ACT therapy online (acceptance and commitment therapy)

What is ACT?

Acceptance and commitment therapy, usually shortened to ACT and said as the word “act” rather than the separate letters, is a modern form of behavioural therapy rooted in the science of human language and cognition. Unlike approaches that focus on reducing or controlling difficult thoughts and emotions, ACT works from the premise that struggling against painful internal experiences often makes things worse. Instead, it teaches you to make room for those experiences while redirecting your energy towards what genuinely matters to you.

This can sound counterintuitive at first. Most of us have learned that the way to feel better is to get rid of bad feelings. But many of the strategies we use to avoid or suppress difficult emotions, such as withdrawing from people, overworking, ruminating or numbing ourselves, end up shrinking our lives and creating new problems. ACT offers a different path. Rather than waiting until the difficult feelings pass before you start living, you learn to carry them with you while moving towards the life you want.

At its centre, ACT develops six interrelated processes that together make up what is called psychological flexibility: the ability to stay in contact with the present moment and to change or persist with your behaviour in the service of your values. You do not need any background in mindfulness or meditation to benefit from it. ACT uses experiential exercises, metaphors and practical behavioural steps to help you build a richer, more meaningful life, even when pain or difficulty is part of the picture.

The six core processes of ACT

The six processes below work together rather than in a fixed order. Your psychologist will move between them depending on what is most useful, but it helps to understand each one in plain terms, with an everyday example.

Cognitive defusion

Defusion means stepping back from a thought and seeing it as a thought, rather than as a fact or an instruction you have to obey. When you are caught up in a thought, you are inside it, and it drives what you do. Take the thought “I am going to embarrass myself”, which can keep you from speaking up in a meeting. In defusion, you might learn to notice it and silently reframe it as “I am having the thought that I will embarrass myself.” That small shift creates enough distance to choose whether to speak, rather than letting the thought choose for you.

Acceptance

Acceptance is about making room for uncomfortable feelings, urges and sensations instead of fighting them or pushing them away. It does not mean liking them or giving up. Picture the tight chest and racing heart that arrive before a job interview. The instinct is to suppress those sensations, which usually makes them louder. Acceptance means allowing them to be there, breathing around them, and going into the interview anyway. The feeling is carried rather than fought.

Present-moment contact

Much of our distress lives in the future (“what if it all goes wrong?”) or the past (“I should have handled that differently”). Present-moment contact is the practice of bringing your attention back to what is actually happening now. On a walk, for example, you might notice you have spent twenty minutes replaying an argument. Gently returning your attention to the feel of the ground, the air and the sounds around you is a present-moment skill you can use anywhere, with no formal meditation required.

Self-as-context

This is the sense that there is a “you” who notices your experiences and stays constant, separate from the thoughts and feelings that come and go. A helpful image is the sky and the weather: thoughts and moods are the weather, sometimes calm and sometimes stormy, while you are the sky that holds them all and is not damaged by any of it. Recognising that you are the one observing your anxiety, rather than being your anxiety, makes difficult experiences easier to hold.

Values

Values are the qualities you want to bring to your life, the kind of partner, parent, friend or colleague you want to be. They are directions rather than destinations. Someone might realise that connection and honesty matter deeply to them, yet notice they have been avoiding both to stay comfortable. Clarifying values gives therapy a compass. Instead of only asking “how do I feel less anxious?”, the question becomes “what do I want to move towards, and what is getting in the way?”

Committed action

Committed action means taking concrete steps in the direction of your values, even when it is uncomfortable. These steps are usually small and specific. If family closeness is a value, a committed action might be phoning a relative you have been avoiding, or saying yes to a gathering despite feeling anxious. What matters is that you act in line with what you care about and notice what happens when you move towards it rather than away.

When ACT can help

ACT has a growing evidence base across a wide range of psychological difficulties, including:

• Chronic anxiety and worry
• Depression and persistent low mood
• Chronic pain and long-term health conditions
• Stress and burnout
• Grief and loss
• Obsessive compulsive difficulties
• Social anxiety
• Perfectionism and self-criticism
• Adjusting to major life changes
• Low self-esteem and a loss of direction

ACT tends to be a good fit when you feel stuck in patterns of avoidance, when previous attempts to control your thoughts and feelings have not worked, or when you have lost touch with what matters most to you. It often resonates with people who have tried to think their way out of their difficulties and found that the more they analyse and ruminate, the worse things get.

It is also well suited to situations where the source of your distress cannot simply be removed. If you are living with a long-term health condition, coming to terms with grief, adjusting to a major change, or facing ongoing stress that has no quick fix, ACT helps you find ways to live well alongside the difficulty rather than putting your life on hold until it passes.

ACT is not the right fit for everyone, and we will say so if we think another approach suits you better. Where your main goal is to reduce a specific, well-defined symptom, such as a single phobia, a more targeted method may work more quickly. ACT tends to come into its own when avoidance, self-criticism or a sense of being stuck runs across several areas of your life, or when the difficulty is one you will need to live alongside rather than remove.

