ACT Therapy for Anxiety
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Quick Answer
Acceptance and Commitment Therapy (ACT) is an evidence-based approach to anxiety that focuses on changing how you relate to anxious thoughts and feelings rather than trying to eliminate them. Instead of fighting anxiety or waiting for it to go away, ACT helps you develop psychological flexibility so anxiety has less control over your behavior and decisions.
ACT is commonly used for chronic worry, panic attacks, social anxiety, health anxiety, and trauma-linked anxiety, especially when anxiety persists despite insight or past coping strategies.
Video overview: ACT therapy for anxiety
This video provides a concise overview of how Acceptance and Commitment Therapy approaches anxiety, including why struggling with anxious thoughts often makes anxiety more persistent rather than less.
Who this is for
This guide is for adults who:
Feel stuck in cycles of worry, avoidance, or panic
Have tried to think their way out of anxiety without lasting relief
Want an evidence-based approach that does not require suppressing thoughts or emotions
What you will learn
In this guide, I explain:
What ACT therapy is and how it works for anxiety
The six core ACT skills and how they reduce anxiety’s grip
How ACT differs from CBT for anxiety
Which anxiety patterns ACT is commonly used for
When self-guided ACT may help and when therapy is likely needed
Last Updated: January 2026
What is ACT therapy for anxiety?
Definition Acceptance and Commitment Therapy (ACT) is a behavioral therapy that helps people respond differently to anxious thoughts, sensations, and urges by building psychological flexibility rather than attempting to control or eliminate anxiety.
Why this matters Anxiety becomes most disabling when efforts to control it lead to avoidance, restriction, and increased distress over time.
Evidence ACT has been shown to reduce anxiety symptoms and improve functioning across generalized anxiety, panic disorder, and social anxiety by targeting experiential avoidance and cognitive fusion (Hayes et al., 2006; A-Tjak et al., 2015; Arch & Craske, 2013).
Elaboration In ACT, anxiety is treated as a human experience rather than a problem to be solved. Instead of waiting to feel calm before living your life, ACT helps you take meaningful action while anxiety is present.
Clinical application In my practice, I help clients apply these ACT principles to real-life anxiety patterns that interfere with work, relationships, and daily functioning.
How does ACT work for anxiety?
Definition ACT works for anxiety by increasing psychological flexibility, the ability to stay present, open, and engaged in valued action even when anxious thoughts and sensations arise.
Why this matters When anxiety dictates behavior, life gradually narrows. Flexibility allows life to expand again.
Evidence Research shows that psychological flexibility mediates improvement in anxiety outcomes, meaning changes in flexibility predict symptom reduction more strongly than symptom suppression (Kashdan & Rottenberg, 2010; A-Tjak et al., 2015).
Elaboration ACT focuses on loosening the struggle with anxiety rather than winning a fight against it. Over time, this reduces the secondary suffering that comes from constant monitoring and avoidance.
Clinical application Therapy focuses on identifying where anxiety is running the show and practicing skills that restore choice and agency.
What are the six core ACT skills for anxiety?
| ACT Skill | What It Targets | How It Helps Anxiety | Example |
|---|---|---|---|
| Acceptance | Struggle with sensations | Reduces resistance and rebound anxiety | Allowing a racing heart during a meeting |
| Cognitive Defusion | Belief in anxious thoughts | Creates distance from what-if thoughts | My mind is telling me |
| Present-Moment Awareness | Rumination and future focus | Anchors attention to current safety | Grounding during panic |
| Values | Avoidance-based decisions | Reorients life toward meaning | Attending an event despite anxiety |
| Self-as-Context | Identity fused with anxiety | Separates self from symptoms | I experience anxiety, I am not anxiety |
| Committed Action | Paralysis and avoidance | Builds confidence through action | Small steps despite discomfort |
Clinical application These skills are introduced and practiced in ways that match each person’s specific anxiety patterns and life context.
What is cognitive defusion and how does it help anxiety?
Definition Cognitive defusion is an ACT skill that helps create distance between you and anxious thoughts so they are experienced as mental events rather than facts or commands.
Why this matters When thoughts are taken literally, anxiety intensifies and behavior becomes reactive.
Evidence Defusion techniques reduce the believability and emotional impact of anxious thoughts and are a core mechanism of ACT’s effectiveness (Hayes et al., 2006; Arch & Craske, 2013).
Elaboration Instead of arguing with a thought like I am going to panic, defusion helps you notice I am having the thought that I am going to panic, which changes how the thought functions.
Clinical application In therapy, defusion skills are practiced in ways that match your specific anxiety triggers rather than as abstract exercises.
