Cognitive Behavioral Therapy (CBT)
Some of the challenges in life seem like they’re fixed and won’t be moved. It feels like we spin our wheels trying to change the circumstances but some problems just can’t be solved. How are we meant to address these in therapy?
The underlying principles of CBT are that:
Our stressors are caused, in part, due to faulty/unhelpful thought patterns.
Our stressors are caused, in part, due to learned behaviors that are unhelpful.
We can relieve stress when we learn better methods of coping.
CBT helps us see the connection between our thoughts, feelings, physical sensations and behaviors. A negative impact in one area creates a vicious cycle. We learn to: break down problems into smaller parts; change negative thought patterns; and face our fears rather than avoid them.
Chronic pain or health condition: If you have chronic pain, IBS, fibromyalgia or another health problem, you have likely noted a connection between your experience of symptoms and your mood. Perhaps you feel more down if you have to spend time in bed due to pain; or maybe anxiety worsens GI symptoms for you. CBT teaches strategies to calm the body, cope with unpleasant symptoms and learn to face difficult situations. Check out this ELC blog post on chronic pain and counseling to learn more!
Depression & anxiety: Depression and anxiety are both notably impacted by unhelpful thinking patterns, such as “I’m such a screw up” or “Today is going to be terrible”; and negative behavior patterns. CBT helps identify and challenge thought patterns that are contributing to depressive or anxious emotions, as well as build the vocabulary to name these feelings and structure activities into productive behavior patterns. *See below for ERP for OCD.
Self-esteem & body image: What we perceive is what we believe. Negative self-talk contributes to poor self-image and CBT helps us to identify unhelpful beliefs, such as “I’m not good enough because I don’t look like everyone else,” challenge them and come up with alternatives. Using self-compassion, a healthy relationship with the therapist and building context with one’s thoughts, we build a healthier sense of self.
Exposure and Response Prevention (ERP) for OCD
A type of CBT, ERP is an evidence-based treatment that helps people with OCD learn they can tolerate anxiety and distress without needing a ritual or compulsive behavior. This is done by exposing clients to situations that provoke their fears and anxieties (within a safe environment) and encouraging them not to avoid the feelings via compulsive behavior. Clients are taught to use coping skills when triggered; aided in challenging unhelpful beliefs about the need for certainty; and self-efficacy is highlighted when new behavior is learned.
“The central shift is from a focus on what you think and feel to how do you relate to what you think and feel. Specifically, the new emphasis is on learning to step back from what you are thinking, notice it, and open up to what you are experiencing. These steps keep us from doing the damage to ourselves that efforts to avoid or control our thoughts or feelings inflict, allowing us to focus our energies on taking the positive actions that can alleviate our suffering.”
— Steven Hayes
Acceptance and Commitment Therapy (ACT)
About ACT
ACT is a mindfulness-based therapy that works to create a rich and meaningful life while accepting that pain is inevitable. It teaches us to use our values to build meaningful experiences and use mindfulness in everyday life. ACT teaches that suffering/pain is part of the human experience; thus, the goal is not “symptom” reduction or eliminating suffering. Rather, mindfulness skills of acceptance; cognitive delusion; contact with the present moment; and the observing self are taught to build acceptance of private experiences outside of our personal control and to build commitment and action toward living a valued life.
Who benefits
I have incorporated ACT techniques into the treatment of depression, anxiety, chronic pain, overeating and negative self-talk in the context of other stressors. A review of the evidence is listed on the ACT website.