We all feel anxious from time to time whether that’s because of an upcoming job interview or an unexpected bill. However, when your worry becomes uncontrollable and starts affecting your quality of life, it may be an indication that you have an anxiety disorder.
Anxiety disorders are a common mental health concern, affecting more than 40 million adults in the U.S. However, their prevalence doesn’t mean that they are easy to navigate or that those affected have a universal experience. People are impacted by anxiety in different ways, which also means that there’s no singular treatment approach that works for everyone.
Cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT) are two widely used, evidence-based approaches for anxiety treatment. While they are both behavior-based psychotherapies, there are distinct differences in how they view thoughts and feelings and an individual’s relationship to them.
If you’re considering CBT or ACT to improve your mental health, this article can help you make an informed choice. We explain each approach, explore their similarities and differences, and highlight factors to consider when choosing between them.
Key takeaways
- CBT and ACT are both effective therapies for anxiety, but they take different approaches.
- CBT focuses on changing negative thought patterns and behaviors.
- ACT encourages acceptance of thoughts and feelings while committing to meaningful actions.
- Research shows CBT is often the first-line treatment, but ACT is gaining recognition, particularly for people who struggle with traditional cognitive restructuring techniques.
- The ‘better’ approach depends on personal preference, your type of anxiety disorder, and treatment goals.
What is cognitive behavioral therapy (CBT)?
Cognitive behavioral therapy (CBT) is one of the most common and best-studied forms of talking therapy. It’s a structured approach that helps people manage their mental health by challenging unhelpful or negative thoughts and behaviors.
CBT combines two therapeutic approaches:
- Cognitive therapy: focuses on identifying and restructuring negative thought patterns.
- Behavioural therapy: helps change unhelpful behaviours that reinforce distress.
Rather than focusing on past experiences, CBT is typically present-focused and goal-oriented. It teaches practical coping strategies that individuals can apply in everyday life. As one patient shares:
“Before starting therapy, I really had no path on how to cope with my anxiety, how to communicate my needs with my partner or other people, or how to understand and acknowledge my thoughts and emotions head on. Now, I've been able to control and process my anxiety in healthier ways than ever in the past eight or nine years. My relationship has come to a brighter, more peaceful place after learning how to build trust in myself and others. Moreover, I've learned how to become more confident in my relationships with friends and families and how to express myself more authentically.”
CBT is widely used to treat various mental health conditions, including:
- Generalized anxiety disorder (GAD)
- Panic disorder
- Obsessive-compulsive disorder (OCD)
- Post-traumatic stress disorder (PTSD)
- Depression
- Phobias
- Eating disorders
- Insomnia
CBT is also used to help people with physical conditions, such as chronic pain and irritable bowel syndrome (IBS), cope with their symptoms and improve their overall well-being.
CBT for anxiety: How does it work?
CBT helps people with anxiety by identifying and changing unhelpful thought patterns and behaviors that contribute to the emotional distress and physical manifestations they experience. It is based on the idea that thoughts, feelings, and behaviors are interconnected. By altering negative thoughts and avoidance behaviors, anxiety symptoms can be reduced.
CBT for anxiety typically involves:
- Identifying negative thought patterns: Recognizing anxious thoughts and their impact.
- Cognitive restructuring: Challenging and replacing irrational fears with balanced, more neutral perspectives.
- Exposure therapy: Gradually facing feared situations to reduce avoidance and build confidence.
- Behavioral strategies: Techniques like relaxation training and problem-solving to improve coping skills.
In a real-life context, the changes that CBT encourages can look like this:
What is acceptance and commitment therapy (ACT)?
ACT is a modern form of psychotherapy that was developed in the 1980s by psychologist Steven C. Hayes. It helps people develop psychological flexibility by encouraging them to accept difficult thoughts and emotions without judgment and focus on what truly matters to them. Its principles were founded on Hayes’ own experiences of panic attacks and his determination to accept himself and his challenges.
It can be used to treat many mental and physical conditions including:
- Social anxiety disorder
- Panic disorder
- Psychosis
- Obsessive-compulsive disorder (OCD)
- Eating disorders
- Substance use disorders
- Workplace stress
- Chronic pain
ACT is built on six core processes:
- Acceptance: Acknowledging difficult emotions and experiences rather than fighting them.
- Cognitive defusion: Learning to see thoughts as just thoughts, not absolute truths.
- Mindfulness: Focusing on the here and now and accepting your thoughts in the present moment without judging or trying to change them.
