Acceptance and Commitment Therapy (ACT)

Our rating
 2 smilies: This treatment is useful. It is supported by scientific evidence as effective, but the evidence is not as strong.

What does this rating mean?

The rating system

  • 3 smiliesThese treatments are very useful. They are strongly supported as effective by scientific evidence.
  • 2 smiliesThese treatments are useful. They are supported by scientific evidence as effective, but the evidence is not as strong.
  • 1 smileyThese treatments are promising and may be useful. They have some evidence to support them, but more evidence is needed to be sure they work.
  • No smiley On the available evidence, these treatments do not seem to be effective.
  • Question markThese treatments have not been properly researched. It is not possible to say whether they are useful or not.
  • These treatments are not recommended and could be dangerousSafety or other concerns have been raised for the use of these treatments.

What is it?

Acceptance and Commitment Therapy (ACT) is a type of talking therapy. ACT teaches people two main processes:  (1) acceptance of the situation based on what can and can’t be changed; and (2) commitment to personal values. These processes aim to help a person cope better with experiences that may cause depression.

How does it work?

ACT teaches psychological flexibility. Psychological flexibility is the ability to be aware of your own thoughts and choose how you think and respond to certain situations. The opposite is psychological rigidity. This means that a person reacts automatically to situations or emotions without much thought about the consequences. By teaching psychological flexibility, ACT empowers a person to break psychological rigidity and respond to situations in a way that will help their depression.

ACT also teaches people how to identify and commit to their personal values. This helps people to choose better ways of responding to situations and encourages them to make choices that align with their personal values.

Is it effective?

ACT is a newer kind of therapy and there is not as much evidence to support is as there is for other types of therapy, such as cognitive behaviour therapy. However, studies have found that that ACT is more effective at reducing depression symptoms than no treatment. Some studies have found that ACT is about as effective as other psychological therapies at treating depression.

More research is needed to determine if ACT is effective in the long term and if it is effective for people with severe depression.

Are there any disadvantages?

ACT may involve seeing a therapist weekly for several months. It can be expensive, although in Australia Medicare provides rebates for visits to clinical psychologists, psychologists and other therapists (see below).

Where do you get it?

ACT is available from a range of people with different levels of training, including psychologists (see Psychologists & other therapists).

In Australia, Medicare provides rebates for visits to some therapists under the Better Access to Mental Health Care scheme. ACT may be covered by some private health insurance funds and is sometimes available from therapists employed in hospitals or government-funded clinics.

Recommendation

ACT appears to be an effective treatment for adults with mild-to-moderate depression in the short term. It is not clear if ACT is effective for depression in the long term.

Key references

  • Bai Z, Luo S, Zhang L, Wu S, Chi I. Acceptance and Commitment Therapy (ACT) to reduce depression: A systematic review and meta-analysis. J Affect Disord. 2020; 260: 728-37.
  • Churchill R, Moore THM, Furukawa TA, Caldwell DM, Davies P, Jones H, et al. 'Third wave' cognitive and behavioural therapies versus treatment as usual for depression. Cochrane Database of Systematic Reviews. 2013(10).
  • Hunot V, Moore THM, Caldwell DM, Furukawa TA, Davies P, Jones H, et al. 'Third wave' cognitive and behavioural therapies versus other psychological therapies for depression. Cochrane Database of Systematic Reviews. 2013(10).
  • Ost LG. The efficacy of Acceptance and Commitment Therapy: an updated systematic review and meta-analysis. Behaviour research and therapy. 2014; 61: 105-21.
  • Powers MB, Zum Vörde Sive Vörding MB, M.G. Emmelkamp P. Acceptance and commitment therapy: A meta-analytic review. Psychotherapy and Psychosomatics. 2009; 78: 73–80.

Last reviewed and updated: 1 December 2019