What to expect in ACT therapy

ACT sessions are collaborative and often experiential. Rather than only talking about your difficulties, your psychologist may guide you through exercises designed to shift how you relate to your inner world. This is part of what makes ACT distinctive. Alongside understanding your patterns intellectually, you practise new ways of responding to them in the room.

For example, your psychologist might use the “passengers on the bus” metaphor to explore how you relate to difficult thoughts. You are the driver of the bus, and your anxious or self-critical thoughts are noisy passengers shouting instructions from the back. The question becomes who is actually steering. You might also practise brief mindfulness exercises, work through values-sorting activities, or explore what happens when you make space for a difficult feeling instead of pushing it away.

Early sessions usually focus on understanding your current patterns, particularly any cycles of avoidance or control that keep you stuck. Your psychologist will be curious about what you have already tried and what has not worked, not to judge those strategies but to understand the trap you are caught in. From there, the work moves towards building skills in defusion, acceptance and present-moment awareness, alongside identifying and clarifying your values.

Values work is central to ACT and often proves one of the most useful parts of therapy. Many people find they have been so focused on managing their symptoms that they have lost sight of what they want their life to be about. Clarifying your values gives you something to steer by and a source of motivation that goes deeper than symptom reduction.

Between sessions, you will be encouraged to practise new skills and try out values-based actions in daily life. These might be small, specific steps, such as having a conversation you have been putting off, or going to a social event despite feeling anxious. The aim is to practise willingness and notice what changes when you move towards what matters, not to do any of it perfectly.

Therapy is usually delivered weekly, and most people benefit from 8 to 16 sessions, though this depends on the complexity of your difficulties. Some people find a shorter course gives them the tools they need, while others benefit from longer-term work, particularly where patterns of avoidance are deeply ingrained.

The evidence for ACT

ACT has a substantial and growing research base, and the number of published randomised controlled trials has risen sharply over the past two decades. A widely cited meta-analysis by A-Tjak and colleagues (2015) pooled 39 randomised controlled trials and found that ACT outperformed control conditions and produced outcomes broadly comparable to established treatments such as CBT, across problems including anxiety, depression and chronic pain. A later umbrella review by Gloster and colleagues (2020), drawing together 20 separate meta-analyses, reached a similar overall picture: the evidence is strongest for chronic pain and depression, with promising but more mixed findings for other difficulties such as anxiety and OCD.

NICE guidance deserves an accurate description here, because ACT is sometimes called “NICE-recommended” in a general way that overstates the position. NICE specifically recommends ACT as an option for chronic primary pain in its 2021 guideline, NG193. For anxiety and depression, ACT is not singled out by NICE in the way that CBT is, and the case for using it there rests on the meta-analytic evidence above rather than on a specific NICE recommendation. We would rather be straight about that than imply a stronger endorsement than the evidence supports.

A consistent thread across studies is that ACT appears to work through its proposed mechanism, psychological flexibility, rather than simply by reducing symptoms. Studies suggest people improve as they relate to difficult thoughts and feelings differently and become more able to act on their values, rather than by getting rid of those thoughts and feelings altogether.

Online delivery is well supported. The experiential, metaphor-based nature of ACT translates well to video, and several trials have found that internet-based and video-delivered ACT produces outcomes comparable to face-to-face therapy.

ACT vs CBT: how they differ

ACT and CBT come from the same broad cognitive behavioural family and share a great deal of common ground, but they emphasise different things. The table below sets out the main contrasts.

Dimension	ACT	CBT
Core idea	Build psychological flexibility so you can act on your values while difficult thoughts and feelings are present	Identify and change unhelpful thoughts and behaviours to reduce distressing symptoms
Relationship to thoughts	Notice thoughts and hold them lightly, without needing to change their content	Examine thoughts, test how accurate they are, and develop more balanced alternatives
Main techniques	Defusion, acceptance, mindfulness, values clarification, committed action	Thought records, behavioural experiments, graded exposure, activity scheduling
Best suited for	Avoidance patterns, chronic pain, distress that cannot be removed, people who find thought-challenging unhelpful	Specific anxiety disorders, panic, depression and OCD, where changing thoughts and behaviour is the goal
Typical length	Often 8 to 16 sessions	Often 8 to 20 sessions, depending on the difficulty

In practice the line between the two is not rigid, and many clinical psychologists draw on both. Neither is better across the board. Trials that compare them tend to find similar outcomes, so the choice often comes down to fit. Some people prefer the structured thought-challenging of CBT, while others find it frustrating and respond better to ACT’s focus on values and acceptance, particularly if they have tried to argue themselves out of their feelings before and found it did not hold. If you are unsure, your psychologist can help you weigh it up during your consultation, and your treatment can adapt as you go.

