You want to change. You want to escape painful feelings, such as sadness, anxiety or shame…and rid yourself of any troubling thoughts you might be having, such as No one likes me. Or you want to change ineffective or dangerous behavior, whether it’s drinking too much, arguing with your loved ones or being a couch potato.

Psychotherapy is an option. But will it work for you?

An approach you may not be aware of: An increasing body of scientific evidence shows that an action-based therapy known as acceptance and commitment therapy (ACT) can be highly effective in treating a range of mental health problems, including depression, anxiety disorders, chronic pain syndrome and drug and alcohol abuse. Here’s how ACT could help you—or a loved one…


A number of other types of therapies guide you through your past to understand where “wrong” feelings come from. Sometimes, however, you can end up mired more deeply in the very thoughts you’re trying to dispel. With these therapies, negative thoughts and feelings are the enemy. Not so with ACT. With this “outside-the-box” therapy, you become aware of your thoughts and feelings without treating them as “good” or “bad.” This means that you don’t argue with your thoughts. And above all, you don’t try to subtract, suppress or eliminate them…you accept them.

Acceptance doesn’t mean that you put up with feelings like hopelessness or anxiety. Because they aren’t battling their thoughts and feelings, people who use ACT become more able to behave in healthier, more fulfilling ways—to do things they want to do and feel are worthwhile.

ACT helps you learn how to step back from thoughts by recognizing that they’re yours…but they’re not you. (ACT therapists call this defusion.) With this approach, you’re not exhausted and frustrated by constantly trying to control or change your thoughts and feelings.


The key to ACT’s main principle—paying attention to your thoughts and feelings and accepting them—is “defused mindfulness.” This might mean observing your emotions as they grow stronger…noting where you feel them in your body or how they begin and end…and how they combine with other experiences. Defusion is the process of looking at thoughts with an attitude of dispassionate curiosity.

ACT offers many defusion techniques to blunt the power your thoughts have over you—sometimes in a matter of minutes.

Technique #1: If you have a persistently troublesome or unpleasant thought, such as, I’m a failure or I always feel like an outsider, distill it into a single word, such as failure. Say the word out loud, rapidly, once a second for 30 seconds (research shows that is the sweet spot in terms of rate and length). At the end of this time, see whether the thought has the same powerful hold over you. This simple technique has been shown to work even with very painful thoughts.

Technique #2: Give your mind a name, like Casey, and as you focus on a distressing thought, preface it with, Casey says… This technique creates a gap between you and your thought so that you can look at your thinking rather than automatically believing your thinking.

The commitment part of ACT means transforming your acceptance of your thoughts and feelings into positive, meaningful action. If you’re no longer overwhelmed by your feelings, you can turn the energy you once spent trying to change or control them toward discovering what you truly care about and linking your actions to that choice.

Treatment with ACT can yield significant improvement in as few as four to five sessions. Eight to 12 weekly sessions are a more common course. However long the therapy takes, homework is always an important part of ACT. People typically spend 45 minutes a week with the therapist, leaving a lot of time in between sessions.

For homework, you may practice the skills learned in the session and try out new techniques to observe thoughts and feelings dispassionately in real life, gradually turning this new approach into a habit.

Important: No particular therapy works for everyone. If mindfulness is unappealing to you or you aren’t ready to look deeply into your own pain, values and sense of self, you may do better with a different type of therapy. But if you’re intrigued by the ACT principles—especially if you’ve tried other therapies without satisfactory results—this approach could be worth a try.

To find an ACT therapist: Visit the website of the Association for Contextual Behavioral Science (ACBS) at While ACBS doesn’t certify therapists, each listing includes the therapist’s background and training in the technique.


There are nearly 250 randomized trials of acceptance and commitment therapy (ACT). In clinical trials, it has been shown to improve not just various emotional and psychiatric problems but also help individuals become more effective in addressing health issues, such as diet and exercise, and dealing with physical disease.

For example, just four sessions of ACT were associated with substantial improvements in depression. More impressively, when participants were contacted five years later, 40% of those treated still reported minimal or no depressive symptoms.