Techniques of practice
CBT (Cognitive Behavioural Therapy)
Quite simply, CBT helps you learn to change your thoughts, and behaviours so you feel better. By exploring your reactions to situations, CBT can help you react more effectively in challenging situations, and even teach you to feel better when you are unable to change situations happening around you.
IT'S GOAL-ORIENTEDCBT is a problem-solving therapy aimed at helping you achieve your goals. The goals can be anything from leaving/pursuing a relationship to finding a job or reducing feelings of depression or anxiety.
IT'S PRESENT-FOCUSEDCBT typically focuses on current difficulties and present situations that are distressing. This allows you to manage current problems more quickly and effectively. Identifying specific challenges and focusing on them in a consistent and structured manner results in greater treatment gains, and in a shorter period of time than in traditional talk-therapy.
IT'S ACTIVECBT requires you and your therapist to work as a team, collaborating to solve problems. Rather than waiting for problems to get better after talking about them repeatedly from week to week, you are able to take an active role in your own treatment, using self-help assignments and CBT tools between sessions to speed up the process of change. Each session is focused on identifying ways of thinking differently, and unlearning unwanted reactions.
IT'S BRIEFCBT is a time-limited therapy, meaning once you feel significant symptom relief and have the skills you need for success, treatment can end. This makes CBT significantly shorter in duration than traditional talk-therapy, which can last years. Many people finish CBT after just a few months of treatment. However, not everyone makes significant progress in a short time; some people may need additional therapy to reduce symptoms and create lasting change. Those with serious, chronic psychological problems may need anywhere from six months to several years of treatment. However, even in these cases CBT is generally more effective and of shorter duration than traditional talk therapy.
IT'S WELL-RESEARCHEDThe most widely researched therapy that exists, over 500 studies have demonstrated the effectiveness of CBT for numerous psychological and medical problems. It is one of the few therapies that is scientifically proven to be effective.
IT'S SUPPORTIVEMaking big changes can be difficult. Cognitive behavioral therapists take this very seriously, and are dedicated to helping the client along this process at the client's own pace, offering CBT tools in an environment of warmth and caring. Relying on the foundation of this supportive relationship helps clients feel more comfortable exploring behaviours that may be outside of their comfort zone.Psychodynamic approach
Psychodynamic therapy explores the client’s hidden needs, urges, and desires. It considers the present issues, but delves much deeper into the subconscious. This approach also focuses more on mental and emotional processes, opposed to exploring behaviour. In these sessions, the therapist will encourage the client to talk freely about whatever is on their mind. The thoughts and feelings discussed will be explored for recurring patterns of emotions, thoughts, and beliefs in the client’s unconscious mind.
Psychodynamic therapists try to help clients find these patterns in order to gain understanding of their current self. These patterns are often found to begin in the client’s childhood, since psychodynamic theory holds that early life experiences are extremely influential in psychological development and functioning as an adult.Mindfulness Therapy
Mindfulness represents a new innovation in cognitive-behavioral therapy, with scientific research backing up its numerous psychological benefits. But it's not all that new; Mindfulness comes from an ancient Buddhist meditation practice that has been around for millennia.
Originally aimed at spiritual training of the mind, contemporary psychology researchers have adapted the most powerful components to treat everything from depression, anxiety, ADHD, bipolar disorder, OCD, PTSD, chronic pain, and many other psychological problems. This has resulted in cognitive-behavioral treatments that are even more effective. Examples of mindfulness-based therapies include Mindfulness-Based Cognitive Therapy, Mindfulness-Based Stress Reduction, Acceptance and Commitment Therapy, and Dialectical Behavior Therapy. The latest research indicates these treatments can be more effective than traditional talk therapy in treating a host of problems and disorders.
Mindfulness techniques focus on awareness of thoughts and feelings without attachment or judgment. When we are having intense emotions, it is often because we are caught up in our catastrophic interpretations about what is going on. The more we become entangled in the thoughts about the situation, the worse it feels, and the more intense our emotions become. Mindfulness short-circuits this process by helping us to disentangle ourselves from our distorted thought patterns and connect to the actual situation. This enables us to more skillfully address the difficult situation, and to do so with less emotional reactivity and psychological suffering.Exposure Therapy
Exposure Therapy is one of the most effective treatments for anxiety problems, with up to 80% of patients experiencing a significant reduction in anxiety after only a few sessions. It is based on the fact that anxiety is maintained by avoidance of what is feared. The more the client avoids what they fear, the greater the fear becomes. Furthermore, as the avoidance continues, the fear “generalizes” to other areas of the person’s life, meaning more and more things become the objects of fear and avoidance. Exposure works by allowing the patient to come into contact with what he/she fears long enough for the patient to learn the negative consequences the patient expects does not occur, and the anxiety diminishes.
