CBT and ACT
Choosing Between CBT and ACT Therapy
How Are CBT and ACT Actually Different in Practice?
If you've had CBT, the experience of ACT is likely to feel noticeably different from the first session.
CBT | ACT | |
Focus | Changing unhelpful thoughts | Changing your relationship with thoughts |
Goal | Reduce distressing symptoms | Increase psychological flexibility |
Approach | Analytical, structured | Experiential, often uses metaphor and mindfulness |
Homework | Thought records, behavioural experiments | Mindfulness exercises, values-based activities |
Success looks like | Feeling better, thinking more clearly | Living in accordance with your values, even with discomfort |
One thing people sometimes notice is that ACT feels less like a problem-solving exercise and more like a shift in perspective, almost philosophical. It draws on mindfulness, though you don't need any prior experience of meditation for it to be useful.
Who Might ACT Be Particularly Good For?
ACT tends to resonate with people who:
Have tried CBT and found the thought-challenging approach frustrating or exhausting
Feel that their problems keep coming back even after periods of improvement
Struggle with chronic conditions, whether physical or mental, where "getting better" isn't a straightforward linear journey
Feel disconnected from what gives their life meaning and purpose
Find that trying not to think about something just makes them think about it more
It also has a strong evidence base for anxiety, depression, OCD, chronic pain, and stress, comparable to CBT in many contexts, and in some cases superior, particularly for people with a history of treatment that hasn't fully worked.
A Note on Language and Fit
I want to be honest about something: the word "acceptance" puts some people off. It can sound passive, even defeatist.
Accept that I feel terrible? No thank you.
But what ACT means by acceptance is more akin to willingness. A willingness to have your experience without it running your life. It's not giving up. It's about understanding how we are hard wired to move away from unpleasant thoughts, feelings and sensations and how, in turn, we also move away from what is really important to us.
I've seen this shift be genuinely life-changing for people who came to us feeling like therapy had nothing left to offer them. That's one of the reasons I feel so strongly about making sure people know there are options.
What Should You Do If You're Not Sure?
If you're considering therapy, or reconsidering it after a previous experience that wasn't quite right; the most important thing is to speak openly with your therapist about what you're looking for and what you've found helpful or unhelpful before.
At Towards, we have therapists who are trained in ACT, CBT, counselling and other evidence-based therapies. We take the time to match people to the approach that's most likely to fit their needs, history, and goals. There's no one-size-fits-all in therapy, and there shouldn't be.
Whether you've never tried therapy, are dipping a toe back in after a difficult experience, or are simply curious about what else is out there — we'd love to have that conversation with you.
Dr Sarah Bateup is Chief Clinical Officer at Towards, where she leads clinical training and quality across the therapy practice. If you'd like to find out more about therapy at Towards, get in touch with our team.