ACT (Acceptance and Commitment Therapy)

What is ACT?

Acceptance and Commitment Therapy, known as ACT, helps you change how you relate to difficult thoughts and feelings rather than trying to eliminate them. Rather than removing anxiety or low mood, it builds the flexibility to act on what matters even while they’re present.

ACT sits within the cognitive behavioural family of therapies but takes a different route to change. Where some approaches focus mainly on correcting or disputing unhelpful thoughts, ACT asks you to notice those thoughts, make room for them, and choose actions guided by your values anyway. The word ‘acceptance’ here does not mean liking a difficult situation or giving up on change. It means dropping the exhausting fight against thoughts and feelings that will not simply go away on command, so your energy can go somewhere more useful.

The six processes of ACT

ACT is built around six interlinked skills, sometimes shown as a hexagon in training materials. In practice a therapist will not necessarily name each one, but most sessions draw on all six over time.

Cognitive defusion

Defusion means learning to notice a thought as a thought, rather than treating it as a command or a fact. A thought such as ‘I’ll make a mess of this’ can be observed and labelled, which loosens its grip, instead of being followed automatically or argued with at length.

Acceptance

Acceptance is the willingness to feel difficult emotions and sensations without immediately trying to push them away, distract from them or numb them. This is a practical stance, not resignation. It creates space to act deliberately rather than reactively.

Present-moment contact

Much of ACT involves practising attention to what is actually happening now, rather than being pulled into rehearsing the past or rehearsing worst-case futures. This overlaps with mindfulness skills, though ACT uses them for a specific purpose: helping you respond to the situation in front of you.

Self-as-context

This process helps you notice that you are the person having thoughts and feelings, not the thoughts and feelings themselves. A low mood, a worry or a memory can pass through without becoming your whole identity. Some people find this the hardest process to grasp at first and the most useful once it clicks.

Values

Values work identifies what genuinely matters to you: relationships, work, health, creativity, community, or something more personal. Values are directions rather than destinations, and they are chosen by you rather than handed down as goals you feel you ought to have.

Committed action

The final process turns values into concrete, workable steps, even small ones, and builds a pattern of acting on them repeatedly. This is where ACT moves from insight into daily behaviour, adjusting the plan when life gets in the way rather than abandoning it.

When ACT can help

ACT was developed as a general approach to psychological distress rather than a treatment for one specific condition. It is used with anxiety, low mood, chronic pain, stress, and difficulties adjusting to health conditions or major life changes, and it can also help when someone feels stuck after trying other approaches without much change. Because it focuses on how you relate to thoughts and feelings rather than on removing a single symptom, it can be useful alongside other treatment or as a standalone course of therapy.

What to expect in ACT sessions

An initial session usually covers what has brought you to therapy, what you have tried already, and what a workable outcome would look like for you. From there, sessions typically combine conversation with practical exercises: noticing exercises, short written reflections on values, and planning specific actions to try between sessions. Homework in ACT tends to be behavioural rather than purely reflective, for example trying a values-guided action in a situation you would normally avoid, then discussing what happened next time. Progress is usually measured less by a drop in symptom scores and more by whether you are able to do more of what matters to you, even when difficult thoughts or feelings show up.

The evidence for ACT

ACT has a substantial evidence base built up over several decades, with randomised trials across anxiety, depression, chronic pain and long-term health conditions. NICE guidance on chronic primary pain (NG193) recommends ACT as one of the psychological therapies that can be offered, and ACT also appears in NICE guidance and evidence reviews for other conditions where psychological flexibility is a relevant treatment target. It is generally considered comparably effective to CBT across many of the difficulties both approaches treat, with neither consistently outperforming the other; the right choice often depends on what has or has not worked for you before, and which style of working suits you.

ACT compared with CBT

ACT and CBT share roots and overlap in places, which sometimes causes confusion. Traditional CBT often works by identifying unhelpful thoughts, testing how accurate they are, and building more balanced alternatives. ACT does not ask you to test whether a thought is true or false; it asks you to notice the thought, allow it to be present, and choose your next action based on your values regardless. Both approaches use structured, collaborative sessions and often set tasks to practise outside the room. A therapist may draw on techniques from both within a single course of treatment, depending on what you find helpful.

Getting started with ACT in Brighton and East Sussex

Clinical psychologists for Brighton and East Sussex, working online with adults, can offer ACT to people across the city and the surrounding towns, from Hove and Portslade to Kemptown, Hanover, Preston Park and Withdean. Working online removes the need to travel into the Lanes or North Laine for an appointment, which suits the mix of commuters, students and people who have recently moved to the area from London, many of whom already spend part of the week travelling through Brighton station or Preston Park. Sessions are arranged around your schedule rather than a fixed clinic location, and we will update this site as the practice develops.

If you are weighing up ACT against other therapy options, a first conversation is usually enough to work out whether it is a reasonable fit for what you are dealing with, without committing to a particular number of sessions in advance.