Changing content vs changing impact
When it comes to psychological therapies, cognitive behavioural therapy (CBT) is one of the most extensively researched and widely practised approaches, with acceptance and commitment therapy (ACT) now also supported by a substantial and growing evidence base. Both are effective for a variety of mental health difficulties, but they differ in how they view and work with thoughts. This article looks at some distinctions regarding how the two modalities approach thoughts.
The CBT approach: challenging the content of thoughts
CBT is a structured, problem-focused therapy that primarily aims to help individuals identify and challenge unhelpful thought patterns. The core idea in CBT is that distorted or irrational thoughts (often referred to as cognitive distortions) play a significant role in emotional distress.
For example, if someone frequently thinks, “I always fail at everything,” CBT would encourage them to examine the evidence for and against this belief. A therapist might ask, “Is it really true that you always fail? Can you think of times when you succeeded?” By reframing such thoughts into more balanced and realistic ones, CBT seeks to reduce distress and improve outcomes.
CBT treats thoughts almost like a faulty programme in the mind. If you can debug the programme and replace the errors with accurate information, you can improve mental health. This approach is highly effective for conditions like anxiety, depression, and obsessive-compulsive disorder (OCD).
CBT also focuses on helping individuals act differently by modifying unhelpful thinking patterns and testing new behaviours. When the thought “I’m a terrible parent” arises, CBT would work toward a more balanced understanding and encourage behavioural experiments, such as trying a different response in a challenging parenting situation and observing the outcome.
The ACT approach: changing the relationship with thoughts
ACT, on the other hand, takes a very different stance. Instead of focusing on the content of thoughts, ACT teaches individuals to change their relationship with their thoughts. Rather than arguing with or trying to reframe unhelpful thoughts, ACT encourages clients to observe these thoughts with curiosity and detachment.
Imagine you’re having the thought, “I’m a terrible parent.” Instead of disputing this thought (as you would in CBT), ACT would encourage you to notice it as just a thought – and not necessarily as an ultimate truth. You might practise saying, “I’m having the thought that I’m a terrible parent,” which creates metaphorical space between you the thinker, and the thought itself. This process, called cognitive defusion, helps reduce the power that the thought holds over you.
ACT also emphasises the importance of staying present in the moment and aligning your actions with your deepest values. For example, even if the thought “I’m a terrible parent” arises, you can still choose to act in a way that reflects your values as a caring and supportive parent.
A fundamental difference: changing content vs changing impact
One of the key differences between CBT and ACT lies in how they aim to influence thoughts and emotions. CBT works on the assumption that thoughts and feelings can often be modified by examining their accuracy and usefulness. By actively reshaping unhelpful thinking patterns into more balanced and realistic ones, CBT seeks to reduce emotional distress and support effective behaviour.
ACT takes a different approach. Rather than prioritising changes in the content of thoughts, ACT focuses on changing their function and impact. Research and clinical experience within ACT suggest that attempts to eliminate or control unwanted thoughts and feelings can sometimes increase struggle and distress. Instead, ACT helps people learn to make room for internal experiences as they arise, while loosening the grip those experiences have on behaviour. The emphasis is not on whether a thought changes, but on whether it continues to dictate what a person does, particularly in relation to what matters to them.
Practical examples
To better understand how CBT and ACT work, here are some practical examples of how each approach might respond differently to specific types of thoughts. You can also download these for your own use from our resource hub: CBT vs ACT – how do they work with thoughts?
Thought – “I’m a failure.”
CBT response: Challenging and reframing the thought
1. Identify the thought
“What is the thought that’s causing you distress?”
Client: “I’m a failure.”
2. Examine the evidence
“What evidence do you have that supports this thought? And what evidence do you have against it?”
Client: “Well, I made a mistake at work, but I’ve also done a lot of things right recently.”
3. Reframe the thought
“Could we reframe this thought to make it more balanced?”
Client (with therapist’s help): “I made a mistake, but that doesn’t mean I’m a failure. I’ve succeeded at many tasks before and can learn from this experience.”
4. Translate the new perspective into action
“Based on this more balanced view, what would be a helpful next step?”
Client: “I could apologise for the mistake and make a plan to avoid it in the future.”
ACT response: Changing the relationship with the thought
1. Notice the thought
“Let’s take a step back. Notice the thought, ‘I’m a failure.’ It’s a string of words your mind has created.”
