The Cognitive Behavioral Therapy

Major Tenets of Cognitive Behavioral Therapy

Cognitive Behavioral Therapy (CBT) comprises a short-term psychotherapeutic treatment that is oriented towards changing patterns of destructive thinking or behavior behind a person’s difficulties and thereby changing how they feel. By definition, Cognitive Behavioral Therapy (CBT) is the intentional implementation of methodological rigor, applied within behavior-altering procedures and cognitive processes to elicit adjustment (Benjamin et al., 2011). Succinctly, internal thoughts are perceived as the mechanisms for change. Despite therapy always being tailored to an individual patient, there are specific principles that underlie cognitive behavior therapy for all patients. These central tenets are implemented by a psychologist or interventionist to understand a patient’s difficulties and use this understanding to conduct a therapy session and plan treatment effectively. The principle tenets of Cognitive Behavioral Therapy include:

1. CBT is anchored on an always-evolving formulation of a patient’s problems, and the succinct conceptualization of each individual patient in cognitive terms.
2. Effective CBT orientation requires a basis of a good client-therapist professional relationship.
3. CBT is problem-centric and goal-oriented.
4. CBT initially emphasizes the present.
5. CBT emphasizes collaboration and active participation.
6. CBT emphasizes relapse prevention and is inherently educative.
7. CBT teaches a patient to identify, evaluate, and address their dysfunctional belief system and thoughts. It ultimately teaches a patient to be their own therapist.
8. CBT sessions are structured.
9. CBT aims to be time-limited.
10. CBT uses diverse techniques tailored specifically to change the mood, thinking, and behavioral processes of a patient (Beck & Beck, 1995).

CBT ultimately aims at empowering an individual to take control of their lives, eliminate dysfunctional behaviors, and overcome destructive thoughts through psycho-education via a vast array of techniques that are specific to a diagnosis. In this approach, unconditional self-regard is extended to encompass the unconditional regard of others. This is congruent with strength-based values of social work, and the goal becomes to allow a client to resolve their issues and manage their life in a holistic, adaptive manner (Beck & Haigh, 2014). These tenets are applicable for all facets of cognitive behavioral therapy, including Acceptance and Commitment Therapy (ACT), which will be covered during this review.

The Acceptance and Commitment Therapy (ACT) was developed, comprising the third wave of CBT interventions to confront an inherent conundrum present within CBT. This anomaly was presented whereby contemporary psychologists generally conceded that conventional behavior therapy was vastly inadequate and that more efficient methods were required to address thoughts and feelings. However, the central conception of conventional cognitive behavioral therapy and cognitive therapy, which provides that cognitive change is critical for clinical improvement, is weakly supported (Hayes et al., 2006). ACT, along with other third-wave therapeutic interventions, addresses each of these core problems with the general goal of improving psychological flexibility; which is the ability to interact the present as a more aware human being, and to modify or retain behaviors where implementation serves a valued purpose.

Historical Development of the Theory(s) Associated with CBT Orientation

The advent of CBT can foundationally be traced to the earliest developments in the field of psychology as far back as 1913. A significant precursor to the CBT development was with the emergence of the Social learning theory by Albert Bandura (Bandura, 2004; Bandura, 2006). Unlike more conventional behavioral and psychodynamic views of psychological disturbance at the time, Bandura perceived people as actively and consciously interfacing cognitively with their environment. Bandura also introduced a grounding theory that cognitive mediation occurred in the behavioral cycle of stimulation-response which inherently suggested that people tend to think before they do (Bandura, 2006). In effect, this theory offered a new target for therapeutic interventions, and led to the eventual development of Cognitive Behavioral Theory.

Before cognitive behavioral therapy, as it is known today, there was a rather controversial approach that was termed as behavior therapy. Behavior therapy was grounded on two primary commitments; the empirical validation of specific interventions for specific problems, and the analysis of underlying problems and treatments for basic psychological processes (Hayes et al., 2006; Rachman, 2015). This approach initially comprised treatments done on youths to correct enuresis. The respondent conditioning strategies employed in this treatment led to a better understanding of anxiety, and consequently, the development of extinction, counter-conditioning, and habituation techniques (Hayes et al., 2006). The development of operant learning theory also significantly influenced the development of behavioral therapy and CBT development among child clients. From this theory, there arose the concept of positive and negative reinforcement in the context of childhood development. This deeper understanding of cognition that drives behavior contributed to a better comprehension of applicability within CBT.

