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Introduction: People with dementia can experience a high level of psychological distress (Muliyala & Varghese, 2010; Badrakalimuthu & Tarbuck, 2012). Although psychological approaches have been proposed as potential treatments for this population (NICE, 2018), there is indication that older adults (Laidlaw, 2013) and people with dementia have reduced opportunities for psychological treatments designed to improve their wellbeing. An increasing number of studies have evidenced the efficacy of Acceptance and Commitment Therapy (ACT) for anxiety, depression (Ӧst, 2014), distress in older adults (Gould et al., 2021; O'Keeffe et al., 2021) and illness-related distress (Mccracken & Gutiérrez-martínez, 2011). But, to date, no studies have investigated the effectiveness of ACT specifically for a dementia population, despite a conceptual case for its suitability, which is empirically supported by its use with parallel populations (other long-term and neurological conditions). Furthermore, no dementia studies involving therapeutic intervention have used a case series approach to explicitly examine change processes, integral for understanding and refining interventions. Therefore, the current research aims to investigate the effectiveness and acceptability of ACT for people with dementia. Methods: A hermeneutic single case efficacy design (HSCED) series was used to analyse therapy process and outcome data to ascertain whether and how changes may have occurred over the ACT intervention. Three clients with a diagnosis of dementia, who experienced psychological distress, and their caregivers were recruited from a National Health Service (NHS) Memory Assessment Service (MAS) in Nottinghamshire and the Dementia Research UK website. Clients were offered 12 sessions of ACT. Quantitative and qualitative clinical data was collated ('rich case records') and subject to critical analyses by three independent psychotherapy experts who identified change processes and determined the outcome for each client. Results: Adjudication concluded that one client made positive changes which were largely attributable to ACT, whilst two clients remained unchanged. Where change occurred, ACT-specific processes, namely values, committed action and acceptance, seemed to mediate change, alongside the client-carer relationship. Moderating factors included client willingness, resilience and perseverance, a history of values-based behaviour and established coping and hobbies. Discussion/Conclusion: The HSCED enabled a dismantling of therapy components to understand change processes for people with dementia. For the client who demonstrated change, ACT processes and a strong working alliance between client and carer, in combination with existing client interests and individualised therapy adaptations, appeared to provide the setting in which an ACT intervention was effective. Reliable distress reduction occurred for this client without therapeutic aims to change their distressing thoughts, which has important theoretical implications for understanding the use of acceptance-based approaches for people with dementia. ACT may be a feasible, effective vehicle for therapeutic change by helping carers to better meet the needs of their loved ones. Based on the outcomes of the current study (one improved case and two cases of no change), future research to optimise ACT delivery in this population may be beneficial. Furthermore, to explore whether change processes occur by proxy, assessing carer factors (e.g., their psychological flexibility, the client-carer relationship) may enhance the evidence-base for systemic ACT-use.