Cognitive behavioural therapy (CBT) vs acceptance and commitment therapy (ACT)

Cognitive behavioural therapy (CBT) A structured, practical form of talking therapy. It's built on a simple idea: what you think affects how you feel, and both affect what you do. More in the jargon decoder and Acceptance and commitment therapy (ACT) A practical talking therapy, said as the word "act". It helps you live well alongside hard thoughts and feelings, instead of waiting for them to go away first. More in the jargon decoder are two of the most common talking therapies in Australia. They’re close relatives, and a lot of therapists use both.

The biggest difference is what they do with a painful thought:

CBT helps you check whether the thought is accurate, and replace it with a more balanced one.
ACT spends less time on whether the thought is true. It helps you step back from the thought and act on what matters to you, whether the thought goes away or not.

For most common problems, research finds they work about as well as each other. So the choice usually comes down to which way of working makes more sense to you.

The same problem, two approaches

Say you’ve started turning down invitations. Before each one you think I’ll have nothing to say and people will notice. You feel anxious, you stay home, and the relief makes staying home seem like the right call.

In CBT, you’d look at that thought closely. What’s the evidence you’ll have nothing to say? What happened last time? What would you tell a friend who said the same thing? Then you’d test the thought by going to something small and seeing what actually happens. The aim is a more accurate thought, and less anxiety as a result.

In ACT, you’d notice the thought without arguing with it. I’m having the thought that I’ll have nothing to say. You’d practise letting the anxiety be there. Then you’d think about what these friendships mean to you, and go along for that reason, anxious or not. The aim is a fuller life. The anxiety often eases along the way, and ACT treats that as a side effect rather than the goal.

Both approaches get you out the door. They give you different reasons for going.

Side by side

	CBT	ACT
Main question about a thought	Is it accurate?	Is holding onto it helping?
What it tries to change first	The thought itself	How much the thought runs things
Main aim	Less distress	A life that fits your values, with or without the distress
Typical tools	Writing down and checking thoughts, testing predictions, facing fears step by step	Noticing thoughts without arguing, Mindfulness Paying attention to what's happening right now, including what you feel, without being pulled into the past or the future, and without acting on it straight away. Several therapies teach it, including ACT and DBT. More in the jargon decoder , working out your values
Between sessions	Usually, often written	Usually, often practice
Typical length	About 8 to 20 sessions	About 8 to 16 sessions

The lengths are rough. Both are used in shorter and longer forms.

What the evidence says

CBT has the largest evidence base of any talking therapy, built up over more than 50 years. Most guidelines recommend it first for anxiety, depression, panic, obsessive compulsive disorder (OCD) and insomnia.

ACT’s evidence is younger and smaller, and it has grown fast. A 2020 review of 20 earlier reviews found ACT helped with anxiety, depression, substance use and chronic pain. When ACT was compared directly with CBT, the difference was very small (Gloster and colleagues, 2020).

The small gap between them fits a wider pattern. When established therapies are compared with each other, rather than with no treatment, the differences are usually small. The relationship with your therapist tends to matter more than which of the two they use. Why who you see matters more than what they do goes into this.

For some specific problems, CBT has the more tailored evidence. OCD, panic and insomnia each have a version of CBT designed for them. ACT is especially well supported for chronic pain.

How people choose

The lists below describe preferences, not rules.

CBT often makes sense to people who

like evidence and logic, and want to test their thinking
have a clear, specific target, such as panic attacks or a particular fear
want a set structure with clear steps

ACT often makes sense to people who

can already see their thoughts are unreasonable, and still feel them completely
are tired of trying to get rid of a feeling before getting on with life
are living with something that won’t fully go away, such as pain, illness or loss
are drawn to working out what matters to them

The Approach (modality) The kind of therapy someone uses, such as CBT or psychodynamic therapy. You'll also see it called a modality. More in the jargon decoder that matches your personality isn’t always the one that helps most. Someone very analytical can get a lot from an approach that asks them to stop analysing for a while. Why the obvious match isn’t always the right one explains why.

If you’ve done one of them already

ACT comes at a thought from a different angle to CBT. Some people who found that challenging their thoughts didn’t change how they felt get more from ACT.

The reverse happens too. Someone who found ACT too loose can do well with the tighter structure of CBT.

Sometimes neither reaches far enough — the patterns feel old, or keep repeating in relationships. Therapies that spend more time on your history may suit you better then. Schema therapy is one of them.

Getting either in Australia

Both are widely available from Psychologist Someone trained to assess mental health problems and treat them with therapy. It takes at least six years of study and supervised practice, and they're registered with Ahpra, the national regulator. Psychologists can't prescribe medication. More in the jargon decoder , Counsellor Someone trained to help people talk through and work on difficulties. The title isn't protected in Australia, so it's worth checking a counsellor's training and registration. Medicare doesn't give a rebate for counsellors. More in the jargon decoder , Psychotherapist Someone trained in therapy, often for longer-standing patterns. Like counsellor, the title isn't protected in Australia, and Medicare doesn't give a rebate for psychotherapists. More in the jargon decoder , mental health social workers and occupational therapists. Both work in person and by Telehealth A session by video or phone instead of in person. Medicare gives the same rebate for a session by video as in person. More in the jargon decoder .

A Mental Health Treatment Plan A document your GP writes with you. It makes you eligible for a Medicare rebate on up to ten individual sessions a calendar year: six, then a review with your GP, then the remaining four. The plan itself isn't therapy. More in the jargon decoder from your GP (general practitioner) For most people, where getting help starts. A GP can write a Mental Health Treatment Plan, prescribe medication and refer you on, and some are trained to deliver a small number of structured therapy sessions themselves. More in the jargon decoder gives you up to ten Medicare-rebated sessions a calendar year. That applies to psychologists, Mental health social worker A social worker with an extra mental health accreditation. They're trained in therapy, and in the practical things around it, such as housing, money, family services and the systems people get stuck in. More in the jargon decoder and mental health occupational therapists. It doesn’t apply to counsellors or psychotherapists.

Medicare Australia's public health insurance scheme. For mental health, it gives rebates on sessions with psychologists and some other professionals, usually through a Mental Health Treatment Plan. More in the jargon decoder keeps a list of approaches Registered For psychologists, psychiatrists and occupational therapists, registration with Ahpra is required, and using the title without it is an offence. Counsellors and psychotherapists can register with their national associations, which is voluntary. More in the jargon decoder psychologists can use under the plan. CBT is on it. ACT isn’t named, and in practice it’s commonly offered under the plan as part of CBT.

Many therapists blend the two. Asking a therapist how they’d work with you usually tells you more than asking which label they use.

If you’re still working out whether you want therapy at all, what therapy actually is covers the basics, and would I benefit from therapy? helps you work out whether it’s worth a try.