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The purpose of this paper is to show that Acceptance and Commitment Therapy (ACT) may have utility with this client group in routine clinical practice.

This uncontrolled double case study describes the targeting of ACT processes with people referred to a mental health service for people with intellectual disabilities because of distressing intrusive thoughts. It includes qualitative data to illustrate the opinions of the participants eight weeks after the end of therapy.

Both clients described rapid relief from distress, with some additional untargeted benefits emerging too. The participants provided follow-up qualitative data in which they described how the therapy had helped them as well as areas where it had not.

This paper presents uncontrolled case studies selected from routine clinical practice. They were selected due to their similarity of outcome and will not represent the experience of every client treated this way.

The practical implications are that a therapy often considered to rely on the use of metaphors and the manipulation of complex metacognitions may be useful for people with more limited verbal and cognitive ability if the therapy is adapted to meet their level of ability.

There has been very little published on using ACT with an intellectual disabilities population. This paper has originality value in that it illustrates the application of the approach in routine clinical practice. Additionally, the qualitative follow-up allows the participants’ voices to be heard about their experience of this approach.