ACT vs CBT: Which Is the Most Effective Approach in Neurorehabilitation?
ACT vs CBT: Which Is the Most Effective Approach in Neurorehabilitation?
Psychological therapy is a core component of neurorehabilitation, supporting individuals as they adjust to cognitive, emotional, and functional changes following neurological injury or illness. Two commonly used approaches are Cognitive Behavioural Therapy (CBT) and Acceptance and Commitment Therapy (ACT). While both are evidence-based and widely respected, their usefulness in neurorehabilitation depends less on which approach is “better” and more on how well each fits the individual’s cognitive capacity, emotional needs, and stage of recovery. Understanding their differences helps guide effective, person-centred rehabilitation.
CBT in Neurorehabilitation
CBT focuses on identifying and modifying unhelpful thoughts and behaviours to improve emotional wellbeing. In neurorehabilitation, CBT can be effective for managing anxiety, depression, and unhelpful beliefs such as catastrophising or avoidance. When cognitive capacity allows, CBT supports structured problem-solving, behavioural activation, and emotional regulation.
However, CBT relies heavily on cognitive processes such as insight, flexible thinking, memory, and verbal reasoning — abilities that may be compromised after brain injury. For some individuals, challenging thoughts can feel invalidating when distress arises from real and ongoing limitations rather than distorted thinking. In these cases, CBT requires careful adaptation to avoid increasing frustration or cognitive load.
ACT in Neurorehabilitation: A Different Focus
ACT takes a fundamentally different approach. Rather than aiming to change thoughts, ACT focuses on helping individuals change their relationship with thoughts, emotions, and symptoms. In neurorehabilitation, this can be particularly valuable where difficulties are persistent or fluctuating.
ACT supports individuals in accepting what cannot be changed while committing to meaningful action within current limits. Concepts such as psychological flexibility, values-based living, and present-moment awareness align closely with the realities of neurological recovery. ACT often places less demand on cognitive restructuring and can be more accessible for individuals with executive or memory difficulties, especially when delivered in an adapted, experiential way.
Which Approach Works Best in Neurorehabilitation?
In practice, the most effective approach is rarely CBT or ACT in isolation. Neurorehabilitation benefits from flexibility rather than allegiance to a single model. CBT may be particularly helpful early on for addressing anxiety, low mood, or unhelpful avoidance patterns. ACT may be more suitable when individuals are struggling with adjustment, identity change, or ongoing symptoms that require acceptance rather than resolution. Neuropsychologists play a key role in determining which approach — or combination — best fits the individual’s cognitive profile, emotional readiness, and rehabilitation goals. Therapy is often adapted dynamically as capacity and needs evolve.
A Neuropsychology-Led Perspective
At The London Neurocognitive Clinic, psychological therapy within neurorehabilitation is guided by neuropsychological understanding rather than protocol alone. Our clinicians consider cognitive capacity, fatigue, emotional resilience, and real-world functioning when selecting and adapting therapeutic approaches. Whether drawing on CBT, ACT, or an integrated model, the aim remains the same: to support emotional wellbeing, promote meaningful engagement, and help individuals live well alongside neurological change.
