Trying to decide between Acceptance and Commitment Therapy (ACT) and Dialectical Behavior Therapy (DBT)? Both are evidence-based approaches, but they take different paths. ACT helps you build psychological flexibility, learning to sit with difficult emotions while moving toward what matters.
DBT focuses on concrete skills to manage strong emotions, improve relationships, and balance acceptance with change. Understanding the difference helps you choose the approach that best fits your needs and goals.
Understanding ACT and DBT: Core Principles Explained
If you’re new to therapy or just frustrated with one-size-fits-all advice, it helps to understand what actually sits at the heart of these two approaches. ACT and DBT are each built on their own frameworks, philosophies, and guiding principles. While their names may sound like alphabet soup, their goals are pretty straightforward: help us live better, more authentic lives, even with the painful stuff that doesn’t just go away.
ACT centers around accepting thoughts and feelings rather than wrestling with them, then guiding us toward action rooted in our deepest values. It’s not just “think positive”. It’s about noticing thoughts, making space for them, and still choosing what matters. DBT, however, teaches us a lineup of practical skills like: mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness, to keep our heads above water in the face of overwhelming emotions, relationship challenges, or impulsive actions.
Why does it matter how these therapies are built? Because the map shapes the journey. Understanding these core blueprints puts us in the driver’s seat, letting us ask better questions and spot what will actually support real change.
ACT Therapy: How Acceptance and Commitment Therapy Works
ACT, short for Acceptance and Commitment Therapy, was designed to tackle our very human habit of fighting with uncomfortable thoughts and feelings. Instead of trying to erase pain or “fix” our minds, ACT teaches us how to accept what we can’t control and commit to actions that reflect our true values. The foundation of ACT is psychological flexibility, which simply means being able to show up fully for life, pain, doubts, and all, while still reaching for what matters most.
The six core processes of ACT include acceptance, cognitive defusion (stepping back from sticky thoughts), present-moment awareness, self-as-context (seeing ourselves as more than just our thoughts), clarifying values, and committed action. For example, someone with chronic worry learns through ACT not to waste energy fighting anxiety, but to notice it, make space for it, and still show up for important areas like work or relationships.
ACT’s roots come from behavioral science, tied together with relational frame theory and something called functional contextualism, the idea that the meaning of thoughts depends a lot on circumstances. It’s not just about symptom relief, but about building a bigger, richer life even if pain is along for the ride.
DBT Therapy: What Dialectical Behavior Therapy Involves
DBT or Dialetical Behavior Therapy, was created to help people dealing with intense emotions, impulsive behaviors, or chaos in relationships. Built by Dr. Marsha Linehan, DBT marries cognitive-behavioral techniques with mindfulness, acceptance, and the powerful idea of “dialectics”, that is, learning to hold two opposing things at once (for example, wanting change and accepting yourself at the same time).
A standard DBT program offers a combo plate of skills groups (where you learn emotional regulation, distress tolerance, interpersonal effectiveness, and mindfulness exercises), individual therapy (to tailor skills to your real-life problems), and often phone coaching (support when life crashes down between sessions). DBT shines at teaching us how to endure emotional pain without making things worse, communicate honestly, and stop black-and-white, all-or-nothing thinking from running the show.
DBT isn’t just for folks with big trauma or a certain diagnosis. It’s for anyone who feels emotions hitting like a freight train or is tired of boom-and-bust cycles in life or relationships..
Comparing ACT and DBT: Similarities and Differences That Matter
Now that we’ve covered the “what is it” of ACT and DBT, let’s step back and compare how they line up and where they part ways. Both therapies are big names in the mental health world for a reason, and there’s plenty of overlap, especially when it comes to mindfulness and learning to live with, not wage war against, difficult emotions.
But ACT and DBT are not twins. Their basic building blocks and end goals set them apart. These differences show up in how sessions look and which strategies you practice between appointments. That’s why understanding the similarities and distinctions isn’t just interesting; it’s crucial for choosing an approach that matches your struggles and style.
Mindfulness and Acceptance in ACT and DBT
- ACT’s Mindfulness: In ACT, mindfulness means learning to notice what’s happening in our minds and bodies right now, without getting stuck or swept away. The practice goes hand-in-hand with acceptance—making room for difficult thoughts and feelings so you can act in line with your values, even when life is painful.
- DBT’s Approach: DBT sees mindfulness as the foundation of all its other skills. Here, mindfulness means pulling your attention back from worries or regrets to what’s right in front of you. DBT teaches specific exercises like “What” and “How” skills (What am I noticing? How am I paying attention?) to help break the cycle of impulsivity or shutdown.
