A comprehensive comparison of Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT) to help therapists understand when to use each approach.
ACT is considered a "third-wave" cognitive-behavioral therapy, meaning it evolved from traditional CBT but represents a significant shift in philosophy and approach. While both are evidence-based and effective, they differ fundamentally in how they view and address thoughts, feelings, and symptoms.
Traditional CBT focuses on changing thoughts and feelings to reduce symptoms, while ACT focuses on accepting internal experiences and committing to values-based action. Understanding these differences helps therapists choose the most appropriate approach for each client.
CBT operates on the principle that thoughts cause feelings and behaviors. The goal is to change maladaptive thoughts and behaviors to reduce symptoms and improve functioning.
ACT operates on the principle that attempts to control thoughts and feelings often create suffering. The goal is psychological flexibility—accepting internal experiences while committing to values-based action.
CBT teaches clients to identify, evaluate, and change thoughts:
ACT teaches clients to observe and accept thoughts without changing them:
Primary focus on symptom reduction:
Primary focus on psychological flexibility:
Both CBT and ACT have strong research support:
Extensive research spanning decades. Gold standard for many conditions including anxiety, depression, OCD, PTSD. Well-established protocols and treatment manuals. Strong evidence base.
Growing research base showing effectiveness comparable to CBT for many conditions. Particularly strong for chronic conditions, treatment-resistant cases, and when experiential avoidance is present. Recognized as empirically supported.
Research generally shows both are effective, with CBT having more extensive research and ACT showing promise, especially for chronic and treatment-resistant conditions. Some studies show ACT may be more effective when experiential avoidance is high.
CBT and ACT can be integrated thoughtfully:
Some therapists are trained in both and flexibly choose techniques based on client needs and response. However, it's important to maintain therapeutic coherence and not send mixed messages about the approach to thoughts and feelings.
PracFlow supports both CBT and ACT practices with flexible documentation, outcome tracking, values-based goal setting, and treatment planning tools.