ACT (Acceptance and Commitment Therapy)

A compassionate, evidence-based approach to care

Most approaches to psychological distress start from the same basic premise: something is wrong inside, and the goal of treatment is to fix it. To reduce the anxiety, to eliminate the negative thoughts, to get rid of the depression, to feel better. That premise makes intuitive sense. Of course the goal is to feel better. But there is a problem with it, and the problem is that it does not always work. People try very hard to control or eliminate unwanted internal experiences, and often find that the harder they try, the more those experiences persist. The struggle itself becomes part of what is keeping them stuck.

Acceptance and Commitment Therapy starts from a different place. Rather than asking how to get rid of difficult internal experiences, it asks a different question: what would you do with your life if you were not spending so much of it fighting what is happening inside? What matters to you, and what is getting in the way of moving toward it? ACT does not promise that the anxiety will disappear or that the difficult thoughts will stop coming. What it offers is a way of holding those experiences differently, so that they no longer have to dictate the direction of your life.

For a lot of people, that reframe is genuinely liberating. It means the goal of therapy is not contingent on achieving a particular internal state. It is contingent on living in a way that reflects what you actually value, which turns out to be something that is available even when things inside are hard.

At Vantage Mental Health, we offer ACT as part of individualized care for adults and teens across Minnesota. We offer in-person care at our clinics in Stillwater, Edina, and St. Anthony, with telehealth available throughout Minnesota.

Understanding ACT

Acceptance and Commitment Therapy was developed by psychologist Steven Hayes in the 1980s and has since accumulated one of the largest and most diverse evidence bases in psychotherapy research. It sits within what is sometimes called the third wave of cognitive behavioral therapies, meaning it builds on the foundations of CBT while adding a significant focus on acceptance, mindfulness, and values-based action rather than primarily on changing the content of thoughts.

The model is organized around six core psychological processes, often referred to as the ACT hexaflex. Acceptance involves opening up to difficult thoughts and feelings rather than fighting them, not because they are pleasant but because the fight tends to cost more than the feelings themselves. Defusion involves changing the relationship with thoughts, learning to notice them as passing mental events rather than literal truths that demand a response. Present moment awareness involves bringing attention to what is actually happening now rather than being lost in mental commentary about the past or future. Self as context involves developing a perspective on the self that is broader and more stable than any particular thought, feeling, or role. Values clarification involves identifying what truly matters to a person, what kind of life they want to build and what qualities they want to embody in how they show up for it. Committed action involves moving toward those values through concrete behavioral steps, even in the presence of difficult internal experiences that might otherwise get in the way.

These six processes work together rather than sequentially. The goal is what Hayes calls psychological flexibility, which is the ability to be present, open, and engaged with whatever life brings, while moving persistently in directions that matter. Research consistently shows that psychological flexibility is one of the strongest predictors of mental health and wellbeing across populations, and that increasing it through ACT produces meaningful clinical outcomes across a remarkably wide range of presentations.

Conditions Treated with ACT

One of the things that distinguishes ACT from some other therapeutic approaches is how broadly applicable it is. Because it works at the level of a person’s relationship with their internal experience rather than targeting specific symptom clusters, it adapts naturally to presentations that are varied, complex, or do not fit neatly into a single diagnostic category.

Conditions and concerns commonly addressed through ACT include:

Depression and persistent low mood, particularly when rumination and withdrawal are significant features
Generalized anxiety and worry, including anxiety that has not responded fully to other approaches
Social anxiety and performance-related fears
Chronic pain and the psychological suffering that accompanies ongoing physical discomfort
Chronic illness and the adjustment challenges that come with living with an ongoing medical condition
OCD and related conditions, where ACT principles complement exposure-based approaches
Trauma and post-traumatic stress, particularly experiential avoidance of trauma-related material
Eating and body image concerns
Substance use and behavioral patterns driven by experiential avoidance
Burnout and loss of meaning in work or daily life
Grief and loss, particularly when avoidance of grief-related feelings is prolonging the adjustment process
Self-esteem and identity concerns rooted in rigid self-concepts
Life transitions that have disrupted a person's sense of direction or purpose
Perfectionism and the self-criticism that tends to accompany it

ACT also works well alongside other treatment modalities and is frequently integrated with exposure-based approaches, behavioral activation, and mindfulness practices depending on what the clinical picture calls for.

Individual Therapist

Specialties:

Adults and Teens with Depression, Anxiety, and Trauma.

Julie Sabin, LPCC, RPT-S

Child Therapist

Specialties:

Trauma, Anxiety, Depression, ADHD, OCD (ERP/CBT), Autism Spectrum Disorder (PEERS® certified), LGBTQI+ allyship.