CBT and its proper practice, however, may have begun in the 1960s. Dr. Beck designed and conducted experiments purposely to test psychoanalytic concepts with widely divergent results from mainstream psychotherapeutic procedures. He asserted that depressed patients reported a myriad of intrusive adverse thoughts that appeared to arise spontaneously (Hayes et al., 2006). Dr. Beck then categorized these intrusive thoughts into three primary categories; patients that have negative thoughts regarding themselves, their world, and their future (Hayes et al., 2006; Beck & Haigh, 2014). These findings led to a change in theory and the development of alternative ways to view depressive disorders.

The theory of cognitive distortion by Dr. Beck and Dr. Ellis’ Theory of Irrational Thinking helped significantly further comprehension of psychological problems. Dr. Beck theorized that these psychological problems arose due to the development of maladaptive processes in childhood, with this theory primarily grounded within the cognitive triad (Beck et al., 1991). On the other hand, the Theory of Irrational Thinking developed by Dr. Ellis was based on a set of pre-defined irrational assumptions. The terms employed to define these assumptive patterns were also loosely linked to rudimentary cognitive psychology, such as ‘schemas’ (Ellis, 1962). Dr. Beck, with his approach, started helping his patients reassess their thoughts and perceptions about themselves, finding out that the clients developed better resilience for handling their routine functions, and was sustainable for longer. While the efficacy of the approach has been evaluated and debated (Butler et al., 2006), it has become a treatment modality that is characteristic of cognitive behavioral therapy and is highly regarded as a therapeutic approach.

Steven Hayes, a psychology professor, developed the Acceptance and Commitment Therapy (ACT) model in 1986 on the curiosity of how language and thought influenced an individual’s inherent experiences. This would provide the backdrop for the development of ACT as it is practiced in contemporary settings (Harris, 2011). Hayes challenges the assertion that pain and suffering are to be buffered and avoided whenever possible. Instead, his position saw pain as an indelible and inescapable part of the experience of being a human being, as well as a source of fulfillment whenever an individual confronts what most scares them (Hayes et al., 2006). He makes a rather compelling case for the development of acceptance and self-compassion, which is rooted in his own experience and psychological exploration of ACT.

Philosophical Foundations of Theory

A variety of research extensively supports CBT as a non-pharmaceutical intervention with a high efficacy in the treatment for psychological disorders. Several philosophical traditions ground the CBT approach, stemming essentially from the researchers and scholars that helped to develop and popularize the different facets of CBT. It is, therefore, essential to review the different philosophical foundations on which this therapeutic approach is based. The following philosophies have been identified in scholarly works as influential to the development of various facets of CBT.

Aristotle and the Stoics are credited to be a critical influence to Ellis, who is credited with significantly developing CBT theory, has central Stoic ideas. The most prominent is about the belief that the current situation is responsible for the current psychological state. The second primary theory regards agency, which dictates that an individual can only do what they can, and if a situation spirals out of control, then it would be best to let it go (Murguia & Díaz, 2015). To better understand Stoic philosophy, Aristotelian logic is applied to contextualize this philosophy. According to Aristotle, eudaimonia, which was the state in which individuals who flourished and lived well throughout their lives were said to enjoy, is contingent on factors beyond personal control and is, therefore, not accessible to every individual.

However, when detailing a good life, the Stoics, much like Aristotle, asserted that it was critical to question the standout features that define a human being. Reason was believed to play a fundamental role in a person’s well-being, as human nature is characterized by an ability to reason, and the choices made directly reflect rational knowledge (Murguia & Díaz, 2015). Furthermore, if rational thought is reasonably outlined in the implemented choices, then that is a viable metric to ascertain optimal functioning as human beings. It is through this reasonable ability that allows an individual to critically appraise the environment, identify challenges, and appropriately address them. Because of this emphasis on reason, Stoics believed in moderating human emotion as a vital element of achieving eudaimonia (Karwoski et al., 2006). Erroneous judgments can only be corrected through a level outlook and, therefore, a rational individual should question if it was within their power to change a disturbing situation. If it is, then they take appropriate action, but if it is not, then it is preferably best to not be perturbed as a reasonable intervention cannot be implemented to resolve the issue.

