How ACT works: making room for feelings and moving toward what matters

The skills ACT brings together

ACT includes noticing the present moment, allowing feelings, stepping back from thoughts (defusion), seeing yourself as more than a thought or diagnosis, identifying values, and taking committed action. These processes overlap; they are not levels to complete perfectly.

A value is a personally chosen direction such as being a caring friend. A goal is a concrete action that can express it, such as sending a message. The client's values guide the work, rather than the parent's or therapist's preferences.

Source context: Association for Contextual Behavioral Science: ACT

What a session might involve

A therapist explores where efforts to control internal experiences are helping or restricting life, then practices a different response with the person.

1. Notice the pattern

   Identify a difficult feeling or thought and the actions that tend to follow it.

2. Practice a little distance

   Notice that a thought is occurring, without needing to prove it true or false or force it away.

3. Choose a valued direction

   Explore what matters to the person in this situation and what support or environmental change is needed.

4. Take and review a small step

   Agree an achievable action and review whether it served that value, even if discomfort was present.

Source context: Association for Contextual Behavioral Science: ACT · NHS Scotland Matrix: ACT overview and evidence

A fictional example: reaching out while anxious

An adult values friendship but waits to feel completely confident before contacting someone. They notice the thought, ‘I will be awkward.’ An ACT therapist might help them acknowledge that thought and choose a short message they want to send.

The meaningful change is taking a chosen step while making room for nervousness. The therapist would also consider whether the relationship is safe and whether practical or communication support is needed. Sending a message is an illustration, not an assignment for every reader.

With practice, the person may spend less of life waiting for thoughts or feelings to be perfect. Symptoms may improve too, but an individual result or timeline cannot be promised.

Source context: NHS Scotland Matrix: ACT overview and evidence

How ACT fits with OCD treatment

ACT principles can help a person notice intrusive thoughts and choose valued action without entering a certainty debate. They may be incorporated into an OCD treatment plan that includes ERP.

ERP has a stronger established role as a first-line psychological treatment for OCD. ACT for OCD has promising research; it should not be presented as an interchangeable replacement. Ask whether the proposed approach addresses compulsions and avoidance, and what evidence supports it.

A phrase such as ‘I am noticing a thought’ can itself become a ritual if repeated until the person feels safe. The clinician should help distinguish flexible use from another demand for certainty.

Source context: International OCD Foundation: what is ACT? · International OCD Foundation: OCD treatment guide · IOCDF-hosted clinician resource: common OCD treatment myths (PDF)

Supporting values without applying pressure

Ask what matters to the person and offer practical help with their chosen next step. Avoid ‘If family mattered to you, you would do this.’ Values should not become a way to demand compliance.

If abstract metaphors or inward-focused exercises are confusing or distressing, ask for a concrete explanation and an adapted approach. Keep sensory and communication supports. Feeling uncomfortable is not a reason to ignore genuine pain or danger.

• How do you adapt ACT to this person's communication and learning needs?
• What condition and outcome are you treating, and how strong is the evidence for that use?
• How will we tell whether the work is increasing choice and participation?

• Compare therapy types →
• Understand ERP →