Comparing ACT Vs CBT for Anxiety.
Anxiety is a common human experience, characterised by excessive apprehension, worry, nervousness, and unease. It can manifest with obsessive thoughts, compulsive acts, restlessness, fatigue, irritability, difficulty concentrating, and physical symptoms like increased heart rate, sweating, or chest pains, particularly in panic attacks. While anxiety is a natural response to potential danger, it becomes problematic when it is all-encompassing and life-limiting. Therapeutic approaches like Acceptance and Commitment Therapy (ACT) and Cognitive Behavioural Therapy (CBT) offer different frameworks for addressing anxiety.
Understanding the Nature of Anxiety
CBT approaches suggest that anxiety can be created or worsened by certain types of thinking. Anxiety is seen as resulting from how people interpret events, sometimes distorting reality through specific thinking processes.
ACT, in contrast, views mental health problems, including anxiety, as stemming from normal processes. Within ACT, suffering is contended to be the norm. ACT offers a process-based approach, focusing on the underlying processes of distress rather than viewing anxiety as a disease.
The Role of Thoughts and Cognitions
CBT involves examining and challenging the way individuals think about situations that trigger anxiety. A therapist in traditional cognitive therapy seeks out and identifies maladaptive or irrational thoughts, then disputes, challenges, or weighs the evidence for and against those thoughts. The aim is to set up realistic standards and evaluate whether perceived risks are truly realistic. Keeping thought records is a central technique in CBT.
ACT takes a different stance on thoughts. It de-emphasises the disputation component, viewing the more you challenge thoughts, the more you are reifying them. Arguing with a thought makes it more real when it is just a mental event. While challenging thoughts in traditional CBT may involve defusion (talking about the thought as a thought, gaining a different perspective), ACT de-emphasises direct disputation and instead focuses on defusion. Defusion is about stepping back from anxious thoughts. From an ACT perspective, anxiety and fear become problematic when persons react to their own evaluations of the world and their private experiences in a literal and inflexible way. ACT seeks to undermine this tendency. Worry, a common manifestation of anxiety, is seen in some ACT contexts as a mostly word-based, verbally generated symptom that can separate us from our immediate experience.
The Challenge of Avoidance and Control
Rigid and inflexible patterns of emotional and experiential avoidance are considered common to all anxiety disorders and function to make anxiety problematic. Avoiding or escaping fear and anxiety at all costs is a key problem. Living a life focused on trying not to have anxiety and fear is quite limiting.
ACT views experiential avoidance as a core toxic process driving “disordered” experiences of anxiety and fear. This struggle for control is seen as a battle with one’s own experiences that paradoxically cannot be won. Efforts to control or minimise anxiety take energy and time away from valued life activities. ACT aims to undermine the client’s anxiety control agenda and loosen the hold that emotion regulation has on the lives of anxiety sufferers. The strategies used to “not have” anxious thoughts and feelings are seen as the problems. ACT promotes experiential willingness, which is the opposite of control and avoidance. It means showing up and being open to experiencing life as it is.
CBT also addresses avoidance behaviour. For example, in social anxiety, avoidance of social contact can cause unrealistic goals and expectations. Exposure-based methods, common in CBT, aim to help clients do the opposite of what they think ought to be done about their anxiety, letting clients experience that escape and avoidance are uncalled for and do not serve any functional adaptive purpose.
Goals of Therapy
Traditional CBT approaches often focus on symptom alleviation and control as therapeutic goals. Some suggest that CBT interventions aim to help clients reduce or eliminate unwanted anxiety and fear.
ACT challenges the symptom- and syndrome-focused change agenda. The goal of ACT is explicitly stated as not being anxiety reduction and symptom control. Although clients may initially seek anxiety reduction, ACT aims to help the client create a life worth living, even if there is some anxiety that comes along for the ride. The ultimate therapeutic prize in ACT is to help the client live a full, rich, and meaningful life. ACT focuses on helping clients get unstuck from the pattern of avoiding and controlling symptoms. It is an approach to helping clients live fully and richly, rather than about alleviating disorders.
Relationship with Internal Experiences
CBT’s approach to anxiety often involves changing anxious thoughts and feelings. The focus is on altering the structure or content of those experiences.