- Self-as-context: Recognizing that you are more than your thoughts and emotions.
- Values clarification: Identifying what truly matters in your life and striving to live according to these values rather than societal standards or other peoples’ expectations.
- Committed action: Taking meaningful steps toward goals that align with your values despite discomfort.
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ACT for anxiety: How does it work?
ACT helps individuals with anxiety by shifting their focus from controlling or eliminating anxious thoughts to accepting them and choosing meaningful actions. The goal is not to remove anxiety but to change the relationship with it.
Here’s how the six processes of ACT address different aspects of anxiety:
- Acceptance: Encourages acknowledging anxiety instead of resisting or avoiding it, reducing struggle and distress.
- Cognitive defusion: Teaches you to see anxious thoughts as temporary notions rather than facts.
- Mindfulness: Helps you stay present instead of getting caught up in worry about the past or future.
- Self-as-context: Creates a sense of detachment from anxious thoughts, recognizing that thoughts do not define you as a person.
- Values clarification: Promotes focus on what truly matters to you instead of letting anxiety dictate your choices.
- Committed action: Supports taking meaningful steps in life despite feeling anxious, rather than avoiding challenges.
As an example, the impact of ACT for anxiety disorders can transform situations:
ACT vs CBT: Key Differences
Both CBT and ACT are effective therapies for anxiety, but they take different approaches to how you process your thoughts and feelings. However, the differences between the two therapies go beyond just their methodology.
While there’s a wealth of information online about each, comparing their key aspects side by side can be useful when it comes to focusing your research or reaching out to therapists.
Is CBT or ACT better for anxiety disorders?
Both CBT and ACT can be effective for anxiety disorders but as anxiety is such a unique experience, there isn’t one approach that is definitively better for everyone; it depends on an individual's circumstances, challenges, preferences, and goals. However, the results can be life-changing. As one patient explains:
“The progress I have made since seeing (Michelle) has been huge. I feel like I am a different person. I am me but just a better version of myself. She has taught me many different methods to cope with my anxiety and depression."
There are studies that indicate that CBT and ACT result in similar levels of overall improvement of anxiety whereas others conclude that CBT outperforms ACT on anxiety while ACT has a greater impact on short-term mindfulness.
Ultimately, the best therapy for anxiety disorder is the one that you find the most helpful and that produces positive outcomes. You may find that CBT is a good starting point, moving to ACT if CBT isn’t effective or you can even combine therapies to reap the benefits of a wider range of techniques.
How to choose between CBT and ACT interventions for anxiety
Whether you settle on cognitive behavioral therapy or acceptance and commitment therapy for anxiety, your path to the right intervention is likely to be as unique as your reasons for seeking support in the first place. Your choice will be based on a multitude of factors including:
- Personal preferences in approach
- Type and severity of anxiety
- Previous therapy experience
- Therapist availability and expertise
- Long-term goals
Asking yourself the following questions can help you hone in on your decision:
- Do you prefer a structured, problem-solving approach? CBT provides step-by-step strategies to identify, challenge, and replace unhelpful thoughts.
- Are you open to mindfulness and acceptance-based techniques? ACT encourages observing thoughts without judgment rather than trying to change them.
- Do you struggle with emotional avoidance? ACT focuses on accepting uncomfortable feelings instead of trying to push them away.
- Are you looking for short-term, goal-oriented therapy? CBT is typically more structured with clear targets for progress.
- Do you feel exhausted from fighting anxious thoughts? ACT may help by shifting focus from struggling with thoughts to taking meaningful action.
- Have you tried CBT but found it too rigid? Some individuals prefer the flexibility and values-based approach of ACT.
Finding the right form of therapy is paramount to personal progress. One patient, who has been working with Laurie Parsons, describes the difference it has made to their life:
“I have battled with PTSD and extreme anxiety for over 20+ years now and since beginning treatment with Laurie I have been able to actually enjoy my life again, sleep through the night, and be in social settings without any fear. She has given me every tool I need to be able to manage my stress and anxiety levels daily.”
If you or a loved one is struggling with anxiety and you’re still unsure of whether CBT or ACT is the right fit, our diverse team of 300+ therapists and psychiatrists can help. To start your care, answer a few questions and get matched with top therapists.
References
In brief: Cognitive behavioral therapy (CBT) - InformedHealth.org - NCBI Bookshelf
Acceptance and Commitment Therapy | Psychology Today United Kingdom