Sometimes, it can be hard to know what mental health treatment is right for you, especially when evidence-based treatments like cognitive-behavior therapy (CBT) and acceptance and commitment therapy (ACT) are so similar.
CBT is a form of treatment developed in the 1960s. It aims to help people reflect on how they think and change inaccurate or unhelpful thought patterns.
ACT, is part of the third wave of cognitive-behavioral therapy, which focuses on mindfulness, values, goals, and other related concepts. While these interventions may seem similar, they differ in how they approach and address our thoughts and feelings.
The current evidence on ACT vs. CBT suggests that both techniques can be effective. Their common goal is to help people work through difficult feelings and lead better lives. Moreover, both interventions may benefit individuals with depression, anxiety, and stress-related disorders.
What is Acceptance and Commitment Therapy?
Acceptance and Commitment Therapy (ACT) is an action-oriented intervention developed in the 1980s by psychologist Steven C. Hayes.
This technique revolves around psychological flexibility, or the ability to stay rooted in the present moment while accepting our thoughts and emotions.
Hayes believed that stress, anger, guilt, and other negative emotions are integral to the human condition and, therefore, it doesn’t make sense to resist them. Your thoughts and feelings don’t define you and shouldn’t keep you from pursuing a meaningful life.
This therapeutic approach is based on the relational frame theory (RFT), which suggests that human language and communication are rooted in our ability to make connections between words, concepts, and events. ACT can help people acknowledge these connections and manage them more effectively.
During therapy, you’ll learn to accept the things you have no control over and act based on your personal values. The goal is to build a fulfilling life, regardless of the challenges you face.
“One of the things I find useful about ACT is the opportunity it presents to practice accepting the uncomfortable stuff that happens in your internal and external world,” says Nicole Love, a licensed clinical social worker with Grow Therapy. “By putting more emphasis on your values, ACT guides you to take action and change behavior that aligns with your unique value system.”
What is Cognitive-Behavioral Therapy?
Cognitive-behavioral therapy (CBT) was developed in the 1960s by American psychiatrist Aaron T. Beck.
Just like ACT, it’s based on the premise that our thoughts, feelings, and actions are interconnected. Its primary goal is to help people identify and change unhealthy thought patterns, or cognitive distortions, which can ultimately improve mental health.
Often touted as the gold standard of psychotherapy, CBT recognizes that it’s normal to experience negative emotions like anger, guilt, or fear. But it also suggests that intense and excessive emotional upset sometimes results from irrational thinking. Cognitive behavioral therapy teaches us that by changing how we think, we can feel better and reach our goals in life.
Let’s say you experience intense anxiety, especially in social situations. This problem affects your work, personal relationships, and overall well-being.
A cognitive-behavioral therapist can help you identify and reframe the thoughts behind your anxiety. For instance, you might think, “I’ll embarrass myself in front of others” or “I feel like people are constantly judging me.”
During therapy, you’ll learn to challenge irrational thoughts by examining the evidence for and against them. For example, your therapist might ask you to think about instances where others have been supportive. They will also use behavioral techniques, such as gradual exposure, to help you face your fears.
At the same time, you’ll learn coping strategies like deep breathing and mindfulness techniques. These will allow you to manage anxiety symptoms and keep your cool in high-stress situations.
What’s the Difference Between ACT and CBT?
Both ACT and CBT aim to help people identify and manage unhelpful thoughts that interfere with their lives. The difference lies in their approach.
Unlike traditional cognitive-behavioral therapy, ACT doesn’t aim to change or correct unhelpful thoughts and beliefs. These are considered a normal part of life, and we should accept them without judgment. Our observing self, or the self-as-context, allows us to understand that our thoughts and emotions are transient and don’t define who we are.
That said, let’s take a closer look at ACT vs. CBT and what these differences mean in practice.
Goal and Focus
Traditional CBT, or the second wave of cognitive-behavioral therapy, focuses on modifying dysfunctional thoughts and behaviors. This form of psychotherapy often targets specific symptoms or disorders, such as anxiety, depression, chronic insomnia, and phobias.
By comparison, ACT fosters psychological flexibility. Its goal is to improve mental well-being and quality of life rather than reduce specific symptoms.
Say you experience chronic pain due to arthritis.
CBT can help you identify and challenge the negative thoughts associated with your condition. For example, you may think you can’t play sports or enjoy your favorite activities because of the pain.
A therapist would use guided questioning and other cognitive restructuring techniques to help you find an alternative way of looking at your situation. By doing so, you may come to the conclusion that even though you may experience physical pain from your condition, the fear around the pain doesn’t need to be the main factor in your decision-making.
Cognitive restructuring promotes adaptive thinking, which may help reduce the fear and anticipatory anxiety associated with a stressful event. As a result, you will develop more realistic beliefs about feared situations.
Gradual exposure to stressors that people typically want to avoid, such as thinking about past traumatic experiences, is another commonly used technique in CBT.
“We create a dynamic interplay between past experiences and the evolution of emotional intensity through exposure therapy. As I like to illustrate, this dance can, over time, reduce the emotional impact of traumatic events, enhance the quality of life, and build resilience,” explains Carrie Freshour, a licensed certified social worker-clinical with Grow Therapy.
“This ‘dance’ can also address multiple areas simultaneously, as emotions from the past impact the present. Improvements in one area often lead to better relationships, ultimately improving life quality and emotional regulation,” she added.
