ACT vs. DBT: What's the Difference?
Acceptance and Commitment Therapy (ACT) and Dialectical Behavior Therapy (DBT) are two widely-used types of Cognitive Behavioral Therapy (CBT). While these two modalities share a few similarities, they involve very different therapeutic techniques.
ACT vs. DBT: What’s the difference? And which modality is a better fit for your needs? Keep reading to learn more.
What Is ACT?
Acceptance and Commitment Therapy (ACT), as stated in the name, focuses primarily on acceptance strategies. Instead of trying to change a patient’s feelings, ACT works to help the patient understand them. “ACT can be good if you feel you are pretty good at getting through day to day life with general ease, but perhaps are struggling more with a sense of meaning and purpose,” says Jason Jones, PhD.
Conditions frequently treated with ACT include:
Depression
Eating disorders
Obsessive-Compulsive Disorder (OCD)
Substance use disorder
Alcohol use disorder
“ACT in particular focuses on letting go of emotional control while retaining the ability to take action in the way you choose,” says Dr. Jones. It helps patients to take control of negative thoughts and reframe them instead of ruminating.
What Does a Session Using ACT Techniques Look Like?
ACT techniques are used in therapy sessions to promote mindfulness, explore values, and more deeply understand core emotions. “In an ACT session, you might use a metaphor to explore why controlling emotions can be an ineffective response,” says Dr. Jones. “You might also find yourself practicing a skill to allow for more acceptance of thoughts and feelings, to clarify values, or to explore making good on commitments to your life’s purpose in the face of confusion or overwhelming feelings.”
Dr. Jones says that he’s seen the benefit of ACT techniques both in and out of session. “I know these approaches are helpful not just because of what I see in work with clients, but when I use them in my own life. I have used ACT skills to help me figure out how to make my life feel more full when it becomes mundane. I have also found ACT helpful in detaching from unhelpful cultural narratives about gender, mental health, success, and self-esteem so I can be more connected to my personal values.”
What Is DBT?
Dialectical Behavior Therapy (DBT) is a practical, hands-on type of therapy that works to help patients acknowledge where they are and their current challenges while developing awareness of the benefits of change—and working toward that change through action steps. It was first designed for people experiencing personality disorders, specifically Borderline Personality Disorder (BPD). However, according to Will Fairchild, LCSW, it has since been found to be helpful in treating a wide variety of presenting problems.
“I have found it helpful for all clients regardless of diagnosis,” says Fairchild. “Folks who have experienced trauma or have a trauma diagnosis can benefit from learning how to regulate their emotions and communicate with others, two areas that can be impacted from these experiences. Someone with anxiety can be supported through learning mindfulness exercises to help stay present and grounded in the current moment, or someone with Obsessive-Compulsive Disorder (OCD) can benefit from interrupting compulsive behaviors by using distress tolerance techniques instead. DBT is based in Buddhism which makes it very practical and versatile for a variety of diagnoses, symptoms, and needs.”
Conditions frequently treated with DBT include:
Borderline Personality Disorder (BPD)
Obsessive-Compulsive Disorder (OCD)
Anxiety
Post-Traumatic Stress Disorder (PTSD)
Depression
Self-harm
Suicidal behavior
Eating disorders
Substance use disorder
“DBT is a very versatile modality,” Fairchild continues. “Because the skills it offers are practical and structured, it makes it great for anyone participating in therapy regardless of diagnoses, symptoms, or issues.”
What Does a Session Using DBT Techniques Look Like?
As DBT is a very actionable style of therapy, Fairchild says that a session can look very structured. Often, a therapist and their patient will go through a DBT workbook together for a set number of sessions, reading through various chapters and discussing skills, concepts, and application. The client intentionally practices the skills discussed between sessions to gain insights into the techniques that best fit their life and needs, and troubleshoot challenges or difficulties with their therapist in session.
For example, Fairchild says that a client struggling with emotional outbursts and dysregulation toward their partner might benefit from learning and practicing emotion identification, expression, and regulation, including working with a therapist to identify specific skills to regulate targeted emotions and role playing communication techniques in session to express needs in a more healthy manner. Moving forward, that client might notice decreased conflict with their partner, but also overall improvement of mood and lower anxiety and depression symptoms as a result of feeling more in control of their emotions.
For therapists who may choose to simply incorporate select DBT techniques throughout their sessions, there are a number of different approaches. Therapists may incorporate a DBT skill without specifically stating that they’re doing DBT therapy. Moment to Pause, Radical Acceptance, Ride the Wave, and I Feel Statements are all common skill techniques used in conjunction with a variety of therapeutic modalities.
What Do ACT and DBT Have in Common?
Though ACT and DBT are different treatment approaches, they have similar core intentions. “Both approaches balance the need for change and acceptance when facing life’s difficulties,” says Dr. Jones. “Each approach focuses on accepting reality as it is using mindfulness skills while also working to change behaviors so that they align with a person’s values and their path to a meaningful life.”
He also shares that both approaches see showing up and having different kinds of experiences as more effective than just sitting and thinking about life. There is an emphasis on action—on intentional change and doing things differently.
Both modalities are based in mindfulness and staying in the present moment. “They ask folks to face and accept reality for what it is, learn to get comfortable being uncomfortable, and focus more on behavioral changes rather than modifying or challenging thoughts or beliefs,” says Fairchild. “They both work to support people in creating a life worth living.”
ACT vs. DBT: What’s the Difference?
Despite their similarities, ACT and DBT are very different types of therapy. Dr. Jones says that this difference can most easily be summed up by the fact that DBT tends to lean into “change strategies,” whereas ACT focuses primarily on “acceptance strategies.”
According to Fairchild, ACT works to support flexible thinking as well as helping patients live in accordance with their values. It encourages looking at thoughts and feelings with curiosity and recognizing that just because someone thinks something doesn’t mean it’s true, and just because someone feels something doesn’t mean it’s real. This change in thinking about feelings and emotions then helps develop behavioral changes that support value alignment to ultimately decrease the potential for distressing thoughts or emotions.
Meanwhile, he says that, as DBT is very practical and skills-based, it primarily helps patients learn techniques to help identify and regulate emotions, improving effective communication and increasing the patient’s ability to sit with distress and live in the present moment. “DBT can be good if your suffering has been more intense and life has felt more chaotic or stuck,” says Dr. Jones, as its practicality helps patients begin to move forward.
Gain Emotional Freedom Through Evidence-Driven Support With Aspire Psychology
Whether you’re struggling with rumination, anxiety, trauma symptoms, or obsessive-compulsive cycles, change is possible. At Aspire Psychology, our expert therapists in Portland, Oregon are ready to provide compassionate care through modalities like ACT, DBT, and beyond.
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