ACT and CBT

Many people are familiar with a therapeutic approach known as CBT (cognitive behavioral therapy). It is well documented by research that CBT is an effective treatment for many sorts of mental disorders. Basically, clients gain a greater sense of self-awareness through CBT learning skills like mindfulness. They are taught to identify negative thought patterns and replace them with alternative thoughts which promote greater health.

Central to the CBT model is the belief that negative thoughts are responsible for creating the context for the symptoms of the client’s mental disorder to grow. Now, there is no arguing that CBT is effective. Research has proven so time and again and most insurance companies specifically ask providers if they practice this method.

However, there are some clinical reasons to second guess the use of CBT. Here are some questions that I have and that reflect a growing body of clinical critiques of CBT. Should we assume negative thoughts always precede negative emotions? If so, why does research demonstrates CBT is largely ineffective with depression? Should we assume that every negative thought is “pathological?” If so, what about the psychological scars that may be a part of a person’s experience of past abuse and trauma? Why would a CBT therapist work with a client to “reframe” them when reality is that they are quite accurate in many cases.

CBT is a pragmatic and sometimes useful tool but it has a serious limitation in that it seeks to create within a client’s experience a sort of “idealist” version of their world. In essence, a core piece of CBT work seeks to sever the relationship between what is and what we hope things to be in this world. And, the last time I turned on the news, “what is” in this world has not improved at all. Maybe it’s time we learned to quit avoiding what we experience and learn to cope with it in a way that allows us to move forward with life even though this world is not what we hoped.

That is why ACT (acceptance and commitment therapy) make so much sense to me as a person and a practitioner. I take notice when the Veteran’s Administration spends a lot of money researching what works with people who have serious trauma, addictions, and depression. It’s impossible to “reframe” what happened to a lost mate in combat or a missing limb. Reality is that these things are what they are. ACT has taught me as a person and a practitioner that it is the struggle (i.e. avoidance) of our negative thoughts that is most responsible for the mental anguish we experience.

The research evidence for ACT (now a 30 year old therapeutic method) continues to validate its effectiveness. More, it is a therapy that grounds us in the world in which we live. If one learns the skills of ACT, they will discover an application to a wide variety of circumstances. In the real world many people do not experience a full remission of symptoms of depression, anxiety, or addictive cravings. ACT will help you to accept that this truth does not mean you cannot go on living and even thriving. Learn how to stop obsessing over those things which may be beyond our control. Instead, create new lifestyle patterns and healthier choices. Be present in the moment without having to fight unnecessarily against thoughts or feelings that you might be experiencing.

Author: Eric Greer, MS LMFT

I'm a licensed marriage and family therapist and have been practicing since 1995. I am the sole owner of Restoration Community Counseling in Kingston, MA. My primary areas of practice include couples, post-traumatic stress, anxiety, depression, and veteran's issues.

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