Acceptance and commitment therapy (ACT)

Acceptance and commitment therapy, usually shortened to ACT, is a psychological therapy that helps people build a more flexible relationship with difficult thoughts and feelings, rather than trying to eliminate them. It combines mindfulness-based skills with values-based action.

The approach sits within the broader family of cognitive behavioural therapies but takes a different route to change. Rather than focusing mainly on challenging or correcting unhelpful thoughts, ACT works on changing how a person relates to those thoughts, so that painful experiences carry less weight and interfere less with daily life. The aim is not comfort for its own sake. It is a life guided by what a person cares about, even when difficult thoughts and feelings are present.

The six core processes of ACT

ACT is built around six interlinking processes, often drawn as a hexagon in training materials. In practice, therapy rarely moves through them in a fixed order. A psychologist will draw on whichever process is most useful for what a person brings to a session, and most people end up working with several processes at once, rather than one at a time.

Cognitive defusion

Cognitive defusion means learning to notice a thought as a thought, rather than treating it as a fact that must be obeyed or argued with. A thought such as ‘I always mess things up’ feels different once it is held more lightly, observed rather than fused with. This does not make the thought go away. It changes the amount of influence it has over what someone does next.

Acceptance

Acceptance in ACT means making room for difficult internal experiences, sadness, worry, physical pain, unwanted urges, rather than spending energy trying to suppress or avoid them. This is an active stance, not passive resignation. Avoidance often narrows a life over time, cutting out activities, people and places. Acceptance frees up that energy for something more useful.

Present-moment contact

Present-moment contact is the practice of noticing what is actually happening now, in thought, feeling and surroundings, rather than being pulled into rumination about the past or worry about the future. Simple attention exercises are often used to build this skill, in a way that is grounded and practical rather than abstract or vague.

Self-as-context

Self-as-context is the idea that a person is not the same as their thoughts, moods or life story. There is a stable sense of self that has observed every thought and feeling a person has ever had, without being defined by any single one of them. This process can be useful for people whose sense of identity has become tangled up with a diagnosis or a difficult period in their life.

Values

Values work in ACT involves clarifying what actually matters to someone, in areas such as relationships, work, health or community, distinct from goals, which can be ticked off, or from what other people expect of them. Values act as a compass for decisions and effort, particularly when motivation is low or a situation feels stuck.

Committed action

Committed action means setting goals that are guided by those values and building habits that support them, even when it is uncomfortable to do so. This is the behavioural end of ACT. Insight and acceptance are worked towards not as an end point but as a foundation for doing more of what matters, in small, repeatable steps.

When ACT can help

ACT has been applied to a wide range of difficulties, including anxiety, depression, chronic pain, stress, obsessive-compulsive difficulties and adjustment to long-term health conditions. It tends to suit people who have found that arguing with their thoughts, or trying to push feelings away, has not worked, and who want a different way to approach persistent worry, low mood or physical symptoms that will not resolve quickly. It can also work well alongside practical, skills-based approaches such as CBT, and is sometimes used when someone has tried therapy before without lasting change.

What to expect in ACT sessions

Sessions typically begin with a discussion of what is happening in someone’s life and what has already been tried. From there, a psychologist introduces the six processes gradually, often through short exercises, metaphors and structured conversation rather than worksheets alone. Homework between sessions is common, usually short practices connected to noticing thoughts, building present-moment awareness or taking a small step towards a value. Progress is measured less by symptom checklists and more by whether someone is able to act on what matters to them, even while difficult thoughts and feelings are still present in the background.

The evidence for ACT

ACT has a substantial and growing evidence base. It is recommended by the National Institute for Health and Care Excellence as part of the management of chronic primary pain, where it is used alongside other approaches to help people live well despite ongoing symptoms. Trials have also found it useful for anxiety, depression and stress-related difficulties, generally performing comparably to established cognitive behavioural approaches, sometimes with better results for problems where avoidance plays a large role, such as chronic pain or health anxiety.

ACT and CBT: how they compare

ACT grew out of the same behavioural tradition as CBT and shares some of its practical, structured approach. The main difference lies in how each treats unhelpful thoughts. Traditional CBT often works to identify and restructure thoughts that are inaccurate or unhelpful. ACT works on the relationship a person has with those thoughts, teaching skills to hold them more lightly rather than trying to change their content. Many psychologists draw on both traditions, and someone might use thought records in one phase of therapy and defusion exercises in another, depending on what proves useful for that person.

Online ACT therapy for Maidstone and Kent

Clinical psychologists for Maidstone and Kent, working online with adults, we offer ACT to people living across ME14, ME15 and ME16 postcodes and the surrounding areas, including Bearsted, Allington, Barming, Loose, Penenden Heath and Tovil. Sessions take place by secure video call, which suits people commuting from Maidstone East or Maidstone West to London Victoria or Blackfriars, and anyone who would rather build therapy around work or family life than travel into the town centre near Fremlin Walk and Week Street. We will update this site as the practice develops.

Frequently asked questions

Is ACT the same as mindfulness-based therapy?

Mindfulness is one part of ACT, used to build present-moment contact and cognitive defusion, but ACT is a broader therapy that also works on values and committed action. Mindfulness alone is a set of techniques, while ACT combines several processes aimed at helping someone live in line with what matters to them.

What if I do not know what I value?

Many people start ACT unsure what matters to them, often because avoidance or a difficult period has crowded values out. Values work is part of the therapy itself, using structured exercises and questions to help this become clearer over the course of sessions, rather than something a person is expected to arrive already knowing.

How is ACT different from CBT?

Both are structured, practical therapies, but they take different routes to the same problem. CBT often works to change the content of unhelpful thoughts, while ACT focuses on changing a person’s relationship with those thoughts, alongside a strong focus on values and committed action.

Can ACT help if I have tried other therapies before?

Yes, this is one of the situations ACT was developed for. Because it does not depend on changing the content of thoughts, it can suit people who found that thought-challenging approaches did not fit how their mind works, or whose main struggle is avoidance rather than the accuracy of specific thoughts.

Is ACT therapy available online in Kent?

Yes. ACT translates well to video call, since much of the work involves conversation, guided exercises and reflection that do not require being in the same room. We offer ACT to adults across Maidstone and the wider Kent area entirely online.