What Is ACT? How Acceptance and Commitment Therapy Helps with Anxiety and Depression

Acceptance and Commitment Therapy (ACT, pronounced as the word "act") is an evidence-based psychotherapy that helps you build psychological flexibility—the ability to be present with difficult thoughts and feelings while taking action aligned with what matters to you. Rather than trying to eliminate anxiety or depression, ACT teaches you to change your relationship with these experiences so they no longer control your life. Developed in the 1980s by psychologist Steven C. Hayes, ACT combines mindfulness, acceptance strategies, and commitment to behavior change in a way that's proven effective for both anxiety and depression.

If you've noticed that trying harder to control or eliminate unwanted thoughts and feelings only makes them stronger, or if traditional approaches haven't provided lasting relief, ACT offers a fundamentally different path.

What Makes ACT Different from Other Therapies?

Unlike traditional Cognitive Behavioral Therapy (CBT), which often focuses on changing or challenging negative thoughts, ACT takes a different stance: it teaches you to accept thoughts and feelings as they are, without trying to change them, while still moving toward your values.

The key distinction is this: ACT doesn't ask "Is this thought true or false?" Instead, it asks "Is holding onto this thought helping you live the life you want?"

Where CBT might help you challenge the thought "I'm not good enough" by looking for evidence against it, ACT teaches you to notice the thought, recognize it as just that—a thought, not a fact—and choose your actions based on your values rather than what the thought demands. This process, called cognitive defusion, helps you step back from thoughts rather than being controlled by them.

ACT also emphasizes psychological flexibility—the ability to stay present, open up to difficult experiences, and take action that aligns with what truly matters to you, even when anxiety or depression shows up. Research shows that increases in psychological flexibility predict better outcomes across multiple mental health conditions (López-Pinar et al., 2024).

What Is Psychological Flexibility?

Psychological flexibility is the core skill ACT helps you develop. It's the capacity to be fully present in the moment, acknowledge and accept difficult internal experiences like anxiety or sadness, and persist with or change behavior in service of your values.

Think of it as mental agility—the ability to adapt your responses to what the situation requires rather than reacting automatically to whatever thought or feeling shows up. When you're psychologically flexible, anxiety doesn't have to stop you from connecting with people you care about, and depressive thoughts don't have to prevent you from pursuing meaningful work.

A recent meta-analysis by Zou et al. (2025) published in BMC Psychiatry found that ACT significantly improves depressive symptoms, anxiety, and psychological flexibility in individuals with depression. The study included 13 randomized controlled trials with 1,362 patients, demonstrating that building psychological flexibility translates into real symptom relief.

What Are the Six Core Processes of ACT?

ACT works through six interconnected processes that, together, build psychological flexibility. Each process offers practical skills you can develop in therapy and use in daily life:

Acceptance

Acceptance means making room for uncomfortable thoughts, feelings, and sensations rather than struggling to suppress or control them. It's not resignation or giving up—it's choosing to stop fighting an internal battle that keeps you stuck. When you accept anxiety as it is, you free up energy to take meaningful action instead of exhausting yourself trying to make it go away.

Cognitive Defusion

Defusion helps you step back from your thoughts and see them as mental events—just words or images passing through your mind—rather than literal truths or commands you must obey. You learn to notice "I'm having the thought that I'm a failure" rather than believing "I am a failure." This subtle shift creates distance and reduces the power thoughts have over your behavior.

Present Moment Awareness

Present moment contact involves paying attention to what's happening right now rather than getting lost in worries about the future or regrets about the past. Mindfulness practices help you develop this skill, allowing you to engage fully with your current experience even when it's difficult.

Self-as-Context

This process helps you recognize that you are the observer of your thoughts and feelings, not the thoughts and feelings themselves. You're the space in which all your experiences happen—the "you" that's always been there, watching your life unfold. This perspective gives you stability even when emotions feel overwhelming.

