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There's a version of struggling that many people recognise but find difficult to describe. You understand your difficulties well — you might even be able to explain exactly where they come from. But understanding hasn't made them go away. You've tried thinking differently about things. You've reasoned with yourself, argued with your own thoughts, pushed feelings aside. And yet the anxiety still shows up. The low mood returns. The same patterns keep playing out.

Acceptance and Commitment Therapy (ACT) was developed specifically for this kind of stuck — the kind where the problem isn't a lack of understanding or effort, but the strategies being used to manage difficult thoughts and feelings that are, paradoxically, keeping them in place.

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What is ACT Therapy?

ACT is an evidence-based psychological therapy that focuses on changing your relationship to difficult thoughts, feelings, and memories, rather than trying to eliminate them.

Most of us have learned, often without realising it, that the way to deal with painful inner experience is to fight it, suppress it, avoid it, or reason our way out of it. We treat distressing thoughts as problems to be solved and uncomfortable feelings as things to be got rid of before we can get on with living.

ACT starts from a different premise: that this struggle with inner experience is itself a major part of what keeps us stuck. The effort to control anxiety, suppress unwanted thoughts, or escape difficult feelings frequently makes those experiences more intense and more intrusive — not less. And the behavioural strategies we use to avoid them — avoiding situations, withdrawing from relationships, staying busy, drinking, checking, seeking reassurance — quietly narrow our lives in ways that compound the original difficulty.

ACT offers an alternative. Rather than teaching you to control what you think and feel, it helps you develop a different kind of relationship with your inner experience — one where difficult thoughts and feelings no longer determine what you do. This creates genuine freedom: not freedom from difficult emotions, but freedom to act in line with what matters to you, even when those emotions are present.

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The Three Core Ideas in ACT

Acceptance means making room for difficult thoughts, feelings, and physical sensations rather than fighting them. Not because they're welcome or pleasant, but because the fight against them is often what keeps them powerful. Acceptance in ACT isn't resignation — it's the recognition that trying to eliminate difficult inner experience rarely works, and costs a great deal of energy that could be spent living.

Defusion is the process of changing your relationship to your own thoughts — learning to notice them as mental events rather than treating them as literal truths. A thought like "I can't cope" or "I'm going to fail" has far less power over your behaviour when you can hold it lightly as something your mind is doing, rather than a fact about the world that must be acted on or eliminated.

Committed action means identifying what genuinely matters to you — what kind of person you want to be, how you want to spend your time, what kind of relationships and experiences you want to build — and taking deliberate steps in that direction, even in the presence of difficult feelings. This is where ACT becomes most practical and most demanding: it asks you to act in line with your values rather than in response to your fear.

 

What Can ACT Help With?

ACT has a strong evidence base across a wide range of psychological difficulties. Below are the presentations I work with most frequently.

• Anxiety: Including generalised anxiety, social anxiety, health anxiety, and panic. ACT is particularly effective for anxiety that has become self-sustaining, where the fear of anxiety itself and the avoidance it drives have become as much of the problem as the original anxiety.

• OCD: ACT and ACT-informed approaches work well alongside ERP (Exposure and Response Prevention) for OCD, particularly for the cognitive dimensions of the condition and for building the willingness to tolerate uncertainty that recovery requires.

• Trauma and PTSD: ACT offers a framework for working with the avoidance and experiential suppression that maintains trauma responses. In my practice it is often used alongside EMDR for a comprehensive approach to trauma recovery.

• Depression and Low Mood: Particularly for patterns of withdrawal, rumination, and disconnection from meaning and purpose. ACT's emphasis on values-based action provides a route back into life that goes beyond symptom management.

• Burnout and Chronic Stress: Especially where the cost of the way someone is living has become impossible to ignore, and where reconnecting with what actually matters is as important as managing the immediate distress.

• Grief and Loss: ACT's emphasis on acceptance and values offers a compassionate framework for navigating loss, without either suppressing it or becoming defined by it.

• Patterns That Keep Returning: For people who have had therapy before, who understand their difficulties well, but who find that insight alone has not produced the change they were hoping for.

 

What ACT Therapy Actually Looks Like

ACT sessions are structured and collaborative. We begin by developing a clear understanding of what's keeping your difficulties in place — not just what happened in the past, but what's maintaining the problem now. This is a functional analysis: understanding the specific patterns of thought, feeling, and behaviour that are sustaining your distress and limiting your life.

