Living with a chronic health condition involves more than managing physical symptoms; it often requires a deep, ongoing process of psychological and identity adjustment. For many clients, this includes confronting uncertainty, navigating role loss, renegotiating identity, as well as living with their symptoms.
This article looks at how acceptance and commitment therapy (ACT) can offer a powerful, compassionate model to support this process, and one that prioritises vitality, meaning, and psychological flexibility over symptom reduction alone.
ACT: a model for living well with difficulty
ACT doesn’t aim to eliminate pain, fatigue, or fear; nor does it ask clients to accept suffering passively. Instead, ACT helps clients relate differently to the unavoidable difficulties of chronic illness, while gently moving toward the things that matter. At the core of physical health, is psychological flexibility, especially in fluctuating or progressive conditions. This is why ACT is such a key tool for working with clients experiencing these difficulties.
Rather than fixating on symptom control or cognitive correction, ACT holds a broader agenda:
“You can live a rich, meaningful life, even when your body isn’t doing what you hoped.”
This shift from control to connection, from struggle to engagement, is often transformative for those adjusting to life with long-term health conditions. In this blog, we will look at each of the core processes and how they can support with adjustment.
Six psychological flexibility processes in adjustment work
Each ACT process offers a way to navigate common experiences in chronic health conditions. Together, they form a framework for flexible, values-based living in the midst of difficulty.
1. Acceptance
Clients are often caught in cycles of resistance; pushing away pain, fatigue, or fear in a fight that only adds more suffering. They might also be pushing away the thoughts and worries that show up about the future, or the impact on their relationship, for example.
ACT helps clients make space for uncomfortable experiences without trying to control or eliminate them.
Key questions: “What if you could allow this feeling to be there, just for a moment, and gently turn toward what matters?”
2. Cognitive defusion
Chronic illness often gives rise to powerful, sticky narratives that become fused with identity: “I’m broken,” “My body has failed me,” “I can’t contribute anymore,” or “There’s no point if I can’t do what I used to.” These thoughts may feel entirely believable, or may even actually have an element of truth to them, especially when reinforced by real physical limitations, medical language, or societal responses.
ACT doesn’t ask clients to dispute these thoughts, but rather to notice them as thoughts, mental events, not absolute truths.
“I’m noticing the thought that… my life has no value if I’m unwell.”
This simple shift creates space. Space to breathe. Space to choose a different response. And sometimes, space to reconnect with a sense of worth and identity that illness hasn’t erased, only obscured.
3. Contact with the present moment
Living with chronic illness can pull clients out of the present:
- Into the past — remembering life before symptoms, dwelling on loss
- Into the future — anticipating decline, fearing pain, or mentally rehearsing worst-case scenarios
ACT cultivates present-moment awareness, not as a relaxation technique, but as a skill for grounding attention in what’s actually happening now, in the body, in the breath and in the room.
“Right here, right now, what’s within my control?”
This anchors clients in the reality of this moment and often more spacious and workable than their mind suggests.
Clients may find themselves mentally anchored in the past (before diagnosis) or the feared future.
ACT cultivates present-moment awareness as a grounding practice, not a relaxation technique; helping clients reconnect with what’s actually here, now.
“Right here, right now, what’s possible?”
4. Self-as-context
Chronic illness can become fused with identity: “I am my diagnosis. I am my fatigue. I am not the person I used to be.”
ACT invites a broader sense of self, the “noticing self”, that can observe thoughts, feelings, and bodily states without being defined by them.
“There’s more to me than this illness. I can notice pain and I can also notice love, connection, curiosity.”
This process can be deeply liberating for clients whose lives have become dominated by a single identity, perhaps as “patient”, “sick”, “ill”.
5. Values
When chronic illness disrupts roles, work, hobbies, and relationships, clients often report a loss of meaning or direction.
“What’s the point?” becomes a genuine and painful question.
ACT helps clients clarify what matters – even now. While some valued domains may no longer be accessible in the same way, others may emerge, evolve, or deepen.
“Even if I can’t go hiking anymore, I can still connect with nature, with loved ones, with moments of creativity.”
Values work offers a compass; a way to navigate forward, even when the map has changed.
6. Committed action
With values as a guide, ACT supports clients to take small, workable steps, not toward fixing their illness, but toward living meaningfully with it.
This might mean:
- Asking for help
- Saying no
- Working on pacing of activity level
- Expressing emotion
- Reclaiming joy
“What’s one small step you could take today, in service of the kind of life you want, even with everything you’re carrying?”
ACT supports clients to move gently, flexibly, and with compassion, knowing that setbacks and bad days are part of the journey. This includes values-based pacing, flexible goal setting, and allowing for setbacks without self-judgment.
Common clinical traps
Adjustment to chronic illness brings complexity and some common traps for therapists and clients alike.
- The fixing trap: Trying to “solve” the client’s symptoms or emotional distress, reinforcing a control agenda that often leads to more struggle.
- Fusion with hopelessness: When clients (or therapists) get caught in the narrative that “nothing will help,” progress stalls.
- Values confusion: A sense of “what’s the point now?” is common after diagnosis or health-related role loss.
- Overfocus on outcomes: Both therapist and client may drift into symptom-reduction as the primary goal, rather than cultivating a flexible, values-based life alongside symptoms.
Bringing attention back to process, not outcome, is often a turning point.
Holding pain and possibility together
ACT offers a way to sit alongside suffering without needing to fix it, and to support clients in reconnecting with the things that matter, even when life feels smaller, slower, or less certain than it once was.
As therapists, we are invited into a stance of openness, presence, and hope:
“This is hard. And life is still worth showing up for.”