Cognitive Behavioral Therapy vs. Acceptance & Commitment Therapy: Coping with Negative Thought Patterns

Cognitive Behavioral Therapy vs.Being diagnosed with a health condition, quite frankly, sucks.

Most people, no surprise, aren’t happy with the news that they have a health problem that will require care and monitoring for months, years, or a lifetime. Receiving the news is an emotionally traumatic experience. Over time, there are other difficult moments, too:

  • Not being able to eat normally or having to take medication
  • Going to the doctor more often than other people
  • Enduring uncomfortable or even painful treatments
  • Feeling different or weird, especially with stigmatized conditions or if your peers are all healthy
  • Not seeing improvements in outcomes over time, even when you feel like you’ve done really well with your health

All of these bumps in the road mean it’s important to help people who have a chronic health issue cope with their emotional responses to their illness (as emphasized in the Chronic Disease Self-Management Program at Stanford). There are two distinct approaches used in behavioral health that approach acceptance and changing negative thoughts from different angles.

Acceptance and Commitment Therapy (ACT)

Acceptance and Commitment Theory (ACT) is a clinical approach to helping people cope with negative thoughts and feelings. The central idea in ACT is that people exist “in context.” Our thoughts and feelings are affected by the events we experience, the people we meet, and the environment we live in. An example of context is getting a diagnosis of diabetes, which leads to negative feelings. The feelings don’t just arise out of nowhere. They happen because of a situation we encounter.

Another concept in ACT is that our core values  drive our actions. So, a person who values responsibility will make choices reflecting that, and those choices might be different from someone who values creativity. ACT teaches that we should recognize negative thoughts and feelings, accept them, and then let them go. In other words, we shouldn’t dwell on things we can’t control. Instead, we should focus on making choices that support our values.

Many traditional cognitive behavioral approaches set out to help people recognize and then change unwanted thoughts and behaviors. ACT is different. It says we should accept those thoughts, not necessarily change them. How do you know when to accept a negative thought and when to try to change it?  Here’s a rule of thumb: ask yourself if the situation can be changed. You can’t change having many health conditions, so you might want to accept feelings of sadness, anger, or fear… and then let them go. On the other hand, you can change the way you interpret your experiences with your health condition. So that might be a time to use a cognitive behavioral technique instead.

Cognitive Behavioral Therapy (CBT)

Cognitive behavioral therapy is about learning to recognize negative thinking patterns and replace them with more adaptive ones; this then helps people behave in more goal-consistent ways and reduces emotional distress. This technique addresses the connection between a person’s thoughts (cognitions), behaviors, and emotional experiences. Our thoughts and attitudes are a real part of the environment that we react to, and may affect both our emotions and our behaviors. Being able to recognize maladaptive thoughts, and the harmful ways in which they affect feelings and actions, can help improve a person’s functioning. Changing thoughts and attitudes can be an important part of changing one’s behavior.

CBT is a useful tool for depression, anxiety, insomnia, and other behavioral health issues due to its superior outcomes. Although cognitive behavioral therapy is typically thought of in a behavioral health context, maladaptive thinking patterns may affect people’s behavior related to many health conditions. Consider someone who is trying to lose weight, and “gives up” after eating a plate of donuts or skipping a run. Negative thoughts like “I’ll never lose weight at this rate, so I might as well do what I want” may lead to further bad decisions. They will certainly lead to feelings of emotional distress.

The key is to help people identify and combat negative thinking. Helping people to not only identify where these thought patterns are present but also what the antecedents to these thoughts are can help to address and break the habitual patterns that often exist in individuals. Some of these include errors of generalization, all-or-nothing thinking and perceived external locus of control. CBT lends itself to specific activities and exercises that a user can practice on his or her own. It is important to set expectations with users that changing negative thinking patterns takes time and effort, and that early attempts are likely to be difficult. To achieve long-term success with CBT, a user or patient must practice the techniques regularly until they become almost automatic.

Can these techniques help you cope with something you’re dealing with? Can you use them to help someone else?

Key References

Acceptance and Commitment Therapy (ACT)

Biglan, A., Hayes, S.C., & Pistorello, J. (2008). Acceptance and commitment: Implications for prevention science. Prevention Science, 9(3), 13-152. DOI: 10.1007/s11121-008-0099-4.

Hayes, S.C. (2004). Acceptance and commitment therapy, relational frame theory, and the third wave of behavioral and cognitive therapies. Behavior Therapy, 35(4), 639-665. doi:10.1016/S0005-7894(04)80013-3.

Roemer, L. & Orsillo, S.M. (2009). Mindfullness & Acceptance-Based Behavioral Therapies in Practice. The Guilford Press, New York.

Cognitive Behavioral Therapy (CBT)

Beck, A.T., & Alford, B.A. (2009). Depression: Causes and Treatment (2nd ed.). Philadelphia, PA: University of Pennsylvania Press.

Bedrosian, R.C., & Beck, A.T. (1980).  Principles of cognitive therapy.  In M.J. Mahoney (Ed.), Psychotherapy process: Current issues and future directions.  New York:  Plenum.

Butler, A.C., Chapman, J.E., Forman, E.M., & Beck, A.T. (2006). The empirical status of cognitive-behavioral therapy: A review of meta-analyses. Clinical Psychology Review, 26(1), 17-31.