Is Acceptance and Commitment Therapy (ACT) a viable alternative to Cognitive Behavioural Therapy (CBT) for Generalised Anxiety Disorder (GAD)?

This article is written in a slightly different style to my usual posts as it is an edited version of one I originally wrote for a blogging job application. However, I thought I’d reformat it a little and share it here as it might be useful to some readers.

Generalised Anxiety Disorder (GAD) is a common mental health problem which significantly impairs daily activities. It is a chronic condition with little likelihood of spontaneous recovery. It is characterised by frequent and excessive worry across a range of areas in a person’s life and an underlying intolerance of uncertainty.

Cognitive Behavioural Therapy (CBT) has been widely researched and is currently recommended by the National Institute for Clinical Excellence (NICE) as the preferred psychological therapy for GAD. However, the effectiveness and perceived acceptability of CBT varies between individuals and, of all the anxiety disorders, the proportion of people who do not respond optimally to CBT is greatest for GAD. Only 50% of people experiencing GAD achieve high functioning following treatment.

Acceptance and Commitment Therapy (ACT) is a form of “third wave” CBT which places emphasis on working towards greater psychological flexibility by focusing on present moment awareness, acceptance of unpleasant internal feelings and taking actions in areas of life that the client values. This contrasts with standard CBT which aims to change unhelpful thinking and behaviours to reduce symptoms.

Avdagic, Morrissey and Boschen (2014) conducted the first Randomised Controlled Trial (the gold standard in psychological research) comparing CBT and ACT. Half their participants received a 6-week CBT group intervention and the other half received a 6-week ACT group intervention.

The study found that ACT was as effective as CBT for individuals experiencing GAD. Symptoms of anxiety, depression and stress had all significantly improved by the end of treatment for both therapeutic interventions. At follow-up symptoms had reduced further for both groups. The results suggested worry reduced more rapidly for the ACT group, between pre-treatment and post-treatment. The ACT group also reported significantly lower levels of distress and interference with daily life post-treatment. Further, they showed a greater decrease in positive beliefs about worrying and sharper increase in terms of acceptance and ability to take worthwhile actions. Similarly, there was good improvement in tolerance of uncertainty for the ACT group.

The authors assert that these findings are particularly relevant for situations where “longer term therapy is not feasible”. They also conclude that ACT can result in rapid clinical improvement, particularly in relation to worrying, for people with GAD.

If you experience the symptoms described in this article and would like to try one-to-one sessions based on ACT, I am able to offer these in central Exeter with a free initial consultation. I would love to work with you if you are local and like the sound of this approach. Please contact me if you wish to discuss this further.

Avdagic, E., Morrissey, S.A. & Boschen, M.J. (2014). A Randomised Controlled Trial of Acceptance and Commitment Therapy and Cognitive-Behaviour Therapy for Generalised Anxiety Disorder. Behaviour Change, 31 (2), 110-130.

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