There is a groundbreaking finding in an exciting new meta-analysis on ACT and depression that I think deserves more attention than it will probably get. In this new study a team of 29 authors (Borgogna et al., 2026; DOI: 10.1080/16506073.2026.2633192) reviewed 263 studies with 21,830 participants, almost half receiving ACT. The main finding: ACT had a large impact on depression when you target it (in geek speak, the average impact was about 4/5ths of a standard deviation).
That is exciting because of the enormous size of the review – but what makes it groundbreaking? It is this: ACT was associated with moderately large depression reductions (about 2/3rds of a standard deviation) even when depression was not the primary target, and regardless of where in the world the study was done.
That is worth our attention and when you dig deeper, it has important implications for everyone wanting to see less depression in the world – whether in own lives or in the lives of others.
Think about it.
Depression went down even when it wasn’t the target, and even in cultures that are quite different than the places where ACT was originally developed. There are lots of situations that can lead to depression – a person gets chronic pain after an injury; a relationship is on the verge of a break up; a college student has to redo a course they failed; a routine check-up leads to a cancer diagnosis. In times like these, depression might not be front and center, but it could well be lurking in the background and if researchers working on such issues think to measure it, those data might find their way into the results of their studies.
Voila! That’s what this meta-analysis pounced on.
ACT focuses on broad and important steps we can take that lift us up (what we call “processes of change”) and over its 45 years of development, it’s done so in terms of basic foundations while empowering needed cultural modifications. ACT is not a technique – it’s the application of a model called psychological flexibility. That means to learn to be more open, aware, and actively engaged in a life worth living, while scaling that also to your relationships and your body. Across those 263 studies were a myriad of protocols, techniques, and intervention methods from countries all over the world. They were all called “ACT” because of their process focus. And if you look hard at processes of change in the depression area, we know that a key process target is values AND that mere values-awareness is not nearly so powerful as values-based action.
Now, before I walk out the implications a few words of caution. ACT is not magic and other good therapies might help in similar ways. We can look at this issue with ACT in part because there are nearly 1,500 randomized trials on it (bit.ly/ACTRCTs) which is second only to mainstream CBT. Most other methods just don’t yet have enough research in hand even to consider a question like this, but when they do the findings could be similar. And ACT looked much better as compared to passive controls such as waitlists, while its edge over active interventions like traditional CBT was statistically significant but small. Higher-quality studies also tended to show weaker effects. All of that is usual in studies like this.
Still, it makes sense to think through possible implications.
Let me take you back to a very old study of mine from over 45 years ago (Harmon, Nelson, & Hayes, 1980: DOI: 10.1037//0022-006X.48.1.30) – right as ACT was beginning. In that study we found a way to address an age-old question: do I do more of what is important to me because I feel better or do I feel better because I do more of what’s important to me? Said more simply, which is the horse, and which is the cart: mood or meaningful, pleasant activity?
To study that question we took advantage of a robust finding. When you frequently monitor things about your own way of living, the positive ones increase and the negative ones decrease. You want to decrease smoking? Monitor it regularly. You want to increase saying kind things to friends? Monitor it regularly.
In that ancient paper, treatment-seeking depressed clients were cued through the day to monitor either their mood or their pleasant activity. The resulting pattern was so consistent that this small study published in of the best journals in clinical psychology (the Journal of Consulting and Clinical Psychology or JCCP). We found that monitoring pleasant activity improved mood notably more than vice versa. Action was more likely the horse. Mood was more the cart.
That old study has stayed with me and it is deeply embedding into ACT as a method and model. It’s a foundational idea that prevent a mistake that is easily made.
If people are struggling with depression or with other issues that could lead to it, and are being encouraged to focus on symptoms alone, they can become trapped in a kind of bad 5G commercial: “Am I feeling better yet? Am I thinking rationally yet? Am I there yet?” Therapeutic change can then can easily turn into a wrestling match with feelings or thoughts.
But when people monitor the processes that produce or ameliorate their suffering and vitality – things like emotional openness, awareness, cognitive defusion, self-kindness, values, committed action, avoidance, entanglement, disconnection — something very different can happen. They are no longer just staring at distress. They are learning how their life works.
And once that takes hold, gains can spread.
Values are a central part of the human story, but not in a sentimental or slogan-like way. Values matter most, in my view, when they stop being nouns and become verbs. Caring is not a word on a worksheet. It is the text you send, the truth you tell, the walk you take, the apology you make, the boundary you set, and the hand you hold. Courage is not an idea. It is a step taken while fear, sadness, or anger is present. Love is not a feeling state to wait for. It is a way of showing up when you feel vulnerable.
The psychological flexibility model inside ACT encourages that step and this new study shows how it can spread. When people learn to open up to difficult inner experiences, notice what is happening in the present moment, hold their thoughts a little more lightly, remember what matters, and take workable steps in that direction, improvements in one area are more likely to generalize. Why? Because the steps there are the same! It may not matter so much if you learn these lessons in the context of working on chronic pain, or health behavior; on shame or social withdrawal; on an issue at work, or feelings of panic.
This is great news and it has a practical implication for helping professionals.
Forget about organizing treatment only around symptom reduction. Focus instead on processes of change, and make sure that these changes finally touch on that place where the rubber meets the road: actual values-based behavior change.
For the rest of us, the message is not so different. Do not wait to feel good before doing what matters. Start small enough that your mind cannot make a federal case out of it. Send the text. Step outside. Stand up and stretch. Put on your shoes. Wash one dish with care. Write three honest lines. Forgive a friend you have a falling out with. Thank somebody. Take one step toward the kind of person you actually want to be.
These are not tricks. They are acts of re-entry. And when people re-enter life and all of its challenges, mood often follows.
Not always quickly. Not always completely. Not in a straight line. But this happens often enough that we should stop believing that the only road to less depression in the world is by targeting it.
Treat values as verbs; Track the processes that matter; And do not wait to feel better before re-entering your life.
The life is not something that starts after that work. A meaningful life is that work.
