Acceptance and Commitment Therapy (ACT)

What is ACT?

Acceptance and Commitment Therapy, usually shortened to ACT, is a form of psychological therapy that helps people build a different relationship with difficult thoughts and feelings while acting in line with what matters to them.

Developed from behavioural and cognitive science, ACT sits within the group of approaches often described as third-wave cognitive behavioural therapies. It combines mindfulness-based skills with practical steps towards value-driven action, treating a fuller life as the aim of therapy alongside any reduction in symptoms. ACT was developed in the 1980s by Steven Hayes and colleagues, and has since been adapted into individual and group formats for a wide range of psychological and physical health difficulties.

The six core processes of ACT

ACT is built around six interlinked processes, sometimes described together as psychological flexibility. Sessions do not usually move through them as a fixed checklist; a psychologist draws on whichever process fits what a person brings to that particular session.

Cognitive defusion

This involves noticing thoughts as mental events passing through the mind, rather than facts that must be obeyed or argued with. A thought such as “I am not good enough” can be held lightly, as one thought among many, instead of treated as a verdict.

Acceptance

Acceptance involves allowing difficult feelings, sensations or urges to be present without a struggle to push them away, even when that means feeling some discomfort on the way towards something that matters.

Present-moment contact

ACT encourages attention to what is actually happening now, rather than being carried into rumination about the past or worry about the future. This process often draws on mindfulness exercises, adapted to a person’s own life and preferences.

Self-as-context

This process helps someone notice that they are the person having thoughts and feelings, not the thoughts and feelings themselves. Building this perspective can create some distance from painful self-judgements.

Values

Values work involves identifying what genuinely matters to a person, in areas such as relationships, work or health, separate from goals that can simply be ticked off. Values act as a compass for choices, guiding decisions over time rather than marking a single finish line.

Committed action

The final process turns values into specific, workable steps, even when anxiety, low mood or self-doubt are still present. Progress is tracked by whether actions match what a person cares about, alongside whatever else is going on for them at the time.

When ACT can help

ACT has been used with anxiety, depression, chronic pain, stress, and difficulty adjusting to health conditions or major life changes. People often bring difficulties such as ongoing worry, low mood, panic, health anxiety, work-related stress or the emotional impact of long-term physical health problems. Others come because they feel caught in a cycle of avoidance, where steering away from certain situations or feelings has started to shrink their day-to-day life. It can also suit people who feel worn down by trying to manage their thoughts through willpower alone, or who have found that arguing with unwanted thoughts keeps those thoughts in the foreground rather than reducing them. ACT is offered here for adults; it does not replace urgent or crisis support.

What to expect from ACT therapy

Early sessions usually cover current difficulties and what has been tried already, alongside starting to map out personal values. A psychologist will introduce specific exercises, some talked through in session, others practised between appointments, so new ways of relating to thoughts and feelings get tested against daily life rather than discussed in the abstract. The pace and number of sessions depend on what someone brings to therapy and how they respond, agreed between the person and their psychologist as things progress. Some people notice a shift in how thoughts affect them fairly early on; for others, especially where difficulties have built up over years, the work takes longer and unfolds gradually across a course of sessions.

The evidence for ACT

ACT has a substantial body of research behind it, including trials in chronic pain, anxiety and depression. NICE guidance on chronic pain (NG193) includes ACT as part of a recommended psychological support offer for people living with persistent pain. For anxiety and depression, established CBT protocols remain the primary NICE recommendation, and many clinicians use ACT as an evidence-based option alongside or instead of CBT where an acceptance-based approach suits someone better. Trials have also looked at ACT for workplace stress and for supporting people managing long-term physical health conditions, generally reporting improvements in day-to-day functioning alongside reductions in distress.

ACT compared with CBT

ACT and CBT share roots in behavioural science, and both are structured, present-focused therapies. Traditional CBT often works by identifying unhelpful thinking patterns and testing or changing them directly. ACT works instead on a person’s relationship with their thoughts, aiming for psychological flexibility over the removal of any specific thought. Many psychologists draw on both, since some ACT skills, such as noticing thought patterns, overlap with CBT technique. Someone who has already tried CBT and found the process of challenging thoughts difficult to sustain may find ACT’s acceptance-based approach a more workable alternative.

Online ACT therapy for Greenwich and south east London

Clinical psychologists here work online with adults across Greenwich and south east London, covering SE10 and the western edge of SE3, from the river by Cutty Sark up through Greenwich Park towards Blackheath. Sessions are available to people in Charlton, Deptford, Lewisham, New Cross and Maze Hill as well as Greenwich itself, and to anyone connecting near the Cutty Sark and Greenwich DLR stops or Greenwich and Maze Hill stations on the Southeastern line. Working online means appointments can fit around commutes into central London and the routines of streets that stay busy around Greenwich Market and the Old Royal Naval College, without adding travel time either side of a session. We will update this site as the practice develops.

Getting started

If ACT sounds like a good fit, the next step is to get in touch and talk through what is going on and what kind of support you are looking for. This page covers ACT for adults; a psychologist can then explain how ACT might apply to your own situation before any sessions begin.