Acceptance and Commitment Therapy (ACT) for Addiction: Definition, Techniques, Application, Activities, and Benefits

Acceptance and Commitment Therapy (ACT) for addiction focuses on accepting and embracing difficult thoughts, feelings, and cravings related to addiction while committing to actions aligned with one’s values to create a meaningful life beyond the addiction.
ACT for addiction uses techniques like mindfulness, cognitive defusion, values clarification, and committed action to help individuals accept and make room for difficult addiction-related experiences while moving toward a life guided by their deepest values.
These techniques have been proven through research to be effective for anxiety and depression which are both signs and symptoms of various forms of addiction. According to research by Öst, L. G. (2008), titled, Efficacy of the Third Wave of Behavioral Therapies: A Systematic Review and Meta-Analysis of Acceptance and Commitment Therapy, ACT demonstrated significant reductions in both anxiety and depressive symptoms compared to control conditions, supporting its effectiveness as a viable treatment option for these mental health issues in addiction.
Acceptance and Commitment Therapy (ACT) for addiction incorporates exercises and activities such as mindfulness practices, metaphors and analogies, value clarification, and behavioral commitment strategies to help individuals build psychological flexibility, accept difficult addiction-related experiences, and take actions aligned with their deepest values.
ACT has been shown to improve substance use outcomes, reduce psychological distress, increase quality of life, and foster a greater sense of purpose and meaning for individuals struggling with addiction by cultivating acceptance, mindfulness, and value-guided behavior change.
What is Acceptance and Commitment Therapy (ACT) for Addiction?
Acceptance and Commitment Therapy (ACT) is a form of psychotherapy that combines acceptance and mindfulness strategies with commitment and behavior change strategies to help individuals develop psychological flexibility and lead more meaningful lives.
The core premise of ACT is that the struggle to control or eliminate difficult thoughts, emotions, and experiences often leads to greater suffering and impedes valued living. Instead, ACT encourages individuals to practice acceptance and mindfulness, to defuse unhelpful thoughts, and to engage in actions aligned with their deepest personal values.
Hayes, et al (2006) in their seminal review paper titled, Acceptance and Commitment Therapy: Model, Processes, and Outcomes, provided a comprehensive overview of the ACT model, its theoretical foundations, and the empirical evidence supporting its effectiveness as a therapeutic approach. The paper highlighted the promise of ACT and called for further research to elucidate the underlying mechanisms of change.
The overarching goals of ACT are to:
- Increase psychological flexibility – the ability to be present, open to experiences, and take action guided by one’s values rather than being controlled by internal experiences.
- Foster acceptance and mindfulness – helping individuals make room for difficult thoughts, feelings, and sensations without trying to change or get rid of them.
- Clarify and commit to values – supporting individuals in identifying their core personal values and using those to guide their behaviors.
- Take committed action – encouraging individuals to engage in behaviors that are consistent with their values, even in the presence of challenging internal experiences.
ACT integrates mindfulness practices, metaphors, and experiential exercises to help cultivate acceptance and present-moment awareness. It also utilizes cognitive defusion techniques to create distance from unhelpful thoughts. Importantly, ACT emphasizes a commitment to value-driven action as the path to a more meaningful and fulfilling life, even in the face of addiction-related struggles.
History and Development of Acceptance and Commitment Therapy
Acceptance and Commitment Therapy (ACT) has its roots in the development of contextual behavioral science, which emerged in the late 20th century as a reaction to the limitations of traditional cognitive-behavioral therapy (CBT).
- The origins of ACT traces back to the work of Steven C. Hayes, a psychologist who in the 1980s began developing a new approach to psychological treatment that focused on the function of language and cognition, rather than simply the content of thoughts and beliefs.
Hayes and his colleagues were influenced by the philosophical tradition of functional contextualism and the theory of language and cognition known as Relational Frame Theory (RFT). - In the early 1990s, Hayes and his collaborators at the University of Nevada, Reno formally introduced the ACT model, which emphasized the importance of acceptance, mindfulness, and values-based action as a means of fostering psychological flexibility and reducing human suffering. This marked a significant shift away from the traditional CBT emphasis on changing the content of thoughts and emotions.
- Over the following decades, ACT continued to evolve and gain empirical support through numerous clinical trials and meta-analyses. Influential figures such as Kirk Strosahl, Patricia Robinson, and Kelly Wilson played key roles in further developing and disseminating the ACT approach.
