Acceptance and Commitment Therapy: A Critical Review to Guide Clinical Decision Making
Abstract
This chapter examines the degree of empirical support available for the theoretical model, treatment components, and clinical applications of acceptance and commitment therapy (ACT). It highlights the clinical implications of existing knowledge and theoretical model of ACT as well as key questions to be tested in future research. Psychological inflexibility is the core pathological process targeted by ACT. ACT is designed to be a transdiagnostic treatment targeting a common core pathological process and mechanism of change. Thus, quite naturally, ACT has been applied broadly across clinical populations. Behavior therapies share common components with ACT but may offer advantages because they are more efficiently targeted at the behavioral strategies to promote clinical change. Preliminary moderation research has highlighted some clues regarding for whom ACT or traditional cognitive behavioral therapy (CBT) may be more effective in the area of anxiety disorders.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Psychological suffering derives from psychological inflexibility, a core pathological process wherein behavior is rigidly guided by immediate psychological experiences rather than by the individual's values or goals.
“Theoretically, psychological suffering derives from psychological inflexibility, a core pathological process wherein behavior is rigidly guided by immediate psychological experiences rather than by the individual’s values or goals (Levin et al., 2017).”
From Examining a Group Acceptance and Commitment Therapy Intervention for Music Performance Anxiety in Student Vocalists (2020) · cites this paper as Levin et al., 2017
ACT meets the well-established standard as a treatment for social anxiety disorder.
“Currently, ACT meets the “well-established” standard as a treatment for a variety of health problems including social anxiety disorder (Levin et al., 2017), a disorder very similar to MPA that is technically included in the same diagnostic profile (American Psychiatric Association, 2013).”
From Acceptance and commitment therapy for the treatment of music performance anxiety: A pilot study with student vocalists (2017) · cites this paper as Levin et al., 2017
Cites
Using Self-Report Assessment Methods to Explore Facets of Mindfulness
Baer, R. A., Smith, G. T., Hopkins, J., Krietemeyer, J., & Toney, L. (2006) · Assessment · doi:10.1177/1073191105283504 · Cited by 7,511 · see citing works
(1999) · Cited by 5,934 · see citing works
Bond, F. W., Hayes, S. C., Baer, R. A., Carpenter, K. M., Guenole, N., Orcutt, H. K., Waltz, T., & Zettle, R. D. (2011) · Behavior Therapy · doi:10.1016/j.beth.2011.03.007 · Cited by 3,950 · see citing works
Measuring experiential avoidance: A preliminary test of a working model
Hayes, S. C., Strosahl, K., Wilson, K. G., Bissett, R. T., Pistorello, J., Toarmino, D., Polusny, M. A., Dykstra, T. A., Batten, S. V., Bergan, J., et al. (2004) · The Psychological Record · doi:10.1007/bf03395492 · Cited by 2,140 · see citing works
Dimidjian, S., Hollon, S. D., Dobson, K. S., Schmaling, K. B., Kohlenberg, R. J., Addis, M. E., Gallop, R., McGlinchey, J. B., Markley, D. K., Gollan, J. K., et al. (2006) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.74.4.658 · Cited by 1,607 · see citing works
Acceptance and commitment therapy.
Hayes, S. C., & Lillis, J. (2012) · American Psychological Association eBooks · doi:10.1037/17335-000 · Cited by 1,543 · see citing works
(1990) · Cited by 1,282 · see citing works
Mindfulness and acceptance: expanding the cognitive-behavioral tradition
(2005) · Choice Reviews Online · doi:10.5860/choice.42-6797 · Cited by 1,273 · see citing works
A-Tjak, J. G. L., Davis, M. L., Morina, N., Powers, M. B., Smits, J. A. J., & Emmelkamp, P. M. G. (2015) · Psychotherapy and Psychosomatics · doi:10.1159/000365764 · Cited by 921 · see citing works
Hayes, S. C., Villatte, M., Levin, M., & Hildebrandt, M. (2011) · Annual Review of Clinical Psychology · doi:10.1146/annurev-clinpsy-032210-104449 · Cited by 800 · see citing works
The Origins and Current Status of Behavioral Activation Treatments for Depression
Dimidjian, S., Barrera, M., Martell, C., Muñoz, R. F., & Lewinsohn, P. M. (2011) · Annual Review of Clinical Psychology · doi:10.1146/annurev-clinpsy-032210-104535 · Cited by 785 · see citing works
(2010) · Redalyc (Universidad Autónoma del Estado de México) · Cited by 542 · see citing works
Levitt, J. T., Brown, T. A., Orsillo, S. M., & Barlow, D. H. (2004) · Behavior Therapy · doi:10.1016/s0005-7894(04)80018-2 · Cited by 479 · see citing works
Levin, M. E., Hildebrandt, M. J., Lillis, J., & Hayes, S. C. (2012) · Behavior Therapy · doi:10.1016/j.beth.2012.05.003 · Cited by 471 · see citing works
Gaudiano, B. A., & Herbert, J. D. (2006) · Behaviour Research and Therapy · doi:10.1016/j.brat.2005.02.007 · Cited by 435 · see citing works
What Does the Acceptance and Action Questionnaire (AAQ-II) Really Measure?
