As ACT practitioners, we’re no strangers to helping clients turn toward their pain, make room for discomfort, and live more fully in line with their values. But what happens when shame and self-criticism are so entrenched that clients struggle even to begin this process? A new study by Kleiman et al. (2025), published in Frontiers in Psychology, explores one possible answer: integrating the power of compassion into the ACT framework through compassion-focused acceptance and commitment therapy (CFACT).
What is CFACT?
CFACT blends the core processes of acceptance and commitment therapy (ACT) with the compassionate mind training principles of compassion-focused therapy (CFT). The model, known as compassionate flexibility, brings together key ACT processes, such as defusion, acceptance, and committed action with compassion-based elements like empathy, distress tolerance, and care for well-being.
While ACT and CFT already share overlapping concepts (e.g., mindfulness, acceptance, and values), CFT adds an explicit focus on addressing shame and cultivating a sense of inner safeness which is so often essential for clients with histories of trauma, neglect, or high self-criticism.
The study: CFACT via telehealth in a community setting
The research team implemented a 16–19 session CFACT protocol with adult clients experiencing anxiety, depression, and trauma-related difficulties. Importantly, this was a real-world setting: a community behavioural health clinic, delivered via telehealth, and facilitated by clinicians. The study used a non-concurrent, multiple baseline, series of single-case experimental design to explore feasibility, acceptability, and preliminary outcomes.
Key findings
1. High acceptability and receptivity
- Participants rated the therapy highly in terms of helpfulness, relevance, and impact on their daily lives.
- Clinicians reported that CFACT was compatible with their existing therapeutic style and appreciated the manual and training materials provided.
2. Positive clinical outcomes
- Reduced symptom distress: All participants showed decreased levels of depression, anxiety, and stress, with three participants demonstrating reliable treatment effects.
- Increased psychological flexibility: Four of five participants showed reductions in inflexibility (AAQ-II), with three showing reliable improvements.
- Greater self-compassion: Four participants demonstrated reliable increases in self-compassion (SCS-SF), reinforcing the value of targeting this process directly.
- Increased detachment (as an adaptive attributional style): Most participants showed gains in their ability to take a step back from self-blame.
- Changes in guilt, shame, and quality of life were more variable, suggesting individual differences in response or measurement sensitivity.
3. Strong therapeutic engagement
- Participants consistently completed values-based behavioural tasks between sessions with high self-rated effectiveness and self-compassion.
- Dropout rate was just 21% (lower than typical for many CBT studies) suggesting strong engagement with the approach.
4. Mixed predictive relationships
- While self-compassion and psychological flexibility were closely related, there was no consistent pattern in which changes came first, suggesting these processes may be mutually reinforcing.
Why this matters for ACT practitioners
For those trained in ACT, CFACT may feel both familiar and expansive. The ACT model implicitly supports compassion, but CFACT brings this into the foreground. In doing so, it may offer a more accessible route for clients struggling with harsh self-judgment or shame and those who find it hard to take committed action because they don’t feel they deserve change.
As the authors note, CFACT may be especially helpful for clients with low baseline self-compassion or high psychological inflexibility; precisely the individuals who often present with complex, chronic difficulties in therapy.
What next?
This study is an exciting step toward integrating the best of both worlds: the deeply validating, shame-sensitive stance of CFT with the flexible, value-driven processes of ACT. For those of us interested in expanding our therapeutic repertoire, CFT offers a rich framework and CFACT provides a promising bridge between two powerful models.
If you’d like to find out more about CFT, we have this Introduction to compassion-focused therapy workshop this autumn. While not integrated with ACT, the training will provide ACT practitioners with a foundational understanding of CFT theory and practice, including how it can complement your existing work.
Join us to explore how compassion can become a more deliberate part of your therapeutic process.