The New Anxiety Therapy That’s All About Accepting Your Fears

A new kind of counseling is changing how people get help — and it’s working

Credit: Pradeep Kumar/EyeEm/Getty

When Brenda Hurwood was in her thirties, she had an accident that left her with a partial disability: She worked in home care support with elderly patients, and she injured her shoulder and neck while helping a client get out of a chair.

The injury left her with decreased stamina and constant pain, Hurwood says, and she found it difficult to continue working. “It eroded away my self-confidence as a person,” she says.

Hurwood, 63, who lives in Nova Scotia, Canada, says she developed generalized anxiety disorder, which persisted for decades. She tried different forms of therapy and various medications, but nothing worked — until 15 years ago, when a therapist introduced her to acceptance and commitment therapy.

ACT (pronounced like “act”) is a relatively new form of therapy centered on accepting that pain and suffering are an inevitable part of life, and using that acceptance to manage negative thoughts and feelings. In addition to anxiety, it’s been used as a treatment for depression, chronic pain, anger, phobias, and a host of other issues.

Its primary conceit is that instead of trying to control or push away your negative emotions, you should focus on learning to live with them. For some people, more traditional ways of coping with those thoughts and feelings can have the opposite of their intended effect, says Jenna LeJeune, PhD, a therapist and ACT practitioner based in Portland, Oregon: “Paradoxically, the more we focus on trying to get rid of painful thoughts or feelings, the more those things become the center of our lives.”

Although ACT has technically been around for over 30 years — it was developed in the mid-1980s by psychologist Steven Hayes, PhD — it’s only in the last couple of decades or so that it’s begun to gain traction. Hayes’ book on the topic, Get Out of Your Mind and Into Your Life, was published in 2005.

“We’re not trying to make you have more positive thoughts or more rational thoughts. We’re trying to help people have a different relationship to their thoughts.”

The research on ACT is still nascent, and sometimes conflicting, but it’s growing. LeJeune estimates that there are over 250 randomized controlled trials of ACT in various contexts. One recent study found that ACT could reduce anxiety and depressive symptoms; a 2017 analysis pointed to evidence that it may be beneficial for the treatment of chronic pain; and a 2013 trial found that ACT decreased maladaptive behaviors in students with learning disorders. A 2009 review concluded that ACT was more effective than control settings (placebo, waiting list, or preexisting treatment) for some problems, though not in cases of anxiety or depression. The same review also found that it wasn’t more effective than more established practices like cognitive behavioral therapy, or CBT. (Although ACT technically falls under the wider umbrella of CBT, it is markedly different from Beck CBT, the mainstream form, which is more focused on helping people correct their unproductive lines of thinking.) Another review from 2013, however, did find preliminary support for ACT as a treatment for anxiety.

“We’re not trying to make you have more positive thoughts or more rational thoughts. We’re trying to help people have a different relationship to their thoughts.”

Despite the ambiguity in ACT research, Hurwood, who now works part-time at a virtual call center, says the therapy has had a tremendous impact on her anxiety. “I’m more content and much more easygoing than I was,” she says. “It’s made a total difference for me in terms of my relationships with people and the way I look at life.”


Positive thinking is not going to magically get rid of all of your pain,” says Dr. Russ Harris, author of The Happiness Trap: How to Stop Struggling and Start Living, one of the seminal texts on ACT. “We don’t learn, at least in Western culture, how to deal effectively with the pain that’s inevitable in life. ACT gives you practical skills for how to drop the struggle with that pain, how to make room for it, and how to let it be there without getting consumed or controlled by it.”

ACT is composed of six core principles to help patients develop psychological flexibility, or the ability to adapt to life’s changing circumstances; with this skill, the thinking goes, you’ll have more mental space to focus on other things.

The first principle is something called defusion, which involves accepting your thoughts for what they are — thoughts — rather than seeing them as the objective truth. “In ACT, we don’t care about changing the content of your thoughts,” LeJeune says. “We’re not trying to make you have more positive thoughts, more rational thoughts, or true thoughts. What we’re trying to do is help people have a different relationship to their thoughts.”

Take this example: Let’s say you just had a big presentation at work that didn’t go well. You saw a co-worker snicker to another co-worker, and your boss looked less than pleased. Afterward, you might have started ruminating over how terrible you are at your job, or convincing yourself that you were about to get fired. Instead of accepting these things as true or trying to will them away with cheerful thoughts, you would instead see the thoughts for what they are and let them pass. Some ACT-recommended strategies include stripping a thought of its power by singing it to the tune of “Happy Birthday,” or putting it in perspective by adding another layer of distance: “I realize I’m having the thought that I’m terrible at my job and that I’ll probably get fired.”

Learning to acknowledge her negative thoughts and then let them pass was difficult at first, Hurwood says, but incredibly impactful once she got the hang of it. “That was a hard thing to learn — that those emotions will pass and you don’t have to interact with them,” she says. “But when I learned that, it was like, Oh my god. It changed a lot of things for me.”


Harris, the ACT pioneer, says the biggest difference between ACT and CBT is that with the former, you’re not challenging your thoughts, getting rid of your thoughts, or trying to discern whether your thoughts are true. “It’s recognizing that your thoughts are here, and learning how to let them come and go,” he says. “The question is not whether your thoughts are true or false, but rather whether they’re helpful.”

ACT isn’t without its critics. Some traditional CBT practitioners believe the two forms of therapy aren’t as different as some ACT practitioners suggest. Others don’t think there’s enough evidence yet to support ACT’s benefits.

Despite the lack of consensus on ACT’s efficacy, practitioners have applied it to a wide range of conditions. ACT is considered what’s known as a transdiagnostic behavior therapy, which means it wasn’t designed for one specific diagnosis, LeJeune says. Although therapists commonly use it for anxiety and depression, they’re also using ACT for people with chronic pain, anger, and phobias. Some even use it to help their patients quit smoking.

Melissa Kirk, 48, had a fear of driving that consumed her for decades. Kirk, a freelance writer based in Richmond, California, says she unsuccessfully tried several different strategies over the years to conquer her fear. Around 16 years ago, she was working at a publishing company that produced several books on ACT, and she began reading up on it. Eventually, with the help of ACT, Kirk says she learned to separate her fearful thoughts — like “I will die if I drive” — from the reality of the situation and finally learned how to drive.

“It totally shifted my mindset about discomfort,” she says. “Just the idea that I’m allowed to be uncomfortable or anxious or whatever — I just use it in my whole approach to life now. It’s part of my nature. And my life is way better now.”

LeJeune says she often tells people to think of it this way: Let’s say you could choose between a life that is full of meaning but also includes suffering, or a life that is devoid of suffering but lacks meaning. Most people would choose the life of meaning.

“Most of us have been taught that we are first supposed to focus on getting rid of the suffering part and then eventually we get to living a meaningful life,” she says. “ACT sort of flips those.”