- By the 2000s, ACT had become a well-established and evidence-based form of psychotherapy, recognized for its efficacy in treating a wide range of mental health and behavioral issues, including depression, anxiety, chronic pain, substance abuse, and even psychosis.
- Today, ACT is considered one of the “third wave” of cognitive-behavioral therapies, alongside other mindfulness-based and acceptance-oriented approaches. It continues to be an active area of research and clinical practice, with ongoing efforts to refine the model and expand its applications.
The historical development of ACT has been marked by a shift away from traditional CBT towards a more contextual, acceptance-based approach to psychological treatment, led by the pioneering work of Steven C. Hayes and his colleagues over the past several decades.
Theoretical Foundations of Acceptance and Commitment Therapy
theory The theoretical coundations of ACT encompass Relational Frame Theory (RFT), psychological flexibility, functional contextualism, and experiential avoidance:
1. Relational Frame Theory (RFT)
Relational Frame Theory (RFT) is a theory of human language and cognition that serves as a primary theoretical foundation for Acceptance and Commitment Therapy (ACT).
RFT posits that the capacity for human beings to relate stimuli in arbitrary and contextual ways is the foundation of language, cognition, and the development of psychological suffering. This relational framing process leads to the rigid fusion of thoughts, emotions, and experiences, contributing to psychological inflexibility.
2. Psychological Flexibility
The concept of psychological flexibility is a theoretical underpinning of ACT. Psychological flexibility is defined as the ability to be present with one’s experiences, to adopt a perspective that is open, curious, and accepting, and to take action that is guided by one’s values. This stands in contrast to psychological inflexibility, which is characterized by rigid, rule-governed, and avoidant behavioral patterns.
3. Functional Contextualism
ACT also draws on principles from functional contextualism, a philosophical approach that emphasizes the importance of understanding psychological phenomena in their broader context, rather than focusing solely on their internal content.
This contextual understanding informs the ACT approach, which aims to help individuals interact with their internal experiences more flexibly and adaptively.
4. Experiential Avoidance
Additionally, ACT is influenced by the concept of experiential avoidance, which refers to the tendency to avoid or attempt to control unpleasant thoughts, emotions, and sensations. ACT posits that this avoidance leads to the amplification of psychological suffering and the development of maladaptive behavioral patterns.
These interconnected theoretical principles, including relational frame theory, psychological flexibility, functional contextualism, and experiential avoidance, provide the conceptual underpinnings for the ACT model and its emphasis on mindfulness, acceptance, and value-guided action as pathways to increased well-being and flourishing.
Principles of Acceptance and Commitment Therapy (ACT)
These 6 principles of ACT, according to the Association for Contextual Behavioral Science, are acceptance, cognitive diffusion, contact with present moment,self-as-context, values, and committed action:
1. Acceptance
ACT emphasizes the importance of acceptance, which involves actively embracing and allowing one’s internal experiences (thoughts, emotions, sensations) without attempting to change or control them. This stands in contrast to the traditional cognitive-behavioral therapy approach of challenging and modifying the content of one’s thoughts and beliefs.
Example: In therapy, clients might practice mindfulness exercises to observe their thoughts without judgment, allowing feelings to come and go naturally.
2. Cognitive Defusion
Defusion is the process of creating psychological distance from one’s thoughts and feelings, allowing individuals to experience them as passing mental events rather than as literal truths or facts about the self. This helps to reduce the rigid fusion with internal experiences that contribute to psychological inflexibility.
Example: A common exercise is repeating a negative thought aloud until it loses its meaning and impact, helping to reduce its control over behavior.
3. Contact with the Present Moment
ACT encourages individuals to cultivate a mindful, non-judgmental awareness of the present moment, rather than being caught up in ruminations about the past or anxieties about the future. This present-moment focus allows for greater psychological flexibility and engagement in valued actions.
Example: Techniques such as mindful breathing or body scans help individuals stay grounded in the present, enhancing awareness and reducing stress.
4. Self-as-Context
The “self-as-context” principle in ACT refers to the idea that individuals are free to adopt a perspective of the self as a constant, observing presence that is distinct from the content of their thoughts, emotions, and experiences. This helps to foster a more transcendent sense of self.
Example: Exercises that emphasize observing the self from a distance, such as imagining watching oneself on a screen, promote this perspective.
5. Values
ACT emphasizes the importance of identifying and living in alignment with one’s values, which serve as guides for meaningful and values-consistent action. This helps to counteract the tendency towards experiential avoidance and provides a sense of purpose and direction.
