ACT vs CBT Therapy: Key Differences, Benefits & Which Is Right for You

Life can be stressful, and kids can be impacted by stress just as much, if not more, than adults. To help your child learn to cope, you might be seeking out a therapist. Chances are, in your research, you’ve heard of CBT or ACT therapy, but how do you know which one is right for your child? Read on to learn more about these therapy modalities.

Overview of CBT and ACT

CBT and ACT are common modalities for treating various mental health conditions. They both fall under behavioral therapy, but they’ve evolved along different theoretical and research lines.  

CBT focuses on changing thoughts, whereas ACT emphasizes acceptance rather than changing the content of thoughts.

What is CBT?

Cognitive behavioral therapy, or CBT, is an evidence-based form of psychotherapy with the goal of modifying inaccurate and/or unhelpful thoughts. It was developed in the ‘60s by Aaron Beck, under the premise that our thoughts influence our emotions and behaviors.

CBT aims to correct these cognitive distortions by challenging irrational beliefs, testing them against evidence, and replacing them with more balanced, realistic perspectives. Therapy sessions often use exercises to facilitate healthier coping skills and a fulfilling life.

Traditional CBT uses techniques such as:

• Identifying cognitive distortions (determining what thoughts are distorted, unhealthy, and unhelpful)
• Cognitive restructuring (identifying the unhelpful thoughts and replacing them with healthier, more rational thoughts) 
• Thought challenging (challenging whether a thought is factual and rooted in reality or not)

What is ACT?

Acceptance and commitment therapy, or ACT, was developed in the 1980s by Steven C. Hayes. ACT principles are rooted in mindfulness and psychological flexibility, which is the ability to participate in life despite your troublesome emotions. Mindfulness is at the heart of working through emotions, along with cognitive defusion, which involves learning to “unhook” those thoughts. Unhooking from thoughts means creating distance or detaching from them, which weakens their power.

With ACT, therapists teach you how to accept your problematic thoughts and then shift to actions aligned with your values. 

ACT does not aim to alter thoughts directly, as CBT does. Instead, ACT teaches:

• Acceptance of internal experiences (noticing any uncomfortable feelings or thoughts you’re having and allowing them to be there rather than pushing them away) 
• Cognitive defusion (detaching from your thoughts, creating distance from them, which weakens their power)
• Values-based action (acting in line with your values, regardless of thoughts or feelings in the moment)

Key principles of CBT and ACT compared

Cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT) are two of the most commonly used approaches in modern psychology. Both tackle troublesome thoughts, emotions, and behaviors, but they differ in their philosophies and how they’re managed. 

Cognitive restructuring vs. cognitive defusion

Cognitive restructuring and cognitive defusion are both used to help clients through their negative thoughts, but their approaches vary. 

Cognitive restructuring is a part of CBT and involves identifying, challenging, and replacing irrational thoughts with more helpful, reality-based ones. The goal is to change the content of thoughts to reduce emotional distress. 

On the other hand, cognitive defusion, which falls under ACT, focuses not on changing thoughts but on changing your view of those thoughts. Clients view thoughts as “transient” rather than truths. By learning to “defuse” from thoughts, the thoughts don’t completely lose all influence. Rather, clients learn not to allow unhelpful thoughts to dominate or dictate their behavior.  

Basically, CBT aims to change how we think, while ACT aims to help us accept how we think.

Symptom reduction vs. psychological flexibility

Both CBT and ACT aim to reduce psychological distress, but they take different paths to get there.

CBT focuses on identifying and changing unhelpful thought patterns. By reframing distorted or irrational thoughts, individuals can experience a reduction in anxiety or depressive symptoms that often result from these thinking patterns.

ACT, on the other hand, centers on developing psychological flexibility, which is the ability to accept thoughts and emotions without judgment and to act in ways that align with personal values. Instead of trying to change negative thoughts, ACT encourages acknowledging and making space for them. Over time, this acceptance reduces their influence, allowing individuals to live more fully and meaningfully.

