Choice point

How Acceptance and Commitment Therapy (ACT) can help manage ADHD symptoms

ADHDACTAcceptance and Commitment TherapyMental Health
Cor van Lith

Cor van Lith

June 10, 2024

Have you ever felt like your mind is constantly wandering, making it impossible to stay focused? My mind sometimes feels like a traveler, trying to explore all the worlds it creates. This makes life sometimes unnecessarily complicated. During over thirty years without a diagnosis, Acceptance and Commitment Therapy (ACT) was a game-changer for me.

Understanding ACT and ADHD

ACT is a type of cognitive-behavioral therapy. It focuses on psychological flexibility, helping you handle various thoughts and feelings without becoming overwhelmed. The six core processes of ACT are:

  • Acceptance: Embracing your thoughts and feelings instead of fighting them.
  • Cognitive Defusion: Seeing thoughts as just thoughts, not absolute truths.
  • Mindfulness: Staying present and aware of the moment.
  • Self-as-Context: Viewing yourself from a broader perspective.
  • Values: Identifying what is truly important to you.
  • Committed Action: Taking steps that align with your values.

Imagine trying to fight a powerful wave in the ocean. The more you resist, the more exhausted you become. ACT teaches you to ride the wave instead, accepting it as part of your experience, which can make navigating life with ADHD much smoother.

Understanding the Choice Point in ACT for ADHD

A key concept in ACT is the 'Choice Point.' This is a brief moment in which you decide to either move towards what is important to you (unhooked) or get caught into a pattern that is baked into your system (hooked). If you have ADHD these moments are sometimes almost non-existent. This results in constantly being trapped in old coping mechanisms and behavioural patterns.


When you are 'hooked,' you are caught by emotions and thoughts that pull you into unhelpful patterns. This typically leads you to react in ways that do not serve your long-term well-being or values. Here are some characteristics of being hooked:

  • Fusion with Thoughts: You believe your thoughts to be literal truths and act upon them without question. For example, thinking 'I'm not good enough' and avoiding challenges because of it.
  • Experiential Avoidance: You try to escape or avoid unpleasant emotions and experiences. Like feeling anxious and choosing to stay home instead of going to a social event.
  • Automatic Reactions: You engage in habitual behaviors without conscious awareness. For example, reaching for a snack when feeling stressed, or all of a sudden finding yourself in the kitchen doing the dishes, when you were busy filling your taxes a split second ago.
Choice point


When you are 'unhooked,' you are mindful and aware of your thoughts and emotions, but you do not let them dictate your actions. Instead, you choose behaviors that align with your values, even if it means facing discomfort. Here are some characteristics of being unhooked:

  • Defusion from Thoughts: You see your thoughts as just thoughts, not as literal truths. For example, noticing the thought 'I'm not good enough' without letting it control your actions.
  • Acceptance: You open up to and accept your emotions and experiences as they are, without trying to change or avoid them. For example, feeling anxious but choosing to attend the social event anyway.
  • Values-Driven Actions: You consciously choose actions that align with your values. For example, feeling stressed but choosing a healthy coping mechanism like exercise instead of mindless snacking.

You might feel overwhelmed by a big project at work. You think you aren't capable of finishing it and get anxious. To distract yourself from these thoughts you automatically start a Youtube binge that lasts 12 hours. Afterwards, you feel guilty and your self-doubt gets enforced because you didn’t manage to finish or even start the project.

ACT helps you recognise this choice point and decide on a small, value-driven step forward. First it learns you to become more aware of the moment. You are feeling anxious! The next step is accepting and defusing "I'm having the thought i'm not able to finish it", "It is ok to feel anxious or overwhelmed!". This creates the choice point. You now are now aware of your feelings and behaviour. Creating clarity of why the project is important to you and why you would like to make a step, helps you to move even though these feelings can be very unpleasant.

This is easier said than done, it takes practice. Buhdi can help you go through these steps.