In Exposure Therapy, clients can work at their own pace, not engaging in any exposure assignments that feel too aversive or overwhelming.Trauma Focused CBT
Trauma Focused Cognitive Behavioral Therapy is a form of cognitive behavioral therapy designed for people who have experienced some kind of traumatizing event, and have difficulty coping with the aftermath. A trauma can include combat, sexual or physical assault, being the victim of a crime, surviving a disaster, being in an accident, or any other potentially life-threatening situation. Sometimes people who experience or witness a trauma can go on to develop painful psychological symptoms such as flashbacks, nightmares, and intrusive images of the trauma. Trauma Focused Cognitive Behavioral Therapy helps people cope with and significantly reduce these symptoms through emotional reprocessing.
Prolonged Exposure Therapy: Prolonged exposure is a form of exposure therapy helps people process the trauma that occurred, and find meaning in the experience. Prolonged exposure therapy works from the premise that the brain is overloaded when a trauma occurs, and this causes problems processing and encoding the information in the brain. Prolonged exposure remedies this through the patient recounting the trauma in session, reducing the emotional dysregulation caused by memories of the trauma, and finding new ways of thinking about how it fits into one’s own personal narrative.
Cognitive Processing Therapy: Cognitive processing therapy is a trauma focused CBT that focuses more on the thoughts people have in response to their trauma. Essentially, cognitive processing therapy helps people examine their maladaptive patterns in thinking and find more effective ways of making sense of the trauma. This is achieved through homework assignments involving patients writing out their trauma narrative, and engaging in cognitive restructuring of maladaptive or problematic thinking patterns.
Seeking Safety: Seeking safety is a Trauma Focused Cognitive Behavioral Therapy that helps people learn to regulate their intense emotions in the aftermath of a trauma. By learning behavioral coping skills such as relaxation training and mindfulness, people are better able to deal with symptoms resulting from experiencing a trauma. Because the treatments described above can be stressful, Seeking safety is generally used to help prepare people for these more intensive treatments by building up their coping skills.Solution-Focused Brief Therapy (SFBT)
Solution-Focused Brief Therapy (SFBT), is a type of therapy that focuses on solutions, rather than problems. In a SFBT session, the focus will be on working towards the future in which your current problems have less impact on your life, opposed to exploring your childhood, or your subconcious.
SFBT is committed to finding realistic, workable solutions for clients as quickly as possible, and the efficacy of this treatment has influenced its spread around the world and in multiple contexts.
This form of therapy has been successfully applied in individual, couples, and family therapy. The problems it can address are wide-ranging, from regular stressors of life to high-impact life events.Assertiveness Training
Assertiveness training is designed to help people find their voice and get what they want from life. This can include expressing one’s feelings effectively, making one’s wishes known, making requests, saying “no,” and standing up for oneself. People who have difficulties with assertiveness may be overly passive and never getting what they need, or overly aggressive and getting what one wants at the expense of relationships with others.
This particular treatment begins with listing the situations in which assertiveness is lacking. From this list, a hierarchy of assertiveness opportunities is created, arranged in order of least anxiety provoking to most difficult. To ensure success and maximize comfort, the least difficult situations are targeted first. Once these situations are mastered, increasingly difficult situations are targeted, until the client has effectively rehearsed and mastered all of the situations on his/her hierarchy.Social Skills training
This treatment focuses on skills in meeting other people, starting and maintaining conversations, acting effectively in a variety of social situations, and starting and strengthening relationships. Social skills training treatment can be used with a number of psychological problems such as depression and anxiety, which can inhibit social interaction and interfere with the learning of appropriate social behavior.
Social Skills Training begins with a thorough assessment of interpersonal skills deficits. Sometimes these deficits are in the knowledge of appropriate social behavior, but sometimes the individual knows the appropriate behavior, and is inhibited from engaging in the behavior due to anxiety. Deficits can range from basic skills, such as making eye contact, to more complex sets of skills, such as how to initiate a friendship, ask someone on a date, or say no to a request.
