An effective treatment rationale is important because it can affect whether or not a client decides if they will commit to the therapeutic approach. In recent years, acceptance and commitment therapy (ACT) has developed as an approach that, although related to cognitive-behavioral therapy (CBT), is philosophically distinct. CBT typically places a greater emphasis on changing/eliminating “symptoms” of psychological disorders and the role thoughts play in directly influencing emotional and behavior problems. ACT, on the other hand, places a heavier emphasis on accepting and changing one’s relationship to aversive private experiences. When comparing the assumptions and goals underlying CBT and ACT, individuals from Western cultures are more likely to be familiar with those consistent with CBT. These fundamental differences in how psychological difficulties are conceptualized and treated will be reflected in treatment rationales presented to clients. The aim of the current study was twofold. The first was to determine if there are differences in the acceptability of treatment rationales based on CBT or ACT. The second was to learn why the treatment rationales were deemed acceptable or unacceptable. A mixed-methods between-groups design was utilized where participants were randomly assigned to complete one of two surveys. The surveys included a vignette where a therapist presented a hypothetical client a treatment rationale, one based on CBT and the other on ACT. These treatment rationales were reviewed and approved by subject matter experts in both ACT and CBT. Following the vignette, participants rated the vignette in terms of clarity and acceptability and responded to open-ended questions concerning components of the treatment they liked/disliked as well as what questions they would want to ask the therapist. Results indicated that there is a negative correlation between age and high ratings of clarity for CBT. Though these two approaches are very different in terms of the proposed causes of psychological problems and recommended treatment strategies, results indicate that clients rate them as being equally clear and acceptable. Therefore, concerns about ACT being incompatible with Western views of psychological problems may be unfounded.


Jeffrey Buchanan

Committee Member

Kari Much

Committee Member

Eric Sprankle

Date of Degree




Document Type



Master of Arts (MA)




Social and Behavioral Sciences

Creative Commons License

Creative Commons Attribution 4.0 International License
This work is licensed under a Creative Commons Attribution 4.0 International License.



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