Have you heard about the “third wave” in psychotherapy but you're not sure whether it refers to a crossing of the Atlantic, a set of mysterious new therapies, or the latest evidence-based development in psychological science?

Let's start at the beginning. I'm not going to cover every third-wave therapy, because they span a range of approaches far beyond the scope of one essay.

What I do want to share, as fully and as plainly as I can, is the approach I work from with my clients. What Acceptance and Commitment Therapy — ACT — actually is, and why, alongside Mindfulness-Based Cognitive Therapy, it becomes the most effective route towards the life you want.

What is Acceptance and Commitment Therapy?

Acceptance and Commitment Therapy — ACT, pronounced as a single word — is one of the third-generation behavioural therapies. That “third wave” emerged in the United States between the 1980s and 1990s, and belongs within the behavioural and cognitive family.

It is “third” because it differs from two earlier movements that were far more focused on fighting automatic thoughts and replacing them with supposedly more adaptive ones.

Broadly speaking, third-generation therapies place greater emphasis on dialogue and on each person's context, working with acceptance and a non-judgemental stance as the route to wellbeing.

ACT looks for a balance between two pairs of processes: attention and acceptance on one side, commitment and behaviour change on the other. All of it in the service of greater psychological flexibility and of engaging with what matters to you — in other words, with your values.

As an approach, ACT sits within the cognitive-behavioural tradition: it shares its pragmatism, its commitment to evidence-based practice and its grounding in learning principles. But it also differs from standard CBT in several important ways.

How does ACT differ from traditional CBT?

Mainly, ACT sets different treatment goals: the aim is not to reduce symptoms, as in conventional CBT, but to reorient your life in a more holistic way.

The understanding is that what causes distress is not situations themselves, but how we relate to them and which emotions we attach to them.

And it isn't about avoiding what hurts — which tends to backfire — but about learning to accept your own internal experience. Symptom intensity then drops as a consequence.

ACT focuses on changing your relationship with your internal experiences rather than on altering their presence, form or intensity.

At its core, ACT starts from the idea that psychological pain and distress are unavoidable facets of being alive, and cannot be fully sidestepped or eliminated.

And yet both our culture and the psychological community endorse an active struggle to change, control, minimise or avoid painful thoughts and feelings.

The message runs like this: “once you think or feel better, or differently, then you'll live better”. Painful thoughts and emotions are cast as barriers to a well-lived life, which justifies direct efforts to change them.

ACT challenges that view, teaching you how to live alongside the painful parts of your history, the mental chatter and the unpleasant experiences, while still doing what matters to you.

We use metaphors, experiential exercises and mindfulness and acceptance strategies to build three skills: thinking and feeling whatever shows up without judging it, recognising your history and what the situation allows, and persisting in actions aligned with your own values.

The six processes of ACT

ACT rests on a model that links six processes contributing to psychological inflexibility — and to many forms of human suffering — with six intervention processes designed to increase psychological flexibility.

For each of these processes, ACT proposes an intervention target. Let's look at them one by one.

Fusion vs. defusion

We speak of cognitive fusion when the process of thinking gets confused with the products of thought themselves. Fusion is neither good nor bad in itself: it lets us get absorbed in a good book, a film or in love. But it becomes a problem when it stretches to the point of believing thoughts literally.

In ACT we learn to see thoughts for what they are: words, images, small pieces of language.

It sounds like saying “I'm having the thought that…” or “I notice such-and-such a thought”. And that exercise lets us step back from thinking by noticing the difference between ourselves as observers of the activity of thinking, and the activity of thinking itself.

Just as we can observe objects in the outside world, defusion creates the space to do the same with our inner one. We are not our thoughts. The mind is always thinking, because that is what minds do. And we don't have to believe or trust everything it says.

Experiential avoidance vs. acceptance

Just as we'd try to avoid an external source of threat, we tend to try to avoid the internal experiences we find unpleasant. Experiential avoidance describes that tendency, along with the rigid or inflexible efforts we often make to pull it off.

But the evidence shows these attempts take enormous effort and rarely change the quality or form of the inner experience at all.

Above all, they carry a heavy cost in terms of living a valued life, because in general, when we move away from the painful parts of our history, we also move away from the things that matter to us.

It seems that trying to suppress or control unwanted thoughts and emotions produces more of them, not fewer.

What you resist persists, as Carl Jung put it.

Experiential acceptance, by contrast, means acknowledging and allowing our experience without judging it, treating ourselves kindly despite being imperfect, and neither fighting our internal states nor running from them.