- Acceptance in ACT: Acceptance is a core pillar. Instead of fighting thoughts (“I shouldn’t feel this way!”), ACT invites us to make peace with what’s out of our control. It’s more than passive surrender, it’s the starting point for values-driven change.
- Acceptance in DBT: DBT builds acceptance into its skills too, especially in “Radical Acceptance.” Here, it means fully embracing reality as it is, without sugarcoating or resistance, so you can move forward rather than be frozen by pain or injustice.
- Real-World Impact: Both therapies use mindfulness and acceptance so we don’t have to drown in our feelings or react in old, unhelpful ways. Whether it’s riding out a craving or facing a hard conversation, these shared anchors help us keep our heads above water.
Key Differences: ACT Versus DBT for Behavior Change and Emotion Regulation
- ACT Emphasizes Acceptance, DBT Focuses on Change Skills: ACT’s claim to fame is teaching us to drop the struggle with thoughts and feelings through acceptance and diffusion. The goal is living life guided by your values, even if discomfort shows up along the way. DBT, while honoring acceptance, puts the spotlight on skills for behavioral change
- Emotion Regulation—Process vs Technique: In ACT, emotion regulation comes by changing your relationship with your emotions (not letting anxiety call the shots). You practice noticing and allowing emotions, then pivot toward meaningful action. DBT, by contrast, offers concrete techniques in its emotion regulation module. Think homework sheets, crisis plans, and real-time practice for turning down emotional intensity.
- Approach to Distress: Distress in ACT is met with willingness, making space for discomfort and using it as motivation to live in line with your values. In DBT, distress tolerance skills are more tactical, helping you survive crises, ride out urges, or make it through a tough moment without self-harm or sabotage.
- Self-Judgment: ACT teaches us to step back (defuse) from self-critical thoughts and not buy into every mental story. DBT, too, challenges judgments but leans on practical tools like “opposite action” and validation techniques to shift harmful patterns.
- Real-Life Application: If you crave detailed “how-to” steps and structure, DBT may feel like a better fit. If you want to focus on the bigger “why” (living by your values, not your fears), ACT’s flexible, contextual approach might be more your speed.
Clinical Applications: When to Use ACT Versus DBT
With so many therapy approaches out there, knowing when to seek ACT or DBT can feel overwhelming. This section zeroes in on where each therapy truly shines, using research and day-to-day clinical experience to help you sort your options, not just by diagnosis, but by real needs and goals.
DBT was first developed for situations where intense emotions lead to harmful patterns, such as self-harm or relationship blow-ups, and it has a long track record for borderline personality disorder and emotional dysregulation. ACT, meanwhile, offers new hope for those living with chronic pain, persistent anxiety, or the grind of depression, especially when “just think positive” advice falls flat.
DBT for Borderline Personality Disorder and Emotional Regulation Challenges
DBT is recognized as the gold standard for treating borderline personality disorder (BPD) and the rollercoaster of emotions that comes with it, with meta-analytic research confirming its effectiveness in reducing self-harm and emotional dysregulation (Kliem, Kröger, & Kosfelder, 2010).
At the heart of DBT are four main skills: mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness. For folks with BPD, learning these isn’t just helpful—they can be lifesaving. The distress tolerance module, for example, gives strategies to weather emotional storms without defaulting to self-destructive habits.
DBT doesn’t promise to erase pain overnight. Instead, it offers real, practical skills—like using opposite action when urges are strong, or radical acceptance when life feels unfair.
ACT for Chronic Pain, Anxiety, and Depression
Living with chronic pain, anxiety, or depression can feel like battling quicksand—every strategy to fix or avoid the struggle just leads to more stuckness. ACT offers a different way out. Instead of waging war against pain or distress, ACT helps us accept what’s out of our control, while still moving toward a life that matters.
The heart of ACT is willingness. Choosing to allow feelings and thoughts, rather than push them away. For chronic pain, this can mean finding meaning and connection, even when symptoms persist. In anxiety or depression, ACT helps people notice unhelpful thinking, let go of rigid avoidance, and build daily routines guided by personal values.
Using Both Therapies for Substance Abuse and Bipolar Disorder
- Why Blend ACT and DBT?: Some struggles, like substance use or bipolar disorder, need a toolkit larger than either therapy alone. Combining ACT’s focus on values and psychological flexibility with DBT’s hands-on emotion regulation skills offers a more robust approach, especially for clients with co-occurring conditions—a strategy supported by meta-analytic reviews highlighting ACT’s broad empirical effectiveness across diverse populations (Gloster et al., 2020).
