In psychological practice, especially within an ACT framework, “end of life” refers to the period leading up to death, often involving terminal illness or limited life expectancy. People in this phase may experience fear, sadness, regret, isolation, or a search for meaning, and often seek therapy to process these emotions, strengthen relationships, and come to terms with their mortality. ACT practitioners can support clients by helping them accept what cannot be changed, connect with what matters most, and live in alignment with their values during their remaining time.
In this blog, we’ll explore six specific ways ACT can support clients at the end of life, with tangible examples of how these principles can be applied.
1. Embracing emotions rather than suppressing them
At the end of life, people often experience an overwhelming mix of emotions, such as fear, sadness, or regret. ACT invites individuals to make space for these emotions rather than fighting against them. The focus is on reducing the struggle with emotional pain, not eliminating it.
Example: A client facing terminal cancer might feel paralysed by fear of the unknown. An ACT practitioner could guide them to visualise their emotions as waves that rise and fall, helping them see that emotions, like waves, are temporary and manageable. This process can reduce the emotional burden and create room for meaningful experiences.
2. Clarifying values to guide meaningful action
When time feels limited, reflecting on what truly matters becomes essential. ACT helps individuals identify their core values and take action in line with these, creating a sense of purpose even in their final days.
Example: A client might realise that family connection is their deepest value. With this clarity, they could decide to write letters to loved ones, share meaningful conversations, or create a photo album as a keepsake. These actions ensure their remaining time is spent in a way that feels fulfilling.
3. Using mindfulness to savour the present moment
It’s common for people at the end of life to become consumed by worries about the future or regrets about the past. ACT teaches mindfulness techniques to help individuals anchor themselves in the present moment, where they can find moments of peace and joy.
Example: A patient in hospice care, for instance, might practise mindfulness by focusing on the feeling of sunlight on their skin or the taste of their favourite tea. These small, sensory experiences can help them connect with life as it unfolds, rather than being lost in unhelpful thoughts.
4. Making space for existential fears
Fears about death and the unknown are a natural part of the end-of-life experience. ACT offers a compassionate way to approach these fears by encouraging individuals to “make room” for them, rather than trying to avoid or suppress them.
Example: A person who feels consumed by anxiety about what happens after death might use an ACT metaphor, such as imagining their fear as an unwanted guest at a party. Instead of trying to evict the guest, they might practise allowing the fear to coexist with other aspects of life. This shift can reduce the intensity of the fear and free up energy for meaningful actions.
5. Reconnecting with relationships
Relationships often take on heightened importance at the end of life. ACT helps individuals reflect on their values around connection and take steps to nurture or repair relationships, even if it feels difficult or uncertain.
Example: Someone who has grown distant from a sibling might feel regret but believe it’s too late to reconcile. Through ACT, they could explore what matters most to them, such as leaving behind a sense of love and connection, and take a small step, like writing a heartfelt letter or making a phone call.
6. Finding meaning in leaving a legacy
For many, the end of life is a time to reflect on their legacy and the impact they’ve had on others. ACT supports individuals in finding meaning in their lives, even if they feel they haven’t achieved enough.
Example: Imagine an elderly man who worries that his life lacked significance. Through ACT, he might reflect on moments where he influenced others, like mentoring younger colleagues or raising a family. He could then decide to record his life story, share lessons with grandchildren, or create something tangible to leave behind. This process can bring a deep sense of purpose and fulfilment.
ACT offers gentle and practical tools to support individuals at the end of life. By helping people accept difficult emotions, connect with their values, and savour present-moment experiences, ACT offers a sense of meaning, peace, and connection during this profound phase of life.
As practitioners, our role is to create a compassionate space where clients can explore their fears, uncover what matters most to them, and take meaningful steps that align with their values. In doing so, we help them navigate this transition with dignity and purpose. If you’re a practitioner learning to use ACT, consider how these principles can guide your work with clients at the end of life. Small, value-driven actions can make a world of difference in creating a sense of meaning and peace in their remaining time.
Dr. Toni Lindsay, clinical psychologist and author of ACT at the End: Acceptance and commitment therapy with people at the end of life, joins us in February 2026 for a short workshop offering practical tools, insights, and techniques to enhance your therapeutic practice with individuals approaching the end of life. Sign up to ACT at the end of life: Applying principles of acceptance and commitment therapy with individuals approaching the end of their lives and save your space!