How ACT can help with specific ADHD challenges

ADHD challenge:

Difficulty Starting Tasks

ACT Solution:

Values Clarification and Committed Action

  • Identify why the task is important based on your values.
  • Break the task into smaller steps and commit to completing just one step at a time.

Example: Procrastination on work or creative projects due to feeling overwhelmed.

ADHD challenge:

Emotional Dysregulation

ACT Solution:

Mindfulness and Acceptance

  • Practice mindfulness exercises to stay present and observe emotions without judgment.
  • Accept your feelings as they are, reducing the struggle against them and allowing for more balanced responses.

Example: Frequent mood swings or intense emotional reactions.

ADHD challenge:


ACT Solution:

Cognitive Defusion and Mindfulness

  • Use cognitive defusion techniques to see impulsive thoughts as just thoughts, not commands you must follow.
  • Implement mindfulness practices to increase awareness of impulses and create a pause before reacting.

Example: Acting on urges without thinking, like interrupting others or making hasty decisions.

ADHD challenge:

Difficulty Sustaining Attention

ACT Solution:

Mindfulness and Committed Action

  • Regular mindfulness exercises to train your attention to stay in the present moment.
  • Set clear, value-driven goals to stay motivated and focused on tasks that matter to you.

Example: Losing focus during meetings or while reading.

ADHD challenge:

Negative Self-Judgment

ACT Solution:

Self-as-Context and Cognitive Defusion

  • View yourself from a broader perspective, recognizing that your thoughts and feelings do not define you.
  • Practice cognitive defusion to see self-critical thoughts as separate from your identity.

Example: Harsh self-criticism and low self-esteem due to ADHD symptoms.

Evidence Supporting ACT for ADHD

Research supports the effectiveness of ACT in managing ADHD symptoms. A study highlighted on the National Center for Biotechnology Information (NCBI) shows that ACT can significantly improve psychological flexibility and reduce ADHD symptoms. This evidence suggests that ACT is a promising approach for enhancing your quality of life despite the challenges posed by ADHD.

Recommended Books on Acceptance and Commitment Therapy (ACT)

'ACT Made Simple: An Easy-to-Read Primer on Acceptance and Commitment Therapy'
-by Russ Harris

This user-friendly guide simplifies the core concepts of ACT, making it accessible for practitioners or people with an interest in how ACT works.

'The Happiness Trap: How to Stop Struggling and Start Living'
-by Russ Harris

A popular and approachable book that introduces ACT concepts to a general audience. It offers practical strategies for overcoming common psychological obstacles and building a more fulfilling life.

'Get Out of Your Mind and Into Your Life: The New Acceptance and Commitment Therapy'
-by Steven C. Hayes

This self-help book provides a step-
-by-step program based on ACT principles, helping readers to break free from negative thought patterns and embrace a more values-driven life.

'ACT with Love: Stop Struggling, Reconcile Differences, and Strengthen Your Relationship with Acceptance and Commitment Therapy'
-by Russ Harris

A great resource for couples, this book applies ACT principles to relationship issues, offering strategies to improve communication, resolve conflicts, and build stronger connections.

'The Mindfulness and Acceptance Workbook for Anxiety: A Guide to Breaking Free from Anxiety, Phobias, and Worry Using Acceptance and Commitment Therapy'
-by John P. Forsyth and Georg H. Eifert

This workbook combines ACT and mindfulness techniques to help individuals manage anxiety and stress, with practical exercises and worksheets for daily practice.

'The Reality Slap: How to Find Fulfillment When Life Hurts'
-by Russ Harris

This book offers support for those dealing with major life challenges and changes, using ACT principles to provide coping strategies and resilience-building techniques.


ACT offers a valuable approach for managing ADHD by promoting acceptance, mindfulness, and values-based actions. By focusing on the Choice Point and becoming aware of your thoughts and emotions, you can make more conscious decisions that align with your values and long-term goals. Imagine steering your life’s ship with a clear destination in mind, navigating through the stormy seas of ADHD with newfound resilience and direction.

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