ACT, on the other hand, can help you accept the presence of stressors and difficulties, such as the chronic pain from the example above, and live a full and meaningful life despite it. With this approach, you’ll identify the things that matter most to you and take committed action based on those values “It focuses on learning to accept and unhook from difficult thoughts and feelings instead of trying to change and reframe them,” explains Julia Preamplume (LCSW) a licensed clinical social worker with Grow Therapy.
“From an ACT lens, we all experience difficult thoughts and feelings. Problems arise when we get hooked into them, meaning we feel overwhelmed or consumed by them; they become our truth and reality when we’re hooked,” says Preamplume.
“When we unhook from our difficult thoughts and feelings, we can turn our attention toward living within our values. A therapist who practices ACT will help someone learn how to unhook, identify their values, explore ways in which one can live within their values, and encourage practicing self-compassion.”
The Role of Values
If you opt for traditional CBT, your therapist can help you identify and assess your values in life.
However, these are not a central component of the intervention. The focus is on changing unhealthy behaviors and thoughts.
Your values, or the activities that give you a sense of purpose, play a pivotal role in ACT. Their role is to guide your behavior and actions toward a fulfilling life.
For example, a young woman is dissatisfied with her career in finance. Because of that, she’s constantly stressed and lacks motivation.
Through introspection and discussion, an ACT therapist helps her identify her core values. The young woman realizes that her true values revolve around art, creativity, and making a positive impact on others.
Moving forward, the young woman decides to study graphic design and work with local artists on small projects. These actions gave her a sense of purpose and fulfillment.
Mindfulness and Acceptance
Mindfulness-based interventions may help reduce anxiety, depression, and stress while improving well-being. These include guided imagery, deep breathing, and other techniques aimed at bringing attention to the present moment.
When you are fully present, you can observe your thoughts, emotions, and sensations without judgment. Acceptance involves acknowledging these experiences as they are, without trying to change or suppress them.
Traditional CBT doesn’t use mindfulness techniques or emphasize the acceptance of thoughts and emotions. Its primary focus is on symptom reduction.
The newer forms of CBT, including ACT, revolve around mindfulness and acceptance. The same goes for dialectical behavior therapy (DBT), which uses mindfulness meditation and similar techniques to improve emotion regulation.
Approach to Change
Both ACT and CBT employ behavior-change strategies. However, CBT focuses on modifying or replacing negative thoughts and behaviors, whereas ACT aims to help people change how they relate to these events.
Again, imagine you’re living with chronic pain.
During CBT, you’d learn to challenge limiting beliefs, such as “I can’t do anything because of the pain,” and replace them with more adaptive thoughts. Your therapist may use behavior modification techniques and encourage you to take part in sports or other activities you enjoy.
During ACT sessions, a therapist would help you accept the presence of pain without trying to change or control it. They may use mindfulness exercises and other techniques to help you create distance between yourself and your pain. Over time, you may find it easier to engage in the activities you love, acknowledging the discomfort but not allowing it to keep you from living fully.
Treatment Duration
Cognitive-behavioral therapy is more structured and goal-oriented than ACT. Since it addresses specific problems and symptoms, it involves a limited number of sessions spanning several weeks or months. Most clients can benefit from 12 to 20 sessions or more, depending on what they’re dealing with.
ACT focuses on increasing psychological flexibility, which may take a longer time. However, both approaches are evidence-based and, therefore, tend to work faster than non-evidence-based treatments.
Treatment with CBT or ACT could last anywhere from just a few sessions to much longer. The length of treatment is always determined by the client and therapist based on individual needs.
Is ACT or CBT more Effective?
Both types of therapy can be successfully used to treat anxiety disorders and other mental health conditions. Here are some examples of mental health disorders for which both ACT and CBT can be effective:
- Depression
- Obsessive-compulsive disorder
- Post-traumatic stress disorder (PTSD)
- Eating disorders
- Stress-related disorders
- Substance abuse
These therapies can also be used in conjunction with medication for treating the symptoms of bipolar disorder and psychotic disorders, such as schizophrenia.
Generally, CBT is a preferred choice for the treatment of eating disorders, especially bulimia nervosa. However, a randomized controlled trial published in the journal Behavior Modification found that ACT may benefit individuals with eating disorders, too.
In another clinical trial, researchers looked at ACT vs. CBT in the treatment of depressive and mixed mental disorders. They found that both ACT and CBT worked equally well for treating these conditions in inpatient settings.
A systematic review featured in the International Journal of Psychology and Psychological Therapy reports similar results. As the scientists note, ACT is just as effective as or more effective than CBT for patients with social anxiety.
Researchers analyzed 16 different studies on ACT vs CBT. Acceptance and commitment therapy outperformed cognitive-behavioral therapy in 11 studies, whereas traditional CBT produced better results than ACT in two studies. Plus, two other studies found that ACT and CBT are equally beneficial.
Both interventions can be used to treat anxiety disorders, depression, and addictive behaviors, such as cigarette smoking, and improve quality of life in people with cancer or chronic pain, according to the above review.
Find a Therapist Who’s Right for You
ACT and CBT can be equally effective, depending on the problem you want to address. Each form of therapy uses different techniques, so you’ll want to discuss your options with a specialist.
Sometimes, these interventions are used together or in combination with other therapies. For example, someone with borderline personality disorder may benefit from ACT or CBT used along with DBT. The right approach depends entirely on your needs.
Now that you know more about these interventions, look for a therapist who speaks your language. You can find a therapist directly on Grow Therapy and book your appointment today..