Wolgast, M. (2014) · Behavior Therapy · doi:10.1016/j.beth.2014.07.002 · Cited by 421 · see citing works
Examining psychological inflexibility as a transdiagnostic process across psychological disorders
Levin, M. E., MacLane, C., Daflos, S., Seeley, J. R., Hayes, S. C., Biglan, A., & Pistorello, J. (2014) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2014.06.003 · Cited by 400 · see citing works
Development of the Valuing Questionnaire (VQ)
Smout, M., Davies, M., Burns, N., & Christie, A. (2014) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2014.06.001 · Cited by 350 · see citing works
Masuda, A., Hayes, S. C., Sackett, C. F., & Twohig, M. P. (2004) · Behaviour Research and Therapy · doi:10.1016/j.brat.2003.10.008 · Cited by 317 · see citing works
Surfing the urge: Brief mindfulness-based intervention for college student smokers
Bowen, S., & Marlatt, A. (2009) · Psychology of Addictive Behaviors · doi:10.1037/a0017127 · Cited by 316 · see citing works
Acceptance and commitment therapy for anxiety and OCD spectrum disorders: An empirical review
Bluett, E. J., Homan, K. J., Morrison, K. L., Levin, M. E., & Twohig, M. P. (2014) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2014.06.008 · Cited by 306 · see citing works
Forman, E. M., Hoffman, K. L., McGrath, K. B., Herbert, J. D., Brandsma, L. L., & Lowe, M. R. (2007) · Behaviour Research and Therapy · doi:10.1016/j.brat.2007.04.004 · Cited by 295 · see citing works
The Wiley Handbook of Contextual Behavioral Science
(2015) · doi:10.1002/9781118489857 · Cited by 256 · see citing works
A Longitudinal Study of Experiential Avoidance in Emotional Disorders
Spinhoven, P., Drost, J., de Rooij, M., van Hemert, A. M., & Penninx, B. W. (2014) · Behavior Therapy · doi:10.1016/j.beth.2014.07.001 · Cited by 241 · see citing works
Craske, M. G., Niles, A. N., Burklund, L. J., Wolitzky-Taylor, K. B., Vilardaga, J. C. P., Arch, J. J., Saxbe, D. E., & Lieberman, M. D. (2014) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0037212 · Cited by 206 · see citing works
Assessing Psychological Flexibility: What Does It Add Above and Beyond Existing Constructs?
Gloster, A. T., Klotsche, J., Chaker, S., Hummel, K. V., & Hoyer, J. (2011) · Psychological Assessment · doi:10.1037/a0024135 · Cited by 206 · see citing works
Herbert, J. D., Gaudiano, B. A., Rheingold, A. A., Myers, V. H., Dalrymple, K., & Nolan, E. M. (2005) · Behavior Therapy · doi:10.1016/s0005-7894(05)80061-9 · Cited by 203 · see citing works
Kashdan, T. B., Goodman, F. R., Machell, K. A., Kleiman, E. M., Monfort, S. S., Ciarrochi, J., & Nezlek, J. B. (2014) · Emotion · doi:10.1037/a0035935 · Cited by 187 · see citing works
Wolitzky-Taylor, K. B., Arch, J. J., Rosenfield, D., & Craske, M. G. (2012) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0029418 · Cited by 185 · see citing works
Forman, E. M., Butryn, M. L., Juarascio, A. S., Bradley, L. E., Lowe, M. R., Herbert, J. D., & Shaw, J. A. (2013) · Obesity · doi:10.1002/oby.20169 · Cited by 182 · see citing works
Levin, M. E., Pistorello, J., Seeley, J. R., & Hayes, S. C. (2014) · Journal of American College Health · doi:10.1080/07448481.2013.843533 · Cited by 179 · see citing works
Eisenlohr-Moul, T. A., Walsh, E. C., Charnigo, R. J., Lynam, D. R., & Baer, R. A. (2012) · Assessment · doi:10.1177/1073191112446658 · Cited by 137 · see citing works
Chase, J. A., Houmanfar, R., Hayes, S. C., Ward, T. A., Vilardaga, J. P., & Follette, V. (2013) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2013.08.002 · Cited by 135 · see citing works
Personal values and pain tolerance: Does a values intervention add to acceptance?