Example: Patients use values worksheets to reflect on what is truly important to them in various life domains, guiding goal-setting and actions.
6. Committed Action
Committed action refers to the engagement in behaviors and actions that are guided by one’s values, even in the face of difficult thoughts, feelings, or circumstances. This principle helps to translate the insights gained from the other ACT principles into tangible, value-driven behaviors.
Example: Developing action plans that break down goals into manageable steps helps individuals commit to value-driven behavior.
These six core principles – acceptance, defusion, contact with the present moment, self-as-context, values, and committed action – work together to cultivate psychological flexibility and promote psychological well-being within the ACT framework.
Psychological Flexibility
Psychological flexibility is the cornerstone of Acceptance and Commitment Therapy (ACT). It refers to the ability to fully encounter an experience without unnecessary defense and, depending on the context, continuing or changing behavior in the pursuit of goals and values.
This flexibility enables individuals to adapt to situational demands, shift perspectives, and balance relevant aspects of life effectively. Increased psychological flexibility is associated with improved mental health and resilience, as individuals are better able to navigate life’s challenges without becoming overwhelmed by negative experiences.
Research by Bohlmeijer, et al, (2011) titled, Efficacy of an Early Intervention Based on Acceptance and Commitment Therapy for Adults with Depressive Symptomatology, showed that ACT increased psychological flexibility, which in turn predicted reductions in depressive symptoms.
Acceptance and Commitment Therapy (ACT) promotes psychological flexibility, which reduces experiential avoidance, enhances emotional regulation, and encourages value-driven behavior – all of which have been found to improve mental health and support long-term recovery from addiction.
Specifically, ACT helps individuals face and accept negative experiences without resorting to harmful behaviors, improves their ability to manage cravings and stress, and provides a strong motivational foundation for pursuing meaningful, substance-free goals – ultimately addressing the underlying mental health issues that often co-occur with addiction and reinforcing sustained recovery efforts.
What are the Key Techniques Used in ACT?
The key techniques used in ACT include mindfulness exercises, values clarification, and commitment to action. A study by Russell Harris (2012), titled, Embracing Your Demons: An Overview of Acceptance and Commitment Therapy found that with only four hours of ACT, hospital re-admission rates for schizophrenic patients dropped by 50% over the next six months.
Mindfulness Exercises
Mindfulness is a core component of Acceptance and Commitment Therapy (ACT), involving present-moment awareness and acceptance of experiences without judgment. These mindfulness exercises are designed to help individuals cultivate this state of being.
Examples of mindfulness exercises used in ACT include:
- Mindful breathing, where individuals focus their attention on the sensations of inhaling and exhaling
- Body scans, which involve systematically attending to different parts of the physical body
- Defusion exercises that create distance from thoughts, allowing individuals to observe them rather than becoming entangled with them.
A meta-analysis by Karyadi et al. (2014) titled, A meta-analysis of the relationship between trait mindfulness and substance use behaviors, found that mindfulness-based interventions were effective in treating alcohol and substance use disorders.
Values Clarification
A key technique in ACT is values clarification, which involves helping individuals identify their core personal values – such as being a caring family member, pursuing meaningful work, or contributing to the community. This process is intended to provide a solid foundation for committed action.
Examples of values clarification exercises in ACT include structured activities that guide individuals through identifying and prioritizing their most substantial values. A study by Michalak et al. (2016) titled, Personal values and value-behaviour relation in chronic depression, found that values-based action mediated the relationship between ACT and reduced depressive symptoms.
Commitment to Action
The commitment to action component of ACT involves setting specific, achievable goals and taking concrete steps to live in alignment with one’s values, even in the face of challenges. This technique is designed to translate the insights gained through mindfulness and values clarification into meaningful behavioral change.
Examples of commitment to action exercises include developing detailed action plans and engaging in value-guided behaviors, such as pursuing a new hobby or volunteering in the community.
Research has shown that the commitment to action component of ACT leads to improved behavioral outcomes. A study by Luoma et al. (2012) titled, Reducing self-stigma in substance abuse through acceptance and commitment therapy, found that ACT-based training for individuals with substance use disorders resulted in increased value-consistent behavior and reduced substance use.
How Effective is Acceptance and Commitment Therapy for Addiction?
Acceptance and Commitment Therapy (ACT) is very effective in treating addiction. Numerous studies have demonstrated the efficacy of ACT for treating a range of addictive behaviors, including alcohol, tobacco, and illicit drug use.
