Acceptance and Commitment Therapy (ACT)

Acceptance and Commitment Therapy, pronounced "act", was developed in the 1980s and 1990s by Steven Hayes and colleagues in the United States. It belongs to the broad cognitive behavioural family, but with a different angle: rather than trying to change the content of negative thoughts, it works on our relationship with them.

The core idea is simple but deep: much of our suffering comes not from pain itself but from the constant struggle to escape it. When we run from anxiety, sadness or a painful memory, life often shrinks: we avoid situations, withdraw from people and postpone what we care about. ACT aims to break that cycle.

ACT aims at what it calls psychological flexibility: being present, experiencing difficult feelings without drowning in them, and still acting in line with your values. This is usually described through six linked skills.

Acceptance: making room for unpleasant feelings instead of suppressing or escaping them; it does not mean giving up or liking the pain. Cognitive defusion: seeing thoughts as thoughts, not absolute truths ("I am having the thought that I am a failure"). Present-moment awareness: mindful attention to now. Self as context: the part of you that notices thoughts and feelings without being identical to them. Values: clarifying what makes life meaningful to you. Committed action: small, concrete steps in the direction of those values.

ACT sessions are active and experiential. The therapist uses metaphors, short mindfulness exercises and between-session tasks, not just listening.

Imagine Maryam, who moved to Germany two years ago and avoids work meetings because of social anxiety. Together they look at what avoidance gives her in the short term and what it costs in the long term. Then they explore her values, perhaps connection and professional growth. The therapist might use the "passengers on the bus" metaphor: frightening thoughts are noisy passengers, but Maryam is still the driver. A weekly task might be to say one sentence in a meeting, with the anxiety along for the ride.

ACT now has a substantial research base. Evidence suggests it can help with anxiety, depression, chronic pain and stress related to physical illness, with results in many comparisons close to classic CBT. For chronic pain in particular, it is among the better supported approaches.

There are also studies for OCD and psychosis, but there ACT is usually used alongside standard treatments rather than instead of them. ACT is not a miracle and does not suit everyone equally; what matters is the fit with your problem and personality.

ACT is often relatively short-term. Many programmes run 8 to 16 weekly sessions, longer for complex or long-standing difficulties. Much of the progress happens between sessions, as you practise the skills in daily life.

ACT works well online, since it relies on conversation, metaphor and practice. Doing it in your mother tongue matters: metaphors and values expressed in Farsi connect to your real experience.

For many Iranians abroad, migration brings homesickness, guilt towards family in Iran or questions of identity. Rather than treating these feelings as problems to remove, ACT helps you build a life alongside them that fits your values, including culturally rooted ones like family and respect. Practical tip: have a quiet space and headphones for the mindfulness exercises.

ACT is not the best choice for everyone. In acute crisis, with serious suicidal thoughts, or if you want to work deeply on childhood roots and relationship patterns, another approach or a combination may fit better. Some people also first experience "acceptance" as giving in, and it takes time to see what it really means.

If harsh self-criticism and shame are central, Compassion Focused Therapy (CFT) is a good complement. If you prefer to work directly on changing thoughts and behaviours, Cognitive Behavioural Therapy (CBT) is a close alternative. Your therapist can help you decide in the first session.