Is Acceptance and Commitment Therapy Similar to CBT?

Written By John Driessnack

Acceptance and Commitment Therapy (ACT) is a type of Cognitive Behavioral Therapy (CBT). Specifically, ACT belongs to what is known as “third-wave” CBT, which means that it focuses less on changing a person's problematic thoughts and more on helping a person to accept them. (Another therapeutic modality that belongs to the same “third-wave” family is Dialectical Behavior Therapy [DBT], which I discussed in one of my previous articles.)

Now that we’ve worked our way through the abbreviation salad, let’s take a closer look at how ACT (pronounced as “act”, not as “ey-see-tee”) differs from CBT and what the two approaches have in common.

Like CBT, ACT acknowledges that a person’s maladaptive thoughts may have a detrimental effect on his emotional state and mental health in general. However, note that not all thoughts that might make a person sad are maladaptive. For instance, it is perfectly reasonable to feel sad at the thought of a loved one who has passed. A thought becomes maladaptive when it turns invasive, persistent, and irrational, which leads to a specific, lasting dysfunction in a person's life. Therefore, neither CBT nor ACT attempts to rid a person of all unpleasant thoughts. Instead, both modalities seek to make a person notice the connection between his thoughts and emotions.

Where ACT and CBT differ is in their treatment of a person’s maladaptive thoughts. CBT teaches her to modify such thoughts so that they reflect the reality of a situation, not the person’s subjective negative core beliefs. ACT, in turn, teaches a person to accept maladaptive thoughts for what they are—mere thoughts—and doesn’t focus much on changing them.

ACT and CBT

Related therapies with different ways of responding to difficult thoughts

Primary emphasis

ACT Change the perspective Notice and accept thoughts as mental events, without letting them dictate behavior.
CBT Examine the thought Evaluate maladaptive thoughts and modify them to better reflect the reality of the situation.
Key contrast: ACT focuses on changing how a person relates to a thought; CBT more directly evaluates and restructures the thought’s content.

When a difficult thought appears

ACT “This is just a thought.” Register it, make room for discomfort, reconnect with values, and continue toward a chosen goal.
CBT “Is this thought accurate?” Inspect the evidence, identify distortion, and develop a more balanced or realistic interpretation.
Key contrast: ACT makes room for the thought while choosing behavior from values; CBT tests the thought and develops a more accurate alternative.

Shared ground

Both approaches help people respond more skillfully to difficult thoughts and emotions

  • Connect thoughts, emotions, and behavior
  • Do not aim to eliminate every unpleasant thought
  • Distinguish maladaptive thoughts from unpleasant but adaptive ones

ACT’s core prescriptions are as follows. First, a person needs to identify his values and use them to form specific life goals. Second, he needs to understand and accept that the pursuit of his goals can, at times, produce real mental discomfort such as fear of rejection when dating or “impostor syndrome” when climbing the career ladder. Third, the person needs to accept such discomfort as part of the price he pays for pursuing his goals. Whenever he feels uneasy about a situation, he should remember why he is doing what he is doing, recommit to doing it (if the goal is still relevant), and accept the emotional cost of this commitment.

A good metaphor for ACT’s view of maladaptive thoughts is a road toward a person’s goals. She travels that road in a car and occasionally sees various road signs that warn her of road obstructions ahead, instruct her to take a detour, or suggest that she turn back. The road signs are maladaptive thoughts. CBT would suggest inspecting those signs to realize that they are inaccurate or old and have no legal force. ACT, instead, proposes to mentally register their existence and simply drive past them because road signs by themselves have no power over a driver’s behavior. The obvious question is: What if the signs warn you of a real danger ahead? Well, in that case, they would not be maladaptive thoughts. On the contrary, they would be perfectly adaptive thoughts that both CBT and ACT would recognize as such. Learning to distinguish between maladaptive and adaptive but unpleasant thoughts is an important part of therapy.

The ACT Hexaflex is a famous six-part model of a person’s mental phenomena. If sufficiently developed, they will improve a person's mental health. If lacking, they may lead to dysfunction.

The ACT Hexaflex

Six mental phenomena that shape psychological flexibility

Swipe or drag horizontally to explore the full hexagon

Inflexibility Experiential avoidance Trying to escape, suppress, or control unwanted thoughts, emotions, and sensations.
Flexibility Acceptance Willingness to experience difficult thoughts and emotions without trying to avoid or control them.

ACT teaches a person to distance herself from her thoughts but not to fight them or flee from them. If the person engages in a fight-or-flight response to negative thoughts, she will, first, miss out on unpleasant but adaptive thoughts and, second, become increasingly detached from a part of herself. ACT sees both fighting and fleeing as inadequate responses to difficult thoughts, because ultimately the person will end up fighting or fleeing from herself. When the desire not to accept unpleasant thoughts is sufficiently strong, it leads to suboptimal responses and, potentially, psychopathology. In this respect, ACT is similar to existential therapy that also advises a person to confront existential concerns instead of hiding from them.

John Driessnack
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Demystifying Gestalt Therapy