ACT for Anxiety and Panic: A Different Way to Work With Fear
Anxiety, worry, and panic are common human experiences, yet they can feel overwhelming when they start to shape daily decisions, limit activities, or dominate attention. Many people try to manage these experiences by controlling thoughts, avoiding triggers, or pushing uncomfortable sensations away. While these strategies often provide short-term relief, they frequently increase distress over time.
Acceptance and Commitment Therapy (ACT) offers a different way of working with anxiety, worry, and panic. Rather than focusing on symptom elimination, ACT helps people develop psychological flexibility—the ability to stay present, open, and engaged in life even when anxiety shows up. The goal is not to feel calm all the time, but to live meaningfully without being driven by fear.
Understanding Anxiety, Worry, and Panic
Anxiety is a natural response to perceived threat or uncertainty. It often involves heightened alertness, physical tension, and concern about future outcomes. Worry is the cognitive component of anxiety, characterized by repetitive thinking about what might go wrong. Panic involves sudden surges of intense fear accompanied by physical sensations such as a racing heart, dizziness, or shortness of breath.
These experiences are part of a healthy nervous system. They become problematic when internal experiences—thoughts, emotions, and bodily sensations—are treated as dangers that must be avoided or controlled. ACT focuses on changing how people relate to these experiences rather than trying to eliminate them.
The ACT Model of Psychological Flexibility
ACT is grounded in the concept of psychological flexibility, which refers to the ability to remain in contact with the present moment and take actions aligned with values, even when uncomfortable internal experiences are present (Hayes et al., 2012).
Psychological flexibility is developed through six core processes:
Acceptance
Cognitive defusion
Present-moment awareness
Self-as-context
Values clarification
Committed action
Together, these processes help reduce the struggle with anxiety, worry, and panic while supporting meaningful engagement in life.
Acceptance: Making Room for Anxiety and Panic
In ACT, acceptance means allowing internal experiences to be present without trying to change, suppress, or avoid them. Acceptance is not the same as liking anxiety or giving up. It is a willingness to experience discomfort without letting it dictate behavior.
When anxiety or panic is resisted, it often becomes more intense. Acceptance reduces this secondary struggle. People often discover that sensations rise and fall naturally when they are not being fought, monitored, or judged.
Cognitive Defusion: Stepping Back From Anxious Thoughts
Anxious thoughts often sound urgent and convincing, such as “Something is wrong,” “I can’t handle this,” or “This feeling will never end.” ACT does not focus on disputing these thoughts. Instead, it helps people see thoughts as mental events rather than literal truths.
Cognitive defusion techniques create distance from thoughts. For example, noticing “I’m having the thought that something is wrong” helps reduce the thought’s influence. The question becomes not whether a thought is true, but whether following it moves life in a meaningful direction.
Present-Moment Awareness
Anxiety and worry tend to pull attention into imagined futures, while panic pulls attention toward feared interpretations of physical sensations. ACT emphasizes present-moment awareness as a way to stay grounded in what is actually happening right now.
This involves:
Noticing sensations without judgment
Observing thoughts as they come and go
Gently returning attention when the mind drifts
Present-moment awareness is not a relaxation technique, though calm may occur. It is about being fully present so choices are guided by intention rather than fear.
Self-as-Context: You Are More Than Your Anxiety
ACT introduces the idea of self-as-context—the perspective from which experiences are observed. Thoughts, emotions, and sensations happen within awareness, but they are not the entirety of who a person is.
This perspective can be particularly helpful during panic. Rather than being consumed by sensations, individuals learn to notice that panic is an experience occurring in awareness, not something that defines them. This shift often reduces fear of the experience itself.
Values: Clarifying What Matters
Values are central to ACT. They represent chosen directions for living, such as connection, growth, compassion, honesty, or creativity. Anxiety often pulls people away from values by encouraging avoidance or overcontrol.
ACT helps individuals clarify what matters most so decisions are guided by purpose rather than fear. Values are not goals to be completed; they are ongoing ways of living that can be expressed even when anxiety is present.
Committed Action: Moving Forward With Anxiety Present
Committed action involves taking steps aligned with values, even when anxiety, worry, or panic shows up. This does not require confidence or certainty first.
Examples of committed action include:
Attending social events despite anxious thoughts
Continuing daily routines while worry is present
Allowing panic sensations without escaping the situation
Through committed action, people learn that anxiety does not need to disappear for life to continue meaningfully.
ACT for Panic Symptoms
Panic is often maintained by fear of bodily sensations. ACT helps by changing how sensations are interpreted and responded to. Rather than treating sensations as signs of danger, they are approached with openness and curiosity.
Acceptance and defusion reduce the panic cycle by removing the struggle. Over time, panic often loses intensity because it is no longer treated as a threat that must be escaped.
ACT for Worry
Worry often feels like problem-solving but typically involves repetitive thinking without resolution. ACT helps individuals notice when worry is occurring and choose whether engaging with it is useful.
Instead of eliminating worry, ACT encourages allowing worry thoughts to come and go while redirecting attention toward valued action. This reduces the dominance of worry without requiring certainty.
When ACT May Be Helpful
ACT has demonstrated effectiveness for anxiety-related concerns, including generalized anxiety, panic, and stress-related difficulties (A-Tjak et al., 2015). It can be especially helpful for individuals who feel stuck in cycles of avoidance, overthinking, or control strategies that are no longer effective.
Working with a therapist trained in ACT can help tailor these processes to individual experiences and provide structured support.
A More Flexible Way Forward
ACT offers a compassionate approach to anxiety, worry, and panic—one that emphasizes flexibility rather than control. Rather than asking how to eliminate anxiety, ACT invites a different question: How do I want to live, even with anxiety present?
Psychological flexibility allows anxiety to take up less space, not because it disappears, but because it no longer determines behavior. Over time, life becomes broader, richer, and more aligned with what truly matters.
References
A-Tjak, J. G. L., Davis, M. L., Morina, N., Powers, M. B., Smits, J. A. J., & Emmelkamp, P. M. G. (2015). A meta-analysis of the efficacy of acceptance and commitment therapy for clinically relevant mental and physical health problems. Psychotherapy and Psychosomatics, 84(1), 30–36. https://doi.org/10.1159/000365764
Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2012). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). Guilford Press.
Hofmann, S. G., & Hayes, S. C. (2019). The future of intervention science: Process-based therapy. Clinical Psychological Science, 7(1), 37–50. https://doi.org/10.1177/2167702618772296
Twohig, M. P., & Levin, M. E. (2017). Acceptance and commitment therapy as a treatment for anxiety and depression: A review. Psychiatric Clinics of North America, 40(4), 751–770. https://doi.org/10.1016/j.psc.2017.08.009