Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2012 Oct;80(5):750-65.
doi: 10.1037/a0028310. Epub 2012 May 7.

Randomized clinical trial of cognitive behavioral therapy (CBT) versus acceptance and commitment therapy (ACT) for mixed anxiety disorders

Joanna J Arch  1 , Georg H Eifert, Carolyn Davies, Jennifer C Plumb Vilardaga, Raphael D Rose, Michelle G Craske
Affiliations
Randomized Controlled Trial

Randomized clinical trial of cognitive behavioral therapy (CBT) versus acceptance and commitment therapy (ACT) for mixed anxiety disorders

Joanna J Arch et al. J Consult Clin Psychol. 2012 Oct.

Abstract

Objective: Randomized comparisons of acceptance-based treatments with traditional cognitive behavioral therapy (CBT) for anxiety disorders are lacking. To address this gap, we compared acceptance and commitment therapy (ACT) to CBT for heterogeneous anxiety disorders.

Method: One hundred twenty-eight individuals (52% female, mean age = 38, 33% minority) with 1 or more DSM-IV anxiety disorders began treatment following randomization to CBT or ACT; both treatments included behavioral exposure. Assessments at pre-treatment, post-treatment, and 6- and 12-month follow-up measured anxiety-specific (principal disorder Clinical Severity Ratings [CSRs], Anxiety Sensitivity Index, Penn State Worry Questionnaire, Fear Questionnaire avoidance) and non-anxiety-specific (Quality of Life Index [QOLI], Acceptance and Action Questionnaire-16 [AAQ]) outcomes. Treatment adherence, therapist competency ratings, treatment credibility, and co-occurring mood and anxiety disorders were investigated.

Results: CBT and ACT improved similarly across all outcomes from pre- to post-treatment. During follow-up, ACT showed steeper linear CSR improvements than CBT (p < .05, d = 1.26), and at 12-month follow-up, ACT showed lower CSRs than CBT among completers (p < .05, d = 1.10). At 12-month follow-up, ACT reported higher AAQ than CBT (p = .08, d = 0.42; completers: p < .05, d = 0.56), whereas CBT reported higher QOLI than ACT (p < .05, d = 0.42). Attrition and comorbidity improvements were similar; ACT used more non-study psychotherapy at 6-month follow-up. Therapist adherence and competency were good; treatment credibility was higher in CBT.

Conclusions: Overall improvement was similar between ACT and CBT, indicating that ACT is a highly viable treatment for anxiety disorders.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Patient Flow
Figure 2
Figure 2
a–c. Primary outcomes in the ITT sample with ACT vs. CBT differences
See this image and copyright information in PMC

References

    1. Addis AE, Hatgis C, Bourne L, Krasnow AD, Jacob K, Mansfield A. Effectiveness of Cognitive–Behavioral Treatment for Panic Disorder Versus Treatment as Usual in a Managed Care Setting. Journal of Consulting and Clinical Psychology. 2004;72(4):625–635. - PubMed
    1. Arch JJ, Craske MG. Acceptance and commitment therapy and cognitive behavioral therapy for anxiety disorders: Different treatments, similar mechanisms? Clinical Psychology: Science and Practice. 2008;15(4):263–279.
    1. Barlow DH. Anxiety and its disorders: The nature and treatment of anxiety and panic. 2nd. New York, NY: Guilford Press; 2002.
    1. Barlow DH, Cerny JA. Psychological treatment of panic. New York, NY: Guilford Press; 1988.
    1. Barlow DH, Gorman JM, Shear MK, Woods SW. Cognitive-behavioral therapy, imipramine, or their combination for panic disorder: A randomized controlled trial. Journal of the American Medical Association. 2000;283(19):2529–2536. - PubMed

Publication types