Both Acceptance and Commitment Therapy (ACT) and Cognitive Behavioural Therapy (CBT) are therapeutic approaches used to address psychological distress, but they differ in their underlying philosophies and techniques.
Core Differences: ACT vs CBT
- Focus on Thoughts: CBT directly addresses maladaptive or irrational thoughts by disputing, challenging, or weighing evidence for and against them. ACT, on the other hand, focuses on changing the relationship with thoughts rather than changing the thoughts themselves, through defusion techniques. ACT de-emphasises thought disputation, since doing so often results in arguments and battles, giving thoughts more power.
- Role of Acceptance: ACT incorporates acceptance and mindfulness processes to help people relate differently to distressing thoughts and feelings. It aims to foster acceptance of unwanted thoughts and feelings whose occurrence or disappearance clients cannot control. CBT does not focus as much on acceptance; its focus is more on challenging and changing maladaptive thoughts.
- Emphasis on Values: ACT strongly emphasises commitment and action towards living a life that clients value. This includes identifying personal values and using them to guide behavior. While CBT may touch on values, it is not the central focus. ACT is about living well, rather than feeling well, so as to live well.
- Approach to Suffering: ACT normalizes human suffering and redirects clinical attention to feeling well because of living well, not feeling well so as to live well. CBT focuses on symptom reduction and problem-solving.
- Therapist Stance: In ACT, therapists use both formulations and questions, initiating and responding to client contributions, with a primarily positive tenor. Client-centred therapists, by contrast, use formulations almost exclusively, and their contributions are primarily negative.
- Language: ACT highlights the ways that language entangles clients into futile attempts to wage war against their own inner lives, through control, suppression, avoidance, and escape, which are seen as the primary causes of problematic anxiety.
Key Concepts
- Cognitive Defusion: In ACT, cognitive defusion is a key process. It involves uncoupling or disentangling words and thoughts from the actual events they refer to. This aims to reduce the literal interpretation of thoughts and evaluations of experience. In CBT, the process is similar and called ‘distancing’.
- Experiential Avoidance: ACT views experiential avoidance, or efforts to control unwanted private experiences, as a core issue in anxiety disorders. This includes avoiding or suppressing uncomfortable thoughts, emotions and physical sensations. The goal is to loosen the hold that emotion regulation has on the lives of anxiety sufferers.
- Values-Based Action: ACT emphasises the importance of committed action towards valued life goals. This includes taking steps to engage with meaningful activities, even when experiencing anxiety.
Similarities:
- Behavioural Roots: Both ACT and CBT have roots in behaviour therapy and use some behavioural techniques. Both approaches can incorporate exposure and response prevention techniques.
- Mindfulness: Both approaches use mindfulness, but in different ways. For ACT, mindfulness is a way of relating to internal responses that helps people to be less distressed by them, whereas some CBT approaches use mindfulness to develop a deep understanding of how thoughts and emotions work.
- Goal Setting: Both approaches encourage setting goals, but in ACT, the goals are explicitly linked to a client’s values.
When to use which approach:
- CBT may be more suitable for clients who are very focused on the content of their thoughts and want to change them. It is also useful when someone wants to change their behaviours to avoid feeling anxious.
- ACT is better suited for clients who struggle with rigid control over their inner experience, find that challenging thoughts only fuels arguments with themselves, and want to live a values-based life despite experiencing psychological distress. It also works well for clients who want to change their relationship to their thoughts and feelings, and may be more suitable when disputation is not effective for the client.
Integration of ACT and CBT:
- ACT can incorporate useful CBT techniques in the sense that if they work, and help clients move toward their values, they are useful. ACT is not a movement to undermine the behaviour therapy tradition. Rather, it brings a different model of psychological health and human suffering to the behaviour therapy movement.
Summary: CBT aims to modify problematic thoughts and behaviours, and focuses on problem-solving and symptom reduction. ACT, on the other hand, aims to change the relationship with internal experiences through acceptance and defusion, and focuses on values and committed action, promoting living well over simply feeling well. While there are key differences, both approaches can be useful for anxiety, and the best choice of approach may depend on the specific needs and preferences of the client.
Tags: ACT, CBT, Acceptance and Commitment Therapy, Cognitive Behavioural Therapy, mindfulness, cognitive defusion, values, experiential avoidance, anxiety