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Acceptance and Commitment Therapy (ACT) with Children and Adolescents

Acceptance and Commitment Therapy (ACT) with Children and Adolescents

You have probably already heard about Acceptance and Commitment Therapy (ACT), but you may be hesitant to jump in because the concepts can seem complex and confusing. While a deep dive into ACT is far beyond the scope of a blog post, the basics of ACT will be reviewed and resources will be provided to help you on your path to learning more about this exciting and effective therapy. 

What is ACT? 

Acceptance and Commitment Therapy (ACT, pronounced “act” instead of saying each letter) is an action-oriented, evidence-based therapy which has been shown to be effective for a variety of life problems, including, but not limited to, PTSD, anxiety, depression, substance abuse, chronic pain, smoking, impulse control disorders, and weight management. While a substantial portion of previous ACT research has focused on adults, there is emerging evidence that ACT is effective for children and adolescents.

ACT’s overall goal is to increase psychological flexibility. The concept that accepting pain and discomfort as an unavoidable fact of life is a central tenet of ACT. ACT teaches strategies to live more fully in the present moment and to proactively engage with painful thoughts and feelings. Instead of trying to avoid pain and suffering by denying or fighting unpleasant emotions, ACT encourages us to accept and embrace all aspects of life, including the plethora of life’s inevitable messy, complicated, and uncomfortable feelings, thoughts, and problems. By doing so, a rich and meaningful life can be developed through commitment to taking action toward what really matters. 

What are the six essential core processes of ACT?

  1. Acceptance involves actively accepting all of our psychological experiences with full awareness and without attempting to change these experiences. Acceptance does not mean that we are putting on a happy face and ignoring our issues; instead, it means that we open ourselves up to experiencing all facets of life, including the unpleasant thoughts and feelings that are a normal part of life. 
  2. Cognitive Defusion involves changing the way we interact with our thoughts in order to reduce the impact of unhelpful cognitive processes about our thoughts upon our behavior. It helps us to realize that thoughts are just thoughts (in other words, thoughts are simply images or words in our minds) rather than facts, allowing us to detach or gain distance from our thoughts. 
  3. Being Present involves mindful, non-judgmental interaction with events/experiences and feelings/thoughts as they occur, which helps to accurately perceive what is happening in the present moment. 
  4. Self as Context is also referred to as the “observing self.” It is the consistent part of each of us that is able to watch what is happening both internally (feelings/thoughts/sensations) and externally (experiences/events) from a mindful, big-picture, higher-awareness perspective. 
  5. Values define what is most important to us in life. Values point us toward our overall life purpose. Identifying our values helps motivate us to intentionally focus our behaviors on what is most meaningful and valuable in our lives.
  6. Committed Action involves actively implementing effective, purposeful behaviors directed at moving toward a values-driven, meaningful life. 

For a more thorough explanation of the 6 essential core processes of ACT, visit  The Six Core Processes of ACT from The Association for Contextual Behavioral Science.

What methods are used in ACT? 

ACT interventions focus around two primary processes: 1). developing acceptance of unwanted personal experiences, thoughts, and feelings and 2). making a commitment to taking specific direct actions leading toward living a values-based life. To do so, the therapist first confronts the agenda of emotional control, emphasizing that attempted control is problematic rather than helpful, and then moves on to proceeding through ACT’s core processes. ACT strategies include the use of metaphors, mindfulness techniques, experiential exercises, homework, worksheets, and relevant explanations of ACT’s core processes. The resources listed below include specific examples of ACT strategies, as well as links to additional, more in-depth information.

How does ACT with children and adolescents differ from ACT with adults? 

ACT’s concepts, techniques, strategies, and metaphors will need to be modified to the appropriate developmental, academic, and communication levels of the child or adolescent. As with any intervention, the specific strengths and needs of the client must be considered, as well as the client’s background history and all presenting problems. ACT may also need to be used in conjunction with other interventions, such as parent and teacher consultation, skill-building activities, and/or traditional behavioral interventions. Luckily, there are excellent resources for ACT with children and adolescents listed below; please note that ACBS membership may be required to fully access all available items.

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Resources: 

ACT Measures for use with children/adolescents: https://contextualscience.org/child_and_adolescent_specific_actrelated_measures#

ACT Metaphors: https://contextualscience.org/metaphors

ACT Mindfully: Dr. Russ Harris: https://www.actmindfully.com.au/ (Includes free resources: https://www.actmindfully.com.au/free-stuff/)

ACT Miscellaneous Resources: https://contextualscience.org/miscellaneous_resources

ACT Treatment Protocols and Manuals for Children, Adolescents, and Parents: https://contextualscience.org/treatment_protocols_and_manuals_for_children_adolescents_and_parents

ACT in Schools: https://contextualscience.org/act_in_schools

Association for Contextual Behavioral Science (ACBS): www.contextualscience.org: ACBS offers many excellent ACT publicly-available resources, as well as additional professional/members-only resources, which are available with very affordable professional membership fees. 

Black, T. (2022). ACT for Treating Children: The Essential Guide to Acceptance and Commitment Therapy for Kids. New Harbinger Publications.

DNA-V Books and Free Resources for Youth: https://dnav.international/books-for-youth/ and https://dnav.international/downloads/

Harris, R. (2019). ACT Made Simple: An Easy-To-Read Primer on Acceptance and Commitment Therapy (Second Edition). New Harbinger Publications.

Harris, R. (2008). The Happiness Trap: How to stop struggling and start living. Robinson Publishing.

Swain, J., Hancock, K., Dixon, A., & Bowman, J. (2015). Acceptance and Commitment Therapy for children: A systematic review of intervention studies. Journal of Contextual Behavioral Science, 4(2), 73–85. https://doi.org/10.1016/j.jcbs.2015.02.001

Takahashi, F., Ishizu, K., Matsubara, K., Ohtsuki, T., & Shimoda, Y. (2020). Acceptance and commitment therapy as a school-based group intervention for adolescents: An open-label trial. Journal of Contextual Behavioral Science, 16, 71–79. https://doi.org/10.1016/j.jcbs.2020.03.001 

Turrell, S. & Bell, M. (2016). ACT for Adolescents: Treating Teens and Adolescents in Individual and Group Therapy. New Harbinger. 

Anna Lynn Hollis, Ph.D., School Psychologist

Anna Hollis, Ph.D., NCSP, is a nationally certified school psychologist currently living near Detroit, Michigan. She is licensed as a psychologist in 2 states (Michigan and South Carolina) and certified as a school psychologist in in 5 states (South Carolina, Michigan, Vermont, Pennsylvania, and Maryland). She is a member of the American Psychological Association (APA); the National Association of School Psychologists (NASP); the Michigan Association of School Psychologists (MASP); and the Association for Contextual Behavioral Science (ACBS). Dr. Hollis obtained her Ph.D. in School Psychology from the University of South Carolina. Her professional interests include Acceptance and Commitment Therapy (ACT); Positive Psychology; Trauma-Informed Practice; and Urban School Psychology.

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Opinions and viewpoints expressed in this article are the author's, and do not necessarily reflect those of CE Learning Systems.

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