Why Evidence-Based therapy works: ACT, CBT, and moving beyond traditional talk therapy
If you’ve started looking into therapy, you’ve probably come across a wall of acronyms, CBT, ACT, DBT, psychodynamic, psychoanalysis, with little explanation of what actually separates them, or why it matters which one you choose.
Here’s the short version: therapy has changed a lot over the last few decades, and not all approaches are backed by the same weight of evidence.
Where traditional talk therapy came from
Classic psychoanalysis and long-form psychodynamic therapy – the “tell me about your childhood” model most people picture when they think of therapy – grew out of early 20th-century theories about the unconscious mind. It can offer real value, particularly for people who want to deeply understand why they think and feel the way they do, over an open-ended timeframe. But it wasn’t designed to be tested the way modern medicine is tested, and it doesn’t tend to offer much structure around specific, current-day symptoms like panic attacks, insomnia, OCD or addictive behaviours.
What changed with CBT
Cognitive Behavioural Therapy (CBT) reshaped the field by asking a more practical question: what if we focused on the current patterns of thinking and behaviour keeping someone stuck, rather than primarily on the past? CBT is structured, present-focused, and has one of the largest research bases of any psychological treatment, decades of clinical trials support its effectiveness for anxiety, depression, and many other conditions.
Where ACT fits in — and why it’s my main approach
Acceptance and Commitment Therapy (ACT) is often described as part of the “third wave” of CBT-rooted therapies https://contextualscience.org/. Rather than centering on challenging or changing the content of difficult thoughts. ACT encourages accepting difficult thoughts and emotions while building a commitment to act in line with your own personal values.
In practice, that means less time spent fighting or arguing with anxious or self-critical thoughts, and more time building the skills to stay present, unhook from unhelpful mental patterns, and take meaningful action even when difficult feelings are still there. For a lot of people, this feels less like a battle against their own mind and more like learning to carry difficulty differently.
Research directly comparing ACT and CBT generally shows the two performing comparably well overall, with each showing particular strengths depending on the condition and the person. What both have decisively over older models is a strong, growing base of randomised controlled trials meaning we have real evidence for what they help with, not just theory. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11837766/
Why this matters when you’re choosing a therapist
It’s less about picking the “best” therapy in the abstract, and more about finding an approach, and a therapist, that fits how you actually want to work. Some people want structure and a clear set of tools (CBT). Some want to change their relationship with difficult emotions rather than fight them, especially if they’ve tried “just think positive” approaches before without success (ACT). Others want the slower, exploratory work of understanding long-standing patterns (psychodynamic approaches).
In my own practice, I draw primarily on ACT, because I’ve seen how effective it can be for people who feel stuck in a cycle of struggling with difficult thoughts and emotions, something I see often in anxiety, low mood, and the particular stress of adjusting to a new country. That said, no single approach fits everyone, and part of a good first session is figuring out together whether the way I work is genuinely the right fit for you.
If you’d like to explore whether ACT-based therapy could help with what you’re going through, get in touch — I offer both in-person and online sessions in English, Spanish, and Italian.