Taoism also has several tenets that are available in CBT theory, primarily the Taoist contempt of categorization, the Taoist definition of a living being honed with inherent practice, and the Taoist feeling of unity with the universe. Ellis (2007) outlines that the Taoist belief of anti-categorization is essential to the development of CBT theory. However, trying to define Tao constitutes a paradox, as a vital tenet of Taoism constitutes that Tao in indefinite. The anti-categorization impetus of Taoism, however, rejects categorizations and definitions as fossilized misrepresentations of what is always vitally changing. The universe is in a constant state of transformation, and therefore, this prevents people from forming conclusions about the ultimate nature of things (Murguia & Díaz, 2015). Admittedly, the human ability to define and categorize allows one to go through life easier, than without, but it does have inherent drawbacks.

Due to the ability to define and categorize, human beings will often tend to allow categorizations to overwhelm lived-in experiences. As a result, an individual will attempt to fit their experiences within their pre-determined notions of how that experience is supposed to be (Ellis, 2007). This action is a source of much human anxiety that Taoism warns about. Instead Taoist school of thought dictates that to define something is to anchor it in that moment, and the attempt to anchor that which is constantly evolving, such as a concept, a person, a relationship, or an experience, is bound to be problematic. Categorical judgments, besides being misguided, are, at times, dehumanizing whenever various elements in the immediate environment, including people, are forced to behave along rigid categories.

Another Taoist principle implemented in CBT theory is a concept that living is an activity in which human beings are consistently failing, but that which can be worked on. Ultimately, the activity becomes effortless, and a person becomes one with the activity (Murguia & Díaz, 2015). Living can be improved with practice, and sufficient practice allows human beings to transcend struggling through life, to enjoying living. This principle exemplified the notion of Wu Wei, which is the skill of paying attention to little details, and effortlessly nipping problems in the bud before they become insurmountable (Murguia & Díaz, 2015; Ellis, 2007). This notion of Wu Wei heavily mirrors the core principle of CBT, in which a therapist helps the client eliminate dysfunctional behaviors, and actively identify and address any problems.

Buddhism comprises another essential influence of CBT. Ellis (2007) outlines the importance of ancient Buddhist text that asserts the ultimate cause of suffering, and desire is a dysmorphic perception of self. Buddhist philosophy mirrors the Taoist principle that phenomena are void of an inherent existence. This means that, by believing in the permanence of the self, people result in taking themselves too seriously and sinking into egoism. According to a Buddhist school of thought, egoism leads individuals to develop strong feelings of aversion and desire, and ignore the impermanence of phenomena (Murguia & Díaz, 2015). This ignorance leads to an overemphasis on the identities of those who may be considered friends and enemies; ignoring that time changes everything, and in due time, dear friends can turn to foes, and enemies can turn around to help. This over-emphasis on the self also often leads human beings to try and control that which is out of their hands, and resultantly get an unhealthy level of anxiety when things do not go as planned.

This Buddhist philosophy of the “no-self view” is essential in the CBT approach to viewing life and relationships. It also, inadvertently, helps change the perception of time itself. By overemphasizing the future and allowing anxiety over what the future brings, human beings are in fact foregoing the moments in the present and wishing to be in a future time when these desires would presumably be sated (Murguia & Díaz, 2015). An approach in CBT to address anxiety is to ground the client in the present, through an approach heavily reflected in this Buddhist principle of the “no-self view.”

