.Association for Contextual Behavioral Science. (2024). About ACT. https://contextualscience.org/act
5.Harris, R. (2019). ACT Made Simple (2nd ed.). New Harbinger.

Also in the library

Mindfulness & Stress ManagementWhat mindfulness actually is, the research behind MBSR and MBCT, core practices, its role in DBT and ACT, and how to build a sustainable practice.13 min read Understanding AnxietyThe anxiety disorders, the cycle that keeps anxiety going, the fight-flight-freeze response, and how to interrupt it.14 min read Understanding DepressionWhat depression actually is, the major types, how it's diagnosed, why it happens, and the treatments that work.14 min read

This page is general education, not medical advice or a diagnosis. Mental health conditions are best assessed and treated by a qualified professional. If you or someone else is in immediate danger, call or text 988(Suicide & Crisis Lifeline) or NH Rapid Response at 833-710-6477.