Acceptance and Commitment Therapy for Anxiety Disorders: Three Case Studies Exemplifying a Unified Treatment Protocol Georg H. Eifert, Chapman University John P. Forsyth, SUNY–Albany Joanna Arch, Emmanuel Espejo, Melody Keller, and David Langer, UCLA Acceptance and Commitment Therapy (ACT) is an innovative acceptance-based behavior therapy that has been applied broadly and successfully to treat a variety of clinical problems, including the anxiety disorders. Throughout treatment ACT balances acceptance and mindfulness processes with commitment and behavior change processes. As applied to anxiety disorders, ACT seeks to undermine excessive struggle with anxiety and experiential avoidance––attempts to down-regulate and control unwanted private events (thoughts, images, bodily sensations). The goal is to foster more flexible and mindful ways of relating to anxiety so individuals can pursue life goals important to them. This article describes in some detail a unified ACT protocol that can be adapted for use with persons presenting with any of the major anxiety disorders. To exemplify this approach, we present pre- and posttreatment data from three individuals with different anxiety disorders who underwent treatment over a 12-week period. The results showed positive pre- to posttreatment changes in ACT-relevant process measures (e.g., reductions in experiential avoidance, increases in acceptance and mindfulness skills), increases in quality of life, as well as significant reductions in traditional anxiety and distress measures. All three clients reported maintaining or improving on their posttreatment level of functioning. O VER the last 40 years, behavior therapy has led the development of empirically derived and time- limited behavioral and cognitive-behavioral interventions to assist those suffering from anxiety and fear-related problems (Barlow, 2002; Beck, Emery, & Greenberg, 1985). This work continues in earnest, as researchers and practitioners work to improve the potency, durability, and effectiveness of such interventions. Gaining knowledge of mechanisms and processes that mediate positive out- comes continues to receive research attention as well. Over the past decade, part of this effort has focused on exploring mindfulness and acceptance-based approaches. In its most basic form, mindfulness is about focusing our attention on the present moment and making direct contact with our present experiences, with acceptance and without defense, and with as little judgment as possible (Kabat-Zinn, 1994). This work has led to innovative experimental and applied applications for a wide range of psychopathology (Hayes, Follette, & Linehan, 2004), including anxiety (Hayes, 1987; Orsillo, Roemer, Block-Lerner, LeJeune, & Herbert, 2005) and depression (Segal, Williams, & Teasdale, 2002). Acceptance and Commitment Therapy (ACT; Hayes, Strosahl, & Wilson, 1999) is part of this newer line of exploration, and studies have shown that ACT can be effective for the treatment of generalized anxiety disorder (Roemer, Orsillo, & Salters-Pedneault, 2008), obsessive-compulsive disorder (Twohig, Hayes, & Masuda, 2006), and posttraumatic stress disorder (Orsillo & Batten, 2005). Our purpose here is to describe an integrated application of ACT that can be adapted for use with any of the major anxiety disorders (Eifert & Forsyth, 2005), including outcome data from three clients with different anxiety disorder diagnoses. In doing so, we wish to point out that what follows is just one of several ways (not the way) that ACT may be applied to persons suffering from anxiety disorders. ACT has two major goals: (a) fostering acceptance of problematic unhelpful thoughts and feelings that cannot and perhaps need not be controlled, and (b) commit- ment and action toward living a life according to one's chosen values. This is why ACT is about acceptance and it is about change at the same time. Applied to anxiety disorders, clients learn to end the struggle with their anxiety-related discomfort and take charge by engaging in actions that move them closer to their chosen life goals (“values”). Instead of teaching “more, different, better” strategies to change or reduce unwanted thoughts and feelings, ACT teaches clients skills to acknowledge and observe unpleasant thoughts and feelings just as they are. 1077-7229/09/368–385$1.00/0 © 2009 Association for Behavioral and Cognitive Therapies. Published by Elsevier Ltd. All rights reserved. www.elsevier.com/locate/cabp Available online at www.sciencedirect.com Cognitive and Behavioral Practice 16 (2009) 368–385