Existentialism also lends a significant influence to CBT. Under this philosophical foundation, CBT orientation takes an existential therapeutic approach where the client is burdened with an active role in their own therapeutic treatment. Ellis (2007) provides that if a client had a history being a specific type of person, then he or she can choose how they work, think, act, and feel by creating deep and lasting changes to themselves. The primary existentialist tenet is that human beings are inherently not with fixed properties. Therefore, a person’s identity cannot be defined by culture, nor by nature, and there is no pre-determined role allocated for an individual to fulfill (Ellis, 2007; Murguia & Díaz, 2015). Rather, to exist dictates that human beings are constantly creating their own identity in how they live and make choices. As the concept of existentialism cannot be divorced from the perception of freedom, an important approach in CBT is emphasizing that a client can choose how they view the situations that result in their dysfunctional behavior. Therefore, there is the assumption that each individual can view their challenges in a more positive light, and react affirmatively to that which is within his or her control, and not be anxious about that which is not.

Behaviorism is extensively utilized within CBT as well. Behaviorism is a cognition theory that promotes the emphasis on behavior, rather than motivations, feelings or thoughts. Initially developed in the early 20^th Century by John Watson, behaviorism was popularized through the advocacy and experimentation of B.F. Skinner (Hayes et al., 2006; Spiegler & Guevremont, 2010). Other notable philosophers and psychologists also identified as behaviorists, including Ivan Pavlov and Edward Thorndike, which helped popularize the theory, and accelerate its development (Spiegler & Guevremont, 2010). Behaviorism, in contemporary times is widely used in psychological clinical settings, due to the efficiency and perceived ease of observing behavior over analyzing emotions. Mental health professionals, including cognitive behavioral therapists implement behaviorism to address dysmorphic and unhealthy thoughts, rather than analyzing emotions.

Conceptual Foundations of Theory

Cognitive therapies are undergoing consistent development in literature and practice since their inception in psychology. Empirical testing has also significantly refined the advent of cognitive theory, and consequently, cognitive therapy. Research, coupled with implementation in a clinical setting, have proven the benefit of CBT in the reduction of relapse rates and symptoms within a diverse range of psychiatric disturbances and disorders, and in medical and non-medicated interventions.

A number of CBT approached have been developed over the years, with a wide gradient of applicability and success. These CBTs can be broadly organized into three distinctive divisions, including coping skills therapies, which emphasize on the development of skills and a repertoire that grants an individual the instruments necessary to cope with a debilitating problem(s) or a variety of problematic situations (Knapp & Beck, 2008; Ingram & Siegle, 2010). The second division comprises problem-solving therapies, which stress on the development of strategies with wide applicability towards the resolution of a broad range of difficulties (Ingram & Siegle, 2010). Finally, restructuring therapies hold the assumption that emotional problems arise from maladaptive thoughts, and can consequently be addressed through reframing dysfunctional thinking and promoting adaptive thought processes (Knapp & Beck, 2008). Some of the fundamental conceptual models of cognitive behavioral modification are as follows:

Self-instructional training was developed in the 1970s by Donald Meichenbaum. This approach had a particular focus on the relationship existing between verbal self-instruction and behavior (Knapp & Beck, 2008; Meichenbaum, 1993; Ingram & Siegle, 2010). This approach has its emphasis on graded tasks, directed mediation training, self-reinforcement, and cognitive modeling, which is extensively supported within the literature. Meichenbaum also developed Self-inoculation training, which outlines a multi-component approach based on the coping-skills domain of CBT and the theoretical premise that learning to deal with mild stressors inoculates an individual to larger shocks (Knapp & Beck, 2008; Wright et al., 2017). A problem-solving model, termed the self-control training, had also been developed by D’Zurilla and Goldfried (1971) with a primary goal of training rudimentary problem-solving skills that could be applied to contextual problem situations and consequently promote behavioral change (Datta et al., 2016). These models are highly applicable within stress management, depression, and coping with terminal illnesses.

Rational Emotive Behavior Therapy (REBT) is widely regarded as one of the first cognitive behavioral therapies. Consequently, Albert Ellis, who developed REBT, is perceived as a pioneer in the domain (Knapp & Beck, 2008). REBT is a restructuring therapy that derives from the ABC model by Ellis as well. The ABC model posits that any event or specific experience activates (A) personal beliefs (B) that elicit behavioral, emotional, or physiological consequences (C) (Knapp & Beck, 2008; Shafran et al., 2009). He also asserts that fundamental irrational beliefs often in the form of absolutistic and unrealistic expectations cause emotional disturbance (Brewin, 1996). Therefore, the goal of therapy, from Ellis’ perspective, would be to identify these irrational beliefs and through empirical and logical questioning, dispute, challenge, and forcefully modify them.