It is a powerful antidote to avoidance, because it literally means “taking what is here as it is”: staying in contact with painful experiences without trying to change anything. And still acting in line with your personal values.

It is an active and courageous stance, and it should never be confused with passive resignation or giving up.

Disconnection vs. contact with the present moment

When people feel fused with their internal experiences, they tend to focus on the past or on an imagined future, which leads to a narrower range of behaviour: past, habitual and ineffective responses are more likely to dominate, and contact with the current circumstances — which might offer better guidance — is reduced.

The present moment is the only place where we can act to make a difference to our lives, which is why ACT teaches you to pay attention, deliberately, to the moment you are actually in, with an open mind and without judgement.

That is how we counter the pull to avoid or withdraw, both from painful experiences and from the circumstances that could prove valuable.

Attachment to the conceptualised self vs. self as observer

The conceptualised self is the set of stories each of us tells about who we are, and attachment to them is an extreme form of fusion that walls off our range of possible behaviour.

The stories we tell about ourselves shape what we believe we can and cannot do, and much of what we do serves to keep those personal narratives intact.

Whether we identify as a victim, as broken, as incapable or as highly intelligent, it will shape the decisions we make and what we do — or don't do.

Loosening that conceptualised self consists mainly of cultivating a perspective of self as observer. We work to build the sense that the stories we tell about ourselves are only that: stories, and that they don't have to be believed or trusted at face value.

Confusion vs. clarity about values

In ACT, values are defined as directions for intentional action, and they can give new meaning and purpose to what we do. They aren't our beliefs or a matter of morality, but domains of action tied to what a good quality of life means for each of us.

In terms of goals, values-guided action is what client and therapist work towards. Everyone has their own values, but a lack of clarity about them makes it hard to choose how to act.

We often feel “stuck”, on autopilot, serving immediate gratification rather than living a life we'd find valuable. As we learn to let go of the internal struggle, space opens up to consider what genuinely matters, with values as the compass.

Inaction vs. committed action

Being focused on avoiding painful experiences, because we feel fused with uncomfortable thoughts and emotions, can lead to inaction — losing contact with what matters, with committed action and with the present moment.

This domain refers to the commitment to act in line with our values, which is different from intending to act. In ACT there is no middle ground: we can choose to do something or not to do it. In that sense, ACT works with concrete goals which, unlike values, can actually be completed.

We use metaphors, analogies and practical exercises to convey certain key messages: that controlling internal experience isn't viable, that thoughts don't control what we do, and that we get to choose what matters in our lives.

We aim to share psychological knowledge relevant to each case, but in a different way from how psychoeducation is usually delivered in the cognitive-behavioural tradition.

The main difference is that instead of conveying information in a purely logical way, we use these indirect resources, which lets the message land far more experientially and vividly for the person on the other side.

What is Mindfulness?

Imagine I asked you what Mindfulness is. Could you explain it? We hear the word so often, and in so many different contexts, that pinning down what it actually means gets confusing.

It comes up in conversations with friends. Someone tells you they practise and it's going brilliantly. There are articles in the press and posts all over social media. And still it isn't clear what it's actually for, or whether it could help you.

Does Mindfulness have anything to offer you?

Let me answer that now: yes, Mindfulness can do a great deal for your quality of life.

And because I'm well aware of the confusion around the word, let me explain it from the beginning, so that afterwards you can answer that question with confidence.

In 1979, Jon Kabat-Zinn founded the Center for Mindfulness at the University of Massachusetts and began developing his Mindfulness-Based Stress Reduction programme (MBSR).

Kabat-Zinn adapted for Western culture certain insights and tools drawn from psychology and Buddhist meditation, which he gathered under the term “Mindfulness” and defined like this:

“Mindfulness is a method for polishing and cleansing the impurities in our mental outlook and the shadows we have accumulated over a lifetime.”

There are times when your head simply won't stop, aren't there? There ought to be a way, but your attempts don't quite work.

Through the cleansing Kabat-Zinn describes, we can restore to the mind what Buddhism considers its inherent qualities: clarity, wellbeing — peace and balance — and compassion.

Perhaps it's easier to grasp what Mindfulness is by looking first at its opposite: mindlessness.

You know you're in mindlessness when…

• You throw your bank card in the bin and put the wrapper from your lunch in your bag.
• You can't remember whether you locked the door on your way out.
• You bump into things or break them because you're not really in the room you're in.
• You're so focused on what's coming next that you forget something you have to do right now.
• You eat or drink something without being hungry or thirsty.
• An emotion seems to arrive “out of nowhere”.

