CBT vs ACT: What’s the Difference, and Which Is Right for You?

CBT vs ACT: What’s the Difference
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Cognitive-behavioral therapy (CBT) and acceptance and commitment therapy (ACT) both focus on the relationship between thoughts, feelings, and behaviors. However, CBT aims to change distorted thought patterns and reduce symptoms, while ACT encourages you to accept distressing thoughts and emotions without judgment.

This article explains the similarities and differences between CBT and ACT, including what the research says about which is more effective.

What is CBT?

CBT combines elements of two different schools of psychology: behaviorism and cognitive therapy. Behaviorism is a theory of learning suggesting that all behaviors are acquired through conditioning. Conditioning processes include rewards, which promote behaviors, and consequences, which inhibit behaviors. Cognitive therapy is based on the idea that our interpretations of events influence how we feel and function. Let’s dive into the main principles of CBT.

What causes emotional distress, according to CBT?

CBT believes that emotional distress is a result not of the things that happen to us but of how we think about them. Different people in the same life situation explain their experiences differently, which affects how they feel and behave.

For example, Ben and Matt have recently been laid off. Ben blames himself, reasoning that it must have been his subpar performance last quarter that led to the layoff. “I’m not good at my job,” thinks Ben, “I’ll never be successful.”

Matt, on the other hand, attributes the layoff to a company-wide restructuring. He sees it as a blessing in disguise since he wasn’t particularly happy in his job. “I’m a smart guy with 10 years of experience under my belt,” thinks Matt. “I’ll get another job.”

Ben’s interpretation robbed him of the motivation to seek a new job, while Matt felt energized by his prospects. Both Ben and Matt illustrate the interaction of thoughts, feelings, and behaviors and how altering our thoughts can change how we feel and behave. This is the central concept of CBT.

What is the goal of treatment in CBT?

CBT aims to identify problematic thought patterns and replace them with more adaptive ones. Part of this process is identifying distortions and core beliefs.

Distortions are errors in judgment that everyone makes. Our brains have a lot to attend to, so they take shortcuts– for example, categorizing a situation as “good” or “bad” instead of noticing the subtleties. This is known as all-or-nothing thinking. Other distortions include mind-reading (assuming you know what someone is thinking or feeling) and personalization (blaming yourself for events outside your control). For example, Ben personalized his layoff even though he wasn’t directly responsible.

Core beliefs are assumptions about yourself, others, and the world that shape your experience. These beliefs are often formed in childhood in response to things that happened to you. For example, if you were consistently let down by someone you love, you might develop the core belief that people are untrustworthy.

Now that you understand the principles and goals of CBT, let’s look at some of the techniques that might be used.

What are some common CBT techniques?

CBT is goal-oriented and short-term. It will likely begin with the identification of a specific problem that you want to resolve– for example, “I want to feel more confident in social situations.” You and your therapist will then work towards that goal with a combination of strategies, including the following:

  • Cognitive restructuring— Identifying harmful thought patterns (distortions and core beliefs) and reframing them to reflect reality more accurately. For example, “I am a failure in every situation” might be replaced with “I make mistakes sometimes, but that does not make me unworthy.”
  • Exposure therapy— Systematically confronting what you are afraid of. For example, if social situations make you anxious, your therapist might challenge you to schedule get-togethers with close friends, then acquaintances, and finally strangers, providing you with coping strategies to use in each situation.
  • Behavior activation— Making a point of engaging in activities you tend to avoid due to distress or discomfort. For example, if you are depressed, you might struggle to find the motivation for everyday activities. A CBT therapist might encourage you to create a self-care routine as a way of feeling better.

CBT therapists tend to be active participants in the treatment, often assigning homework in the form of behavioral goals or tracking your thoughts in a journal.

Now, let’s look at ACT and how it is similar to and different from CBT.

What is ACT?


We cannot change anything until we accept it.
~ Carl Jung


ACT (pronounced “act”) is similar to CBT in that it focuses on thoughts, feelings, and behaviors. However, instead of seeking to eliminate distressing thoughts and feelings, ACT aims to change your relationship with them. Let’s look at the main principles of ACT.

What causes emotional distress, according to ACT?

ACT is oriented around the belief that emotional distress comes from the avoidance of negative thoughts and feelings. While it’s natural to want to avoid discomfort, avoiding emotions triggers your body’s stress response, producing a range of physical and psychological symptoms.

Unlike CBT, which aims to eliminate negative thoughts, ACT helps you accept that emotional distress is a part of life. ACT uses mindfulness practices to help you observe your thoughts and feelings without reacting to them.

What is the goal of treatment in ACT?

ACT aims to increase psychological flexibility, or the capacity to adapt to challenging situations. ACT does this by helping you to accept your thoughts and feelings instead of judging them. For example, let’s say you struggle with performance anxiety at work. Your internal commentary might be something like, “This is stupid. Why am I getting so worked up? No one else has these issues.” ACT would help you accept that your anxiety is a natural, albeit uncomfortable, response to the situation.

Another goal of ACT is aligning behavior with core values for greater life fulfillment. For example, maybe one of your values is family, but you spend most of your time working. An ACT therapist might help you to create more work-life balance by spending more time on the things that matter most to you.

Now that we’ve covered the principles and goals of ACT, let’s look at some ACT techniques.