Constructivist therapy is a structural cognitive approach that, while not being termed as Cognitive behavioral therapy, draws parallels with CBT, such as with the modification and identification of cognitive structures, implemented via a blend of behavioral and cognitive modalities. However, there are significant differences between CBT, which is often regarded as a ‘rational’ approach, and constructivist perspectives considered the ‘post-rational’ proposals (Meichenbaum, 1993; Whaley & Davis, 2007). However, concern arose over the emphasis of validity over truth in constructivism, whereby rather than dealing with thought content, constructivist therapies would emphasize the thought process and generation of meaning (Knapp & Beck, 2008). As such, while the post-rational approach was fundamental in the contemporary practice of CBT, it is rather divergent from the conventional perspective of cognitive therapy. Other cognitive behavioral approaches have been developing in contemporary practice from the original cognitive behavioral conceptual model. For instance, Schema therapy by Jeffrey Young and the Dialectic Behavior Therapy by Marsha Linehan are CBT approaches used to treat clients with server psychopathologies (Linehan, 1993; Young et al., 2003). Despite the rather divergent nature of constructivist theories to CBT, they form a fundamental basis for the development and applicability of CBT.

Acceptance and Commitment Therapy (ACT) is a contemporary example of what has been termed as third-wave CBT interventions. These interventions in CBT therapy are characterized by the fact that they are grounded in an empirical, principle-focused approach that is especially sensitive to the context and resultant functions of psychological phenomena (Hayes et al., 2006; Longmore & Worrell, 2007). This approach to phenomena, rather than just considering their form, tends to stress contextual and experiential strategies supplemented by direct, didactic ones (Hofmann & Asmundson, 2008). Other approaches under this third-wave of CBT interventions include Dialectical Behavior Therapy (DBT), the Mindfulness-Based Cognitive Therapy (MBCT) and meta-cognitive approaches (Wells, 2000; Linehan, 1993; Segal et al., 2001). Since ACT is an approach to psychological intervention that is characterized by theoretical processes and not a defined technology, this review will focus primarily on the components of ACT, its impact, limitations, and contextual approach of ACT.

CBT’s Mode of Therapeutic Action

Acceptance Commitment Therapy (ACT) was developed within the pragmatic philosophy of functional contextualism, much like the other third-wave interventions of CBT. However, ACT is fundamentally reliant on the relational frame theory (RFT), which is a behavior analysis-derived cognitive language theory. Ultimately, ACT and RFT are derived from Skinner’s philosophy of radical behaviorism (Hayes et al., 2006). As a third-wave CBT therapy, the ACT is an empirically-based intervention as well.

There are inherent differences between the ACT and conventional CBT therapies. While CBT tries to teach individuals to temper better their thoughts, sensations, experiences, and feelings, ACT seeks to prepare an individual to notice, embrace, and ultimately accept their skills, especially the previously unwanted ones (Levin et al., 2017). In doing so, ACT helps an individual transcend into achieving a sense of self that is termed as the self-as-context, where the version of the person that is always present, observing, and experiencing, is distinct from their thoughts, memories, experiences, feelings, and sensations. ACT, therefore, aims primarily to help an individual distinguish their personal values and act on them, thereby bringing more meaning and vitality into their lives, and inadvertently increasing their psychological flexibility.

On the other hand, while contemporary psychology has often preemptively adopted the “healthy normality” assumption, whereby by nature, humans are presumed to be psychologically healthy, ACT assumes that instead, the psychological processes of a functionally normal human mind are usually destructive (Arch & Craske, 2008). The critical tenet of ACT is, in fact, that psychological disturbance is often caused the avoidance of experiences, psychological rigidity, and cognitive entanglement that ultimately leads to failure to implement the necessary behavioral steps aligned with core values. In summation, ACT conceptualizes the epicenter of many psychological disturbances as represented by concepts outlined in the ‘FEAR’ acronym:

• Fusion with an individual’s own thoughts.
• An Evaluation of experience.
• Experiential Avoidance
• Justification or Reason-giving for irrational behavior.

