If you’ve started looking into therapy, you’ve probably come across two sets of letters: CBT and ACT. Both are evidence-based, both are practical, and both are used every day by clinical psychologists. So what’s the difference, and does it matter which one you choose?
What is CBT?
Cognitive Behaviour Therapy (CBT) looks at how our thoughts, feelings and actions affect each other. When we’re anxious or low, our thinking often becomes more negative and less balanced. That shapes what we do, such as avoiding situations, and avoidance can keep the problem going.
In CBT you learn to notice unhelpful thoughts, test how accurate they are, and replace them with more balanced ones. You also change behaviour step by step, for example by gradually facing feared situations. CBT is one of the most researched therapies there is, and it’s recommended in Australian and international guidelines for anxiety, depression, OCD, panic and insomnia.
What is ACT?
Acceptance and Commitment Therapy (ACT), said as the word “act”, grew out of the behavioural therapy tradition and was developed by psychologist Steven Hayes and colleagues. Rather than changing the content of difficult thoughts, ACT changes your relationship with them.
In ACT you learn to:
- Notice thoughts as thoughts, not facts or orders (“I’m having the thought that I’ll fail”).
- Make room for difficult feelings instead of fighting or avoiding them.
- Be present, using mindfulness skills.
- Clarify your values: what really matters to you.
- Take committed action: small steps towards those values, even when anxiety or self-doubt comes along for the ride.
The aim is psychological flexibility: being able to feel what you feel and still do what matters.
The key difference, in one example
Imagine you’re anxious before a work presentation and your mind says, “Everyone will think I’m incompetent.”
- A CBT approach might help you examine the evidence. Have past presentations gone badly? What would you tell a friend? You’d work towards a more balanced thought, such as “I’m prepared, and one stumble won’t define me.”
- An ACT approach might help you notice the thought without arguing with it, let the nervous feeling be there, and give the presentation anyway because your career matters to you.
Both lead to the same place: you give the presentation. They just take different routes.
Is one more effective than the other?
For most common problems, the research suggests they work about equally well. A meta-analysis of 39 randomised trials found ACT worked better than waitlist, placebo and usual care, and found no significant difference between ACT and CBT. A 2020 review of 20 meta-analyses, covering more than 12,000 participants, found ACT effective for anxiety, depression, substance use and chronic pain.
CBT has the larger and longer research base, especially for specific anxiety disorders, OCD and insomnia, so it’s often the first recommendation for those. ACT can be especially useful when:
- you’ve tried to “think your way out” of anxiety and it hasn’t helped
- you live with something that can’t simply be fixed, such as chronic pain, a health condition or grief
- perfectionism, self-criticism or overthinking are part of the picture
- you want to feel more connected to what matters, not just less distressed.
How to choose
You don’t need to decide on your own. In practice many psychologists draw on both, because modern CBT already includes mindfulness and acceptance skills, and ACT uses behavioural steps. In your first session your psychologist will ask about what’s going on, what you’ve tried and what you’d like to change, then suggest an approach. If something isn’t working for you, say so; the approach can change.
Some questions to think about:
- Do I want practical tools to challenge my thinking? (CBT may suit you.)
- Have I spent a long time battling my thoughts? (ACT may suit you.)
- Is there something in my life I can’t change that I need to live alongside? (ACT may suit you.)
- Do I have OCD, panic or insomnia? (CBT-based treatments are the first-line treatments.)
ACT and CBT at MindBox Psychology
All of our clinical psychologists use CBT, and several, including Audrey Tokatlian, Chloe Kim, Michaela Joseph and Dr Macy Chan, also use ACT. We see adults, adolescents and children. For younger people, see ACT for children. If you’re comparing other therapies, you might like our post on DBT vs CBT.
Sessions are face-to-face at our rooms in St Leonards, on Sydney’s lower North Shore, or through online counselling anywhere in Australia. You don’t need a referral to book. Medicare rebates may be available with a referral and Mental Health Treatment Plan from your GP. Private health funds and self-managed NDIS may also cover some costs.
