Acceptance and Commitment Therapy

Acceptance and commitment therapy (ACT, typically pronounced as the word "act") is a form of psychotherapy commonly described as a form of cognitive-behavior therapy or of clinical behavior analysis (CBA). It is an empirically-based psychological intervention that uses acceptance and mindfulness strategies mixed in different ways with commitment and behavior-change strategies, to increase psychological flexibility. The approach was originally called comprehensive distancing. It was begun in 1982 by Steven C. Hayes and was first tested by Robert Zettle in 1985, but was built out into its modern form in the late 1980s. There are a variety of protocols for ACT, depending on the target behavior or setting. For example, in behavioral health areas a brief version of ACT is called focused acceptance and commitment therapy (FACT).

The objective of ACT is not elimination of difficult feelings; rather, it is to be present with what life brings us and to "move toward valued behavior". Acceptance and commitment therapy invites people to open up to unpleasant feelings, and learn not to overreact to them, and not avoiding situations where they are invoked. Its therapeutic effect is a positive spiral where feeling better leads to a better understanding of the truth.

A 2015 review found that ACT was better than placebo and typical treatment for anxiety disorders, depression, and addiction. Its effectiveness was similar to traditional treatments like cognitive behavioral therapy (CBT). The authors suggested that the CBT comparison of the previous 2012 meta-analysis may have been compromised by the inclusion of nonrandomized trials with small sample sizes. They also noted that research methodologies had improved since the studies described in the 2008 meta-analysis.

A 2008 meta-analysis concluded that the evidence was still too limited for ACT to be considered a supported treatment, and raised methodological concerns about the research base. A 2009 meta-analysis found that ACT was more effective than placebo and "treatment as usual" for most problems (with the exception of anxiety and depression), but not more effective than CBT and other traditional therapies. A 2012 meta-analysis was more positive and reported that ACT outperformed CBT, except for treating depression and anxiety.

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