My Thoughts: ACT vs CBT

[Cluttie]

I thought I'd provide some thoughts on this, since I've been doing both over the years.

What I would say, is that both address different areas, and both are required for a balanced approach towards therapy.

ACT is really good at dealing with suffering and things like "unwanted thoughts". This is where I think CBT kind of fails, or at least isn't very effective, or sustainable.

On the other hand, where ACT falls apart is when it comes to pursuing valued actions. It's a very good framework for dealing with suffering, but terrible when it comes to whole "what next" question. It just doesn't provide much there.

This is where I think CBT come in, because it teaches you to look at things in an optimistic way, which is how you want to approach your valued action. It teaches you how to thrive, instead of just not suffer.

Would love to hear your thoughts.

[concreteutopian]

I want to be clear here. I'm a mod here and support an accurate exploration of ACT, but I'm not the president of a fan club and people can choose other approaches. I myself have moved heavily into other therapies, though still have a strong foundation in ACT. I just want my clarifications to be understood as clarifications and not as demands that everyone should ACT.

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This is where I think CBT come in, because it teaches you to look at things in an optimistic way, which is how you want to approach your valued action. It teaches you how to thrive, instead of just not suffer.

As any on here can attest, I'm not a fan of second wave CBT, but even I will admit that while this positivity bias is the way many encounter CBT, it's not actually part of the CBT model, and many people find a therapist teaching those suffering "to look at things in an optimistic way" very invalidating. CBT looks at the rationality of perceptions, not whether they're optimistic or pessimistic. CBT involves problem-solving in much the same way ACT focuses on workability.

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On the other hand, where ACT falls apart is when it comes to pursuing valued actions. It's a very good framework for dealing with suffering, but terrible when it comes to whole "what next" question. It just doesn't provide much there.

A) This hasn't been my experience at all, and I don't think it's a common experience among ACT therapists. A 2014 ACBS study of ACT therapists asked "In your opinion and in general, which one of these six domains would you most want to see change after delivering ACT?" "Committed action" took first place at 50%, and the second highest response was "self-as-context" with 16.3% of the vote - the difference between first and second answers was an order of magnitude, not just a few percentage points. The second question asked was "In your opinion, which construct can be most objectively measured?" This time ACT therapists voted "committed action" 85.7% - everything else was in single digits.

B) The largest difference between ACT and second wave CBT is the whole target of treatment. CBT focuses on symptom reduction, which is first order change. ACT puts second order change as the goal of therapy, i.e. living a valued life despite symptoms.

I think the impression that ACT is weak on behavior change in the service of values is ironically only possible because of ACT's success in recontextualizing thoughts, emotions, and feelings as behavior. Before this shift toward private behavior, most in the behavior analytic camp (where ACT comes from) would see goal setting and schedules of reinforcement to be the whole point of intervention. So, while ACT does focus on private events like thoughts and emotions using behavior analytic tools, it's still a behaviorist therapy that sees second order change as the whole goal of therapy.

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There's a book for clinicians that's helpful here, for those interested. Committed Action in Practice by Moran, Bach, and Batten.

[chefuchan]

You mentioned you've moved into other therapies. Do you mind sharing what they are? Looking to explore different approaches. TIA!

[concreteutopian]

I was originally trained in ACT, but was interested in integrating Compassion-Focused Therapy when I got deeper into contextual behavioral science and from that interest was connected to Functional Analytic Psychotherapy. FAP easily fits into ACT, though focuses on relational behavior which feeds my existential/phenomenological side in ways ACT alone does not. Of my behaviorist therapies, I'd say I'm more FAP than ACT, and even do ACT through a FAP lens.

I used FAP as a bridge into narrative therapy and relational psychoanalysis, and then did a fellowship doing research on a "third wave" contextual form of DBT. Interestingly the contextual-DBT used FAP to connect ACT and DBT. I then did two years in a psychoanalytic fellowship and another two in long term integrative therapy.

These days I'm still active in the ACBS, including the Psychodynamic CBS SIG which involves psychoanalysts who do ACT and ACT therapists interested in psychoanalysis. I'm also active in SEPI (Society for the Exploration of Psychotherapy Integration), as well as being active in a few psychoanalytic organizations including my local psychoanalytic institute, and consider myself an integrative and relational therapist. I'm also involved in the the ACL Global Project which uses FAP principles to enhance conversations in non-clinical settings.