Mindlessness is the state of unawareness in which we operate on autopilot.

We're not really present and, instead, we lean far too heavily on rigid rules we've never stopped to examine.

That's why it leads so easily to getting hooked, with your thoughts still there, bombarding you.

At the other end of the spectrum, Mindfulness is what allows you to notice your uncomfortable emotions and thoughts without getting entangled in them.

When you're fully attentive to your anger, you can observe it with more sensitivity, focus and emotional clarity, and you'll probably discover what it's about. You may even notice that behind the anger there is sadness or fear — and then you'll have far better options for handling it well, and assertively.

On mindful attention

• Mindful attention is neither obscure nor mystical — quite the opposite. It feels familiar because we already know it: it's an innate capacity we lose over the years.
• Nor is it something extra that we do, and it doesn't require us to change who we are, because it simply recognises and cultivates the best of what we already are.
• It has the potential to become a genuinely transformative social phenomenon, because anyone can practise it, it's evidence-based, and it needs no major investment or technology.

What is a formal Mindfulness practice?

It's the one we know from those photographs: a person sitting in a steady posture, eyes closed, apparently not having a single thought (I promise you they're having thousands, but they may have learned to let them pass).

It's a stretch of time in which you do nothing but be in the present moment, without getting tangled up in whatever arises. You move your attention across different anchors — your breath, the sounds around you, physical sensations — observing thoughts and moods without judging them.

Why not learn to be in the present, if it's the only place we can actually be?

1. Bring your attention to your experience

You can start with a single minute and build up as you feel comfortable. Sit comfortably, with your back straight but without straining.

Close your eyes, let your palms face upwards resting in your lap, and take two or three slow breaths, inhaling through your nose until your lungs fill, and exhaling gently.

Notice, with curiosity, how the weight of your body feels against the surface beneath you, the texture of your clothes on your skin, what physical sensations you can find, the temperature of your breath, sounds, smells.

2. Don't fight your thoughts

This isn't about emptying your mind or getting rid of your thoughts — quite the opposite: simply try to observe them for what they are, without adding judgement or evaluation. Notice how thoughts arrive and, just as they arrive, leave again.

Don't fight them, or you may end up frustrated and convinced that meditation isn't for you and that you're no good at it. It can be genuinely challenging, but every time you try to control your thoughts, what you do is amplify them.

3. Observe your emotions too

It matters just as much to notice the emotions that arise. You may feel anxious, sad, irritated or happy. Become aware of your emotions moment by moment without judging them, and without doing anything to change them. Simply observe what happens as if you were a witness watching a film.

Four informal Mindfulness practices

Informal Mindfulness practices are particular ways of approaching the ordinary activities of daily life. They're about learning to live more consciously and less on autopilot.

It means doing what we always do, but paying attention, with full awareness. And the simple act of paying attention brings the self out of the shadows: it creates the space between thought and action that we need in order to be sure we're acting from our own will rather than automatically.

1. Start with the breath

For one minute, focus on your breathing. Begin by inhaling and exhaling gently, in for four and out for four. Naturally, your mind will wander; that's what minds do. Don't scold yourself for doing it wrong: just notice that it happened and let it be. Each time a thought appears, notice it and, kindly, return your focus to your breath. That's all.

2. Sharpen your sense of sight

Choose an object around you — a mug, a book, your own big toe — and focus on it for a minute. Look at it with complete attention, as though you had just landed on a new planet and this were the first object you'd found. Try to identify its different aspects: texture, colour, size, dimensions, any movement it makes.

3. Rework a routine

Think of something you do every day and take entirely for granted, like making coffee or brushing your teeth. Next time you do it, focus on each step of the action, on everything you can see or hear connected with it, on the textures, smells and tastes. Do it fully consciously.

4. Listen with everything you've got

Pick a piece of music — something classical or jazz, for instance — and really connect with it. Use headphones if you can, as though you'd been raised in a cave and this were the first music you heard on coming out. Don't judge it: simply try to identify the different aspects of rhythm, melody and structure. If you feel like it, let your body move consciously to it.

Mindfulness lets you observe the thinker who holds the thoughts — and that helps you step back, gain perspective and choose better.

What is meditation actually for?

