Acceptance and commitment therapy (ACT)

Acceptance and commitment therapy, ACT, helps you change your relationship with difficult thoughts and feelings rather than trying to argue them away. Instead of aiming to feel differently first, it works on acting in line with what matters to you even while anxiety, low mood or self-doubt are still present.

What ACT is and the evidence for it

ACT was developed by the American psychologist Steven Hayes and colleagues from the late 1980s onwards, building on a body of research called relational frame theory. It sits within the broader family of cognitive behavioural approaches but starts from a different premise. Rather than treating difficult thoughts as errors to be corrected, ACT treats the struggle against them, the constant effort to suppress, avoid or argue with a thought or feeling, as the thing that often does the most damage.

NICE recommends ACT specifically for chronic primary pain, where the evidence is strong. For anxiety and depression, the picture is more mixed. CBT remains NICE’s named first-line recommendation for most anxiety and depression presentations, and we say so plainly. ACT has a substantial and growing evidence base of its own for both, with a number of trials showing outcomes comparable to CBT, and it is used widely across NHS psychological therapy services as an established alternative or a complement to CBT rather than a fringe approach.

ACT is usually described through six interlinked processes: acceptance of difficult internal experiences, cognitive defusion, or learning to notice a thought rather than automatically believe it, contact with the present moment, a sense of self that is steadier than any single thought or feeling, clarity about your values, and committed action in line with them. In practice, sessions rarely move through these as a strict sequence. Your psychologist works with whichever of the six is getting in your way most at a given point, then loops back to others as needed.

What ACT helps with

ACT is often used for anxiety and depression, particularly where a lot of effort has already gone into trying to think your way out of a difficulty without success. It can also support work on stress and burnout, where the goal is often less about eliminating pressure and more about reconnecting with what a working life is actually for. Some psychologists draw on ACT alongside exposure-based CBT for OCD, using its focus on willingness to sit with discomfort to support the harder parts of that work. It tends to suit people who have found that trying to control or eliminate a feeling has become its own source of struggle, particularly if the effort spent avoiding a feeling is now costing more than the feeling itself ever did.

What a course of ACT sessions looks like

Early sessions build a picture of your current patterns, particularly where you have been trying to avoid, suppress or argue yourself out of a thought or feeling, and at what cost. From there, work moves through a set of interlinked skills rather than a strict step-by-step sequence: noticing thoughts as mental events rather than facts, staying present rather than caught up in the past or future, and clarifying the values that matter most to you in a handful of areas of life, relationships, work, health.

Sessions are practical rather than purely reflective. You will often try a short exercise together and talk through what came up, then agree a small, concrete action for the week ahead that fits your values, even if the anxious or low thoughts are still present. Courses commonly run for somewhere between eight and sixteen sessions, though this varies with what you are working on, and your psychologist reviews progress with you rather than working to a fixed script.

How ACT works online

ACT translates well to video because much of the work is verbal and reflective, with exercises that need nothing more than the two of you talking it through. Sessions run over secure video, usually fifty minutes, at a time that fits around work. Where an exercise benefits from a visual aid, a values worksheet or a simple diagram of a pattern you have been stuck in, your psychologist can share their screen so you are both looking at the same thing.

Committed action, the practical steps you agree between sessions, tends to work particularly well delivered online, because the situations you are working on, a difficult email, a family conversation, a habit of checking your phone when anxious, are usually happening in the same environment you are sitting in for the session. There is little translation needed between what you discuss and where you go on to practise it.

ACT and life in Islington

Committed action tends to be tested against real life almost immediately, and for people in Islington that often means a specific Upper Street meeting, a tense exchange on the Victoria line, or a habit of checking work email through the evening in Barnsbury or Canonbury. Rather than treating these as abstract examples, sessions work with whatever is actually happening in your week, so the gap between talking about a value and acting on it stays as short as possible.

Who ACT may not suit

ACT asks you to sit with some discomfort rather than resolve it immediately, and that does not suit everyone, particularly early on when a more structured, symptom-focused approach might feel more manageable. If you are looking primarily to challenge and change the content of specific thoughts, CBT may be a closer fit. If your difficulties are rooted in longstanding relational patterns rather than a struggle with avoidance, schema therapy is worth discussing instead. Your psychologist will talk through the options with you at assessment rather than assuming ACT is right by default.

Getting started

ACT here is delivered online. If a values-based approach sounds like it might fit, our get started page is the quickest way to tell us what is going on.