Values

Values clarify what truly matters to you—the qualities you want to embody and the directions you want your life to move in. Unlike goals, which you can achieve and check off a list, values are ongoing: you can always take another step toward being a caring partner, a creative person, or someone who contributes to your community. ACT helps you identify your values and use them as a compass for decision-making.

Committed Action

Committed action means taking concrete steps, even small ones, in directions your values point you—regardless of what thoughts or feelings show up. It's what moves ACT from insight to actual behavior change. You practice doing what matters even when anxiety says "don't" or depression says "why bother."

How Effective Is ACT for Anxiety and Depression?

The research supporting ACT's effectiveness for anxiety and depression has grown substantially in recent years. Multiple meta-analyses show that ACT produces meaningful symptom reduction for both conditions.

For adolescents struggling with anxiety and depression, research by López-Pinar, Lara-Merín, and Macías (2024) published in the Journal of Affective Disorders analyzed 27 randomized controlled trials with 2,860 participants. The meta-analysis found that ACT was significantly more effective than treatment as usual for depression symptoms and inactive controls for both anxiety and depression. Importantly, improvements in psychological flexibility significantly predicted reductions in both depression and anxiety symptoms—showing that the core mechanism of ACT actually drives the results.

For adults with depression, the evidence is similarly strong. ACT has been shown to significantly improve depressive symptoms, with the benefits maintained at follow-up assessments (Zou et al., 2025). This means the skills you build in ACT continue to serve you well after therapy ends.

The effectiveness of ACT appears to work through building psychological flexibility rather than simply reducing symptoms directly—you learn skills that help you live well even when difficult emotions are present.

What Happens in an ACT Therapy Session?

ACT therapy is active, experiential, and skills-focused. Rather than just talking about your problems, you'll engage in exercises and metaphors that help you experience the core processes directly.

In a typical session, you might:

• Practice mindfulness exercises to build present-moment awareness—noticing your breath, body sensations, or the space around you
• Work with metaphors that illustrate psychological concepts (like "passengers on the bus" to understand how thoughts and feelings can be present without controlling where you go)
• Identify your values through exercises that clarify what truly matters to you across different life domains
• Set committed actions—small, concrete steps you'll take between sessions that align with your values
• Practice defusion techniques—saying a distressing thought out loud in a silly voice, or writing it down and observing it as words on paper
• Explore workability—examining whether your current strategies for managing anxiety or depression are actually helping you live the life you want

Your therapist acts as a guide and coach, teaching you skills and supporting you as you practice them. The relationship is collaborative—you're learning tools you'll use long after therapy ends.

Who Is Steven C. Hayes?

Steven C. Hayes is a Foundation Professor of Psychology at the University of Nevada, Reno, and the developer of Acceptance and Commitment Therapy. Hayes created ACT over 20 years ago, partly informed by his own experience with panic disorder. After finding that conventional cognitive strategies failed to free him from anxiety, Hayes began exploring a different approach: instead of trying to eliminate panic, he practiced making room for it while continuing to live according to what mattered to him.

Hayes is the author of 47 books and over 675 articles, with his work published in 20 languages. He also developed Relational Frame Theory, the basic science underlying ACT. His approach has influenced how therapists understand language, cognition, and human suffering—shifting the focus from eliminating symptoms to building a rich and meaningful life even in the presence of pain.

How Does ACT Help with Anxiety Specifically?

Anxiety tells you that you need to avoid, escape, or control whatever triggers the anxious feelings. ACT teaches the opposite: that trying to control anxiety often makes it worse, and that you can take meaningful action even while anxiety is present.

Rather than asking "How do I get rid of this anxiety?" ACT asks "What do I want my life to be about, and can I take a step in that direction even with this anxiety here?"

Through acceptance and defusion, you learn to let anxious thoughts and physical sensations be present without treating them as emergencies. Through values and committed action, you practice doing what matters—reaching out to a friend, pursuing a goal, showing up for something important—even when anxiety says it's too risky.

