ACT and Values-Based Therapy for Neurodivergent Adults
What if the anxious thought doesn't need to change — and you built a life around what matters to you instead?
Closer Horizons | Dr. Kenya Guarnieri (“Dr. G”), Licensed Psychologist | Louisville, KY
If cognitive behavioral therapy asks you to change your thoughts, Acceptance and Commitment Therapy (ACT) asks a different question: what if the thought doesn't have to change at all, and you build a life around what matters to you instead? For many neurodivergent adults exhausted by a lifetime of trying to think their way out of anxiety, that shift in question is the relief they've been looking for.
What ACT Actually Does
ACT is built on psychological flexibility: the ability to stay present with a difficult thought or feeling without being controlled by it or wasting energy fighting it, while still taking action toward what you value. Instead of a program to eliminate anxious thoughts, ACT treats anxiety as something to make room for while you move toward a life that fits you, using tools like defusion (creating distance from a thought instead of arguing with it), acceptance, present-moment awareness, and values clarification.
For a masking-fatigued, high-achieving neurodivergent adult, this reframe can matter enormously. So much of a lifetime of overriding your own signals has been about trying to think your way past discomfort: “I shouldn't feel this exhausted,” “everyone else manages this fine.” ACT doesn't ask you to win that argument. It asks what you actually want your life to be about, and helps you move toward it even while the exhaustion or anxiety is still present.
What the Research Shows
A randomized controlled pilot study of adapted ACT group treatment for autistic adults, known as NeuroACT, found that participants reported lower stress, higher quality of life, better ability to manage distressing thoughts, and less avoidance of stressful situations compared to a treatment-as-usual group, though it did not show significant differences on measures of depression or anxiety specifically. That's a useful reminder that ACT's strength is often in flexibility and functioning rather than symptom elimination alone (Pahnke et al.).
More broadly, a meta-analysis of 39 randomized controlled trials found ACT outperformed control conditions across a range of mental and physical health problems, with effects comparable to established treatments like CBT (A-Tjak et al., 2015). ACT is not a replacement for structure or skills; it's a different relationship with the thoughts and feelings that structure and skills alone don't always resolve.
Values-Based Work and the Masking Question
One of the most useful applications of ACT for neurodivergent adults sits right at the masking question: which parts of how you show up are actually you, and which were borrowed under pressure? ACT's values work gives that question a concrete process. Instead of relying on shame or exhaustion to decide what to change, you clarify what genuinely matters to you — connection, honesty, competence, rest — and let those values, not old fear-based rules, guide which parts of the mask stay and which get set down.
Who This Tends to Help
ACT tends to resonate especially well with late-diagnosed autistic and ADHD adults who have already tried “just think positive” or symptom-focused approaches and found them hollow. It's also a strong fit for people in autistic or ADHD burnout, where the goal isn't to argue yourself out of exhaustion but to build a sustainable, values-aligned life around it.
In practice, this often looks less like a whiteboard of coping skills and more like an honest conversation: what do you actually want more of in your life, underneath the exhaustion — and what is one small, values-aligned step toward it this week, even while the anxious thought is still in the room.
Exploring Whether You Might Be Autistic?
Many adults begin exploring autism after years of feeling overwhelmed, exhausted, or like they have been working harder than others to navigate everyday life.
If you’ve been wondering whether your experiences may connect to autism, my guide: “Could I Be Autistic?” offers a reflective starting point to help you explore your experiences, recognize common patterns, and consider possible next steps.
Ready to Talk It Through?
Closer Horizons integrates ACT alongside modified CBT and DBT for autistic and ADHD adults in Louisville who want therapy that fits how they actually think, not a generic anxiety protocol. Schedule a consultation to see whether a values-based approach is the right next step for you.
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Pahnke et al., Acceptance and Commitment Therapy for Autistic Adults: A Randomized Controlled Pilot Study in a Psychiatric Outpatient Setting https://pmc.ncbi.nlm.nih.gov/articles/PMC10291362/
A-Tjak et al. (2015), A Meta-Analysis of the Efficacy of Acceptance and Commitment Therapy for Clinically Relevant Mental and Physical Health Problems https://www.semanticscholar.org/paper/A-Meta-Analysis-of-the-Efficacy-of-Acceptance-and-A-Tjak-Davis/dd44436caa82e1edcf82c5d5eeb534d959592bde
Association for Contextual Behavioral Science, Summary of the NeuroACT Randomized Controlled Pilot Study https://contextualscience.org/publications/acceptance_commitment_therapy_autistic_adults_randomized_controlled_pilot_study
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What is ACT therapy?
Acceptance and Commitment Therapy, or ACT, is a type of therapy that helps people change their relationship with difficult thoughts and feelings rather than trying to eliminate them completely. ACT focuses on psychological flexibility, values, acceptance, mindfulness, and taking meaningful action even when anxiety, overwhelm, or self-doubt are still present.
Is ACT helpful for autistic or ADHD adults?
ACT can be helpful for autistic and ADHD adults because it does not require every anxious thought to be challenged, corrected, or replaced. Many neurodivergent adults have spent years trying to think their way out of discomfort, masking, burnout, or overwhelm. ACT offers a different path: noticing thoughts, reducing the struggle with them, and building a life around what actually matters to the person.
How is ACT different from CBT?
CBT often focuses on identifying and changing unhelpful thoughts. ACT focuses more on noticing thoughts, making space for discomfort, and choosing actions based on values. For neurodivergent adults, ACT can feel more respectful when a thought is not necessarily distorted — for example, when anxiety is based on real sensory, social, or executive functioning demands. ACT does not ask you to argue with every thought; it helps you decide what matters and how to move toward it.
What does values-based therapy mean?
Values-based therapy helps you clarify what genuinely matters to you, such as connection, honesty, rest, independence, creativity, stability, or meaningful work. For neurodivergent adults, this can be especially important after years of masking, people-pleasing, or building a life around other people’s expectations. Values-based work helps you make decisions from your own priorities rather than shame, fear, or old survival rules.
Can ACT help with anxiety and burnout?
Yes. ACT can help with anxiety and burnout by reducing the constant struggle against difficult thoughts and feelings while helping you take small, meaningful steps toward a more sustainable life. For autistic and ADHD adults, ACT may be especially useful when burnout, masking fatigue, perfectionism, or emotional overwhelm make traditional “just challenge the thought” approaches feel limited or exhausting.