Caution: The Differences Between CT and ACT May Be Larger (and Smaller) Than They Appear

doi:10.1016/j.beth.2009.09.005

Behavior Therapy

Volume 44, Issue 2, June 2013, Pages 218-223

https://doi.org/10.1016/j.beth.2009.09.005 Get rights and content

Abstract

Hofmann, Asmundson, & Beck (2013--this issue) offer an overview of cognitive-behavior therapy (CBT) as well as its similarities and differences from so-called “third-generation” behavior therapies, particularly Acceptance and Commitment Therapy (ACT). In this commentary we suggest that CBT is most accurately viewed as a broad family of distinct psychotherapy models that includes the traditional Beckian approach of cognitive therapy as well as newer acceptance-based approaches such as ACT. We argue that Hofmann, Asmundson, & Beck's discussion of the differences in CT and ACT's view of the causal role of cognition lacks clarity. For instance, the behavior analytic framework of ACT does not categorically deny any causal role of cognitions in behavioral and emotional responses. Similarly, we disagree with the authors’ contention that CT utilizes primarily antecedent-focused and ACT employs response-focused emotion regulation strategies. In addition, we take the view that the empirical evidence for CT, although very impressive, does not reduce the impetus to innovate. We object to some of Hofmann, Asmundson, & Beck's interpretation of component and mediational analyses and argue that the field does, in fact, need to question CT's postulated mechanism of action (i.e., cognitive change), both on theoretical and pragmatic grounds. At the same time, although preliminary research on ACT is promising, we suggest that its proponents need to be appropriately humble in their claims. In particular, like CT, ACT cannot yet make strong claims that its unique and theory-driven intervention components are active ingredients in its effects. We conclude that the fundamental differences between CT and ACT are philosophical and theoretical rather than technological.

Highlights

► CBT is best viewed as a broad family of psychotherapy models, including both CT and ACT. ► ACT theory does not preclude all notions of cognitive causation. ► Despite recent progress, mechanisms underlying both CT and ACT remain unclear. ► CT and ACT share many features, but also have important distinctions. ► The fundamental differences between CT and ACT are philosophical and theoretical.

Section snippets

The Causal Role of Cognition

Hofmann, Asmundson, & Beck (2013--this issue) correctly note that the key distinguishing feature of CT is the centrality of cognitive causes. They write, “Negative emotions and harmful behaviors are products of dysfunctional thoughts and cognitive distortions” (p. 6). They go on to claim that ACT affords no such causal role to cognitive factors:

This view is in stark contrast to other theorists who reject the notion that cognitions can cause emotions and behaviors (Wilson, 1997, Wilson et al.,

Antecedent vs. Response-Focused Emotion Regulation

We are intrigued by Hofmann, Asmundson, & Beck (2013--this issue) notion that traditional CBT strategies such as restructuring are antecedent-focused emotion regulation strategies (i.e., “strategies that occur before the emotional response has been fully activated”), whereas acceptance- and mindfulness-based strategies are response-focused strategies (i.e., strategies “to alter the expression or experience of an emotion after the response tendency has been initiated”; Gross, 1998). However, we

Outcome and Process

There is no doubt that considerable evidence has accumulated over the past three decades on the efficacy of CT for a wide range of conditions. Hofmann, Asmundson, & Beck (2013--this issue) correctly conclude that CT has unparalleled scientific support from large, well-controlled studies, and further imply that CT is highly effective and well established, and that ACT is neither. Although more limited efficacy data are available in the case of ACT relative to CT and proponents of ACT should

The Importance of Cognition

To illustrate the importance of cognition in the genesis and treatment of psychopathology, as well as in human behavior more broadly, Hofmann, Asmundson, & Beck (2013--this issue) contrast traditional behavioral learning theory accounts of various clinical phenomena with modern cognitive accounts. They argue that analyses that omit cognitive factors will be incomplete. The irony is that proponents of third-generation approaches would agree wholeheartedly with Hofmann, Asmundson, & Beck's

Concluding Thoughts

We have attempted elsewhere to compare and contrast CT and ACT, as prototypical models of so-called second-generation and third-generation CBTs, respectively, along philosophical, theoretical, and technological grounds (Forman & Herbert, 2009). Although there are indeed important differences along each of these dimensions, there is also a great deal of overlap. Comparisons of the models typically highlight distinctions, and common ground can be obscured. Ultimately, both CT and ACT aim to

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COMMENTARYCaution: The Differences Between CT and ACT May Be Larger (and Smaller) Than They Appear

Abstract

Highlights

Section snippets

The Causal Role of Cognition

Antecedent vs. Response-Focused Emotion Regulation

Outcome and Process

The Importance of Cognition

Concluding Thoughts

Behavior Therapy

Behaviour Research and Therapy

Journal of Behavior Therapy and Experimental Psychiatry

Clinical Psychology Review

Behavior Therapy

Journal of Anxiety Disorders

Clinical Psychology Review

Behavior Therapy

Journal of Behavior Therapy and Experimental Psychiatry

The use of acceptance and commitment therapy to prevent the rehospitalization of psychotic patients: A randomized controlled trial

Journal of Consulting and Clinical Psychology

On second thought: Where the action is in cognitive therapy for depression

Cognitive Therapy and Research

Cognitive therapy and the emotional disorders

The current state of cognitive therapy: A 40-year retrospective

Archives of General Psychiatry

Problems with the use of placebo conditions in psychotherapy research, suggested alternatives, and some strategies for the pursuit of the placebo phenomenon

Journal of Clinical Psychology

New directions in cognitive behavior therapy: Acceptance-based therapies

COMMENTARY
Caution: The Differences Between CT and ACT May Be Larger (and Smaller) Than They Appear