Branstetter-Rost, A., Cushing, C., & Douleh, T. (2009) · The Journal of Pain · doi:10.1016/j.jpain.2009.01.001 · Cited by 135 · see citing works
Worksite stress management training: Moderated effects and clinical significance
Flaxman, P. E., & Bond, F. W. (2010) · Journal of Occupational Health Psychology · doi:10.1037/a0020522 · Cited by 126 · see citing works
The Drexel defusion scale: a new measure of experiential distancing
Forman, E. M., Herbert, J. D., Juarascio, A. S., Yeomans, P. D., Zebell, J. A., Goetter, E. M., & Moitra, E. (2012) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2012.09.001 · Cited by 117 · see citing works
Self-citationAcceptance-Enhanced Behavior Therapy (AEBT) for Trichotillomania and Chronic Skin Picking
Flessner, C. A., Busch, A. M., Heideman, P. W., & Woods, D. W. (2008) · Behavior Modification · doi:10.1177/0145445507313800 · Cited by 112 · see citing works
McMullen, J., Barnes-Holmes, D., Barnes-Holmes, Y., Stewart, I., Luciano, C., & Cochrane, A. (2008) · Behaviour Research and Therapy · doi:10.1016/j.brat.2007.09.002 · Cited by 99 · see citing works
Kanter, J. W., Baruch, D. E., & Gaynor, S. T. (2006) · The Behavior Analyst · doi:10.1007/bf03392129 · Cited by 96 · see citing works
Pahnke, J., Lundgren, T., Hursti, T., & Hirvikoski, T. (2014) · Autism · doi:10.1177/1362361313501091 · Cited by 88 · see citing works
Acceptance and commitment group therapy (ACT-G) for health anxiety: a randomized controlled trial.
Eilenberg, T., Fink, P., Jensen, J. S., Rief, W., & Frostholm, L. (2016) · Psychological Medicine · doi:10.1017/s0033291715001579 · Cited by 86 · see citing works
Clarke, S., Kingston, J., James, K., Bolderston, H., & Remington, B. (2014) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2014.04.005 · Cited by 79 · see citing works
The Research Journey of Acceptance and Commitment Therapy (ACT)
Hooper, N., & Larsson, A. (2015) · doi:10.1057/9781137440174 · Cited by 70 · see citing works
Acceptance-based exposure therapy for public speaking anxiety
England, E. L., Herbert, J. D., Forman, E. M., Rabin, S. J., Juarascio, A., & Goldstein, S. P. (2012) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2012.07.001 · Cited by 64 · see citing works
Hertenstein, E., Thiel, N., Lüking, M., Külz, A. K., Schramm, E., Baglioni, C., Spiegelhalder, K., Riemann, D., & Nissen, C. (2014) · Psychotherapy and Psychosomatics · doi:10.1159/000365173 · Cited by 63 · see citing works
Davies, C. D., Niles, A. N., Pittig, A., Arch, J. J., & Craske, M. G. (2015) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2014.08.002 · Cited by 62 · see citing works
Timko, C. A., Zucker, N. L., Herbert, J. D., Rodriguez, D., & Merwin, R. M. (2015) · Behaviour Research and Therapy · doi:10.1016/j.brat.2015.03.011 · Cited by 57 · see citing works
Scherr, S. R., Herbert, J. D., & Forman, E. M. (2015) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2014.12.002 · Cited by 44 · see citing works
Acceptance-based exposure therapy for body dysmorphic disorder: A pilot study
Linde, J., Rück, C., Bjureberg, J., Ivanov, V. Z., Djurfeldt, D. R., & Ramnerö, J. (2015) · Behavior Therapy · doi:10.1016/j.beth.2015.05.002 · Cited by 41 · see citing works
Clarke, S., Kingston, J. L., Wilson, K. G., Bolderston, H., & Remington, B. (2012) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2012.03.001 · Cited by 39 · see citing works
A Pilot Study of an Acceptance-Based Separated Family Treatment for Adolescent Anorexia Nervosa
Merwin, R. M., Zucker, N. L., & Timko, C. A. (2013) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2012.11.001 · Cited by 36 · see citing works
Herbert, J. D., Gaudiano, B. A., & Forman, E. M. (2013) · Behavior Therapy · doi:10.1016/j.beth.2013.03.001 · Cited by 33 · see citing works
Acceptance and Commitment Therapy for eating disorders: Clinical applications of a group treatment
Juarascio, A. S., Tronieri, J. S., Forman, E. M., Timko, C. A., Herbert, J. D., Butryn, M. L., & Lowe, M. R. (2013) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2013.08.001 · Cited by 21 · see citing works
Acceptance-Versus Change-Based Pain Management: The Role of Psychological Acceptance
Blacker, K. J., Herbert, J. D., Forman, E. M., & Kounios, J. (2012) · Behavior Modification · doi:10.1177/0145445511420281 · Cited by 19 · see citing works
Self-citationTargeting fear of spiders with control-, acceptance-, and information-based approaches
Wagener, A. L., & Zettle, R. D. (2011) · The Psychological Record · doi:10.1007/bf03395747 · Cited by 18 · see citing works
Carrasquillo, N., & Zettle, R. D. (2014) · The Psychological Record · doi:10.1007/s40732-014-0074-3 · Cited by 15 · see citing works
Flagged first, then by citations
1 of the 59 references couldn’t be matched to a known paper.