What ACT therapy costs

Session fees and your free consultation

ACT sessions cost £130 for 50 minutes, the same as every therapy we offer. There are no contracts and no minimum commitments, so you can stop whenever you need to. Before you begin, you have a free 15-minute consultation with our Clinical Director, Dr Rachel Whatmough, to talk through what you are looking for and check that ACT is a sensible fit. You can see full details on our pricing page.

Using private health insurance

We are recognised by the main UK private health insurers, including Bupa, AXA, Aviva, Cigna, Vitality, WPA and Healix. If you are using insurance, we handle the paperwork and invoice your insurer directly, so you are not left chasing claims. It helps to check a few things with your insurer first: whether you need pre-authorisation, how many sessions your policy covers, and whether any excess applies.

ACT at The Online Psychologists

At The Online Psychologists, ACT is delivered by HCPC-registered clinical psychologists with specialist training in acceptance and commitment therapy. Our psychologists integrate ACT with their wider clinical expertise, which means they can draw on other evidence-based approaches when it helps, while keeping the ACT framework at the centre of your work together.

Our matching process pairs you with a psychologist who has experience with your particular difficulties. Whether you are seeking help for burnout, chronic anxiety, grief or something else, we aim to match you with someone who understands both the difficulty and how ACT applies to it.

Sessions are typically 50 minutes and held weekly to begin with, often moving to fortnightly as you grow more confident applying the skills on your own. Your psychologist will agree clear goals with you while staying open to what emerges, because ACT is a flexible approach and the pace and focus are guided by what is most useful for you.

Online ACT therapy in the UK

Every ACT session is delivered online, by secure and encrypted video, to adults across the whole of the UK. All you need is a private space and a reliable internet connection. Sessions run for 50 minutes, usually once a week to begin with, and your first full session is normally arranged within a week of your consultation.

In a first session, your psychologist will spend time understanding what has brought you to therapy, how the difficulty affects your daily life, and what you would like to be different. There is no need to prepare anything in advance, though it helps to have a quiet, private space and a few uninterrupted minutes before you start. You will be sent a simple link to join the video call, and if technology is not your strong point, that is not a barrier: the setup is straightforward and your psychologist can talk you through it.

Online delivery suits ACT particularly well. The experiential exercises and mindfulness elements translate naturally to video, and many people find it easier to practise these skills in the place where they will actually use them, whether that is at home before a difficult day or in the evening after work. Being in your own space can also make it easier to settle into the open, reflective state that present-moment work relies on.

Online ACT is a good fit if you want specialist input without travelling to a clinic, if your schedule makes regular in-person appointments hard to keep, or if you simply feel more at ease opening up from home. It suits most adults seeking help with anxiety, stress, low mood, burnout and related difficulties. If your needs would be better met by a different level of care, for example if you are in crisis or need urgent support, we will tell you honestly and help you find the right route.

Frequently asked questions

Is ACT the same as mindfulness-based therapy? ACT uses mindfulness as one of its core components, but it is not a mindfulness-based therapy in the way that MBSR or MBCT are. In ACT, mindfulness sits within the broader framework of psychological flexibility, alongside values work, defusion and committed action. You do not need any previous experience of mindfulness or meditation to benefit from ACT.

What if I do not know what my values are? This is very common, and it is one of the things ACT is specifically designed to help with. Many people come to therapy feeling disconnected from what matters to them, particularly after a long stretch in survival mode. Values clarification is a guided process, not something you need to arrive with already worked out. Your psychologist will use exercises and conversation to help you explore and identify your values at a pace that feels right.

How is ACT different from CBT? Both ACT and CBT are evidence-based therapies within the broader cognitive behavioural tradition, but they differ in emphasis. CBT tends to focus on changing the content of unhelpful thoughts, helping you evaluate whether they are accurate and develop more balanced alternatives. ACT focuses on changing your relationship with thoughts, helping you hold them more lightly rather than buying into them or fighting them. Your psychologist can help you work out which approach is likely to be the better fit for you.

Can ACT help if I have tried other therapies before? Yes. ACT is often particularly helpful for people who have had previous therapy, especially if they found that insight alone did not lead to lasting change, or that trying to control their thoughts and feelings gave only temporary relief. ACT offers a different starting point, one focused on living well alongside difficulty rather than eliminating it.

Is ACT therapy available online in the UK? Yes. Every ACT session at The Online Psychologists is delivered by secure video, and the approach is available to adults across the whole of the UK. Research consistently shows that online ACT produces outcomes comparable to face-to-face delivery, and many people find that practising the exercises at home, in the setting where they will actually use them, supports the present-moment awareness ACT builds. Most clients start within a week of their initial consultation, wherever they live.

How much does ACT therapy cost? ACT sessions cost £130 for 50 minutes, the same as every other therapy we offer. Your initial 15-minute consultation with our Clinical Director is free, so you can ask questions and get a feel for the approach before committing. We are recognised by the main private health insurers, including Bupa, AXA, Aviva, Cigna, Vitality, WPA and Healix, and we handle the insurer paperwork and invoicing directly. If you are self-funding, there are no contracts or minimum commitments.