Once deficits are identified, a treatment plan is developed to enhance skill use. This often begins with the therapist modeling or performing the skill with the patient. Then, role-plays are enacted with the patient. This allows the patient to receive direct feedback from the therapist, and correct any problems prior to experimenting with the skills outside of the therapy session. Role-plays are helpful because they facilitate practicing new social behaviors in an anxiety-free environment. This makes developing comfort with the skills faster, making it easier to use the skill in actual situations. Finally, the patient uses the skills in actual situations, mastering the most basic skills first, then moving on to more complex skills with the guidance and support of the therapist.Acceptance and Commitment Therapy (ACT)
Acceptance is a newer therapy that has received a lot of attention in the psychology research lately. Although relatively new, it has been the subject of numerous studies, showing its efficacy with numerous disorders and psychological problems.
Acceptance and Commitment Therapy (ACT) is a mindfulness-based therapy that incorporates elements of Buddhist mindfulness meditation and newer behavioral therapy techniques. ACT is quite different from traditional cognitive behavioral therapy (CBT) in that it teaches people how to accept and embrace unpleasant thoughts, feelings and sensations rather than trying to control or eliminate them. The rationale behind this, is that a great deal of human suffering is the result of not engaging vitally in life due to trying to reduce feelings such as fear, anxiety, frustration, etc. These emotions are necessary parts of working toward what you hold dear, your values, and to try to avoid them is to avoid those aspects of life which bring meaning and vital involvement. Through this process of embracing unwanted feelings in the aim of achieving goals, often the negative feelings are significantly reduced. The paradox is, the more you try to avoid certain feelings, the more they hang around and negatively influence your life. Although a relatively new treatment, there is significant research to show ACT can have a dramatic impact on a whole host of problems, from anxiety and depression to chronic pain and even schizophrenia.
ACT employs six core principles to achieve psychological flexibility:
Cognitive defusion: Learning methods to reduce the tendency to 'buy into' harmful or ineffective thoughts, images, emotions, and memories. Rather than trying to change the way we think about things our try to talk ourselves out of our opinions, cognitive defusion helps to give us the choice to just not engage with harmful thoughts. Acceptance: Allowing thoughts to come, making space for them rather than spending all of one's energy fighting with them. Acceptance also includes acceptance of uncomfortable emotions and physical sensations. By learning to be more willing to tolerate discomfort, actively pursuing what we want in life becomes easier. Contact with the present moment: Having a mindful connection to the present, experienced with clarity, interest, and void of judgment. Rather than giving in to catastrophioc interpretations of what is happening, mindfulness teaches us to connect to the actual reality of the present moment in a way that is more grounded and less painful. Observing self: Accessing a transcendent sense of self, as an arena where both pleasant and unpleasant events are experienced, but have no power to actually harm oneself. When we have anxiety or other painful internal experiences, it feels as though it is harmful to us if we allow it to be there. Unfortunately this results in trying to suppress or avoid these feelings, resulting in them getting more intense and unpleasant. By recognizing that these painful experiences do not actually harm us, but are just some of many internal experiences we have, it can help us to act in meaningful and not get too embroiled in managing our emotions. Values: Discovering what is most important to one's true self. Values are our compass, not the promise of pleasant experiences. Every large goal inevitable has components that are unpleasant, or that we would rather avoid. By clarifying values and acting in ways that realize them, we become less involved in unhelpful emotional avoidance strategies. Committed action: Moving toward value-based goals effectively. This is really about making effort at making our values happen, even when it is difficult, or when we experience unpleasant situations. By consistently building the life we want to live, we move in the direction of being vitally engaged in a life that is meaningful.Communication Training
Problems in communication involve problems with listening, speaking, or both. Effective communication skills training can help people express themselves effectively, while minimizing negative reactions from the intended listener. This can be achieved by emphasizing the subjective nature of the speaker’s comments, expressing positives instead of negatives, and using validation to help disarm the listener and elicit empathy. Listening skills can help people truly understand the speaker, and help the speaker feel understood. This can involve active listening skills, attending, rephrasing, empathizing, validating, and inquiring.
This treatment can be helpful in numerous interpersonal situations, including family relationships, romantic partnerships, and co-worker interactions. It can be used in conjunction with treatments for anxiety and depression when ineffective interpersonal relationships are implicated.Anger Management
We all know what anger is, and we've all felt it: whether as a fleeting annoyance or as full-fledged rage. Anger is a completely normal, usually healthy, human emotion. But when it gets out of control and turns destructive, it can lead to problems—problems at work, in your personal relationships, and in the overall quality of your life. And it can make you feel as though you're at the mercy of an unpredictable and powerful emotion. Anger Management Therapy helps people control and reduce their anger by focusing on the present, and targeting only those problems that need to be solved. CBT for Anger Management involves cognitive behavioral problem solving, mindfulness training, and changing dysfunctional thought patterns.