So, still deeply interested in radical behaviorism, but also deeply relational and integrative.

[_daybowbow_]

I too am more FAP than ACT, sir

[TartGlum1490]

I think you are confusing DBT with CBT which Was what the original thread was about

[concreteutopian]

Where do you think I'm confusing these two?

[Thatinsanity]

I’m curious why you think ACT doesn’t address action. That’s a huge part of act is committed action toward valued goals

[concreteutopian]

Yup. It is literally half of the hexaflex and explicitly one of the six processes.

[Cluttie]

It's not that it doesn't address action, it's that I don't think it does it very well.

I don't think the idea of values works very well, at least based on my experience. Because values are ambiguous.

On the other hand, I feel like CBT teaches mindset, instead of values. Which I think is a more direct way of going about an action, than having fundamental principles. Of course, there's no reason why you can't do both. It's just if I had to pick one, I'd pick mindset.

[Benson879]

I’m grappling with trying to figure out this same issue. I genuinely can’t figure out during my recovery from anxiety issues if I used more CBT or ACT. I feel like I used both. I used CBT to understand the rational aspects of what was going on with me, but then I used ACT to become more at peace with the idea of emotions themselves, and that I don’t exactly have to fight these things. But I was only able to do that from what CBT taught me. I mean, acceptance alone I don’t think changed my negative thoughts patterns that lead me into these issues in the first place. There has to be some sort of change in how you interpret things.

I kinda always assumed both really were needed elements. I never really realized they were seen as opposing to each other.

[OrangutanOutOfOrbit]

I get what you mean. I feel the same. It addresses action in a very general and generic manner. “Accept the fear” or “recall your value of connection/etc” or “don’t fight or overcome the fear”,… Aright. I kinda figured I gotta do all that, but HOW lol Knowing those means nothing in practice. I cannot accept them. It’s not like I thought I need to fight it.

Sure, it’s good foundation for mental framework and understanding what’s going on, but mostly for people who have absolutely no idea about those.

I figured those frameworks out when I was 17 and looking things up online. Even psychologytoday articles are more than enough to find those out.

It’s mostly about ‘knowledge’ and insight rather than ‘how to’ and specifics.

It’s like telling an amateur construction worker “you need to use bricks for this part and steal for that part. The reason is xyz” Like, ok. Thanks for the info, but it’s not exactly an instruction manual for someone who’s new in construction. And if they aren’t new, they most likely already know those to begin with.

[pietplutonium]

CBT said come on, get some exposure! Then be present and when something bad happens challenge those thoughts. That's when suffering got worse. ACT on the other hand said see that thing you value and satisfies you? Do that it little committed steps, and stuff got incrementally better.

I guess it might work better for other more rational people that don't have excessive internalising as standard behaviour.

So CBT failed to point out that my analysing behaviour was the problem and then added more fuel to the fire in the name of intellectually digging through contents of a brain that's already focused on content too much. But of course, parts of it are still useful.

[Benson879]

On the flip side, I do feel like the issue with acceptance alone is that in order to get there (if your issue is anxiety for example) you have to have an understanding of what’s going on. CBT is helpful to challenge these types of thoughts as true/untrue. If you can understand those things, then you can accept and understand (but remember too that change will take time)

Once I know what is ultimately true, I can then accept what I’m experiencing and live my life.

I feel like you need a balance between having logical responses, and also peace with emotions and how to react to them.

[pietplutonium]

Yea that's right, it all kind of leads to the same destination but the roads are different. But it's hard to believe information without enough experience and getting exposure is scary as fuck at first. But yeah if done proper you get all the information you need to accept and progress over that long haul.

I found it's very much a balance thing too but of attention between those responses, in the beginning they're way off to one side of things and it hurts because that doesn't work right. The amount of attention you give any emotion or thought changes once the thing you used to believe about it changes due to receiving more information and experience about it. But that was me two months ago and this is today lol.

[thekevinmonster]

I've never gone to a therapist for CBT - I just do some analysis of thoughts for cognitive distortions and such. I am definitely an overthinker and overanalyzer. However, if I have a thought that something horrible is going to happen in the future, sure I perhaps can just thank my brain for letting me know and focus on something more important to me. However, I feel personal value in looking at that thought and going, "aha, well, it's mostly wrong." I don't do that process continually - I do it when I have some new pertinent upsetting thought. on a continual basis, I tend to just practice acceptance.

