ACT as Part of the Third Wave of Cognitive Behavioral Therapy. The Philosophy of ACT
The development of cognitive behavioral therapy is commonly described in terms of three waves—conceptual stages reflecting a shift in focus regarding the understanding of psychological difficulties and how to overcome them.
The first wave—classical behavioral therapy (behaviorism)—focused on external behavior. It relied on principles of learning and assumed that changing observable actions was possible through modifying stimuli, reinforcements, and responses.
The second wave combined behavioral and cognitive ideas. Thoughts, beliefs, and interpretations moved to the center of attention—cognitive processes that influence emotions and behavior. This allowed therapists to work with internal dialogue and irrational beliefs as the foundation of suffering.
The third wave emphasizes mindfulness, acceptance, and values-based behavior. Rather than seeking to change the content of thoughts, therapy teaches the development of psychological flexibility—the ability to remain in contact with present experience and make conscious choices based on values, despite internal difficulties.
Acceptance and Commitment Therapy (ACT) is a third-wave approach to cognitive behavioral therapy, developed by Steven Hayes, Kirk Strosahl, and Kelly Wilson in the 1980s–1990s. At the heart of ACT is not struggling with thoughts, but the ability to coexist with them while maintaining inner stability. The method helps build a life based on mindfulness, acceptance, and personal values, even in conditions of emotional discomfort.
The name ACT stands for Acceptance and Commitment Therapy. It reflects two key stances of the approach:
- Acceptance means the willingness to encounter unpleasant experiences—fear, anxiety, shame—without rejecting them, acknowledging them as a natural part of life.
- Commitment here is an active choice. Instead of living in attempts to avoid pain, a person takes responsibility for actions that align with their values, even if those actions are accompanied by difficult emotions.
The word “ACT” is pronounced as the English word act—“to act”—which underscores the essence of the approach: not to avoid difficulties, but to learn to act in their presence.
Features of the ACT approach:
- It is a transdiagnostic approach: it is applied to a wide range of difficulties, from anxiety disorders and addictions to PTSD and eating disorders.
- It is a behavioral approach: the focus is on human actions and ways to change behavior, even if internal experiences remain.
- It is a short-term, evidence-based therapy: sustainable results can be noticeable after just 15–20 sessions.
ACT proceeds from the premise that suffering is largely determined not by the experiences themselves, but by our attitude toward them. We tend to perceive anxiety, fear, anger, and sadness as a “mistake” or “malfunction” that urgently needs to be fixed. This creates an internal struggle—a person gets stuck in attempts to stop feeling what they feel, and thereby amplifies the suffering.
Paradoxically, it is the very attempt to avoid discomfort that becomes the cause of psychological rigidity—the inability to adapt, move forward, and make conscious choices. ACT offers an alternative path—the path of acceptance, mindfulness, and movement toward values.
ACT relies on the skill of mindfulness—the ability to notice one’s thoughts, feelings, and bodily sensations without struggling with them. Instead of fighting internal experience, a person learns to observe it with interest:
- noticing emotions (“I am angry,” “I am anxious”);
- accepting them as a normal part of experience;
- not avoiding them, even if it is unpleasant;
- observing bodily and mental manifestations while maintaining the ability to choose one’s actions.
ACT is built on six interrelated psychological processes, each of which contributes to the development of psychological flexibility. Together they form the foundation of therapeutic work and are aimed at helping a person consciously choose behavior that aligns with their values, even in conditions of internal discomfort.
Acceptance
Acceptance is a conscious decision to let unpleasant experiences (emotions, thoughts, bodily sensations) into one’s internal space, without avoiding or suppressing them. It is an active, directed process, an alternative to experiential avoidance—the drive to eliminate internal experience at any cost.
Goal: to develop the skill of openly accepting internal experiences, without succumbing to reflexive avoidance and without letting suffering control behavior.
Why this is important:
- suppressing emotions amplifies them (the rebound effect);
- emotions are not enemies, but signals of needs and boundaries;
- psychological flexibility requires contact with experience, not avoidance.
Contact with the Present Moment
This process involves developing the skill of mindfulness: focusing on current experience rather than thoughts about the past or future.
Goal: to develop the ability to be here and now, noticing current sensations, thoughts, and feelings without judgment.
To immerse the client in the “here and now” moment, use exercises that develop mindfulness.
Cognitive Defusion
The process of defusion allows one to view thoughts as fleeting events of consciousness rather than as objective truths, thereby reducing the influence of negative internal dialogue.
Goal: disidentification from thoughts, reducing their automatic influence on behavior.
To help the client break free from the power of thoughts and learn to relate to them with a touch of humor or distance, the following techniques can be used.
Self-as-Context
Also known as the “observing self,” this process helps one realize that we are more than our thoughts and emotions. A stable sense of self as an observer of internal events is formed.
Goal: developing a stable identity separate from emotional states.
To develop self-as-context—the skill of observing one’s experiences without identifying with them—the following metaphorical and reflective techniques are suitable.
Values
Values are guideposts that determine the direction in which a person wants to move. These are not goals, but principles that give meaning to actions.
Goal: awareness and formation of a value-based foundation for behavior.
To help the client identify what truly gives meaning to their life, the following deep and imaginative practices can be used.
Committed Action
Committed action is consistent behavior in the direction of one’s values, despite fear, uncertainty, and possible mistakes.
Goal: forming sustained activity directed toward value-based guideposts.
To translate values into real actions, it is important to develop persistence and behavioral flexibility. The following techniques can help with this.