A systematic review and meta-analysis by Lee et al. (2015) examined 32 studies on the use of ACT for addiction. The researchers found that ACT was superior to control conditions in reducing substance use, with moderate to large effect sizes. The review concluded that ACT is an effective intervention for substance use disorders.
Another meta-analysis by Cao et al. (2019) focused specifically on the use of ACT for smoking cessation. The authors analyzed 15 studies and found that ACT led to significantly higher abstinence rates compared to control conditions, both in the short-term and long-term.
The mechanisms by which ACT helps treat addiction have been well-documented. As discussed previously, ACT’s emphasis on mindfulness, values clarification, and committed action has been shown to increase psychological flexibility, enhance emotional regulation, and promote value-driven behavior – all of which are key to breaking the cycle of addiction.
For example, a study by Levin et al. (2018) found that increases in psychological flexibility mediated the relationship between ACT and reductions in substance use, supporting the theoretical model of how ACT facilitates behavior change.
Additionally, research has demonstrated that ACT effectively integrates with other evidence-based treatments for addiction, such as cognitive-behavioral therapy and medication-assisted treatments, further enhancing its clinical utility.
In summary, the existing research literature provides strong support for the effectiveness of Acceptance and Commitment Therapy in treating substance use disorders, with the therapy’s unique components contributing to its success in promoting long-term recovery.
What are the Benefits of ACT?
ACT provides psychological, emotional, and behavioral benefits, as has been found by various research works, including the meta-analysis by Lee et al. (2015) which examined 32 studies on the use of ACT for addiction. The researchers found that ACT was superior to control conditions in reducing substance use, with moderate to large effect sizes, demonstrating the effectiveness of ACT in addressing both the psychological and behavioral aspects of addiction.
Psychological Benefits of ACT
- Increased Psychological Flexibility: ACT helps individuals become more open, aware, and committed to their values, rather than becoming entangled with or avoiding difficult thoughts and emotions.
- Values Clarification: The values-clarification process in ACT enables individuals to identify their core personal values, which then serve as a guide for committed action.
- Reduced Psychological Distress: Research shows ACT leads to significant reductions in symptoms of depression, anxiety, and other mental health conditions.
- Enhanced Mindfulness and Acceptance: ACT’s emphasis on mindfulness and acceptance-based strategies helps individuals develop a non-judgmental, present-focused awareness.
Emotional and Behavioral Benefits of ACT
- Improved Emotion Regulation: ACT teaches skills for accepting and managing difficult emotions, rather than trying to control or eliminate them.
- Committed Action Aligned with Values: The commitment to action component of ACT helps individuals engage in behaviors that are consistent with their values.
- Enhanced Quality of Life: By increasing psychological flexibility and values-driven behavior, ACT has been shown to improve overall quality of life and well-being.
- Reduced Problematic Behaviors: Research demonstrates the efficacy of ACT in addressing a range of problematic behaviors, such as substance abuse, self-harm, and compulsive disorders.
The combination of psychological, emotional, and behavioral benefits makes ACT a versatile and effective therapy for a wide range of mental health and behavioral concerns.
What Should I Expect in an Acceptance and Commitment Therapy Session?
An Acceptance and Commitment Therapy (ACT) session for addiction begins with exploration of values, acceptance and mindfulness, cognitive defusion, committed action, ongoing support, and practice.
1. Exploration of Values
The first focus of an ACT session is on exploring your values – what is most relevant to you and what gives your life a sense of meaning and purpose. The therapist will guide you through exercises to help clarify these core values, as they serve as the foundation for the therapy.
2. Acceptance and Mindfulness
Next, the therapist will introduce you to mindfulness and acceptance-based skills. The goal is to help you become more aware of and open to your thoughts, emotions, and experiences in the present moment, rather than trying to avoid or control them. Practices like conscious breathing and cognitive defusion techniques are used to cultivate this mindful, accepting stance.
3. Cognitive Defusion
A key component of ACT is working on cognitive defusion – creating distance from unhelpful, rigid, or negative thought patterns. The therapist will provide strategies to reframe thoughts and see them as just passing mental events, rather than facts or truths about yourself or your situation.
4. Committed Action
Based on your identified values, the therapist will then collaborate with you to set meaningful goals and take committed action in your life. This involves exposure exercises, lifestyle changes, or other behavioral strategies aimed at moving you in a direction that aligns with what you truly care about.