2. Create distance
“Try saying, ‘I’m having the thought that I’m a failure,’ rather than ‘I am a failure.’ Does that feel different?”
Client: “It feels less personal, like it’s just a thought rather than the truth.”
3. Observe without judgement
“Imagine the thought as a leaf floating down a stream. You can notice it passing by, without needing to analyse it, respond to it, or make it go away.”
4. Refocus on values
“What’s important to you right now? What small action could you take that aligns with your values, even if this thought is present?”
Client: “Being reliable at work is important to me. I could apologise for the mistake and make a plan to avoid it in the future.”
Thought – “I’ll embarrass myself if I speak in the meeting.”
CBT response: Testing predictions and building coping confidence
1. Challenge the prediction
“What makes you think you’ll embarrass yourself? Have you spoken up in meetings before? How did it go?”
Client: “Usually, it goes fine, but I always feel so nervous beforehand.”
2. Behavioural experiment
“Let’s test this. In the next meeting, try saying one small thing, even if you feel nervous. Afterwards, we’ll look at what actually happened and how you coped.”
3. Reframe the thought
“Instead of ‘I’ll embarrass myself,’ could you try ‘I might feel nervous, but I can cope with it and it usually goes better than I expect’? How does that feel?”
Client: “That feels more doable.”
ACT response: Defusing from the thought and acting on values
1. Acknowledge
“It’s understandable to have the thought ‘I’ll embarrass myself.’ Let’s notice it as something your mind is producing, rather than something you have to obey.”
2. Practise defusion
“Let’s try relating to the thought differently. You might repeat it slowly, sing it, or say ‘I’m having the thought that I’ll embarrass myself.’ What do you notice?”
Client: “It makes it feel less serious, like it’s just a thought, not a fact.”
3. Focus on values
“Why is it important to you to speak up in the meeting? What value does that connect to?”
Client: “I want to contribute to the team and show that I care about the project.”
4. Act with the thought present
“Even if the thought is there, what’s one small action you could take that fits with that value?”
Client: “I could share one quick idea, even if I feel nervous.”
Thought – “Nobody likes me.”
CBT response: Examining interpretations and testing assumptions
1. Identify the interpretation
“Let’s slow this down. The thought is ‘Nobody likes me.’ What’s been happening that led to that conclusion?”
Client: “People haven’t been messaging me much lately.”
2. Identify thinking patterns
“That sounds like a broad conclusion based on limited information. We might be seeing some mind-reading or all-or-nothing thinking here.”
3. Examine the evidence
“What evidence supports the idea that nobody likes you? And what evidence suggests a more mixed picture?”
Client: “I do have a couple of friends who check in, and colleagues are friendly at work.”
4. Develop a more balanced view
“Given all of that, how could we rephrase the thought in a way that fits the evidence more closely?”
Client: “Some people don’t reach out much, but others do care about me.”
5. Test the new perspective through action
“Based on that more balanced view, what could you do this week to test it?”
Client: “I could message a friend and suggest meeting up.”
ACT response: Loosening the grip of the story and moving toward connection
1. Notice the thought
“Your mind is telling a painful story right now: ‘Nobody likes me.’ Let’s notice that as a thought, rather than a fact.”
2. Create distance from the thought
“Try saying, ‘I’m having the thought that nobody likes me.’ What do you notice when you say it that way?”
Client: “It feels a bit less overwhelming, like it’s not the whole truth.”
Optional metaphor “If it helps, you can imagine that thought like a radio playing in the background. You don’t need to turn it off or argue with it, just notice it while you bring your attention back to what you’re doing.”
3. Clarify values
“What matters to you in your relationships? What kind of friend or family member do you want to be?”
Client: “I want to be kind and supportive.”
4. Act with the thought present
“Even with this thought here, what’s one small action you could take that reflects that value?”
Client: “I could send a message to my friend to check how they’re doing.”
So which approach is right?
Both CBT and ACT are effective, and the choice between them often depends on the individual’s needs and preferences. CBT may be a better fit for those who feel a strong need for practical, problem-solving tools to manage their thoughts. ACT may resonate more with those who are open to mindfulness and value-driven living, especially if they’ve struggled with trying to control their thoughts in the past.
Ultimately, whether you choose CBT or ACT, both approaches can provide meaningful pathways to greater mental well-being. If you’re a practitioner, understanding these differences can help you tailor your approach to meet the unique needs of your clients.
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