Cited by
Sorted by citations
Juncos, D. G., Heinrichs, G. A., Towle, P., Duffy, K., Grand, S. M., Morgan, M. C., Smith, J. D., & Kalkus, E. (2017) · Frontiers in Psychology · doi:10.3389/fpsyg.2017.00986 · Cited by 77 · see citing works
Levin, M. E., Haeger, J., & Cruz, R. A. (2019) · Mindfulness · doi:10.1007/s12671-018-1004-2 · Cited by 59 · see citing works
Clarke, L. K., Osborne, M. S., & Baranoff, J. A. (2020) · Frontiers in Psychology · doi:10.3389/fpsyg.2020.01127 · Cited by 49 · see citing works
“Acceptance and commitment therapy (ACT) is a multicomponent approach incorporating acceptance, mindful awareness of experience, values clarification, and various strategies from traditional behavior therapy such as exposure (Levin et al., 2017).”
BackgroundAcceptance and Commitment Therapy
Podina, I. R., & David, D. (2017) · doi:10.1002/9781119375395.ch6 · Cited by 32 · see citing works
Levin, M. E., Krafft, J., & Twohig, M. P. (2020) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2020.05.001 · Cited by 28 · see citing works
Garcia, Y., Keller-Collins, A., Andrews, M., Kurumiya, Y., Imlay, K., Umphrey, B., & Foster, E. (2022) · Behavior Modification · doi:10.1177/01454455211027301 · Cited by 22 · see citing works
Engle, J. L., & Follette, V. M. (2018) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2018.08.001 · Cited by 16 · see citing works
Pang, N. T. P., Koh, E., Mohd Kassim, M. A., Shoesmith, W. D., Kamu, A., Ho, C. M., Ng, J. R., & Wider, W. (2022) · Sustainability · doi:10.3390/su14137522 · Cited by 6 · see citing works
Elander, J., Kapadi, R., Coyne, E., Taal, M. W., Selby, N. M., Stalker, C., & Mitchell, K. (2021) · BMC Urology · doi:10.1186/s12894-021-00921-5 · Cited by 5 · see citing works
Racial imposter syndrome and music performance anxiety: A case study.
Fraser, T. (2025) · Behavioral Sciences · doi:10.3390/bs15081057 · Cited by 4 · see citing works
Wang, H., Ding, J., Liu, G., Sun, G., Zhang, X., Xiao, W., Cai, Y., & Lin, A. (2025) · Frontiers in Medicine · doi:10.3389/fmed.2025.1630034 · Cited by 2 · see citing works
Sadeghi, A. H., Ghodrati-Torbati, A., Yaghoubi, H., & Ahmadi, S. A. (2023) · Journal of Research and Health · doi:10.32598/jrh.13.5.2285.1 · Cited by 1 · see citing works
(2013) · Wiley eBooks · doi:10.1002/9781118783009.refs
- Authors
- Levin, M. E., Herbert, J. D., & Forman, E. M.
- Venue
- Treatments for Psychological Problems and Syndromes
- Publisher
- Wiley
- Published
- 2017-03-16
- Pages
- 413-432
- OpenAlex
- W2596598078
- Cited by
- 12
- References
- 59
- Citations by year
- 2025: 1 · 2023: 1 · 2022: 1 · 2021: 2 · 2020: 2 · 2018: 2 · 2017: 2 · 2013: 1
- Type
- other
- Language
- en
- Open access
- closed
- Topics
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- acceptance and commitment therapy, psychological inflexibility, transdiagnostic treatment, behavior therapy, cognitive behavioral therapy, anxiety disorders, treatment moderators, empirical evidence
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
