A randomized controlled effectiveness trial of acceptance and commitment therapy and cognitive therapy for anxiety and depression.
ACT equals cognitive therapy for adult anxiety and depression, but works through acceptance instead of thought correction.
01Research in Context
What this study did
Researchers randomly assigned 101 adults with anxiety or depression to two therapy groups. One group got acceptance and commitment therapy (ACT). The other got standard cognitive therapy (CT).
Both groups met over the study periodly sessions. Therapists followed manuals. Clients filled out mood and quality-of-life forms before, during, and after treatment.
What they found
Both therapies cut anxiety and depression by a lot. ACT and CT scored the same on every measure.
The big difference was inside the black box. ACT clients got better by learning to let thoughts come and go without fighting them. CT clients got better by changing the content of negative thoughts.
How this fits with other research
Kaufman et al. (2010) ran the same ACT-vs-CT race with college students who had eating disorders. ACT won big that time. The 2007 study shows the tie happens in mood disorders, so the winner may depend on the problem you treat.
Higgins et al. (2021) moved ACT online. Their pilot kept the good results, proving you can deliver ACT through a screen when clinic space is tight.
Tyndall et al. (2020) sorted clients into three flexibility levels. Low-flex clients match the people Plant et al. (2007) saw—those who avoid feelings. ACT gives these clients a clear skill set.
Why it matters
You now have two evidence-based choices for adult anxiety and depression. Pick ACT when avoidance, not negative content, drives the behavior. Use quick flexibility screens to spot these clients and keep ACT manuals on your shelf.
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02At a glance
03Original abstract
Acceptance and commitment therapy (ACT) has a small but growing database of support. One hundred and one heterogeneous outpatients reporting moderate to severe levels of anxiety or depression were randomly assigned to traditional cognitive therapy (CT) or to ACT. To maximize external validity, the authors utilized very minimal exclusion criteria. Participants receiving CT and ACT evidenced large, equivalent improvements in depression, anxiety, functioning difficulties, quality of life, life satisfaction, and clinician-rated functioning. Whereas improvements were equivalent across the two groups, the mechanisms of action appeared to differ. Changes in "observing" and "describing" one's experiences appeared to mediate outcomes for the CT group relative to the ACT group, whereas "experiential avoidance," "acting with awareness," and "acceptance" mediated outcomes for the ACT group. Overall, the results suggest that ACT is a viable and disseminable treatment, the effectiveness of which appears equivalent to that of CT, even as its mechanisms appear to be distinct.
Behavior modification, 2007 · doi:10.1177/0145445507302202