5. Ongoing Support and Practice
Throughout the process, the therapist provides ongoing support, encouragement, and accountability as you practice the ACT techniques between sessions. Homework assignments and in-session exercises help reinforce the skills and promote your continued progress and growth.
The overall aim of ACT is to increase your psychological flexibility and help you live a more meaningful life, even in the presence of difficult thoughts, emotions, or circumstances. The therapist acts as a compassionate guide throughout the process.
How Long Does Acceptance and Commitment Therapy Take?
The duration of Acceptance and Commitment Therapy (ACT) is between four weeks to one year, depending on your specific needs and progress.
Short-term ACT interventions: Some ACT-based treatments are designed to be delivered in a brief, time-limited format, such as 4-8 weekly sessions. These short-term approaches are often used for specific problems or as a component within a broader treatment plan.
Standard ACT treatment: Most standard ACT therapy follows a medium-term format, typically ranging from 12 to 20 weekly or biweekly sessions. This allows sufficient time to thoroughly cover the core ACT processes, including values clarification, mindfulness and acceptance skills, cognitive defusion, and committed action.
Longer-term ACT: In some cases, particularly for those with more complex or chronic mental health conditions, ACT is delivered over a longer period, such as 6 months to a year. This extended timeframe provides the opportunity to deeply ingrain the ACT skills and support ongoing behavioral changes.
Some people see significant benefits from a brief ACT intervention, while others require more sessions to achieve their therapeutic goals.
The therapist will work closely with the client to determine the appropriate duration of treatment based on factors such as the complexity of the presenting issues, the client’s rate of progress, and whether the client is reaching their targeted outcomes. Flexibility in the length of ACT is one of the strengths of this approach.
Is ACT appropriate for all patients?
ACT is not be the best fit for all clients, particularly those who prefer a more traditional, problem-solving approach to therapy. The therapist and client work together to determine if ACT is the most suitable treatment.
How does ACT differ from mindfulness-based therapies?
Acceptance and Commitment Therapy (ACT) shares some similarities with mindfulness-based therapies, as both incorporate mindfulness practices, but ACT has a distinct focus on increasing psychological flexibility through acceptance of difficult thoughts and emotions, clarifying personal values, and taking committed action, rather than solely cultivating present-moment awareness like mindfulness-based approaches.
While mindfulness is a key component, ACT utilizes a broader range of therapeutic processes, including cognitive defusion and self-as-context, and is grounded in the contextual behavioral theory of Relational Frame Theory, setting it apart from the Buddhist meditation-based foundations of mindfulness-based therapies.
Can ACT be used in a group setting?
Yes, Acceptance and Commitment Therapy (ACT) is effectively delivered in a group format, allowing clients to benefit from the shared experience and support of others facing similar challenges. The group dynamic provides additional opportunities to practice ACT’s core skills, such as acceptance, cognitive defusion, and values-guided action, under the guidance of the therapist.
How does ACT address relapse and setbacks?
Acceptance and Commitment Therapy (ACT) uniquely addresses relapse and setbacks. Rather than viewing them as failures, ACT encourages clients to see setbacks as natural and inevitable parts of the change process.
The focus in ACT is on cultivating a flexible, self-compassionate approach to dealing with ups and downs. Clients are taught to mindfully observe and accept the difficult thoughts, emotions, and circumstances that arise, without getting caught up in judgmental or avoidant reactions.
Instead of trying to eliminate or control these experiences, ACT guides clients to recommit to their values and take meaningful action, even in the face of setbacks. The therapist helps clients view setbacks as opportunities to practice the very skills they’ve been learning, such as acceptance, cognitive defusion, and committed action.
This perspective allows clients to approach relapse and challenges with more openness, resilience, and self-kindness. Rather than seeing setbacks as failures, ACT empowers clients to use them as springboards for continued growth and living a life aligned with their deepest values.
Can ACT Be Combined With Other Therapies For Addiction Treatment?
Yes, Acceptance and Commitment Therapy (ACT) can be effectively combined with other therapies for addiction treatment. Integrating ACT with cognitive-behavioral therapy (CBT) or aversion therapy provides a balanced approach that addresses both the conscious and unconscious aspects of addiction. This combination allows for a comprehensive treatment plan that includes mindfulness practices, cognitive-behavioral strategies, and behavioral interventions.
Incorporating ACT into specialized programs like addiction treatment for college students offers targeted support for specific populations. This integrated approach enhances the overall effectiveness of addiction treatment by addressing the multifaceted nature of addiction and providing multiple tools and strategies to manage it effectively.
Share This Post