Whilst we’ve seen some progress towards process based CBT and a more integrated approach to the different forms of cognitive behavioural therapy, there is still a tendency towards CBT “separatism”. In particular, some proponents of the ACT model argue that Acceptance and Commitment Therapy is fundamentally different or superior to other forms of CBT. Drawing on philosophical differences between functional contextualism and the rational - empirical school, ACT purists argue that conceptual differences prevent an integrated approach to CBT.
In this brief article I wanted to offer an alternative perspective that supports the process based approach brilliantly outlined in Steve Hayes’ recent book “Process Based CBT”.
How ACT and Mainstream CBT Work Together
ACT focuses on process and perspective in thinking, including the rules of language in thought construction. so in other words – how we think, rather than what we think.
CBT focuses on content, process, and perspective. So in other words what we think and how we think.
For many psychological problems, it’s often important to integrate content, process and perspective when altering the clients relationship with unhelpful or problematic cognitions.
When working with panic disorder for example, it’s helpful to challenge irrational thoughts about cardiac death, teach the client to notice and normalise their reactions to catastrophic thoughts and reframe the thoughts as an oversensitive internal alarm system.
Thought challenging and defusion are different ends of the same cognitive continuum. I think it’s unhelpful to present them as opposites, when we can help our clients to see them as complimentary alternatives to changing their relationship with thoughts.
In my personal experience as a practising clinician, clients often (but not always) need to challenge the content of their thoughts en route to defusion. Sometimes we need to know what we are letting go off before we let go of the cognitive and behaviour struggle.
In the UK,ACT is professionally recognised by the BABCP as a third wave cognitive behavioural therapy.
It’s important to learn the ACT disciplines of defusion and acceptance, whilst recognising that this does not exclude appropriate thought challenging.
As you can tell, I am a CBT integrationist, not an ACT separatist!
I know that there are philosophical differences between CT and ACT, however we should acknowledge these differences rather than using them to mutually exclude the other approach.
There are enough anti-CBT publicists primarily from the psychoanalytic tradition and its derivatives, without perpetuating the problem by entering our own into internecine battles.
ACT, CT, CBT, DBT, IBT, MBCT and REBT all share the same therapeutic tradition and approach. in the UK each of these approaches is acknowledged as a first, second or third wave form of cognitive behavioural therapy. If we support the emerging process based CBT strategy, they are all methodologies with an established CBT tradition that spans back to the 1950s.
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