ACT is third-wave CBT built largely on mindfulness, and to us a lighter, easier, breezier form of CBT. Its core move is stepping back to see thoughts as a process rather than as yourself or the truth, and we pair its skills into medication visits while being clear that this is not therapy. The Happiness Trap is our go-to book.
What it is
Third-wave CBT, especially ACT, is in large part founded on mindfulness.
“I think the third wave CBT, especially acceptance and commitment therapy, a large portion of that is is founded on mindfulness”
5:53Mindfulness in Psychiatry: How to Teach It as a Clinical Treatment SkillMay 2026 The key move is taking a step back and viewing thoughts not as "me" but as a process occurring within you. Cognitive defusion is the best CBT term for it.
“when I think of mindfulness, I think of taking a step back and instead of viewing these thoughts as me, as I, viewing these thoughts as a process that's occurring within the true me. So when I'm practicing mindfulness, experiencing thoughts is a process”
14:40Mindfulness in Psychiatry: How to Teach It as a Clinical Treatment SkillMay 2026 Also said in 1 more episode
“Oh, the terminology I was thinking of that I had just forgotten was cognitive diffusion is probably the best CBT terminology for what you were referring to”
19:01Mindfulness in Psychiatry: How to Teach It as a Clinical Treatment SkillMay 2026 Most of the thoughts in your head are nonsense, 99% of them not true, almost like breathing. You have a little control to guide them in ways that calm things down.
“The actual thoughts in my head are nonsense. It's almost like breathing. I can have a little bit of control to sometimes guide those thoughts in ways that calm things down. But the actual thoughts are 99% are nonsense, not true”
38:08Affective Neuroscience: Understanding Patients Beyond DSM DiagnosesAug 2026
How we use it
In medication visits, pair in ACT processes and skills, and be very clear that this is not therapy: the patient needs to engage in actual psychotherapy.
“I'm trying to pair in ACT processes and skills and point people and be very clear, this is not therapy. You need to engage in actual psychotherapy”
35:40Affective Neuroscience: Understanding Patients Beyond DSM DiagnosesAug 2026Guest episode Mindfulness, contacting the present moment, is step one. Without the ability to come to the present moment you will not observe any information.
“So absolutely, I'm taking people through mindfulness, contacting the present moment. I think that's absolutely step one, the ability to come to the present moment. You're not going to observe any information”
33:50Affective Neuroscience: Understanding Patients Beyond DSM DiagnosesAug 2026Guest episode
Books
The Happiness Trap is our go-to ACT book and a really good one. ACT integrates a lot more mindfulness, and it reads as a lighter, easier, breezier form of CBT.
“The Happiness Trap is a little bit lighter. It's acceptance and commitment therapy, which to me is like a lighter, easier, breezier form of CBT”
11:51Anxiety Medications Tier List: The Best and Worst Treatments for GADJul 2026 Also said in 1 more episode
“I also like my ACT go-to book is The Happiness Trap. I don't know if you've come across that one. That one's really, really good. I think of ACT as a little bit, it integrates a lot more mindfulness”
45:43Beyond Medications: The Best Lifestyle Treatments for Mental HealthFeb 2025 If an adult ACT workbook feels dry, try its teen version: pretty much the same content, and even for an adult it is more fun to read.
“they have a version for teens okay it's got pretty much the same content and even if you're an adult okay i think it's a lot more fun to read it because it's kind of cute”
46:56Beyond Medications: The Best Lifestyle Treatments for Mental HealthFeb 2025
It also comes up on
- Behavioral activationAct like a non-depressed person as much as you can handle, even if it feels bad and you do not enjoy it, on top of medication, to speed recovery. That is the core of behavioral activation, or fake it till you make it.
- Bipolar spectrumClinicians act as if bipolar disorder cannot exist unless they see mania or hypomania in front of them. That is not how you should practice medicine.
- BoundariesMany patients act out conflicts they cannot think about because the conflicts are so overwhelming, so a boundary test is not always deliberate.
- Disability claimsYou do not have to act like a forensic evaluator. You are still a medical evaluator doing your regular job, and most typical disability paperwork is within the average psychiatric practitioner's scope.
- Insanity defenseThe traditional framework: not understanding the nature or wrongfulness of the act, because of a mental illness. A psychopath who does not know right from wrong because they do not care does not qualify.
- Major depressive disorderAct like a non-depressed person as much as you can handle, even if it feels bad and you do not enjoy it, on top of medication, to speed recovery.
- MalingeringIn disability evaluations you do not have to act like a forensic evaluator. You are still a medical evaluator doing your regular job.
- Mental status examAsk how a theoretically healthy person would act in this situation, then how this patient is acting. If there is a significant divergence, look for the medical explanations.
From these episodes
- Affective Neuroscience: Understanding Patients Beyond DSM DiagnosesAug 2026 · 3 points
- Anxiety Medications Tier List: The Best and Worst Treatments for GADJul 2026 · 1 point
- Mindfulness in Psychiatry: How to Teach It as a Clinical Treatment SkillMay 2026 · 3 points
- Beyond Medications: The Best Lifestyle Treatments for Mental HealthFeb 2025 · 2 points
Every point above is something said on the Psychofarm podcast, with the words as spoken and a link to the moment in the episode. It is education, not medical advice, and an episode reflects what we thought when we recorded it.