ACT therapy in Ottawa can help when you are tired of fighting your own thoughts. ACT stands for acceptance and commitment therapy. It helps you stop wrestling with painful thoughts and feelings so you can spend your energy on what matters to you. If you have wondered what actually happens in an ACT session, this post walks you through it, along with three well-known exercises you might try.
This post is general information, not medical advice or a diagnosis.
ACT, the short version
Most of us try to get rid of hard feelings. We distract ourselves, avoid things or argue with our worries. That struggle often takes up a lot of time and energy, and the feelings tend to come back anyway.
ACT offers another option. Instead of trying to win the fight, you learn to drop the rope. You make room for hard thoughts and feelings, and you keep taking steps toward the life you want. Our ACT counselling page explains more about how our team uses this approach.
The aim is not to feel good all the time. The aim is to live well, with all of your feelings along for the ride.
What happens in ACT therapy, session by session
The first conversation. Your first session is mostly about getting to know you. Your therapist will ask what you have been struggling with, what you have tried so far and what it has cost you. Many people notice that their efforts to control a feeling have quietly taken over their life.
You will also start to talk about what matters to you. What would you be doing more of if the struggle took up less room? That question often becomes the compass for the rest of the work.
Later sessions. As you go on, sessions become more hands-on. Your therapist may guide you through short exercises right there in the room or on screen. You might notice your breath, picture your thoughts in a new way or talk through a hard moment from the week.
Between sessions. You may agree to try something small between sessions, such as noticing a thought without arguing with it, or taking one step toward a value. This practice is about trying, not getting it right. If it did not go as planned, that becomes something useful to talk about next time.
Three ACT exercises you might try
ACT uses simple pictures and short exercises to make its ideas easier to use. Here are three well-known ones.
Passengers on the bus. Imagine you are driving a bus. Your thoughts and feelings are passengers. Some are loud and rude. They shout, "Turn back!" or "You can't do this!" You cannot throw them off the bus, but you do not have to let them steer. You can keep driving toward where you want to go, with the noisy passengers along for the ride.
For example, you might want to join a class but hear the passenger say, "Everyone will judge you." In ACT, you notice that passenger, let it ride along and still sign up.
Leaves on a stream. Picture yourself sitting by a gentle stream. Leaves float past on the water. Each time a thought shows up, you place it on a leaf and watch it drift away. You do not need to push it along or hold it back. If you get caught up in a thought, that is fine. You just notice and come back to the stream.
This exercise helps you see thoughts as passing events, not facts you must obey. A worry like "What if I fail?" becomes one more leaf on the water.
A values compass. Values are like a compass direction, not a destination. You never "finish" being kind or curious, but you can always take a step in that direction. Your therapist might ask you to name a few values in areas like relationships, work, health and fun.
Then you pick one small step for the week. If you value connection, that might mean texting a friend you have been meaning to call. The step does not need to be big. It just needs to point the right way.
What people use ACT for
ACT is used for many concerns. People often come to it for worry and anxiety, low mood, stress, burnout, or living with ongoing pain or a long-term illness. It can also help when you feel stuck or unsure what matters to you. Our older blog post on what acceptance is explores that idea in more depth.
Research on ACT is growing. A review that pooled 11 studies of people with depression found that ACT reduced depressive symptoms and improved psychological flexibility, which means the ability to stay open and keep acting on your values when things are hard. The benefits also tended to last after treatment ended (see Sources).
ACT delivered online has also been studied. A review of trials of internet-based ACT found small benefits for depression, anxiety, stress and quality of life (see Sources). That supports online ACT as a reasonable choice for many people.
ACT next to mindfulness and CBT
People often ask how ACT relates to other approaches they have heard of. Mindfulness is one ingredient of ACT. The present-moment exercises in ACT draw on mindfulness ideas, but ACT adds a strong focus on values and action. Our post on mindfulness therapy in Ottawa covers that approach on its own.
CBT, or cognitive behavioural therapy, often works on changing unhelpful thoughts. ACT is less focused on changing the thought itself. Instead, it changes your relationship with it, so the thought has less power over what you do. Our post on CBT therapy in Ottawa explains that approach in more detail. Neither is better for everyone, and many therapists draw on both.
Common questions about ACT
Will I have to do exercises out loud? Only if you want to. Your therapist will explain each exercise and check how it feels. You can always say no or go slowly.
Does acceptance mean I have to like how I feel? No. Acceptance means not fighting what is already there. You can dislike a feeling and still make room for it.
How long does ACT take? It depends on you and your goals. Your therapist will check in with you along the way about how things are going.
What if my thoughts feel too strong to just notice? That is a common worry. Your therapist will start with small, everyday thoughts first, so you can build the skill before trying it with the hardest ones. Practice makes it easier over time.
Is ACT only for anxiety? No. People use it for many kinds of struggle, and the values work can help anyone who feels stuck or unsure what matters to them.
Finding an ACT therapist in person or online
Our Ottawa office is at 1 Rideau St, 7th Floor, a short walk from Rideau Station. You can also meet online from anywhere in Ontario. The free consultation helps match you with a therapist who uses ACT and fits what you are looking for.
Cost, billing and your first step
Sessions with our therapists range from $130 to $200, depending on the clinician.
We accept Health Spending Accounts (HSAs).
We can direct bill many insurers. Coverage depends on your plan, so check with your insurer before you start.
Book a free 15-minute consultation with our admin team. We can answer your questions about ACT and help you choose in person in Ottawa or online.
If you're in crisis: if you or someone you love is in immediate danger, call 911. If you're thinking about suicide, call or text 9-8-8 any time, day or night.
Last reviewed: October 2026
Sources
Zhao B, et al. "Effect of acceptance and commitment therapy for depressive disorders: a meta-analysis." Annals of General Psychiatry, 2023. https://pmc.ncbi.nlm.nih.gov/articles/PMC10486021/
Han A, Kim TH. "Efficacy of Internet-Based Acceptance and Commitment Therapy for Depressive Symptoms, Anxiety, Stress, Psychological Distress, and Quality of Life: Systematic Review and Meta-analysis." Journal of Medical Internet Research, 2022. https://pmc.ncbi.nlm.nih.gov/articles/PMC9789494/