Over time, this shifts the pattern: anxiety still shows up, but it no longer controls your choices. And paradoxically, when you stop struggling against anxiety, it often loses intensity on its own.

How Does ACT Help with Depression?

Depression often comes with thoughts like "nothing matters," "I'm worthless," or "why bother trying." ACT doesn't argue with these thoughts or try to replace them with positive ones. Instead, it helps you notice these thoughts as products of your mind, and gently invites you to try small actions aligned with your values regardless of what depression says.

The focus shifts from "feel better first, then act" to "act on what matters, and notice what happens." You might clarify a value around connection and commit to texting one friend this week, even though depression insists it won't help. You practice the action as an experiment, not because you're convinced it will work, but because it aligns with who you want to be.

Research shows this approach works. By building psychological flexibility—accepting difficult emotions, defusing from depressive thoughts, and taking committed action—people experience meaningful reductions in depressive symptoms (Zou et al., 2025).

ACT also addresses the behavioral withdrawal that often maintains depression. When you feel hopeless, you stop doing things that used to give your life meaning. ACT helps you reconnect with your values and take small steps back toward engagement, even before motivation returns.

Can ACT Be Combined with Medication?

Yes. ACT is a psychotherapy approach that works well alongside medication when needed. Many people benefit from combining therapy and medication, particularly for moderate to severe depression or anxiety. ACT can help you develop skills for managing symptoms and building a meaningful life, while medication can provide neurochemical support that makes those skills easier to practice.

The decision about medication is one you make with your prescriber based on your specific situation. ACT neither requires nor prohibits medication—it's a complementary approach that addresses how you relate to your internal experiences and what actions you take in your life.

How Long Does ACT Take to Work?

The timeline varies depending on your specific concerns and goals. Some people notice shifts in how they relate to their thoughts and feelings within a few sessions. Building robust psychological flexibility and seeing sustained changes in anxiety or depression typically takes several months of consistent work.

Unlike some short-term therapies, ACT focuses on teaching you skills you'll use for the rest of your life. The goal isn't just symptom reduction—it's building flexibility that helps you navigate whatever challenges come up, long after therapy ends.

Most people meet with their ACT therapist weekly at first, then transition to less frequent sessions as skills develop. Between sessions, you practice what you've learned—trying new ways of relating to difficult thoughts, taking committed actions aligned with your values, and noticing what works.

Is ACT Right for You?

ACT tends to work well for people who:

• Have tried to control or eliminate anxiety or depression and found it doesn't work long-term
• Are willing to try a different relationship with difficult thoughts and feelings
• Want practical skills they can use in daily life, not just insight
• Are open to mindfulness and experiential exercises
• Value living according to what matters to them, even when it's hard
• Struggle with avoidance—staying away from situations, people, or experiences because of anxiety or depression

If you've read this far and found yourself thinking "this makes sense" or "I want to try this," ACT might be a good fit. The approach is collaborative and flexible—your therapist will adapt it to your specific needs and pace.

If you're struggling with anxiety or depression that's limiting your life, you don't have to manage it alone. At Amy Robbins Counseling, our therapists offer evidence-based treatment including ACT and other approaches tailored to your needs. We provide therapy in person at our Kirkwood and Grant Park offices in Atlanta, and via telehealth across Georgia. Reach out today to schedule a consultation and take the first step toward building the psychological flexibility that helps you live well.

References

López-Pinar, C., Lara-Merín, L., & Macías, J. (2024). Process of change and efficacy of acceptance and commitment therapy (ACT) for anxiety and depression symptoms in adolescents: A meta-analysis of randomized controlled trials. Journal of Affective Disorders, 368, 633–644. https://pubmed.ncbi.nlm.nih.gov/39303882/

Zou, Y., Wang, R., Xiong, X., et al. (2025). Effects of acceptance and commitment therapy on negative emotions, automatic thoughts and psychological flexibility for depression and its acceptability: a meta-analysis. BMC Psychiatry, 25, 602. https://pubmed.ncbi.nlm.nih.gov/40597900/