Acceptance and commitment therapy

Figures checked September 2026

Acceptance and commitment therapy is usually shortened to ACT, and said as the word “act”. It’s a practical talking therapy. It helps you live well alongside hard thoughts and feelings, instead of waiting for them to go away first.

ACT comes from the same family as cognitive behavioural therapy (CBT), the structured Approach (modality) The kind of therapy someone uses, such as CBT or psychodynamic therapy. You'll also see it called a modality. More in the jargon decoder that works on the links between thoughts, feelings and behaviour. The main difference is what each one does with a painful thought. Cognitive behavioural therapy (CBT) A structured, practical form of talking therapy. It's built on a simple idea: what you think affects how you feel, and both affect what you do. More in the jargon decoder tends to check whether the thought is accurate, and look for a more balanced one. ACT spends less time on whether the thought is true. It focuses on how much the thought gets to run your life.

ACT was developed in the United States in the 1980s and 1990s by Steven Hayes and his colleagues. Russ Harris, a doctor and therapist based in Australia, wrote The Happiness Trap, one of the most widely read books about it.

How it works

ACT is built on an idea most people recognise. The harder you try not to feel something, the bigger it tends to get.

Say you get anxious before social events. One way to handle the anxiety is to avoid the events. Another is to go, and spend the whole night managing how you feel — rehearsing what to say, watching for signs it’s going badly. Either way the anxiety might ease for a while. Your life also gets smaller, and the anxiety usually comes back.

ACT takes a different line. You stop treating the anxiety as something you have to fix before you can get on with your life. You learn to let it be there, and to do what matters to you anyway.

The model describes six skills that work together:

Acceptance — making room for an unpleasant feeling instead of fighting it. This means allowing it, not liking it or giving up.
Defusion — noticing a thought as a thought. I’m having the thought that I’ll embarrass myself feels different from I’ll embarrass myself.
Being present — paying attention to what’s happening now, rather than being pulled into the future or the past. This is what’s usually meant by mindfulness.
The observing self — a sense of yourself as the one noticing your thoughts and feelings, rather than being defined by them.
Values — working out what actually matters to you: the kind of person, parent, friend or worker you want to be.
Committed action — taking steps towards those values, including when it’s uncomfortable.

The first four skills make up the “acceptance” half of the name. The last two make up the “commitment” half. The model calls the overall result psychological flexibility: staying in contact with what you feel, while still choosing what you do.

What a session is like

Sessions run about 50 minutes. They’re usually structured, and more active than people expect.

Your therapist will often use short exercises instead of long discussions. You might say a harsh thought about yourself over and over until it starts to sound like just words. You might picture your thoughts as cars going past while you stand on the footpath. Some exercises feel a bit silly at first. Each one is a way to practise stepping back from a thought instead of arguing with it.

A good part of the work is on values. In ACT, values are what make the discomfort worth going through. Most people will sit through an anxious evening for someone they love, when they wouldn’t do it for its own sake.

There’s usually something to try between sessions. That might be a short mindfulness practice, or one small action towards something that matters to you.

A course of ACT is often somewhere between eight and sixteen sessions. It’s also used in longer therapy and in groups.

Who it tends to suit

ACT often suits people who’ve spent a long time trying to think their way out of a feeling, and found the feeling doesn’t shift. If you can already explain why your worry is unreasonable and still feel it, ACT doesn’t ask you to win that argument.

It can also suit people who care more about how they want to live than about getting rid of a symptom. And it’s often used with things that won’t fully go away, such as chronic pain, a long-term illness, or grief.

ACT is used for anxiety, depression, stress, chronic pain and substance use. It’s often used for a mix of these, since it isn’t built around any one diagnosis.

ACT may suit you less if you want a detailed look at where a pattern came from, because it works mostly in the present. Schema therapy and psychodynamic therapy spend much more time on your history.

What the evidence says

ACT has a large and growing evidence base. A 2020 review pulled together 20 earlier reviews, covering 133 trials and more than 12,000 people. It found ACT helped with every condition it looked at, including anxiety, depression, substance use and chronic pain (Gloster and colleagues, 2020).

