Acceptance and Commitment Therapy (ACT) and traditional Cognitive Behavioral Therapy (CBT) differ significantly in their approaches to treating anxiety, despite both being rooted in behaviour therapy. While traditional CBT aims to reduce distress by changing thoughts and behaviours, ACT seeks to enhance psychological flexibility by accepting thoughts and feelings and engaging in value-driven actions.
Core Differences:
- Focus on Symptoms vs. Processes:
- Traditional CBT typically focuses on alleviating symptoms of anxiety as the primary therapeutic goal. This involves identifying, challenging, and changing maladaptive thoughts and behaviours believed to cause distress.
- ACT, in contrast, views anxiety as a normal part of the human experience and focuses on altering the individual’s relationship with their thoughts and feelings, rather than eliminating them. ACT targets the underlying processes that contribute to anxiety, such as experiential avoidance (attempts to avoid or control unwanted thoughts and feelings) and cognitive fusion (getting caught up in thoughts as if they are reality).
- Approach to Thoughts and Feelings:
- CBT often seeks to directly modify the content of thoughts, aiming to replace irrational or negative thoughts with more rational ones. This is done through techniques such as cognitive restructuring.
- ACT emphasizes defusion, which is about changing the way people relate to their thoughts, viewing them as mental events rather than facts. ACT encourages observing thoughts and feelings without automatically reacting to them, reducing their power and influence over behaviour.
- Traditional CBT may inadvertently strengthen negative thoughts through disputation, whereas ACT accepts thoughts as they are.
- Role of Acceptance:
- While CBT does not typically focus on acceptance, ACT places acceptance as a core treatment component. ACT encourages clients to be open to and accept their internal experiences, including anxiety, without judgment or the need to change them.
- ACT suggests that attempting to control anxiety can be counterproductive, and that acceptance is key to reducing the struggle with it.
- Therapeutic Goals:
- Traditional CBT often aims for symptom reduction and mastery of anxiety, which can sometimes reinforce the idea that anxiety is a problem to be solved.
- ACT’s goal is to help clients live a more full, rich, and meaningful life, guided by personal values, regardless of their anxiety levels. It seeks to enhance psychological flexibility and the ability to take committed action despite challenging thoughts and feelings.
- The Role of Values:
- Traditional CBT does not usually directly address client values in treatment.
- ACT places strong emphasis on identifying and clarifying personal values and using these values as a guide for action and as a motivator to face anxiety-provoking situations.
- Use of Mindfulness:
- While some CBT approaches are incorporating mindfulness, traditional CBT does not typically use these practices directly.
- ACT incorporates mindfulness techniques to help clients stay present, aware of their experiences, and less reactive. In ACT mindfulness is not an escape but rather a way to be more present to what the client is feeling, with the goal to enable the client to live more fully.
- View of Experiential Avoidance:
- Traditional CBT does not specifically address the concept of experiential avoidance.
- ACT considers experiential avoidance as a core issue in anxiety disorders, viewing efforts to avoid unwanted internal experiences as a maintaining factor in anxiety and distress. ACT seeks to help clients reduce this avoidance and learn to accept their experiences.
- Approach to Exposure:
- While CBT uses exposure to help clients confront feared situations to reduce avoidance and fear, the focus is usually on symptom reduction and testing the accuracy of negative predictions.
- ACT frames exposure within a context of acceptance and value-guided action, with the goal of helping clients develop willingness and psychological flexibility, moving in the direction of their values. In ACT, it is more about feeling better by gaining mastery of one’s experience than just to feel better (less anxious).
Summary
In summary, ACT and traditional CBT offer different routes to address anxiety. While CBT targets the content of thoughts and aims to reduce symptoms, ACT focuses on the process of thinking and feeling, aiming to increase psychological flexibility and committed action through acceptance, defusion and mindfulness. ACT provides a more holistic approach that goes beyond symptom management and helps individuals lead richer, more meaningful lives aligned with their values. A client might consider ACT if they feel that traditional CBT is too focused on symptom reduction and is looking for a more comprehensive and value-based therapy that helps them accept their anxiety and move forward in their lives despite their anxieties.
Tags: ACT, CBT, Anxiety Treatment, Psychological Flexibility, Acceptance, Defusion, Mindfulness, Values, Experiential Avoidance, Cognitive Fusion, Third Wave Therapies, Behaviour Therapy.