Acceptance and Commitment Therapy (ACT)

ACT is pronounced like the English word “act” and stands for Acceptance and Commitment Therapy. It was developed by the American psychologist Steven C. Hayes beginning in the 1980s. In professional terms, ACT is part of what is known as the third wave of behavioral therapy. The first wave focused on observable behavior, while the second focused on thoughts and beliefs, as cognitive behavioral therapy does. ACT adds mindfulness and personal values to this framework.

The basic idea is surprisingly simple. Anxiety, grief, tension, and self-doubt are part of being human. People who expend a great deal of energy trying to suppress such feelings often become even more attached to them in their daily lives. ACT therefore cultivates a different approach: difficult inner experiences are allowed to be there, while a person continues to do what is truly important to them. ACT refers to this interplay of acceptance and value-oriented action as psychological flexibility.

ACT describes psychological flexibility through six processes. In technical terms, this model is called Hexaflex because it can be represented as a hexagon. For parents, the principles can be summarized as follows:

• Acceptance: Consciously allowing unpleasant feelings to arise instead of constantly fighting them.
• Defusion: Gaining distance from thoughts. A statement like “I’ll never be able to do this” is recognized as a thought and not treated as an established truth.
• Mindfulness: Bringing your attention to the here and now, away from ruminating on yesterday or tomorrow.
• Self as Context: Experiencing oneself as an observing presence that remains stable even as emotions shift.
• Values: Clarifying what you stand for in life, such as being reliably there for your family or being honest with yourself.
• Committed Action: Taking concrete steps toward these values, even when fear or reluctance are present.

ACT is considered transdiagnostic. This means it is not tied to a single diagnosis but focuses on patterns that occur across many mental health conditions, such as avoiding unpleasant feelings. It is used to treat depression, anxiety disorders, obsessive-compulsive disorder, post-traumatic stress disorder, eating disorders, and addiction issues.

A major area of application is chronic physical complaints, particularly persistent pain. Here, the focus is less on completely eliminating the pain and more on rebuilding a life filled with meaning and activity. ACT is also used in cases of exhaustion and burnout to change how individuals cope with stress. Elements of the method also appear in coaching and stress management programs. A related approach is Dialectical Behavior Therapy (DBT), which also belongs to the third wave and makes extensive use of mindfulness.

ACT has been well studied. There are now several hundred randomized controlled trials—that is, studies with comparison groups and random assignment—which are considered high-quality evidence. Meta-analyses synthesize these individual studies and show small to moderate positive effects for anxiety, depression, and chronic pain.

In direct comparison with established cognitive behavioral therapy, ACT performs similarly well for most conditions. The data do not yet indicate a clear advantage for either method. For some areas of application, the body of research is still limited, particularly regarding children and adolescents. Professional associations classify ACT as an effective, empirically supported approach but emphasize that the choice of method must always be tailored to the specific individual and their presentation of symptoms.

For families, the approach behind ACT can provide relief in everyday life. Supporting a child with a mental illness brings with it fear, helplessness, and anger. These feelings can rarely be talked away. ACT encourages us to acknowledge them while still remaining capable of taking action, guided by what matters to us as parents. Some rehabilitation clinics and outpatient practices also offer ACT groups for family members.

Whether ACT is the right approach for a child or adolescent cannot be determined from the outside. Rückenwind Eltern supports and empowers families, but it is not a substitute for treatment. A diagnosis and the recommendation of an appropriate therapy should be made by a child and adolescent psychiatrist (KJP) or a medical or psychotherapeutic specialist. If you have acute concerns about your child, the child and adolescent psychiatry clinic in your area is the right first point of contact.