About Elizabeth Chattillion, Ph.D.

ACT (pronounced as the word “act”) is a behavioral therapy that can help alleviate many mental health concerns, including anxiety, depression, chronic pain, and more. ACT has been extensively studied and is evidence-backed. The core of ACT centers around your personal values - what is most important to you in life? How do you want to spend your limited time? For many people there’s a disconnect between what is important to them and how they’re actually spending their time day-to-day. There are many reasons for this, and one reason has to do with the human tendency to avoid uncomfortable or painful thoughts and feelings. Our (understandable) instinct is to move away from painful experiences. However, often the things people do to avoid emotional pain actually cause more suffering in the long run. For example, if someone suffers from panic attacks, they might notice a lot of anxiety leading up to a friend’s party or a social event for their children, and might choose to stay home. This lowers their anxiety in the moment, although research shows it can actually increase anxiety over time. If this person continues to avoid social gatherings whenever they feel anxiety, this can cause their life to “shrink” over time, which leads to feeling worse, not better.

ACT acknowledges that we don’t have direct control over our thoughts and feelings, but we can control how we respond to them. ACT is not focused on eliminating unwanted thoughts and emotions, rather, one of the goals of ACT is to teach people more helpful ways to handle painful thoughts and feelings (e.g., mindfulness skills). When you’re not locked in a constant battle with negative thoughts and feelings, this frees up energy to do what matters most to you. The other goal of ACT is to help people clarify their values and take meaningful steps toward those values (even when unwanted thoughts or emotions try to get in the way). ACT helps us learn to respond differently to painful experiences so that they don’t stop us from doing what brings us fulfillment. ACT, as the name suggests, is an active therapy that goes beyond just talking about thoughts and feelings, and focuses on helping people make impactful changes.

Cognitive Behavioral Therapy (CBT) is a type of therapy that has been shown through research to be effective at treating many mental health concerns, including anxiety, depression, PTSD, panic disorder, and more. CBT is typically short-term (often between 6-20 sessions) and is focused on teaching skills to cope with mental health symptoms that are interfering with one’s life. CBT focuses on the relationships between a person’s thoughts (i.e., cognitions), feelings (i.e., emotions or physical sensations) and behaviors. CBT helps people recognize and then change unhelpful thinking patterns and behaviors that may be increasing their emotional distress. For example, someone who struggles with significant anxiety may notice that their mind is often flooded with “worst-case-scenario” thoughts. When this person feels anxious or has scary thoughts about the future, they may choose to avoid situations that bring on these feelings and thoughts. Although this feels good in the moment, research shows that chronic avoidance of anxiety actually increases anxiety over time.

CBT recognizes that these automatic, worst-case-scenario thoughts increase anxiety and lead to more avoidance. These thoughts are often “distorted,” extreme, or inaccurate. CBT helps people (1) identify when their thoughts are unhelpful or making things worse, (2) examine whether these thoughts are accurate, and (3) replace the thoughts with more helpful or realistic thoughts. Over time, challenging and changing unhelpful thoughts can change mood and can help people change their behavior.  CBT also teaches other emotion regulation and problem-solving skills to help people overcome the cycle of anxiety and avoidance. CBT is an active therapy and encourages clients to practice skills learned in session in their own life between sessions.

Although CBT and ACT are distinct types of therapy, they have a lot in common. Both are evidence-backed and shown to be helpful for a variety of mental health concerns. Both teach skills to help people respond to unhelpful or unwanted thoughts and emotions. 

One major difference between ACT and CBT is the specific techniques used to respond to unhelpful thoughts. CBT focuses more on challenging and re-framing unhelpful thoughts. ACT relies more on mindfulness and acceptance-based strategies. Sometimes the more you focus on trying to get rid of certain thoughts, paradoxically, the more they stick around. ACT teaches strategies for acknowledging our thoughts without buying into them or getting locked in a battle with them. These techniques help give your thoughts less power over you, and free up your attention and energy so that you can redirect them to doing what is most important to you in life. 

Both CBT and ACT focus on how to move toward what you want in life when your thoughts and emotions are getting in the way. Part of the assessment process at the beginning of therapy is understanding your concerns so that I can get a sense of what approach might work best for you. During treatment planning, I’ll explain more about each approach and get your feedback about what you prefer or what resonates with you. I often integrate elements of both treatments in my work with clients. Additionally, as part of treatment we will consistently evaluate together whether therapy is working. If things aren’t progressing as we want or expect, we can and should change approaches.

Cognitive Behavioral Therapy for Insomnia (CBT-I) is a structured treatment using CBT skills specifically to address difficulty sleeping. Sleep difficulties can include trouble falling asleep, trouble staying asleep during the night, waking too early, or all of the above. This treatment focuses on thoughts, feelings, and behaviors that contribute to poor sleep. There is a particular focus on how to change behaviors (things people do during the daytime, before bed, and during the night) in order to improve sleep. Treatment is often brief (6-8 sessions, though this can vary) and completing “homework” or implementing changes outside of sessions is essential in order to maximize benefits from treatment. Research shows that CBT-I is very effective for improving sleep. In fact, the American College of Physicians recommends that adults receive CBT-I as a first-line treatment for insomnia, before trying medications for sleep.

I also have extensive training and experience in health psychology. Health psychology recognizes that health and illness are complex and are influenced by biological, psychological, and social factors. More simply put, a health psychologist understands and respects the mind-body connection. Health psychologists can work with individuals to improve health behaviors (e.g., manage diabetes, quit smoking, improve sleep) or to learn to manage anxiety, depression and other psychological issues that can arise from living with a chronic medical illness (e.g., pain, cancer, inflammatory bowel disease). 

Even if you are not actively dealing with a medical diagnosis, my health psychology training helps me understand and focus on how the mind and body interact as you experience other challenges in life such as chronic stress, major life changes, relationship issues, and loss.