Meditating regularly helps you reach a calmer, more balanced state of mind, improves your concentration and brings clarity to how you perceive things. It also builds your capacity to communicate and create; new skills or talents may surface, and it can even strengthen your immunity and your capacity to heal.

There are many physical benefits, but let's focus on some of the ones most relevant to psychological wellbeing and personal development.

1. It helps you handle stress and all its close relatives: fear, anxiety, restlessness

This is the most studied and best validated benefit in the whole field, and I see it in my own clinical practice: eight out of ten people who come to see me do so for something connected with anxiety.

2. It improves your cognitive capacity and your attention

Mindfulness is, above all, attention training: every time you notice your mind has wandered — which is what minds do — your only job is to bring your focus back to wherever you choose. That's why Mindfulness builds your capacity to direct and sustain attention, and why it's used so widely in education and in organisations.

Practising Mindfulness may help prevent burnout and give you tools to move through creative blocks. It improves your perspective, which in turn helps you make better decisions. And as your mind grows more open and relaxed, your creativity, concentration, memory and overall performance improve with it.

3. It develops psychological flexibility

Flexibility is one of the most important aspects of intelligence in general, and of emotional intelligence in particular, because it increases your capacity to adapt and your tolerance for frustration. It's the best protection your mental health has: it helps you avoid developing psychological difficulties, prevent relapses and work through emotional conflicts.

Your greatest enemy in mental health is rigidity. Mental rigidity stops you gaining the perspective you need to make good decisions. And from my own professional experience, most of the benefits of Mindfulness come precisely from working on and increasing psychological flexibility.

4. It gives you emotional regulation tools

Practising Mindfulness is highly effective for learning to regulate your emotions, because you start to notice when an emotion arises, to detect it, to see it clearly and to understand how it works. That helps you get less hooked by emotions and respond consciously instead of simply reacting.

Over time you make better decisions, understand yourself better and take more care of the relationship you have with yourself. You prevent unnecessary conflicts, and you direct your energy towards what matters and what you genuinely want.

In short, practising Mindfulness helps you notice everything pleasant around you, lets you suspend judgement and approach your experience with warmth and kindness. That's why it connects you with life, with others and with yourself.

Why are ACT and Mindfulness the approach I've chosen?

Let me be clear: I accompany my clients with everything I know and everything I have, and fundamentally with two psychological tools:

• Acceptance and Commitment Therapy (ACT), grounded in accepting rather than judging — or fighting — the thoughts and emotions that cause distress, and in committing to act towards what matters.
• Mindfulness-Based Cognitive Therapy (MBCT), which teaches techniques for developing mindful attention and learning to work with automatic thoughts and emotions.

And every day I see the effect of putting these tools into practice in people's lives.

I also see the effect they've had on my own, because everything I share here isn't theory to me: I practise it daily, and have done for many years. ACT, Mindfulness and emotional regulation are the tools that changed my life.

How do those changes show up?

Once you stop adding fuel to the fire — that is, once you stop fighting the thoughts that generate anxiety — the changes start to be felt:

• Less stress, fear and restlessness.
• A lighter body, as though you'd put down a heavy rucksack.
• Emotional distress decreases.
• Your capacity to gain perspective on situations increases.
• And your ability to manage your own emotions improves.

In the end, your decisions become more workable and more values-based, because you learn to know yourself and to listen to yourself — and so you also get better results.

Working this way can feel strange at first. Through experiential exercises, metaphors and paradoxes, it invites you to see something uncomfortable: that what our culture endorses — trying to control your internal experience — is itself the problem.

That attempt at control isn't just not the solution: it is what causes the problem.

In neurobiological terms, working with ACT — and particularly with Mindfulness-based techniques — is associated with lower levels of cortisol, the stress hormone, and with reduced activity in the amygdala, a brain structure closely tied to fear.

• Your psychological flexibility increases.
• You handle your impulses better.
• And you become more intelligent in emotional terms.

Conclusions

As the world and psychological science evolve, so do the opportunities to improve how we accompany human suffering.

The aim in ACT and Mindfulness isn't to control your emotions or thoughts, but to make psychologically flexible responses possible.

Psychological flexibility is about being able to respond sensitively to context, adjusting your actions as needed so they stay consistent with what matters to you.

Working on self-knowledge is what gets you clear on your values and on what building a better life means for you. And, at the same time, it shows you that the struggle against your own internal experience is exactly what holds you back from it.

With love,
Katu.

Katia Rosenbaum

Clinical psychologist · licence No. 33475 (COPC) · MSc in Neuropsychology (UCL) · About