Improve Generalized Anxiety Disorder with Acceptance and Commitment Therapy (ACT)

Improve Generalized Anxiety Disorder with Acceptance and Commitment Therapy (ACT)


By John M. de Castro, Ph.D.


Acceptance and commitment therapy (ACT) is a type of psychotherapy gaining popularity in the treatment of anxiety disorders like generalized anxiety disorder (GAD). It is also used to treat other conditions including depression, eating disorders, chronic pain, and substance use disorders.” – Deborah Glasofer


Anxiety disorders are the most common mental illness in the United States, affecting 40 million adults, or 18% of the population. A characterizing feature of anxiety disorders is that the suffer overly identifies with and personalizes their thoughts. The sufferer has recurring thoughts, such as impending disaster, that they may realize are unreasonable, but are unable to shake. Anxiety disorders have generally been treated with drugs. But there are considerable side effects and these drugs are often abused. There are a number of psychological therapies for anxiety. But, about 45% of the patients treated do not respond to the therapy. So, there is a need to develop alternative treatments. Recently, it has been found that mindfulness training can be effective for anxiety disorders.


A therapeutic technique that contains mindfulness training is Acceptance and Commitment Therapy (ACT). It is a mindfulness-based psychotherapy technique that is employs many of the techniques of Cognitive Behavioral Therapy (CBT) and has also been shown to relieve anxietyACT focuses on the individual’s thoughts, feelings, and behavior and how they interact to impact their psychological and physical well-being. It then works to change thinking to alter the interaction and produce greater life satisfaction. ACT employs mindfulness practices to increase awareness and develop an attitude of acceptance and compassion in the presence of painful thoughts and feelings. ACT teaches individuals to “just notice”, accept and embrace private experiences and focus on behavioral responses that produce more desirable outcomes.


In today’s Research News article “A Multiple-Baseline Evaluation of Acceptance and Commitment Therapy Focused on Repetitive Negative Thinking for Comorbid Generalized Anxiety Disorder and Depression.” (See summary below or view the full text of the study at:, Ruiz and colleagues recruited 6 adults with Generalized Anxiety Disorder (GAD) and also depression. They received a 3 session Acceptance and Commitment Therapy (ACT) protocol of 90, 60, and 60 minutes focused on repetitive negative thinking implemented at different times on a multiple baseline. They were measured weekly over the internet for emotional symptoms (a combination of anxiety, depression and perceived stress), worry, experiential avoidance, cognitive fusion, perseverative thinking, and valuing.


They found that all participants demonstrated no significant changes during the 5 or more weeks of the baseline period in emotional symptoms or worry. But once Acceptance and Commitment Therapy (ACT) was provided all participants immediately demonstrated a precipitous decline in emotional symptoms, worry, experiential avoidance, cognitive fusion, and perseverative thinking that was maintained for 3 months. Effect sizes were very large and 5 of the 6 participants had clinically significant changes in emotional symptoms and worry.


It is well established that mindfulness training reduces anxiety, depression, perceived, stress, and worry. Nevertheless, the results of the present study are striking. Administration of a brief Acceptance and Commitment Therapy (ACT)  focused on repetitive negative thinking produced dramatic clinically significant improvements in the core symptoms of Generalized Anxiety Disorder (GAD) and depression. The fact that this was accomplished in 3-sessions is important as it reduces the investment of therapists in treatment, reducing costs and improving the numbers of people being able to be treated. These findings suggest that this brief form of mindfulness-based therapy be implemented for anxiety and deprressive disorders.


So, improve Generalized Anxiety Disorder with Acceptance and Commitment Therapy (ACT).


ACT helps you take action on your values, instead of letting your anxiety dictate your decisions and your days.” –  Margarita Tartakovsky


CMCS – Center for Mindfulness and Contemplative Studies


This and other Contemplative Studies posts are also available on Google+ and on Twitter @MindfulResearch


Study Summary


Ruiz, F. J., Luciano, C., Flórez, C. L., Suárez-Falcón, J. C., & Cardona-Betancourt, V. (2020). A Multiple-Baseline Evaluation of Acceptance and Commitment Therapy Focused on Repetitive Negative Thinking for Comorbid Generalized Anxiety Disorder and Depression. Frontiers in psychology, 11, 356.



Repetitive negative thinking (RNT) is a core feature of generalized anxiety disorder (GAD) and depression. Recently, some studies have shown promising results with brief protocols of acceptance and commitment therapy (ACT) focused on RNT in the treatment of emotional disorders in adults. The current study analyzes the effect of an individual, 3-session, RNT-focused ACT protocol in the treatment of severe and comorbid GAD and depression. Six adults meeting criteria for both disorders and showing severe symptoms of at least one of them participated in the study. A delayed multiple-baseline design was implemented. All participants completed a 5-week baseline without showing improvement trends in emotional symptoms (Depression Anxiety and Stress Scale – 21; DASS-21) and pathological worry (Penn State Worry Questionnaire; PSWQ). The ACT protocol was then implemented, and a 3-month follow-up was conducted. Five of the six participants showed clinically significant changes in the DASS-21 and the PSWQ. The standardized mean difference effect sizes for single-case experimental design were very large for emotional symptoms (d = 3.34), pathological worry (d = 4.52), experiential avoidance (d = 3.46), cognitive fusion (d = 3.90), repetitive thinking (d = 4.52), and valued living (d = 0.92 and d = 1.98). No adverse events were observed. Brief, RNT-focused ACT protocols for treating comorbid GAD and depression deserve further empirical tests.


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