What to Expect From Treatment

ACT sessions tend to feel somewhat different from traditional therapy, and it is worth knowing what to expect before starting. There is less emphasis on analyzing the content of thoughts and more emphasis on the relationship with thoughts, on learning to notice them, to hold them more lightly, and to act in accordance with values even when the mind is generating noise in the background. That shift can feel unfamiliar at first, particularly for people who have spent a lot of time trying to think their way out of their difficulties.

In early sessions, your therapist will spend time understanding what has been happening, what you have tried, and where things feel most stuck. A central part of early ACT work often involves what is called creative hopelessness, which sounds more alarming than it is. It simply means taking an honest look at the strategies that have been used to manage difficult internal experiences, and examining whether those strategies have actually been working. For most people, this is a clarifying conversation. It reveals the extent to which control-based strategies, avoidance, suppression, distraction, have been consuming significant energy without producing the relief they were supposed to provide.

From there, therapy moves into the core ACT processes. Defusion exercises help create distance between a person and their thoughts, so that a thought like I am not good enough can be noticed as a thought rather than experienced as a fact. Acceptance work helps people open up to difficult feelings rather than fighting them, often starting with smaller, more manageable emotions and building from there. Values clarification is one of the parts of ACT that people often find most meaningful, because it involves a genuine exploration of what matters, not what should matter or what used to matter, but what actually matters to this person in this life. And committed action involves identifying concrete steps toward those values and taking them, with the therapist’s support, even when internal discomfort makes it feel difficult.

Mindfulness practices are woven throughout ACT, though they tend to be used in a functional rather than a formal way. The goal is not to become a meditator but to develop the capacity to be present with whatever is happening, which turns out to be a skill that makes everything else in life more workable.

Sessions are typically 50 minutes and usually weekly, at least initially. ACT can be relatively brief for some presentations and longer for more complex ones. Your therapist will discuss what a realistic timeline looks like based on what you are bringing in.

The Benefits of ACT

ACT offers something that many people have not found in other approaches, which is a framework that does not require eliminating difficult internal experiences as a prerequisite for living well.

Works with human experience as it actually is. ACT does not start from the premise that negative thoughts and difficult feelings are problems to be eliminated. It starts from the premise that they are normal features of a human mind, and that the goal is to build a life that is meaningful and engaged regardless of their presence. For many people, that reframe alone is significant.
Grounded in extensive clinical research. ACT has been studied across hundreds of randomized controlled trials and has demonstrated effectiveness for depression, anxiety, chronic pain, OCD, substance use, eating disorders, and a range of other presentations. The evidence base is broad, diverse, and continuing to grow.
Builds psychological flexibility that applies across all areas of life. Unlike approaches that target specific symptoms in specific situations, the psychological flexibility that ACT builds tends to transfer. People find that the skills developed in therapy show up in relationships, at work, in how they respond to setbacks, and in how they relate to themselves across the full range of situations life presents.
Particularly effective for chronic and complex presentations. For people whose difficulties have been present for a long time, who have tried other approaches without finding lasting relief, or who are managing ongoing conditions like chronic pain or chronic illness alongside mental health concerns, ACT offers a framework that does not require the underlying difficulty to resolve in order for quality of life to improve.

Who This Treatment May Be Right For

Have tried to manage anxiety, depression, or other difficult internal experiences through control-based strategies and find that the struggle itself has become exhausting and is not producing the relief they were hoping for
Are living with a chronic condition, ongoing pain, or a circumstance that is unlikely to change, and want support building a life that feels meaningful and engaged within that reality
Feel like their thoughts or feelings are running their life in ways that do not reflect what they actually value, and want to develop a different relationship with their internal experience
Are in a period of significant transition or loss of meaning and want support clarifying what actually matters to them and finding ways to move toward it
Have been told that ACT might be a good fit for them, or have encountered the ideas behind it and are curious about what working with them in a clinical context might look like
Are looking for a therapy that is skills-based and practical but that also engages with the deeper questions of values and meaning rather than focusing only on symptom reduction
Find that perfectionism, self-criticism, or a very rigid and harsh relationship with themselves is significantly limiting what they allow themselves to attempt or enjoy
Want to be more present in their own life, more able to engage with what is actually happening rather than being caught in mental commentary about it, and are ready to do the work that requires

Ready to Take the Next Step?

If you have been working hard to feel better and find that the working hard is itself part of what is keeping you stuck, ACT might offer something genuinely different. Our team works with adults and teens across Minnesota, with in-person appointments available in Stillwater, Edina, and St. Anthony, and telehealth throughout the state including Northeast Minneapolis, Roseville, and the broader Twin Cities metro. We are here when you are ready to try a different approach.