Acceptance and Commitment Therapy (ACT)

ACT operates on the principle that psychological suffering often stems from what researchers call “psychological inflexibility” — a rigid pattern in which a person becomes entangled with their thoughts, avoids uncomfortable feelings, loses touch with the present moment, and disconnects from what they truly value.²

In therapy sessions, a trained ACT clinician uses a combination of experiential exercises, metaphors, and mindfulness techniques to help clients develop each of the six core processes. Unlike some therapies that rely heavily on worksheets or structured protocols, ACT sessions are often dynamic and interactive.

Metaphors as Teaching Tools

One hallmark of ACT is its use of vivid metaphors to illustrate concepts. For example, the “Passengers on the Bus” metaphor asks clients to imagine themselves as the driver of a bus, with unruly passengers representing their difficult thoughts and feelings. The passengers may shout threatening things, but the driver can still choose where to steer. This metaphor helps clients understand that they can acknowledge their inner experiences without letting those experiences dictate their actions.

Experiential Exercises

ACT places strong emphasis on direct experience. Clinicians might guide clients through exercises that deliberately bring up discomfort in a safe environment so clients can practice responding differently. For instance, a client might be asked to hold in mind a painful memory while simultaneously engaging in a values-driven behavior — demonstrating that action and discomfort can coexist.

Mindfulness Practices

Mindfulness is woven throughout ACT, though it takes a specific form. Rather than lengthy meditation sessions, ACT uses brief, targeted mindfulness exercises designed to build present-moment awareness and self-as-context skills. These might include simple attention-focusing exercises or practices that help clients notice the difference between themselves and the thoughts that pass through their minds.

Values-Driven Goal Setting

Perhaps the most distinctive element of ACT is its focus on values. Clients work with their therapist to identify personal values across various life domains — relationships, career, health, personal growth, community — and then set specific behavioral goals aligned with those values. The emphasis is always on the question: “What do you want your life to be about?”

ACT can be delivered in both individual and group formats, and both are used at Advanced Health and Education. Sessions are typically collaborative and conversational, though they may also include structured exercises and homework between sessions.

In early sessions, your therapist will work with you to understand your history, the problems that brought you to treatment, and the ways you’ve tried to cope with those problems in the past. A key part of this initial phase is gently exploring whether your current coping strategies — including substance use, avoidance, or excessive worry — have truly worked for you in the long run, or whether they’ve come at a cost.

As therapy progresses, you’ll learn and practice the six core ACT processes. Your therapist will introduce these through a mix of conversation, metaphors, and hands-on exercises. You may be asked to do things that feel counterintuitive at first, like deliberately making space for an emotion you’ve been avoiding, or noticing a thought without trying to argue with it or push it away.

You’ll also spend time clarifying your values and identifying concrete steps you can take — this week, today, even in the next hour — to move toward the kind of life you want. Your therapist will support you in committing to these actions and will help you work through the inevitable obstacles that arise.

A typical course of ACT varies depending on the treatment setting and individual needs. In residential or intensive outpatient settings, ACT principles may be reinforced daily through group sessions, individual therapy, and therapeutic activities. Research suggests that meaningful gains can be seen in as few as 8 to 12 sessions, though the skills are designed to be practiced and deepened over a lifetime.⁷

Acceptance and Commitment Therapy has one of the fastest-growing evidence bases in modern psychotherapy. A comprehensive review of 20 meta-analyses encompassing 100 controlled effect sizes across 12,477 participants found ACT to be efficacious for all conditions examined — including anxiety, depression, substance use, chronic pain, and transdiagnostic presentations.¹ ACT was generally superior to inactive controls, treatment as usual, and most active intervention conditions.

For substance use disorders specifically, a meta-analysis of 10 randomized controlled trials found that approximately 67% of individuals receiving ACT showed outcomes above the average for comparison groups at follow-up — suggesting that ACT’s benefits strengthen over time rather than fade.² The Association for Contextual Behavioral Science maintains a continuously updated registry of ACT trials, which currently documents over 1,300 randomized controlled trials.

ACT has been endorsed as an evidence-based treatment by the American Psychological Association, the U.S. Department of Veterans Affairs, the World Health Organization, and SAMHSA. Its transdiagnostic design — treating the underlying processes of psychological inflexibility rather than targeting specific diagnoses — makes it especially well-suited for treatment settings where clients present with multiple co-occurring conditions.