DIAGNOSIS: Mixed Anxiety Conditions
2015 EST Status: Treatment pending re-evaluation
Very strong: High-quality evidence that treatment improves symptoms and functional outcomes at post-treatment and follow-up; little risk of harm; requires reasonable amount of resources; effective in non-research settings
Strong: Moderate- to high-quality evidence that treatment improves symptoms OR functional outcomes; not a high risk of harm; reasonable use of resources
Weak: Low or very low-quality evidence that treatment produces clinically meaningful effects on symptoms or functional outcomes; Gains from the treatment may not warrant resources involved
Insufficient Evidence: No meta-analytic study could be identified
Insufficient Evidence: Existing meta-analyses are not of sufficient quality
Treatment pending re-evaluation
1998 EST Status: Modest Research Support
Strong: Support from two well-designed studies conducted by independent investigators.
Modest: Support from one well-designed study or several adequately designed studies.
Controversial: Conflicting results, or claims regarding mechanisms are unsupported.
Strength of Research Support
(Tolin et al. Recommendation)
Find a Therapist specializing in Acceptance and Commitment Therapy for Mixed Anxiety DisordersList your practice
Brief Summary
- Basic premise: ACT is about both acceptance and change. Clients are encouraged to let go of the struggle to change unwanted thoughts and emotions; instead focusing on the present moment and acting on what the client values most.
- Essence of therapy: Acceptance and Commitment Therapy (ACT), a behavioral therapy based on Relational Frame Theory, aims to change the relationship individuals have with unwanted or feared thoughts, feelings, memories, and physical sensations. Acceptance and mindfulness strategies are used to teach clients to decrease avoidance, attachment to cognitions, instead increasing focus on the present and psychological flexibility. Clients learn to clarify their goals and values and to commit to behavioral change strategies.
- Length: approx. 12 sessions
Treatment Resources
Editors:Natalie Noel, M.A.; Zac Imel, Ph.D.
Note: The resources provided below are intended to supplement not replace foundational training in mental health treatment and evidence-based practice
Treatment Manuals / Outlines
Treatment Manuals
Books Available for Purchase Through External Sites
- Acceptance and Commitment Therapy for Anxiety Disorders: A Practitioner’s Treatment Guide to Using Mindfulness, Acceptance, and Values-Based Behavior Change Strategies(Hayes, Forsyth, & Eifert)
- The Big Book of ACT Metaphors: A Practitioner’s Guide to Experiential Exercises and Metaphors in Acceptance and Commitment Therapy (Stoddard & Afari)
Training Materials and Workshops
Measures, Handouts and Worksheets
- Acceptance and Action Questionnaire – II (AAQ-II)
- The Valued Living Questionnaire (VLQ)
- The Bulls-Eye Values Survey
- Valuing Questionnaire (VQ)
- The ACT Daily Diary and Weekly Report
- Comprehensive assessment of Acceptance and Commitment Therapy processes (CompACT)
- Believability of Anxious Feelings and Thoughts Questionnaire (BAFT)
- Cognitive Fusion Questionnaire
- Stigmatizing Attitudes–Believability (SAB)
- Five Facet Mindfulness Questionnaire (FFMQ)
- Mindful Attention Awareness Scale (MAAS)
- ACT Knowledge Questionnaire
- COPE
- Experiences Questionnaire (EQ)
- Internalized Shame Scale
- Psychological Inflexibility in Pain Scale (PIPS)
- Scale for Personality Rigidity
- Self-Compassion Scale
- Thought Control Questionnaire
- Toronto Alexithymia Scale (TAS-20)
- White Bear Suppression Inventory (WBSI)
Self-help Books
- The Mindfulness and Acceptance Workbook for Anxiety: A Guide to Breaking Free of Anxiety, Phobias, and Worry Using Acceptance and Commitment Therapy (Forsyth & Eifert)
- Get Out of Your Mind and Into Your Life: The New Acceptance and Commitment Therapy (A New-Harbinger Self-Helped Workbook) (Hayes & Smith)
- The Mindfulness and Acceptance Workbook for Social Anxiety and Shyness: Using Acceptance and Commitment Therapy to Free Yourself from Fear and Reclaim Your Life (Kocovski & Fleming)
- Things Might Go Terribly, Horribly Wrong: A Guide to Life Liberated from Anxiety (Wilson & Dufrene)
Important Note: The books listed above are based on empirically-supported in-person treatments. They have not necessarily been evaluated empirically either by themselves or in conjunction with in-person treatment. We list them as a resource for clinicians who assign them as an adjunct to conducting in-person treatment.