Therefore, ACT proposes a healthier alternative embodied in the acronym ACT as follows:

Be present at the moment, and Accept personal reactions.

ACT promotes the continuous and non-judgmental contact with psychological events and the events in the environment in which they occur. Overall, the goal is to have an individual experience the world around them more directly so that their behavior is much more flexible and their actions consistent with their held values. This is usually achieved through the implementation of what works, in order to exert more control over behavior, and use language to describe events and experiences, not simply judge and predict them (Ivanova et al., 2016; Levitt et al., 2004). A ‘self as process’ outlook is actively encouraged, comprising a non-judgmental, continuous description of feelings, experiences, and other private events.

Identify and Choose a valued direction.

A value is a chosen quality of purposive action that will not be obtained as an object but rather initiated in every moment. ACT prompts an individual through various exercises to choose life directions within several significant domains, including career, family, spirituality, and so forth while undermining verbal processes that may initiate choices stemming from fusion, avoidance, or social compliance.

Finally, Take action.

Eventually, ACT encourages the development of larger patterns of practical action that are linked to essential chosen values. In this perspective, ACT bears a close resemblance to conventional behavior therapy, and most behavior-focused change methods can be fitted within ACT parameters, including skills acquisition, goal-setting, and shaping methods (Bluett et al., 2014; Heffner et al., 2003). ACT often involves therapy work that is linked to behavior-change goals that spur an individual towards identifying and working through psychological issues that arise along the way.

In its identification of psychological disturbance and the prescribed course of remedial action, the ACT approach inherently could be defined as a psychological intervention based on contemporary behavioral psychology and the RFT. It applies mindfulness and acceptance processes, supplemented by behavior change and commitment processes, to achieve psychological flexibility.

Goals for Treatment

The overarching goal of ACT, and in extension, CBT interventions is to help, and individual is self-reliant in the solution of their own psychological disturbances, as well as improve their overall psychological flexibility. To the realization of this goal and the individual goals of therapeutic intervention, ACT often employs six core principles that help the development of psychological flexibility. These goals include:

1. Cognitive defusion. These techniques within ACT will attempt to modify undesirable thought functions and other private events, rather than trying to alter their frequency, their form, or their contextual sensitivity (Masuda et al., 2004). ACT simply attempts to change the way that an individual interacts with or relates to thoughts by highlighting the contextual situations in which their dysfunctions are diminished.
2. Acceptance. The tenet of acceptance is achieved when an individual can freely allow unwanted experiences, feelings, sensations, and urges to come and leave voluntarily without struggling psychologically with them.
3. Being grounded and in contact with the present. ACT actively encourages an acute acceptance of the now that can be appreciated and experienced with openness, receptiveness, and interest.
4. The observation of self: The sense of self represents a transcendent state that is aimed at by ACT, which embodies a continuity of consciousness that is consistently unchanging.
5. Values. ACT promotes a discovery process of that which is most important to an individual.
6. Committed action. ACT intervention promotes goal setting, whereby targets can be reasonably set, based on values, and executed in the service of a more meaningful life (Roberts, 2016; Parling et al., 2016).

Empirical evidence sourced from correlational studies has ascertained that the lack of psychological flexibility outlines a wide range of psychopathologies. For instance, Hayes (2006) conducted a meta-analysis that provided that the ACT principles averagely accounted for 16-29 percent of psychopathology, comprising general mental health, anxiety and depression, variance at baseline, depending on the measure used. These findings support the essentiality of using psychological flexibility as the ultimate goal for an ACT intervention.

Ultimately, the primary goal of ACT is not the deletion of problematic feelings but rather to contextualize whatever life brings in the present and enable an individual to move forward towards a valued behavior. ACT encourages and invites individuals to be open to deeply unsettling experiences, and learn gradually not to be overly triggered by them and not actively avoid situations in which these events are invoked. Resultantly, the therapeutic effect represents a positive trend where an individual improving leads to a transcendence towards the truth. The truth, in this case, would be attained through the concept of workability or events that work to allow an individual to move towards what matters most to them.