From there, the work involves a combination of direct discussion, experiential exercises, and between-session practice. ACT is not a passive therapy — the sessions are a space to develop understanding and skill, but change happens through what you do with that outside the room.

You won't be asked to think positively or challenge every difficult thought. You will be asked to notice what's happening in your inner experience with more clarity and less struggle, and to practise acting in line with your values even when doing so is uncomfortable. Over time, most people find that difficult thoughts and feelings gradually lose their grip — not because they've been eliminated, but because they no longer have to be obeyed.

 

Why Work With Me?

I'm Christian Hughes, a BABCP-accredited psychotherapist with over 18 years of clinical experience. ACT and contextual behavioural science are at the heart of how I work — I'm a member of the Association for Contextual Behavioural Science (ACBS) and have worked extensively with ACT across NHS specialist services, military mental health environments, and private practice.

What this means in practice is that ACT is not something I've added to a toolkit — it's the framework I think in. I use it with depth and precision, applying functional analysis to understand your specific difficulties and targeting the ACT processes most relevant to what's keeping you stuck. This is a different clinical experience to working with a therapist who uses ACT occasionally alongside many other approaches.

I work in person in Stourbridge, West Midlands, and online across the UK via Zoom.

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Frequently Asked Questions

• Is ACT the same as CBT?
  ACT sits within the broader CBT family and shares its emphasis on evidence, structure, and behavioural change. The key difference is in how it approaches thoughts and feelings. Where traditional CBT tends to focus on changing the content of unhelpful thoughts — examining the evidence, developing more balanced alternatives — ACT focuses on changing your relationship to those thoughts, so they have less power over your behaviour regardless of whether their content changes. ACT also places much greater emphasis on values and psychological flexibility as the mechanism of change, rather than symptom reduction as the primary goal.

• How many sessions will I need?
  This depends on the nature and complexity of your difficulties. Many people experience meaningful progress within 8–12 sessions. More complex or longstanding difficulties typically require longer. We review progress regularly throughout and I'll always be honest with you about where we are and what further work is likely to involve.

• Will there be homework between sessions?
  Yes — and this is an important part of how ACT works. The sessions develop understanding and skill; what produces lasting change is applying that between sessions, in real situations and real relationships. This might involve brief mindfulness practices, specific behavioural experiments, or values-based activities. Between-session work is always discussed and agreed in session, and adjusted to what's realistic for your life.

• ACT talks about 'acceptance' — does that mean just putting up with things?
  No — and this is one of the most common misunderstandings about ACT. Acceptance in ACT means making room for difficult thoughts and feelings rather than fighting them. It explicitly does not mean tolerating situations that can and should be changed. In fact, ACT's emphasis on values and committed action is fundamentally about change. The acceptance piece is specifically about your relationship to your inner experience, not your life circumstances.

• I've tried CBT before and it didn't fully work. Would ACT be different?
  Possibly, yes. ACT approaches the problem from a different angle — rather than working to change the content of thoughts, it works to change their function and their grip on your behaviour. For people who have engaged genuinely with CBT and found it helpful but incomplete, ACT often provides the missing piece. The focus on acceptance, defusion, and values can unlock movement in cases where cognitive restructuring alone has reached its limits.

• Do you offer ACT online?
  Yes — all of my ACT work is available online via Zoom, UK-wide. Research consistently shows that online therapy is equally effective to in-person for most difficulties, and many clients prefer it for convenience and flexibility. In-person sessions are also available at my practice in Stourbridge, West Midlands.

• How is ACT different from mindfulness-based therapies?
  Mindfulness is one component of ACT — specifically the present-moment awareness and defusion skills — but ACT is considerably broader. Where mindfulness-based approaches focus primarily on developing awareness and acceptance of experience, ACT adds a clear framework for values-based action: using that awareness to move deliberately toward the life you want to be living. ACT is also more explicitly a treatment for specific psychological difficulties, with a strong clinical evidence base and a structured approach to functional analysis and behaviour change.

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Next Steps

If you would like to find out whether ACT is the right approach for you, a free 15-minute call is available to talk through your situation before committing to anything.

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