When ACT was compared with CBT, the difference was very small. For most common problems, the two seem to do about as well as each other.

Chronic pain is one of ACT’s best-supported uses. The UK’s national guideline on long-term pain with no clear physical cause suggests ACT or CBT as a psychological treatment.

The 2020 review also raised some cautions. Many trials were small, some were counted in more than one review, and a fair share of the research comes from people who helped develop ACT. Those problems are common in newer therapies, and worth knowing about.

Getting it in Australia

ACT is widely available here.

Who can provide it. Psychologist Someone trained to assess mental health problems and treat them with therapy. It takes at least six years of study and supervised practice, and they're registered with Ahpra, the national regulator. Psychologists can't prescribe medication. More in the jargon decoder , Counsellor Someone trained to help people talk through and work on difficulties. The title isn't protected in Australia, so it's worth checking a counsellor's training and registration. Medicare doesn't give a rebate for counsellors. More in the jargon decoder , Psychotherapist Someone trained in therapy, often for longer-standing patterns. Like counsellor, the title isn't protected in Australia, and Medicare doesn't give a rebate for psychotherapists. More in the jargon decoder , mental health social workers and occupational therapists all use ACT. Many therapists combine it with CBT.

What Medicare Australia's public health insurance scheme. For mental health, it gives rebates on sessions with psychologists and some other professionals, usually through a Mental Health Treatment Plan. More in the jargon decoder Rebate The amount Medicare pays back towards a session. It comes back to you after you've paid, so what you pay yourself is the fee minus the rebate. More in the jargon decoder . A Mental Health Treatment Plan from your GP (general practitioner) For most people, where getting help starts. A GP can write a Mental Health Treatment Plan, prescribe medication and refer you on, and some are trained to deliver a small number of structured therapy sessions themselves. More in the jargon decoder gives you a Medicare rebate on up to ten sessions a calendar year with a psychologist, Mental health social worker A social worker with an extra mental health accreditation. They're trained in therapy, and in the practical things around it, such as housing, money, family services and the systems people get stuck in. More in the jargon decoder or Mental health occupational therapist An occupational therapist with a mental health endorsement. Their focus is on daily life, such as getting back to work, study and routine, alongside the therapy itself. More in the jargon decoder . It doesn’t currently cover counsellors or psychotherapists. Your first Referral A letter from a GP, psychiatrist or paediatrician that you need for the Medicare rebate. You can see a psychologist without one if you pay the full fee. More in the jargon decoder is for six of those sessions. You then go back to your GP for a review before the last four.

The rebate is $149.05 a session with a Clinical psychologist A psychologist with an extra endorsement, which usually means two more years of training aimed at more complex problems. More in the jargon decoder and $101.55 with a Registered For psychologists, psychiatrists and occupational therapists, registration with Ahpra is required, and using the title without it is an offence. Counsellors and psychotherapists can register with their national associations, which is voluntary. More in the jargon decoder psychologist. Fees vary, so what you pay on top varies too. Work out what each option would actually cost you, rather than assuming the rebated one is cheaper.

Medicare keeps a list of approaches registered psychologists can use under the plan. ACT isn’t named on it. In practice ACT is commonly offered under the plan as part of CBT, which it grew out of. Ask the practice whether the rebate applies.

Free options. The World Health Organization has a free illustrated guide called Doing What Matters in Times of Stress, which is based on ACT. The Happiness Trap is another way in. Neither replaces therapy, and both give you a real sense of how ACT works.

ACT tends to work well by Telehealth A session by video or phone instead of in person. Medicare gives the same rebate for a session by video as in person. More in the jargon decoder , since most of the exercises are easy to do over video.

ACT and CBT

The two are close relatives, and plenty of therapists use both. If you’re weighing them up, CBT vs ACT goes through the differences in more detail, including what each one does with the same problem.

As with any approach, the therapist matters at least as much as the method. Why who you see matters more than what they do explains why.

If you’re still working out whether you want therapy at all, what therapy actually is covers the basics, and would I benefit from therapy? helps you work out whether it’s worth a try.