Role of thoughts and emotions in therapy

Thoughts and emotions influence behavior, and they can be informed by life experiences and trauma. Deeply rooted beliefs may be hard to shake, giving merit to both styles of therapy. In CBT, you are encouraged to challenge problematic thoughts, which lead to anxiety and depression. On the other hand, ACT wants to accept those thoughts. That’s the key to helping to ward off mental health symptoms. 

Mindfulness in CBT and ACT

Mindfulness plays a key role in both CBT and ACT, but for different purposes. In CBT, mindfulness helps people notice their thoughts and feelings so they can challenge unhelpful thinking patterns and develop more balanced ones.

In ACT, mindfulness involves accepting thoughts and emotions without judgment and staying present when making choices that align with personal values. 

Evidence and effectiveness

Research shows that each style has merits for treating different individuals, and may be effective for children and teens. It also shows that neither CBT nor ACT is superior. 

Additionally, research consistently shows that ACT and related approaches can be effective in reducing thought spirals and internalization in children and teens. It can also improve the quality of life. The findings were similar to CBT research, but one was not superior to the other. 

One study reviewed 14 randomized controlled trials involving 1,189 children to assess the effectiveness of acceptance and commitment therapy for various mental and behavioral health concerns. Results showed that ACT significantly reduced symptoms of anxiety and depression, but not more so than CBT. The results showed outcomes similar to those of the children who received CBT. 

The long-term durability depends on the severity of the condition that’s being treated. However, studies show that benefits can last 6 to 12 months, if not longer, after the conclusion of therapy.

Application to specific conditions

The effectiveness of either therapy approach may vary, especially depending on what diagnosis is being treated and a child’s individual treatment response.  Here are common conditions and how CBT and ACT can help with management.

Anxiety disorders

CBT can help with anxiety because it directly challenges the troublesome thoughts that can trigger ongoing worry. Instead of catastrophizing, you’re using logic to go against extreme thoughts. Anxious, irrational thoughts are then replaced with healthier, more logical ones. This can be useful for people prone to panic. 

ACT helps people with anxiety to accept unpleasant thoughts and feelings, which can reduce their impact and make them weaker. 

Depression

CBT is considered the most popular way to treat depression. Like anxiety, it can challenge the thoughts that contribute to negative mental health. 

ACT can still be helpful since the goal is to weaken the intensity of feelings through acceptance. 

ADHD

ADHD can come with a lot of shame. Children with ADHD tell themselves that they’re lazy, that they can’t focus, or that they’re “bad.” In CBT for ADHD management, CBT aims to change the thoughts and behaviors that reinforce the harmful effects of the disorder by teaching people techniques to control the core symptoms. 

By improving coping strategies, organization, and emotional regulation, CBT may be able to reduce challenges such as anxiety, depression, and low self-esteem.

CBT can help to reframe how they feel about themselves. These children can also develop skills to reduce procrastination and improve emotional regulation. 

ACT may help by targeting emotional reactivity with its focus on mindfulness and psychological flexibility. It could also potentially help with feelings of shame associated with ADHD symptoms such as impulsivity and inattentiveness. 

When to choose ACT vs. CBT

Treatment choice depends on the client's preferences and the specific goals they want to achieve. A mental health clinician can help determine which therapy modality will be the most helpful for your child.

ACT may be preferred when children struggle with experiential avoidance, rigid thinking, or need to learn flexibility to help get them unstuck. ACT is also preferred when a child could benefit from a holistic, value-based form of therapy.

CBT is often ideal for children who could use structured techniques to challenge distorted thoughts and reduce anxiety or depressive symptoms. 

Integrating ACT and CBT

Therapists can blend ACT and CBT to create a flexible, personalized approach that addresses both thought patterns and psychological flexibility. For example, cognitive restructuring from CBT can be paired with ACT’s mindfulness and values-based exercises to target symptoms while fostering long-term resilience. This integration allows clinicians to tailor strategies to the client’s unique needs.

How Emora Health can help

Emora Health offers services for kids, teens, and young adults, including evidence-based therapies such as ACT and CBT. Our compassionate clinicians tailor each session to meet individual needs, helping clients build resilience, confidence, and lasting emotional well-being. 

If you want to get your child the help they need, schedule a free consultation to explore which approach fits their goals. Take the first step toward meaningful change today. Get started here.