Smartphone Apps
- ACT Companion: The Happiness Trap App with Dr. Russ Harris (Berrick Psychology)
- 2Morrow Health for Stress and Anxiety (2Morrow Health)
Video Demonstrations
- ACT in Anxiety
- Accepting Emotions
- Anger, Compassion, and What It Means To Be Strong | Russell Kolts | TEDxOlympia
- Chessboard Metaphor
- Eva Adriana Wilson, MD: The Strong and Healthy Self
- Finding your passion by inhaling meaninglessness
- Hank Robb, Ph.D.: Being Where You Are and Doing What’s Important
- Jason Luoma & Jenna LeJeune: The ACT Therapist
- Jesse Crosby: Psych’d Out! Workshop Series
- Joe Oliver: Demons on the Boat
- Joe Oliver: The Unwanted Party Guest
- Jonathan Bricker: The willingness to crave
- Leahy, Hayes, & DiGiuseppe: Cognitive Restructuring and Cognitive Defusion Demonstration
- Learning ACT – Skills and Competencies for Clinicians
- Matthieu Villatte – Self as Context (Flexible Self)
- Mental Brakes to Avoid Mental Breaks | Steven Hayes | TEDxDavidsonAcademy
- Psychological flexibility: How love turns pain into purpose | Steven Hayes | TEDxUniversityofNevada
- Rich Blonna, Ph.D.: A Brief Introduction to ACT
- Russ Harris, MD: About ACT in simple terms
- Struggling with Internal Hijackers? — From Mindi
- The ACT Matrix 101 Videos by Kevin Polk, Ph.D.
- The secret to self control | Jonathan Bricker | TEDxRainier
- Thoughts on the future of ACBS and contextual psychology – 2016 – Steven Hayes & Barbara Gil-Luciano
- Tom Lavin, MFT, LCADC, ACATA: : New Skills for Living – Experts on using ACT in daily life
- Tom Lavin, MFT, LCADC, ACATA: : When Life Hurts – Meaning Can Provide Strength and Direction
- Tom Lavin, MFT, LCADC, ACATA: Live Better Psychoeducation Series
Clinical Trials
- Randomized clinical trial of cognitive behavioral therapy (CBT) versus acceptance and commitment therapy (ACT) for mixed anxiety disorders (Arch et al., 2012)
- A randomised controlled trial of Acceptance and Commitment Therapy and Cognitive-Behaviour Therapy for generalised anxiety disorder (Avdagic, Morrissey, & Boschen, 2014)
- Randomized controlled trial of Cognitive Behavioral Therapy and Acceptance and Commitment Therapy for social phobia: Outcomes and moderators (Craske et al., 2014)
- A randomized controlled effectiveness trial of Acceptance and Commitment Therapy and Cognitive Therapy for anxiety and depression (Forman et al., 2007)
- Treating treatment-resistant patients with panic disorder and agoraphobia using psychotherapy: A randomized controlled switching trial (Gloster et al., 2015)
- Mindfulness and Acceptance-Based Group Therapy versus traditional Cognitive Behavioral Group Therapy for Social Anxiety Disorder: A Randomized Controlled Trial (Kocovski et al., 2013)
- Effectiveness of Acceptance and Commitment Therapy on the decrease of self-focused attention and improving self-efficacy (Mehrdoost, Neshatdoost, & Abedi, 2013)
- The effectiveness of Acceptance and Commitment Therapy based on reducing anxiety and depression in students with social phobia (Molavi et al., 2014)
- Cognitive mediators of treatment for social anxiety disorder: Comparing acceptance and commitment therapy and cognitive-behavioral therapy (Niles et al., 2014)
- Evaluating the effectiveness of ACT for anxiety disorders in a self-help context: Outcomes from a randomized wait-list controlled trial (Ritzert et al., 2016)
- Acceptance and commitment therapy for generalized anxiety disorder in older adults: A preliminary report (Wetherell et al., 2011)
- Moderators and non-specific predictors of treatment outcome for anxiety disorders: a comparison of cognitive behavioral therapy to acceptance and commitment therapy (Wolitzky-Taylor et al., 2012)
- Effect of Acceptance and Commitment Therapy on young people with social anxiety (Yadegari, Hashemiyan, & Abolmaali, 2014)
- Acceptance and commitment therapy (ACT) versus systematic desensitization in treatment of mathematics anxiety (Zettle, 2003)
Meta-analyses and Systematic Reviews
- Acceptance and commitment therapy for anxiety and OCD spectrum disorders: an empirical review (Bluett et al., 2014)
- Acceptance and Commitment Therapy in the treatment of anxiety: A systematic review (Swain et al., 2013)
- A systematic review of Acceptance and Commitment Therapy (ACT) for managing anxiety: Applicability for people with acquired brain injury? (Soo, Tate, & Lane-Brown, 2011)
Other Treatment Resources
- Acceptance and commitment therapy and cognitive behavioral therapy for anxiety disorders: Different treatments, similar mechanisms? Clinical Psychology(Arch & Craske, 2008)
- Treatment of three anxiety disorder cases with acceptance and commitment therapy in a private practice (Codd et al., 2011)
- Acceptance and Commitment Therapy for generalized Social Anxiety Disorder: A pilot study (Dalrymple & Herbert, 2007)
- Acceptance and commitment therapy for anxiety disorders: Three case studies exemplifying a unified treatment protocol (Eifert et al., 2009)