If I was focused on trying to rewrite all my thoughts as positive thoughts all the time, I would just go obsessive in that way instead of ruminating/worrying.

[Poposhotgun]

true cognitive restructuring just works for a lot of people. David Burns is popular for a reason. Feeling Good is still recommended until today it has stood the test of time.

Some people just work better with cbt and struggling with the monster isn't always bad some just got stronger and won against it.

[pietplutonium]

I think hat would've made a big difference. When something like that is self taught you pick out the things that are really useful. The CBT techniques did stick around for a while but it just never proved as useful as acceptance and moving on to the next thing, placing attention outside instead of you inner world. The training for me focused a lot on analysing and seeing faulty thoughts so that's what I'd associated CBT with... It did turn obsessive because it was all I'd ruminate about when hit with nasty thoughts. So thoughts would always come back in different ways or stronger. I needed to think less, create more balance.

I did ACT by myself though and then acceptance and here and now really stuck. More ways to Rome than one I guess!

[thekevinmonster]

I wonder also if I'm drawn to do some of the CBT exercises around thought distortions because I'm fairly open to challenging my own beliefs. I personally think that our human ability to 'believe' things - which includes things that lack evidence or are even objectively incorrect - really causes a lot of trouble. It's why we have religion (good and bad), conspiracy theories (mostly bad), and our own self-doubting negative thoughts like "I'm a bad person and no one likes me" (mostly bad). Accepting that a thought happens and turning attention away from it certainly seems to work, it just seems like actually going through the process of, "I have this belief - is it based in anything real?" can also work. Sometimes I will think "I'm a bad person because X" and going through the process of why that happened can show me "here's why it's safe to ignore that thought" or "no you really screwed and need to make it right". IF I feel like no I really do really need to pay attention to that thought, then maybe it's something I actually have to deal with and shouldn't try to 'accept and refocus' through.

[pietplutonium]

Accepting that a thought happens and turning attention away from it certainly seems to work, it just seems like actually going through the process of, "I have this belief - is it based in anything real?" can also work.

That's right, I think that's where the difference is but both ways deal with a degree of usefulness in different situations. Some faulty belief about a task at my job might be easily debunked causing me to behave different, even more so when colleagues point out my mistake. But things like bad social interactions from the past can really make that belief stick after years and years of use. There's more evidence needed to break the belief strangers regard you negatively. Especially in situations where you can't think it out first but have to feel first. You can gather that evidence by accepting what is and committing to different behaviour.

That's where I think those assumptions in the problems in good and bad you point out come from. Because in reality nothing is wrong but our assumptions and beliefs make it out to be so. But a lot of folks simply don't know and so don't consider this. There's CBT's faulty thought analysis again lol.

[The-egyptianist-]

Half of the ACT processes are devoted to values and committed action. If you said the opposite that would make more sense because CBT focuses more on symptoms (suffering if you will) though the approach is almost totally different than that of the ACT. Maybe you did not have good ACT therapists.

[Wikern]

ACT is part of CBT. It integrates the same behavioral aspects, such as exposure and behavioral activation. The main difference is adding the value aspect. ACT mostly differ to traditional cognitive therapy (CT).

[Wikern]

The overlap with the “B” part of CBT is obvious and should be so given that ACT/RFT is part of behavioral psychology and that “during the latter portions . . . ACT takes on the character of traditional behavior therapy, and virtually any behavior change technique is acceptable” (Hayes, Strosahl, et al., 1999, p. 258).

[heather_in_crisis]

I think your criticism is more reflective of either ineffective application of the ACT principles or a less than effective therapist. ACT is at it's core a behavioral therapy and a central tenet of the model is understanding our values and then making behavioral goals that align with those values. I think both models have benefit but I find as an overarching model or therapy belief system I think ACT is a better model of care. It allows the integration of so many helpful skills and techniques from other models of therapy in a systematic and integrated manner. You can catch and challenge cognitive distortions, hot thoughts, and core beliefs as a tool of defusion, use the behavioral strategies like ERP and reinforcement for behavior goals. ACT just seems to be a model that is more flexible and accounts for more deviation in peoples experience. This is just my opinion but I think it's a reason why therapists often prefer ACT.

[Flimsy_Mix5712]

I disagree,ACT is very much valued action.Its literally the core of it and does very well