Acceptance and Commitment Therapy (ACT) and Cognitive Behavioral Therapy (CBT) are both therapeutic approaches used to treat anxiety, but they differ significantly in their underlying philosophies, techniques, and goals. While CBT aims to reduce distress by changing thoughts and behaviors, ACT focuses on increasing psychological flexibility by accepting thoughts and feelings and committing to valued actions.
Here’s a breakdown of the key differences:
- Focus on Thoughts:
- CBT: Identifies and challenges maladaptive or irrational thoughts, with the goal of replacing them with more rational and adaptive ones. CBT therapists dispute, challenge, or weigh the evidence for and against negative thoughts.
- ACT: Does not aim to change the content of thoughts. Instead, ACT teaches clients to notice thoughts as thoughts, without getting caught up in them, a process known as defusion. ACT emphasizes that disputing thoughts can make them more real and powerful.
- Approach to Feelings:
- CBT: Views feelings, particularly anxious feelings, as problems that need to be alleviated, and aims to help clients control or manage anxiety.
- ACT: Accepts all feelings, including anxiety, as a normal part of human experience. Rather than struggling with feelings, clients learn to experience them fully, without judgement, and still act in accordance with their values. ACT does not seek to produce particular positive feelings or reduce negative ones, but to increase the ability to do what matters, regardless of feelings.
- Goal of Therapy:
- CBT: Aims to reduce symptoms of anxiety, by directly targeting the anxious thoughts, feelings and behaviours that cause distress. The idea is that by controlling symptoms, a person can live a better life.
- ACT: Focuses on living a full, rich, and meaningful life, regardless of the presence of anxiety. The goal is not symptom reduction, but to increase psychological flexibility, and move towards valued actions. Symptom reduction, such as reduced anxiety, may occur as a side effect of living a valued life, but is not the explicit goal of treatment.
- Role of Acceptance:
- CBT: Does not directly emphasize acceptance as a core principle.
- ACT: Emphasizes the importance of accepting unwanted thoughts and feelings. Acceptance, in ACT, means approaching experiences fully and without defense. Clients learn to make space for uncomfortable experiences, without letting them control their actions.
- Use of Mindfulness:
- CBT: While some forms of CBT incorporate mindfulness, it is not a core component of traditional CBT.
- ACT: Utilizes mindfulness techniques to help clients become more aware of their present moment experiences, including thoughts, feelings, and sensations. Mindfulness is a way of experiencing anxiety without trying to fix it, rather than a technique to feel better.
- Approach to Avoidance:
- CBT: Addresses avoidance by encouraging clients to confront feared situations or stimuli, via exposure therapy.
- ACT: Targets experiential avoidance (attempts to avoid or suppress unwanted internal experiences) as a core problem. ACT aims to loosen the hold that emotion regulation has on the lives of anxiety sufferers, promoting a willingness to experience difficult thoughts and feelings, rather than trying to avoid them. ACT reframes exposure exercises as opportunities to feel better by becoming better at feeling, rather than to feel less anxiety.
- Underlying Model:
- CBT: Operates on a problem-solving model that is based on the idea that symptoms are the problem. It tends to apply the “pathology model”.
- ACT: Is based on a model of psychological flexibility. ACT views human suffering as a result of normal processes that have become unworkable, rather than a disorder. It uses a resource model and sees clients as influenced but not damaged.
- Therapeutic Relationship:
- CBT: The therapist may be seen as the expert, with a theory of change that they apply to the client.
- ACT: Views the client as the expert of their own experience and the therapist focuses on the client’s theory of change. ACT therapists collaborate with their clients, helping them to move towards their own values.
In summary, while both CBT and ACT are effective treatments for anxiety, they differ in their approach. CBT focuses on changing the content of thoughts and behaviors, whereas ACT emphasizes acceptance of thoughts and feelings, and commitment to value-based action. ACT seeks to change a person’s relationship to their thoughts and feelings, instead of changing the thoughts and feelings themselves. ACT aims for a more fundamental shift, questioning the dominance of language and rules that don’t work, and helps clients to move towards living a valued life, even in the presence of anxiety.