What are some common ACT techniques?

Unlike CBT, ACT can be both short and long-term. Rather than seeking to eliminate symptoms, ACT sees feeling better as a happy side effect of being more accepting and present. While ACT therapists often tailor techniques to suit individual needs and goals, they are likely to use a combination of the following techniques:

  • Mindfulness– Being present in the moment and observing thoughts and feelings without judgment.
  • Cognitive Defusion– Distancing yourself from your thoughts, recognizing that you are not your thoughts, and thoughts are not necessarily accurate reflections of reality.
  • Values Clarification– Identifying the most important things to you and using them to set goals and make choices.
  • Committed Action– Taking action that aligns with your values. Creating specific, achievable goals to make meaningful changes in your life.

Like CBT therapists, ACT therapists often assign homework or worksheets so that you can practice techniques outside of therapy sessions. This reinforces learning and promotes continued progress.

This chart summarizes the similarities and differences between CBT and ACT:

CBTACT
Short-termCan be short-term or long-term
Problem-orientedAcceptance-oriented
Aims to reduce symptomsSymptom reduction is a by-product
Emotional distress is caused by distorted thinkingEmotional distress is caused by the avoidance of difficult emotions
Goal of treatment is to change thoughtsGoal of treatment is to observe thoughts without judgment
Focus on identifying and restructuring faulty core beliefsFocuses on identifying core values and acting in alignment with them
Treatment includes setting specific, achievable goalsTreatment includes specific, achievable goals
Homework often assignedHomework often assigned

Which Is Right for You — CBT or ACT?

Both CBT and ACT have their pros and cons. CBT tends to work best when there is a specific problem you want to address, and ACT tends to work best if avoidance is your primary coping mechanism. Both CBT and ACT are used to manage the following issues:

  • Anxiety
  • Depression
  • Substance Abuse and Addiction
  • Chronic Pain
  • Chronic Health Conditions
  • Relationship Problems
  • Self-esteem and Self-Confidence Issues
  • Phobias and Fears

Often, CBT and ACT are used in conjunction with other therapies. For example, mindfulness-based CBT combines the elements of CBT with mindfulness exercises. Motivational interviewing is an approach that is often used along with ACT to treat substance abuse. So, while you might decide to pursue CBT or ACT, your therapist will most likely draw from other therapies to provide you with maximum benefit.

The research is somewhat divided on whether CBT or ACT is more effective. A 2021 study of 177 patients found that both CBT and ACT reduced symptoms of depression and increased overall life satisfaction [1]. However, an earlier study reported that CBT patients experienced more lasting benefits 18 months after treatment [2]. More recent research indicates that ACT is slightly more effective than CBT for treating anxiety [3,4].

The Bottom Line

If you are considering CBT or ACT, you can start by identifying CBT or ACT-trained therapists in your area. Schedule an initial appointment with the 2-3 that seem like the best fit for you, and then choose among them.

Keep in mind that the sessions might be uncomfortable at first, so instead of asking, “Did I enjoy talking to that therapist?” ask, “Can I imagine developing trust and rapport with this therapist?” Research indicates that the patient-therapist relationship is the most critical factor in determining whether treatment will be helpful [5].

Sources

[1] Samaan M, Diefenbacher A, Schade C, Dambacher C, Pontow IM, Pakenham K, Fydrich T. A clinical effectiveness trial comparing ACT and CBT for inpatients with depressive and mixed mental disorders. Psychother Res. 2021 Mar;31(3):355-368. doi: 10.1080/10503307.2020.1802080. Epub 2020 Aug 7. PMID: 32762513.

[2] Evan M. Forman, Jena A. Shaw, Elizabeth M. Goetter, James D. Herbert, Jennie A. Park, Erica K. Yuen, Long-Term Follow-Up of a Randomized Controlled Trial Comparing Acceptance and Commitment Therapy and Standard Cognitive Behavior Therapy for Anxiety and Depression, Behavior Therapy, Volume 43, Issue 4, 2012, Pages 801-811, ISSN 0005-7894, https://doi.org/10.1016/j.beth.2012.04.004.

[3] Shin JW, Kim S, Shin YJ, Park B, Park S. Comparison of Acceptance and Commitment Therapy (ACT) and Cognitive Behavior Therapy (CBT) for Chronic Insomnia: A Pilot Randomized Controlled Trial. Nat Sci Sleep. 2023;15:523-531

[4] Carter H. Davis, Michael P. Twohig, Michael E. Levin, Choosing ACT or CBT: A preliminary test of incorporating client preferences for depression treatment with college students, Journal of Affective Disorders, Volume 325, 2023, Pages 413-420, ISSN 0165 0327, https://doi.org/10.1016/j.jad.2022.12.097.

[5] Horvath, A. O., & Symonds, B. D. (1991). Relation between working alliance and outcome in psychotherapy: A meta-analysis. Journal of Counseling Psychology, 38(2), 139–149. https://doi.org/10.1037/0022-0167.38.2.139

Lindsay Schwartz
Lindsay Schwartz
I am a psychotherapist turned mental health writer. My hope is to draw upon my professional experience to provide readers with practical, accessible advice for improving their mental health. When I am not writing or reading about psychology, I’m usually walking my dog or enjoying a mindful moment in nature!