How is ACT different from CBT for anxiety?
| Feature | ACT | CBT |
|---|---|---|
| Primary focus | Relationship to thoughts | Content of thoughts |
| Goal | Psychological flexibility | Symptom reduction |
| View of anxiety | Expected human experience | Cognitive distortion to modify |
| Approach to thoughts | Observe and unhook | Evaluate and challenge |
| Best fit for | Chronic experiential anxiety | Thought-driven anxiety patterns |
Clinical application Understanding these differences helps clarify why ACT may feel more workable for some people, especially when anxiety persists despite insight.
What types of anxiety can ACT help with?
ACT is commonly used to support people experiencing:
Chronic worry and generalized anxiety
Panic attacks and fear of fear
Social anxiety and self-judgment loops
Health anxiety and reassurance cycles
Sleep anxiety and nighttime spirals
Trauma-linked anxiety and hypervigilance
Clinical application Treatment focuses on how anxiety shows up in daily life rather than fitting people into rigid diagnostic categories.
Should you try ACT on your own or work with a therapist?
Definition ACT skills can be learned independently, but therapy is often helpful when anxiety is persistent, impairing, or linked to avoidance and panic.
Why this matters Some anxiety patterns require guided practice and individualized application.
Elaboration Self-help can work well for mild anxiety. Therapy adds structure, feedback, and accountability when anxiety is complex or longstanding.
Clinical application Many clients seek therapy after realizing they understand anxiety intellectually but still feel stuck applying skills consistently.
How these ACT skills are applied in therapy
In therapy, ACT tools are tailored to your specific triggers, patterns, and goals, and practiced in real time with feedback. Therapy can be especially helpful when anxiety leads to avoidance, panic cycles, or repeated reassurance-seeking.
If you are finding that these ACT concepts make sense intellectually but are difficult to apply consistently when anxiety shows up, working with a therapist can help translate these skills into real-life situations. You can learn more about how ACT-based anxiety therapy is offered in my practice, including what sessions look like and how to get started, on the Anxiety Therapy service page.
Further Reading & References
Further Reading (Helpful Resources):
Anxiety Therapy: Learn how ACT-based anxiety therapy is delivered in my practice, including format, fit, and next steps.
PTSD Therapy: Understand how trauma-related anxiety and hypervigilance are addressed.
Complex PTSD Therapy: Explore treatment for long-standing, developmental, or relational trauma patterns.
Attachment Therapy: Learn how attachment patterns can contribute to anxiety and avoidance.
Acceptance and Commitment Therapy (ACT): How It Can Help You Heal - My blog post introducing ACT for trauma recovery and general mental health.
The Happiness Trap by Russ Harris: An excellent self-help book (written by an ACT trainer) that teaches ACT skills for anxiety, stress, and other issues in a very reader-friendly way.
References (Research & Evidence):
Arch, J. J., & Craske, M. G. (2013). Randomized clinical trial of cognitive behavioral therapy (CBT) vs. acceptance and commitment therapy (ACT) for mixed anxiety disorders. Journal of Consulting and Clinical Psychology, 81(5), 750–765. (Demonstrated that ACT was as effective as CBT in reducing various anxiety disorder symptoms).
Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: Model, processes and outcomes. Behaviour Research and Therapy, 44(1), 1–25. (Seminal paper describing the ACT model; explains how acceptance and psychological flexibility lead to better mental health outcomes).
A-Tjak, J. G. L., Davis, M. L., Morina, N., Powers, M. B., Smits, J. A. J., & Emmelkamp, P. M. G. (2015). A meta-analysis of the efficacy of acceptance and commitment therapy for clinically relevant mental and physical health problems. Psychotherapy and Psychosomatics, 84(1), 30–36. (Meta-analysis of 39 RCTs; found ACT superior to control conditions and as effective as established treatments for anxiety, depression, addiction, etc., with improvements in quality of life and sustained effects).
Kashdan, T. B., & Rottenberg, J. (2010). Psychological flexibility as a fundamental aspect of health. Clinical Psychology Review, 30(7), 865–878.
Frequently Asked Questions
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Yes. Acceptance and Commitment Therapy is supported by research across multiple anxiety conditions and is widely used in evidence-based treatment.
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ACT does not aim to eliminate anxiety. Instead, it focuses on reducing how much anxiety interferes with your life and decisions.
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This varies. Progress depends on the type of anxiety, how entrenched avoidance patterns are, and how consistently skills are practiced.
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ACT is commonly used for panic-related anxiety by helping people respond differently to physical sensations and fear-based thoughts rather than trying to suppress them.
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Often, yes. ACT skills such as cognitive defusion can reduce how believable and distressing intrusive thoughts feel, even if they still show up.
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Not universally. Both approaches can be effective. ACT may be a better fit when anxiety is chronic, driven by avoidance, or persists despite insight.
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This is common. Insight can be helpful, but many people struggle to apply skills consistently without guided practice and feedback.
