ACT: What the Research Says

Acceptance and Commitment Therapy, usually pronounced as the word “act” rather than spelled out, takes a slightly different starting point to many other therapies. Instead of focusing primarily on reducing or eliminating difficult thoughts and feelings, ACT asks a different question: even while this difficulty is present, what would it look like to move toward a life that actually matters to you?

What ACT actually involves

ACT is built around six core processes, usually grouped under two broad skills: acceptance and mindfulness, and commitment and behaviour change. A central idea is “psychological flexibility”: the capacity to stay in contact with the present moment and choose behaviour based on what matters to you, rather than being dictated to by whatever thought or feeling happens to be loudest. In practice, this often looks like using metaphor and experiential exercises to loosen the grip of unhelpful thoughts (a process called “cognitive defusion”), clarifying what a person actually wants their life to stand for, and building committed action plans toward those values.

What the research says

ACT has now accumulated a substantial evidence base. A comprehensive 2020 review of meta-analyses pooled findings across 20 separate meta-analyses covering 133 individual studies and more than 12,000 participants. The authors concluded that ACT is efficacious across a genuinely wide range of presentations, including anxiety, depression, substance use, chronic pain and transdiagnostic groups.

Compared with other active, established treatments, ACT tended to outperform most, though it generally showed slightly smaller effects than CBT specifically when the two were compared head-to-head.Journal of Contextual Behavioral Science, 2020

More recent, condition-specific research continues to build on this. A 2024 meta-analysis examined ACT specifically for anxiety and depression symptoms in adolescents, finding meaningful symptom improvement. Other recent systematic reviews have looked at ACT for chronic pain, finding improvements not just in pain-related distress but in broader quality of life and functioning, reflecting one of ACT’s particular strengths: it was designed from the outset to target functioning and valued living, not just symptom counts.

Who tends to benefit from ACT

ACT is particularly well suited to situations where a difficulty can’t simply be “fixed” or removed, such as chronic pain, chronic illness, grief, or longstanding anxiety that hasn’t fully resolved with symptom-focused approaches. It also appeals to people who find the idea of “fighting” their thoughts and feelings exhausting or counterproductive, and who are drawn to a values-based, life-oriented approach to therapy.

Getting started

An initial session typically explores what matters most to you, where things currently feel stuck, and how avoidance or struggle with difficult inner experiences may be getting in the way, before building a plan together.

References:
Gloster, A. T., et al. (2020). The empirical status of ACT: A review of meta-analyses. Journal of Contextual Behavioral Science, 18.
Process of change and efficacy of ACT for anxiety and depression symptoms in adolescents. Clinical Psychology Review (2024).
ACT for patients with chronic pain: A systematic review and meta-analysis. PubMed (2024).
The efficacy of ACT for depression: A systematic review and meta-analysis. Journal of Affective Disorders (2025).