ACT, conversely, teaches clients to approach fear and anxiety more fundamentally, more deeply, and in a different way. It is very much about altering how clients respond to their emotional and psychological experiences, not the structure or content. ACT interventions help clients make contact with thoughts, feelings, memories, and physical sensations that have been feared and avoided. Clients learn to recontextualise and accept these private events, making room for those experiences. Willingness in ACT means making a choice to experience what there is to be experienced, and then experiencing it without trying to change the experience. This is similar to mindfulness, which means being open and accepting of experience, whatever it may be.
Therapeutic Methods
Both ACT and CBT utilise exposure-based methods.
In traditional CBT, exposure aims to extinguish fear or correct catastrophic thoughts.
In ACT, exposure-like techniques are recast within an acceptance and mastery of experiencing framework. The principle of extinction may work regardless of the reasons for engaging in avoided activities (e.g., driving to extinguish fear vs. driving to a job centre to pursue a value). However, ACT exposure emphasises willingness to experience 100 percent of the anxiety that is present, without trying to control it. Mindfulness and acceptance are core components of ACT, used as an alternative to control. ACT is described as using interventions based on metaphor, paradox, and experiential exercises. CBT uses techniques like keeping thought records. Some psychosocial treatments for anxiety, including some skills taught in cognitive behavioural treatments that aim to reduce unwanted anxiety and fear, are seen from an ACT perspective as part of a larger problem-solving control-oriented strategy that does not work as a long-term solution.
Underlying Framework and Dissemination
CBT is described as representing first- and second-generation behaviour therapies.
ACT is described as a new-wave behaviour therapy or third-generation behaviour therapy. It is based on functional contextualism and Relational Frame Theory (RFT). ACT is presented not merely as a narrowband, disorder-specific treatment package, but as a model, an approach, and a set of associated technologies. It is an approach to understanding and treating anxiety. ACT is described as integrating the most successful components of traditional cognitive behavioural therapy within an Acceptance and Commitment Therapy framework, recasting traditional CBT exposure interventions.
CBT approaches are widely disseminated with detailed session-by-session instructions. ACT is also being disseminated in practical forms like treatment manuals and guides, though there is a caution against treating the manual like a cookbook and losing sight of the approach and rationale. Effective psychotherapy in ACT is seen as depending on effective therapists who are flexible and sensitive to client needs, not just the application of techniques.
Common Problems Across Anxiety Disorders
From an ACT perspective, many issues are not disorder specific. The approach in ACT is quite similar across anxiety disorders. Rigid inflexible patterns of avoidance are common to all anxiety disorders. Experiential avoidance becomes the explicit treatment target within the ACT approach.
Some sources suggest that conventional CBT texts tend to emphasise unique aspects of each particular anxiety disorder, although there is emerging evidence that this may be artificially splitting up disorders. One source on social anxiety treatment notes that cognitive-behavioural treatment focuses on restructuring situations and highlights the role of cognitive distortions and biases, but that those with generalised anxiety tend to keep some symptoms after treatment.
Medication
Medications can diminish the frequency, intensity, and duration of problematic content associated with anxiety disorders. From an ACT perspective, this can interfere with treatment processes by creating the illusion that internal worlds can be controlled, which is problematic because ACT is about making contact with problematic content, fully and without defence. As anxiolytic medications diminish full contact with problematic content, there is a risk clients may not derive maximum benefit, potentially contributing to therapeutic setbacks or relapse following medication discontinuation. The suggestion from an ACT perspective is to move clients towards change relying on their efforts in therapy, not temporary symptom relief from pills.
Summary: ACT and CBT offer distinct approaches to addressing anxiety. CBT often focuses on identifying and challenging maladaptive thoughts and reducing symptoms by altering thought content and structure. It also utilises exposure to counter avoidance. ACT, conversely, views avoidance and control efforts as key problems that paradoxically worsen suffering. Its goal is not symptom reduction but helping clients live a full, valued life by fostering psychological flexibility. ACT employs defusion to change the relationship with thoughts rather than disputing them and promotes acceptance and willingness to experience internal sensations and emotions fully, often using mindfulness and exposure techniques reframed within an acceptance context. While CBT is seen as a traditional behavioural/cognitive approach, ACT is considered a newer wave that integrates some CBT techniques within a broader framework centred on acceptance, mindfulness, values, and committed action.