APA Citation
Hayes, S., Strosahl, K., & Wilson, K. (2016). Acceptance and Commitment Therapy: The Process and Practice of Mindful Change. Guilford Press.
Summary
Acceptance and Commitment Therapy (ACT) is a transdiagnostic approach that helps people develop psychological flexibility—the ability to be present with difficult experiences, defuse from unhelpful thoughts, accept painful emotions, connect with values, and take committed action. Rather than fighting to eliminate symptoms, ACT teaches acceptance of inevitable suffering while pursuing what matters. Six core processes—acceptance, defusion, present moment awareness, self-as-context, values, and committed action—work together to promote vital living even in the presence of pain.
Why This Matters for Survivors
Narcissistic abuse leaves survivors fighting internal battles: trying to stop intrusive thoughts, escape painful memories, or feel "normal." ACT offers a different approach: instead of fighting your experience, you learn to carry it while moving toward what matters. If you've been stuck trying to think or feel your way to recovery, ACT's emphasis on values and action provides alternative pathways. You don't have to wait until you're "healed" to live meaningfully—you can live meaningfully as part of healing.
What This Work Establishes
Psychological flexibility is central to wellbeing. The ability to be present with difficult experiences while pursuing valued living predicts better mental health outcomes across conditions.
Acceptance reduces suffering paradoxically. Fighting internal experience often maintains and amplifies it. Accepting difficult thoughts and feelings—being willing to have them while moving forward—often reduces their impact.
Thoughts are not facts. Defusion—seeing thoughts as mental events rather than literal truths—creates freedom. You don’t have to believe or act on every thought; you can observe it and choose how to respond.
Values guide action. Clear values provide direction even when motivation is low or feelings are difficult. Values-driven action can proceed regardless of internal state.
Why This Matters for Survivors
Stop fighting and start living. If you’ve been trying to eliminate intrusive thoughts, escape painful memories, or feel “normal” before living fully, ACT offers a different path. You can carry difficult experiences while moving toward what matters.
Your thoughts aren’t the enemy. The thoughts the narcissist installed—“you’re worthless,” “no one will believe you”—don’t have to be fought. They can be noticed, held lightly, and not acted upon. You don’t have to win the argument with them.
Values survive abuse. Even if the narcissist attacked everything you valued, your capacity to value remains. Reconnecting with what matters—not what the narcissist told you should matter—provides direction for recovery.
Action precedes motivation. You don’t have to feel better before acting on values. Taking valued action, even small steps, often generates the motivation and wellbeing that waiting for doesn’t produce.
Clinical Implications
Target experiential avoidance. Many presenting problems reflect attempts to avoid unwanted internal experience. Helping patients shift from avoidance to acceptance often reduces symptoms and expands life.
Teach defusion skills. Simple techniques—“I’m having the thought that…”—create distance from thought content. This is particularly useful for survivors haunted by internalized criticism.
Clarify values early. Understanding what matters to the patient provides direction for therapy and motivation for difficult work. Values clarification can be done early in treatment.
Integrate with trauma work. ACT’s acceptance and defusion skills support trauma processing by helping patients tolerate activation. ACT isn’t a replacement for trauma therapy but can enhance it.
How This Work Is Used in the Book
ACT appears in chapters on recovery approaches:
“Acceptance and Commitment Therapy offers an alternative to fighting your internal experience. Instead of trying to eliminate intrusive thoughts or escape painful memories, you learn to carry them while moving toward what matters. The voice the narcissist installed—telling you you’re worthless—doesn’t have to be argued with or believed. It can be noticed, held lightly, and not acted upon. You can have that thought and still take action aligned with your values. Recovery isn’t about winning internal battles; it’s about living meaningfully while carrying what you carry.”
Historical Context
ACT emerged from behavioral psychology but incorporated mindfulness and acceptance concepts that were gaining scientific support. Hayes and colleagues developed both the therapy and its underlying theoretical framework (Relational Frame Theory), grounding clinical techniques in basic science.
Published originally in 1999 with this expanded second edition in 2016, the book has become a foundational text in what’s called “third wave” behavioral therapy—approaches that go beyond symptom reduction to address quality of life, meaning, and values. ACT now has extensive research support for depression, anxiety, chronic pain, psychosis, and other conditions.
Further Reading
- Hayes, S.C. (2019). A Liberated Mind: How to Pivot Toward What Matters. Avery.
- Harris, R. (2019). ACT Made Simple: An Easy-to-Read Primer on Acceptance and Commitment Therapy (2nd ed.). New Harbinger.
- Harris, R. (2008). The Happiness Trap: How to Stop Struggling and Start Living. Trumpeter.
- Luoma, J.B., Hayes, S.C., & Walser, R.D. (2017). Learning ACT (2nd ed.). Context Press.
About the Author
Steven C. Hayes, PhD is Nevada Foundation Professor of Psychology at the University of Nevada, Reno. He developed ACT and the underlying theoretical framework (Relational Frame Theory). He has authored over 650 scientific papers and 47 books.
Kirk D. Strosahl, PhD and Kelly G. Wilson, PhD are co-developers of ACT and leading trainers and authors in the field.
Historical Context
This second edition (2016) updates the foundational ACT text originally published in 1999. ACT emerged from behavioral psychology but incorporated mindfulness and acceptance concepts that were gaining traction. The approach became one of the major "third wave" behavioral therapies, distinguished from earlier CBT by its emphasis on acceptance rather than change. ACT now has extensive research support across many conditions.
Frequently Asked Questions
Psychological flexibility is the ability to be fully present with difficult experiences while pursuing valued living. It involves openness to experience, awareness of the present moment, and the capacity to take action guided by values rather than by attempts to avoid pain.
Defusion means stepping back from thoughts to see them as thoughts—mental events rather than literal truths. Instead of being caught in 'I'm worthless,' you notice 'I'm having the thought that I'm worthless.' This creates distance that reduces the thought's power over behavior.
Traditional CBT often focuses on challenging and changing negative thoughts. ACT doesn't try to change thought content; it changes your relationship to thoughts. You don't have to believe or disbelieve thoughts—you can notice them, hold them lightly, and act on values anyway.
Acceptance isn't resignation or approval. It's willingness to experience difficult thoughts and feelings without struggling to eliminate them. Paradoxically, accepting painful experience often reduces its impact more than fighting against it.
Values provide direction for meaningful living. When you're clear about what matters—relationships, growth, creativity, contribution—you can take action aligned with values even when difficult feelings are present. Values pull you forward; avoiding pain just keeps you stuck.
Survivors often get stuck fighting internal experiences: trying to stop intrusive thoughts, eliminate painful memories, or feel 'normal.' ACT offers an alternative: accept that difficult experiences will come while moving toward valued living. You don't have to be 'recovered' to start living meaningfully.
Experiential avoidance is the attempt to escape or avoid unwanted internal experiences—thoughts, feelings, memories, sensations. While natural, excessive avoidance narrows life, maintains suffering, and prevents healing. ACT targets experiential avoidance as a core problem.
Yes. ACT complements trauma processing by helping survivors tolerate difficult material (acceptance), see trauma-related thoughts as thoughts (defusion), and maintain movement toward values even during difficult therapy. Many clinicians integrate ACT with trauma-specific approaches.