Making Room for Difficult Feelings: Acceptance and Commitment Therapy (ACT)

Acceptance and Commitment Therapy (ACT, said like the word "act") helps you respond more flexibly to difficult thoughts and feelings, while taking steps towards a life that matters to you. It combines mindful awareness of the present with practical action guided by your values.

You might know what it's like to put life on hold until you feel less anxious, more confident or completely sure. ACT asks a different question: is there a meaningful next step you can take, while making room for some of that discomfort?

Where did ACT come from?

ACT was developed in the 1980s by psychologist Steven C. Hayes and colleagues. It belongs to the wider family of cognitive and behavioural therapies and also draws on mindfulness. Hayes has described how his own panic attacks shaped the approach. He found that fighting anxiety made it grow, while learning to make room for it let his life get bigger.

The central idea: psychological flexibility

Pain, doubt and hard emotions are part of being human. ACT suggests that much suffering comes not only from these experiences, but from our efforts to avoid or get rid of them. Avoidance can work in the short term. But over time it can shrink our lives.

The goal of ACT is psychological flexibility. That means being able to stay present with whatever you're feeling, and choosing actions based on what matters, not on what feels most comfortable right now.

The six core processes

• Acceptance: making room for hard feelings instead of fighting them.
• Defusion: stepping back from thoughts and seeing them as words and pictures in your mind, not facts or orders.
• Being present: paying attention to what's happening now, with openness and curiosity.
• Self-as-context: knowing you are more than any single thought, feeling or story about yourself.
• Values: getting clear on how you want to live and treat others.
• Committed action: taking practical steps guided by those values.

What does acceptance mean?

Acceptance means acknowledging what you feel inside, while staying open to other possibilities and committed to what matters. A feeling can be there without deciding everything you do.

It does not mean approving of mistreatment, giving up on change or ignoring a problem. Accepting "I feel scared right now" can sit alongside setting a boundary, asking for help or taking action to improve things.

Making space between a thought and a decision

Defusion means noticing a thought as something your mind is producing, rather than treating it as true. "I'm noticing the thought that I'll fail" leaves a little more room to choose than "I'll fail".

Imagine someone who values friendship but worries about being awkward. They notice the worry and the urge to stay home, and still choose a short coffee with a trusted friend. The goal isn't to force the anxiety away. It's to give friendship a say in the decision too.

An example: how ACT might look in practice

The following example is made up to show the process. It is not a real client.

Priya, 45, had chronic back pain and had stopped most of the things she enjoyed, waiting for the pain to go away first. In therapy, she noticed how much energy went into fighting the pain and the thought "I'm useless now". She practised noticing that thought without arguing with it. She also got clear that being an involved grandmother and being outdoors mattered most to her. She began with ten-minute walks along the foreshore with her grandson. Her pain didn't disappear. But over a few months, her life grew around it, and the pain took up less of her attention.

Turning values into goals

Values describe how you want to live, such as with care, honesty, curiosity or connection. Unlike goals, they are never "finished". Goals are specific steps that express your values. If you value being a present parent, one goal might be ten minutes of undistracted time with your child each day.

Steps can be adjusted to your circumstances and energy. A values-based plan shouldn't become another list of demands to judge yourself against. It can include rest, boundaries and asking for help.

What can ACT help with?

ACT has been studied for many problems, including anxiety, depression, OCD, chronic pain, stress and burnout, substance use, psychosis and adjusting to long-term health conditions. Because it focuses on how we relate to our experiences rather than on one diagnosis, it can also help with life changes, grief or situations that can't easily be changed.

What does the research show?

A 2020 review of 20 meta-analyses, covering 133 studies and more than 12,000 people, found support for ACT across many mental and physical health problems. ACT generally did better than waitlists and usual care, and often did about as well as established treatments such as CBT. Results varied by condition.

A review of acceptance- and mindfulness-based therapies for anxiety disorders also found promising short-term results, although longer-term evidence was limited. ACT is a well-supported option, but no single therapy is best for everyone.

How is ACT different from CBT?

ACT and CBT share roots and many techniques, such as practising new behaviours and working towards goals. The main difference is how they handle difficult thoughts. Traditional CBT often checks whether a thought is accurate and looks for a more balanced one. ACT cares less about whether a thought is true, and more about whether holding onto it tightly is helpful. Many psychologists draw on both.

What might sessions involve?

Sessions can include noticing thought patterns, short mindfulness exercises, exploring what matters to you and planning a small action before next time. ACT often uses metaphors, such as imagining thoughts as leaves floating down a stream. Your psychologist should explain these and adapt them to you. You don't need to take up formal meditation.

In ACT, progress is measured by what you're able to do, not only by whether hard feelings have gone. Many people find those feelings ease as their life grows.

Getting support at Invision Psychology

Our psychologists offer ACT at our clinics in Rockhampton (2/72 Bolsover Street) and Yeppoon (3/26 James Street), and by telehealth for people across Central Queensland and beyond.

• You don't need to know which therapy you want. Your first appointment is a chance to talk about what's happening and what you'd like to change.
• Medicare: with a Mental Health Treatment Plan from your GP, you may be able to claim a Medicare rebate for up to 10 sessions each calendar year. See our fees.
• NDIS: we work with self-managed and plan-managed NDIS participants.

Make an enquiry or call 07 5641 4888.

If you need help now

If you or someone else is in immediate danger, call 000. For 24/7 support:

• Lifeline: 13 11 14
• Beyond Blue: 1300 22 4636
• 13YARN (Aboriginal and Torres Strait Islander people): 13 92 76
• Kids Helpline (ages 5–25): 1800 55 1800

An appointment enquiry is not an emergency service.

About the author

Alex Parkes BPsychSci, GradDipPsych, MPsych, MAAPi
Founder and Principal Psychologist, Invision Psychology. Level 1 trained Internal Family Systems practitioner.

Published September 2026 · Last reviewed September 2026 · Next review due September 2027

This article gives general information based on published research. It is not a substitute for personalised advice from a qualified health professional.

References and further reading

• Association for Contextual Behavioral Science. Acceptance and Commitment Therapy (ACT).
• Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2012). Acceptance and Commitment Therapy: The Process and Practice of Mindful Change (2nd ed.). Guilford Press.
• Gloster, A. T., et al. (2020). The empirical status of acceptance and commitment therapy: a review of meta-analyses. Journal of Contextual Behavioral Science.
• Haller, H., et al. (2021). A systematic review and meta-analysis of acceptance- and mindfulness-based interventions for DSM-5 anxiety disorders. Scientific Reports, 11, 20385.
• A-Tjak, J. G., et al. (2015). A meta-analysis of the efficacy of acceptance and commitment therapy for clinically relevant mental and physical health problems. Psychotherapy and Psychosomatics, 84, 30–36.