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Integrating ACT approaches into CBT practice: finding the balance

In the field of psychotherapy, cognitive behavioural therapy (CBT) and acceptance and commitment therapy (ACT) are two prominent approaches that have gained recognition for their effectiveness in treating various mental health conditions. While CBT focuses on changing negative thought patterns and behaviours to improve emotional well-being, ACT emphasises acceptance of thoughts and feelings while committing to actions aligned with personal values. 

A common question frequently posed to us by CBT therapists is whether they can incorporate ACT into their practice. CBT therapists are often intrigued by ACT tools, techniques, and concepts as they perceive it as offering a fresh and valuable perspective within a CBT framework. The question of whether ACT can be integrated into a CBT model is a very interesting one and definitely worth considering.  

Integrating models: salads and watch making

There are two approaches that can be considered when deciding whether to integrate techniques from another model: the salad approach and the watchmaker approach. The salad approach, stemming from an eclectic method, involves a practitioner combining their preferred ingredients, much like assembling a salad with tomatoes, cucumbers, and dressing that suit their taste. This approach results in a therapeutic style driven more by personal preferences than by theory and research. On the other hand, the watchmaker approach, or an integrative method, entails carefully selecting tools and techniques that fit into an overall concept, akin to a watchmaker assembling various parts into a functioning mechanism. An integrative practitioner utilises theory, knowledge, and formulation to choose appropriate tools and techniques for their therapeutic practice. We recommend that an integrative approach is more suitable for determining whether ACT can be utilised within a CBT framework. 

The benefits of integration

Integrating ACT approaches, tools, and techniques within a CBT practice can offer a more holistic and flexible approach to therapy. By incorporating ACT principles, therapists can enhance their ability to help clients develop psychological flexibility and resilience. This integration allows for a deeper exploration of values, mindfulness, and acceptance, complementing the cognitive restructuring and behavioural strategies of CBT.  

One area where integrating ACT into CBT can be particularly beneficial is in working with clients who struggle with experiential avoidance. CBT may sometimes focus heavily on challenging and changing thoughts, leading to a potential avoidance of difficult emotions or sensations. By incorporating ACT techniques such as mindfulness and acceptance, therapists can help clients develop a more compassionate and accepting stance towards their internal experiences. 

Moreover, ACT’s emphasis on values-based living can complement CBT’s focus on goal setting and behaviour change. By helping clients clarify their values and take committed action towards them, therapists can facilitate long-lasting changes that are meaningful and fulfilling for the individual. 

What ACT tools and techniques could I use in my CBT sessions?

Here are some key ways ACT techniques could be brought into CBT work: 

Mindfulness exercises: Incorporate mindfulness techniques, such as mindful breathing or body scans, at the beginning or end of CBT sessions to help clients develop present-moment awareness and acceptance of their thoughts and feelings. 

Values clarification: During the goal-setting process in CBT, encourage clients to connect their goals to their core values. Help them identify what truly matters to them and how their goals align with these values, promoting a sense of purpose and direction. 

Cognitive defusion: Introduce cognitive defusion techniques from ACT to help clients distance themselves from unhelpful thoughts in CBT. This can involve acknowledging thoughts as mental events rather than facts, reducing their impact on emotions and behaviour. 

Experiential acceptance: Encourage clients to practice accepting uncomfortable emotions or sensations without judgment during exposure exercises in CBT. This can help clients build tolerance to distressing experiences and reduce avoidance behaviours. 

Committed action: In CBT behavioural experiments, focus on promoting committed action aligned with clients’ values. Encourage clients to take small steps towards their goals, emphasising the importance of persistence and flexibility in the face of challenges. 

Metaphors and stories: Use metaphors and storytelling techniques common in ACT to illustrate key CBT concepts. Analogies like “being the passenger, not the driver of your thoughts” can help clients understand the distinction between thoughts and self.  

Potential pitfalls

It is essential to recognise that integrating ACT into CBT may not be suitable for every client or every therapeutic situation. Some clients may prefer the structured and problem-focused nature of CBT and may not resonate with the more experiential and acceptance-based approach of ACT. In such cases, a more traditional CBT approach may be more appropriate. 

An area that requires particular attention is how each model approaches thoughts. Cognitive therapy focuses on challenging and seeking evidence for thoughts to generate new, more helpful thoughts. In contrast, the ACT model prioritises understanding how a thought functions within its context, emphasising contextual work instead of directly altering the thought itself. This may entail exploring the usefulness of a thought rather than its truth value. 

Furthermore, while both ACT and CBT share common goals of reducing psychological distress and improving well-being, they differ in their theoretical underpinnings and therapeutic techniques. CBT is rooted in the cognitive model, focusing on changing dysfunctional thoughts and behaviours, whereas ACT is based on relational frame theory and contextual behavioural science, emphasising acceptance, mindfulness, and values. 

The wrap up

Integrating ACT approaches into CBT practice can offer a valuable expansion of therapeutic tools and techniques. By understanding the differences and similarities between these two approaches, therapists can create a more nuanced and personalised treatment plan that addresses the unique needs and preferences of each client. Finding the right balance between cognitive restructuring and acceptance-based strategies can lead to a more comprehensive and effective therapeutic intervention. 

 

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