- Real-Life Example: Say someone is fighting cravings but also gets overwhelmed by shame and spirals into risky behaviors. DBT equips them with distress tolerance tools for crisis moments, while ACT helps them reconnect with the “why”—their values and long-term goals, not just short-term pain relief.
- Better Outcomes for Complex Cases: Recent research and clinical case studies show that when therapy teams use both modalities, clients often show improved skill retention, fewer relapses, and higher satisfaction.
- When to Ask About Integration: If you or a loved one have tried one type of therapy and still feel stuck—or notice patterns that cross diagnostic lines—seeking an integrated approach can offer fresh hope. Therapists with expertise in both ACT and DBT can help build a plan calibrated for your unique real-world needs.
How ACT and DBT Are Offered: Individual, Group, and Virtual Therapy Options
ACT and DBT both have flexibility in how they’re delivered, fitting different lifestyles and preferences. Therapy isn’t just a couch-and-clipboards experience anymore. You’ll find ACT and DBT in one-on-one formats, group settings (especially with DBT skills training), and increasingly on digital platforms for folks needing convenience or privacy.
If you’re new to therapy or prefer a personalized pace, individual sessions offer a more tailored approach, letting you and your therapist dig into your unique goals and obstacles. Group therapy, most common with DBT skills, allows you to learn alongside others, try out new techniques in a supportive environment, and realize you’re not alone in the struggle.
DBT Group Therapy and Skills Training: How It Works
In DBT, group therapy is where the nuts and bolts of skills training happen. Weekly groups follow a clear structure, covering modules like mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness. Each session is focused, practical, and supportive—no lying on couches or abstract analysis here.
Group members learn through real-life examples and role-plays, practicing new behaviors in a safe and encouraging space. The routine and accountability of showing up each week helps skills stick. While most groups are not about sharing your deepest secrets, they are about growing side by side, building a sense of community as you learn to handle tough emotions and everyday stressors.
For those struggling with relationship issues or high-conflict family patterns, couples and family therapy that incorporates DBT skills can also help rebuild connection. Practices like Be Well Atl Psychotherapy offer flexible, relationship-focused therapy, blending structure with warmth—whether in person or virtually—so you never have to face change alone.
One-on-One ACT Therapy and Online Sessions
ACT is built for flexibility, and individual therapy brings that to life. One-on-one sessions give you and your therapist space to explore your personal struggles, clarify what matters most to you, and practice new ways of responding to life’s storms. Sessions often use experiential exercises, not just talking, but doing, so you can learn by living, not theorizing.s.
Choosing the Right Therapy: ACT, DBT, or Both?
- If emotions feel unmanageable: DBT offers step-by-step skills for crisis moments, emotional chaos, and relationship repair.
- If you’re stuck in avoidance or perfectionism: ACT helps break these cycles by fostering acceptance and values-driven living even when life is tough.
- If struggles overlap or you’ve tried it all: A blend of ACT and DBT may offer the best of both worlds, with flexibility and structure where you need each most.
- Still not sure? Reach out for a consult—no pressure, just a real conversation about your options and goals.
Remember, no therapy is one-size-fits-all, and it’s OK to ask questions or change paths. Whether you want proven skills, flexible support, or a brave new start, there’s a way forward. We’re here to help you find it—every step of the way.
Final Thoughts
ACT and DBT are both proven therapies, but they differ in focus and method. ACT builds psychological flexibility by teaching acceptance of thoughts and feelings while committing to actions guided by values. DBT emphasizes practical skills, mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness, to manage intense emotions and crises.
ACT is often best for chronic pain, anxiety, or avoidance patterns, while DBT is highly effective for emotional dysregulation and relationship turmoil. In some cases, blending both approaches provides the most support, combining values-based living with concrete skills.
References
- Beygi, Z., Tighband Jangali, R., Derakhshan, N., Alidadi, M., Javanbakhsh, F., & Mahboobizadeh, M. (2023). An overview of reviews on the effects of Acceptance and Commitment Therapy (ACT) on depression and anxiety. Iranian Journal of Psychiatry, 18(2), 248–257.
- Kliem, S., Kröger, C., & Kosfelder, J. (2010). Dialectical behavior therapy for borderline personality disorder: A meta-analysis using mixed-effects modeling. Journal of Consulting and Clinical Psychology, 78(6), 936–951.
- Gloster, A. T., Walder, N., Levin, M. E., Twohig, M. P., & Karekla, M. (2020). The empirical status of acceptance and commitment therapy: A review of meta-analyses. Journal of Contextual Behavioral Science, 18, 181–192.
