ObjectivesTo date, the effectiveness of acceptance and commitment therapy (ACT) for acute stroke patients has not been well recognized. The study aimed to discover the effectiveness of group‐based ACT in treating depression for acute stroke patients.MethodsWe conducted a randomized controlled trial with 140 acute stroke patients with depression. The ACT intervention comprised seven sessions, of 45–60 min over 4 weeks. Data were collected pre‐ and post‐intervention and at 3‐month follow‐up, assessing depression, health‐related quality of life (HRQoL), psychological flexibility, cognitive fusion, sleep quality, and confidence.ResultsOverall, 99.3% of the included patients were assessed as having mild depression. The ACT intervention significantly reduced depression in acute stroke patients in comparison with the control group post‐intervention and at 3 months (partial ). Additionally ACT significantly improved HRQoL‐mental component summary, sleep quality, psychological flexibility, cognitive fusion, and confidence compared with control group.ConclusionsACT is effective in treating acute stroke patients with depression, and the efficacy was maintained at 3‐month follow‐up.