Cultural Consideration of CBT

The ACT approach has been implemented in mainstream psychotherapeutic interventions and has also been implemented in the execution of non-therapy forms of similar interventions called Acceptance and Commitment training. This approach, primarily oriented towards the development of valued skills, mindfulness, and acceptance, is implemented in a non-clinical setting including schools and businesses and has been adequately grounded in research with favorable preliminary results (Hayes et al., 2006). The third wave of CBT approaches is widely employed in management training movements in business programs, where cognitive-shifting techniques and mindfulness can be employed to promote overarching organizational and productivity goals.

The prominence of ACT on the appreciation of the awareness of the present, committed action, and valued direction is highly similar to other comparable psychotherapeutic approaches that are not primarily outcome-oriented, or explicitly linked to a behavioral science program. Furthermore, Hayes (2006) extensively explores the compatibility of ACT with the 12-step addiction treatment procedure, eventually arguing that, unlike many other psychotherapies, both these interventions can be explicitly or implicitly merged, owing to their extensive commonalities. Both the ACT and 12-step addiction treatment procedure also endorse acceptance as a viable alternative to unproductive control and the cultivation of a transcendent sense of self (Scott et al., 2016). Finally, both these approaches also acknowledge the paradox that acceptance is a vital condition to initiating sustainable change and encourage an awareness of the drawbacks of human thinking.

Strengths and Limitations of CBT

Several empirical studies have been conducted to prove the efficacies and limitations of ACT interventions. For instance, empirical studies within clinical psychology by Arch and Craske (2008) asserted that ACT was not significantly different from other interventions. Furthermore, Hofmann (2008) provided that ACT was eerily similar to the earlier developed Morita therapy, arguing that the criticisms provided by ACT towards the more conventional CBT were grounded on a gross misrepresentation of empirical evidence. Moreover, these ACT strategies are not unique to the theory and the underlying philosophy. As such, there were significant similarities between the ACT and eastern holistic approaches, including Morita Therapy, which was developed much earlier.

A further concern has been raised regarding the qualification of ACT as an empirically supported clinical treatment. For instance, a meta-analysis by Öst (2008) outlined that ACT had not yet qualified as an empirically supported clinical intervention as the research methodology employed for ACT was less stringent than CBT and that the mean effect size was rather moderate. However, proponents of the theory have discredited these findings by arguing that the quality difference in the meta-analysis was brought about by a vast inclusion of funded trials present in the CBT comparison sample. However, in practice, many studies on the ACT have been implemented on adults, resulting to a rather limited knowledge on the efficacy of CBT interventions on children and adolescents.

The development of ACT, and the corresponding theoretical foundations of RFT and functional contextualism has debunked much criticism in that these therapies have not been developed to undermine the traditions on which they are based, or claim to be a panacea. This is primarily in response to concerns, both theoretical and empirical, that have been risen in response to the ACT ascendancy in application and research (Tomlin, 2010). The efficacy of ACT has also been questioned in the broad challenge against third-wave CBT interventions, whereby Kanter (2013) posits that the development of these contextual behavioral science approaches is based on a need to alleviate human suffering. Still, it inherently is obscured by the promotion of the ACT and RFT models and demotion of earlier behavior and cognitive change techniques (Kanter, 2013). This demotion of preceding techniques is also made absent explicit logical and empirical support.

However, many opponents of ACT and RFT interventions do agree that these third waves CBT approaches warrant further consideration. For instance, Kanter (2013) concludes that the ideas presented in the RFT and ACT interventions are worth serious consideration by the mainstream community and bear a significant potential to shape a profoundly progressive clinical science, expertly guiding clinical practice. In the current body of research, ACT seems to be at par with more conventional CBT approaches, with inconclusive evidence arising from meta-analysis as some record slightly higher scores for the ACT while others do not. Overall, whether ACT is more efficient than other therapies is debatable. Still, sufficient empirical evidence exists to suggest its efficiency in the alleviation of human psychological suffering and the improvement of psychological flexibility. Regardless of the support of the efficacy of either intervention, the principles and applicability of Cognitive Behavioral Therapy and Acceptance Commitment Therapy would be of great use to practitioners of positive psychology.

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