Acceptance and Commitment Therapy (ACT), online across NZ

What is Acceptance and Commitment Therapy?

Acceptance and Commitment Therapy (ACT) is a form of cognitive behavioural therapy that aims to build psychological flexibility: the ability to stay present, open up to difficult thoughts and feelings instead of fighting them, and act in line with your values. It has research support for anxiety, depression, chronic pain and stress, and performs about as well as traditional CBT.

The problem ACT is trying to solve

Most of us are taught, without anyone quite saying it, that the goal is to feel good and that painful feelings are a sign something has gone wrong. So we work hard at not feeling them. We cancel the catch-up because we feel anxious. We scroll until midnight to avoid the grief. We tell ourselves we will apply for the job once we feel confident, start exercising once we feel motivated, have the conversation once we feel calm.

ACT calls this the control agenda, and points out that it works beautifully for the outside world and badly for the inside one. You can remove a splinter. You cannot remove a thought by trying not to think it; try not to think of a pavlova for the next minute. Efforts to avoid or suppress inner experience tend to make it louder, and they also shrink life. The things that matter get postponed until a feeling arrives that may never come.

ACT's alternative is not to feel less but to change what you do with what you feel. The technical term is psychological flexibility. The plain version is: make room for the difficult stuff, and keep moving towards what matters anyway.

The six ACT processes in plain language

ACT describes six interlocking skills. You do not learn them in order, and most sessions touch several at once, but naming them helps:

• Being present. Paying attention to what is actually happening now, rather than living in the replay of yesterday or the rehearsal of tomorrow. This is mindfulness in a practical, non-religious sense: noticing your feet on the floor, the taste of your coffee, the tone of your partner's voice.
• Opening up (acceptance). Allowing difficult feelings and sensations to be there without fighting them. Not liking them, not approving of them, just stopping the wrestling match. Anxiety becomes something you are willing to feel in order to do what you want, rather than a reason to stay home.
• Unhooking from thoughts (defusion). Learning to see thoughts as thoughts rather than as truths or commands. "I'm a failure" becomes "I'm having the thought that I'm a failure". It sounds like a small change. In practice it loosens the grip considerably.
• The observing self. Noticing that there is a part of you that watches thoughts and feelings come and go, and that this part is not damaged by any of them. Useful when your sense of who you are has become fused with "the anxious one" or "the one who always fails".
• Knowing what matters (values). Getting clear about the kind of person you want to be and what you want your life to be about: as a parent, a partner, a friend, in your work, in your own wellbeing. Values are directions, not goals; you never finish being a good friend.
• Doing what matters (committed action). Taking concrete steps in the direction of your values, even when the thoughts and feelings are not cooperating. This is where ACT becomes behavioural: the phone call made, the walk taken, the boundary set.

Together these build the capacity to have a hard inner life and a full outer one at the same time.

What an ACT session looks like

ACT sessions are often more experiential than talky. Rather than discussing acceptance, your psychologist might guide you through a two-minute exercise of noticing an uncomfortable feeling in your body and describing it as a shape, a weight, a temperature. Rather than debating whether a thought is true, you might say it in a silly voice, sing it, or write it on a card and carry it in your pocket for the week.

Metaphors are common because they stick. You may hear about passengers on a bus who shout directions while you keep driving, about a tug-of-war with a monster where the winning move is to drop the rope, or about quicksand, where struggling sinks you faster. These are not decoration; they are tools you can reach for in the moment.

Values work is practical. You might spend a session working out what you would want to be doing with your evenings if anxiety were not making the decisions, then choose one small thing to do before the next session. Homework in ACT tends to be about doing rather than recording.

What you will not get is thought-challenging. ACT does not ask whether your thought is accurate, only whether listening to it is taking you somewhere you want to go. For people who have spent years arguing with their own minds, that difference is often the appeal.

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Who ACT suits

ACT was built as a broad approach rather than a treatment for one diagnosis, and it is used at Mindwell for:

• Anxiety and worry, particularly for people who have tried to reason or relax their way out and found the anxiety fights back.
• Depression, where values and committed action give a route back into life that does not wait for motivation.
• Chronic pain and long-term health conditions, where ACT has some of its strongest evidence. The American Psychological Association's Society of Clinical Psychology rates ACT for chronic pain as having strong research support.
• Stress and burnout, where the control agenda often takes the form of working harder.
• OCD, alongside exposure and response prevention, where willingness to feel the anxiety of an exposure is the whole point.
• Eating and body image and grief, where painful experiences cannot be removed but can be carried differently.

It also suits people who do not have a tidy diagnosis but feel stuck, who are living smaller than they want to, or who have "done CBT" and are tired of monitoring thoughts.

What the evidence says

ACT has been tested in a large number of randomised trials. A 2015 meta-analysis of 39 trials found it outperformed waiting lists, placebo and treatment as usual across anxiety, depression, addiction and physical health problems, with a medium overall effect, and found no significant difference between ACT and established treatments such as CBT. A 2020 review of 20 meta-analyses covering more than 12,000 participants reached a similar conclusion: ACT is effective for the conditions studied, generally does better than other active treatments, and performs about the same as CBT.

In other words, ACT is a well-supported option rather than a superior one. Its advantage lies in fit: for some people and some problems, working with thoughts through acceptance and values makes more sense than examining their accuracy, and they engage more fully as a result. The theoretical model behind ACT, including psychological flexibility as the mechanism of change, has also been studied in its own right since the mid-2000s.

Doing ACT online

Self-guided and therapist-supported online ACT programmes have been tested in 39 randomised trials, with small to medium benefits for depression, anxiety and stress compared with no treatment. Live video sessions with a psychologist, as Mindwell provides, sit alongside the broader evidence that video-delivered psychotherapy produces outcomes comparable to in-person treatment.

ACT translates naturally to video. Mindfulness and acceptance exercises are done with your eyes closed or your attention on your body, and it makes no difference whether your psychologist is across a room or across the country. Values exercises are often richer at home, where the photos, the half-finished projects and the people you care about are in view. Committed actions are planned in session and carried out in your real week, which is where they were always going to happen.

One practical note: ACT sessions can go quiet while you do an exercise. That is normal, and your psychologist will tell you what to expect before you begin.

ACT alongside other approaches

At Mindwell, ACT is rarely used in isolation. Sandy Laurenson combines it with CBT, ERP for OCD and DBT skills, so that acceptance and willingness support exposure work and emotion regulation. Jeremy Mason uses ACT with CBT in his work with eating disorders, chronic pain and anxiety. Katherine Lee draws on ACT alongside schema therapy, CBT and DBT, particularly where long-standing patterns are involved.

ACT also shares territory with DBT (mindfulness and acceptance), Compassion Focused Therapy (the observing, kind stance towards oneself) and mindfulness-based approaches. If you are not sure which fits, say so when you book; the first session is for working that out together, and your psychologist will explain what they are suggesting and why.

What to expect at Mindwell

Mindwell runs entirely online. Sessions are 50 minutes by video through Carepatron, in your browser, no software to install. You book online at any time, choosing a psychologist or taking the first available appointment; first sessions are typically within 7 days and no referral is needed. A confirmation email with your video link and a short intake form follow.

The first session is a conversation about what has brought you, what you have tried, and what you want your life to look like. Your psychologist will explain how they propose to work and agree a plan with you, usually weekly or fortnightly. Each session is $199 + GST ($228.85 including GST), paid when you book; you receive a receipt you can submit to your health insurer.

Mindwell works with adults 18 and over in New Zealand, is not an ACC provider, and is not a crisis service.

Related support: CBT therapy · Anxiety therapy · Chronic pain management · Stress and burnout