ACT

What is ACT?

Acceptance and Commitment Therapy (pronounced as the word “act,” not the letters) is a form of therapy that helps you develop psychological flexibility - the ability to be present with difficult thoughts and feelings while taking action toward what matters to you.

ACT belongs to the “third wave” of cognitive-behavioural therapies. Unlike traditional CBT, which focuses on changing unhelpful thoughts, ACT takes a different approach: rather than trying to eliminate difficult thoughts and feelings, it helps you change your relationship with them.

The core question in ACT is not “How can I get rid of this pain?” but “What kind of life do I want to live, and how can I move toward it - even when things are difficult?”

How ACT works

The six core processes

ACT is built around six interconnected processes that together create psychological flexibility:

Acceptance - making room for difficult emotions, sensations, and experiences rather than fighting or avoiding them. This is not passive resignation - it is an active choice to allow pain to be present without letting it control your behaviour.

Cognitive defusion - learning to step back from your thoughts and see them as mental events rather than facts or commands. A thought like “I am not good enough” becomes “I am having the thought that I am not good enough” - creating space between you and the thought.

Being present - paying attention to what is happening right now, rather than being caught up in worries about the future or regrets about the past. This is ACT’s version of mindfulness, though it tends to be less formal than in other approaches.

Self-as-context - developing a sense of yourself as the observer of your experiences, rather than being defined by them. You are not your thoughts, your feelings, or your diagnosis - you are the person who notices all of these things.

Values clarification - identifying what genuinely matters to you. Values are not goals (which can be completed) but directions (which guide ongoing action). They answer the question: “What kind of person do I want to be, and what kind of life do I want to build?”

Committed action - taking concrete steps aligned with your values, even when it is uncomfortable. This is where acceptance meets action - you do what matters, alongside the difficult thoughts and feelings, not in spite of them or after they disappear.

ACT and neurodivergence

Why ACT may suit neurodivergent people

ACT has several features that make it potentially well-suited to neurodivergent people:

It does not require you to “think differently.” Unlike traditional CBT, ACT does not ask you to identify distorted thoughts and replace them with more “balanced” ones. This can be a relief for people who find the metacognitive demands of CBT exhausting, or whose emotional responses are not primarily driven by identifiable thought patterns.

It is values-based, not symptom-focused. ACT does not frame neurodivergence as a problem to be fixed. Instead, it asks what matters to you and helps you move toward that - with your neurodivergent mind, not despite it.

It addresses the struggle against experience. Many neurodivergent people spend enormous energy fighting their own neurology - masking, forcing themselves to conform, suppressing natural responses. ACT names this struggle and offers an alternative: acceptance does not mean liking your difficulties, but it means stopping the exhausting war against your own experience.

It supports authentic living. By clarifying values and committing to action aligned with those values, ACT can help neurodivergent people build lives that fit who they actually are - rather than lives built around performing neurotypicality.

Evidence for autistic people

A randomised controlled pilot trial tested NeuroACT - an ACT programme adapted for autistic adults - with 39 participants in a psychiatric outpatient setting. Compared to treatment as usual, the NeuroACT group showed significant improvements in perceived stress, quality of life, psychological flexibility, and reduced avoidance behaviours.¹

The study found that ACT was particularly effective for managing stress and improving overall wellbeing, rather than directly treating co-occurring conditions like anxiety or depression. Most participants had co-occurring conditions including ADHD, suggesting the approach works for people with multiple neurodivergent conditions.¹

Evidence for ADHD

Research on ACT for ADHD is still in its early stages but shows promise. A scoping review identified studies showing improvements in core ADHD symptoms, academic procrastination, depression, and general psychological distress.²

For people with ADHD, ACT’s emphasis on values and committed action can be particularly helpful. Rather than trying to force executive function through willpower (which does not work), ACT helps you identify what matters and find ways to act on it that work with your ADHD brain - accepting that this will sometimes be messy, inconsistent, or non-linear.

What to expect in ACT

The therapeutic relationship

ACT therapists aim to be warm, genuine, and collaborative. They are not positioned as experts telling you what to think or do, but as guides helping you explore your own values and develop flexibility in how you respond to difficult experiences.

Exercises and metaphors

ACT makes extensive use of experiential exercises and metaphors to illustrate its concepts. For example:

• The “passengers on the bus” metaphor - imagining your difficult thoughts as noisy passengers on a bus that you are driving. They are loud, but they do not control where the bus goes.
• Mindfulness exercises - brief, informal practices that help you notice what is happening in the present moment
• Values exercises - structured exploration of what matters most to you across different life domains (relationships, work, health, personal growth)
• Defusion exercises - techniques for creating distance from unhelpful thoughts (such as singing a critical thought to a silly tune, or saying it in a funny voice)

Session format

ACT can be delivered individually or in groups, typically in weekly sessions. There is no fixed number of sessions - some people benefit from a short course (6-8 sessions), while others work with ACT principles over a longer period.

Unlike traditional CBT, ACT does not typically involve formal homework sheets. Instead, the therapist may suggest small actions aligned with your values to try between sessions.

Adaptations for neurodivergent people

If you are neurodivergent, it is worth discussing the following with your therapist:

• Metaphors - ACT uses a lot of metaphors, which some neurodivergent people find helpful and others find confusing. A good therapist will check whether metaphors work for you and offer alternatives if they do not.
• Mindfulness - as with other approaches, mindfulness practices may need adapting for sensory sensitivities, attention differences, or dissociation. Shorter, externally-focused, or movement-based practices may work better.
• Values clarification - identifying your own values (as opposed to values you have absorbed from others through masking) can be a powerful but emotionally challenging process. Take your time with this.
• Processing style - if you process information visually, prefer written materials, or need extra time to reflect, let your therapist know.

ACT compared to other approaches

Finding an ACT therapist

ACT therapists in the UK may be registered with:

• BABCP (British Association for Behavioural and Cognitive Psychotherapies)
• BACP (British Association for Counselling and Psychotherapy)
• ACBS (Association for Contextual Behavioral Science) - the international organisation for ACT practitioners

When looking for a therapist, ask about their experience with neurodivergent clients and how they would adapt their approach.

Further reading on neurobetter

• Counselling and therapy - overview
• CBT
• DBT
• Masking
• Neurodivergent and autistic burnout

neurobetter services

• Local services directory - find therapists near you
• Ask a Counsellor - get a confidential response from a registered counsellor