Therapeutic Approaches
CBT
Cognitive Behavioral Therapy (CBT) includes a wide range of empirically supported treatments. CBT is a collaborative, structured, and goal-oriented approach that helps individuals gain a better understanding of the interplay of thoughts, emotions, and behaviors. It helps clients work through unhelpful thoughts patterns while also teaching new skills and coping strategies.
ACT
Acceptance and Commitment Therapy (ACT) is an empirically supported treatment that focuses on helping individuals build a full, meaningful life based on one’s own values. It helps people to change their relationship with difficult thoughts and feelings, thereby decreasing suffering and promoting real, lasting change.
CFT
Compassion Focused Therapy (CFT) is particularly helpful when individuals experience high levels of self criticism and shame. Through this work, individuals get a better understanding of the unhelpful ways they respond to suffering with shame and blame, and learn to strengthen a compassion response which has been shown to lead to less suffering and greater overall well-being.
MINDFULNESS
Mindfulness is paying attention to the present moment on purpose. By becoming attuned to our internal experience, we can observe what’s going on in our minds without getting carried away by it. Mindful practices can help us respond, not react, to our experiences, and thereby make more intentional, informed decisions that lead us to a more value-driven life.
Cognitive Behavioral Therapy (CBT)
Cognitive Behavioral Therapy is a term used to describe a wide range of empirically supported treatments. CBT is a collaborative, structured, and goal-oriented approach that teaches new skills and coping strategies.
CBT works at understanding the interconnected relationship between thoughts, behaviors, emotions, and physiological sensations. Through CBT, you will learn to identify the thought patterns (e.g., rumination, excessive worry, etc.) and external behaviors (e.g., procrastination, emotional eating) that keep you stuck, and learn more adaptive ways coping. These changes have a significant impact on easing emotional problems like anxiety, depression, and stress. CBT also incorporates techniques to help target physiological issues such as tension, GI upset, and chronic pain.
Some common types of CBT that I practice include:
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Exposure and Response Prevention (ERP) is an exposure based treatment for individuals with obsessive compulsive disorder and other anxiety disorders, and is seen as the gold standard of OCD treatment approaches. It helps individuals face their fears through exposure, and stop time consuming compulsions through ritual prevention.
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Habit Reversal Training (HRT) helps target unwanted repetitive behaviors or habits, such as tics, hair pulling, nail biting, and skin picking. It helps clients gain a better understanding of their own specific patterns, and provides a personalized set of tools to target these repetitive behaviors.
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Enhanced Cognitive Behaviour Therapy (E-CBT) is a highly effective treatment for eating disorders. It is a “transdiagnostic” treatment approach, meaning that it can be adapted for a range of eating disorders, including anorexia nervosa, bulimia nervosa, and binge eating disorder.
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Prolonged Exposure Therapy (PE), Cognitive Processing Therapy (CPT), and STAIR-NST are specifically for helping individuals with trauma alleviate the symptoms of Post-Traumatic Stress Disorder (PTSD).
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CBT for Insomnia (CBT-I) is a high effective form of treatment for individuals with insomnia.
Acceptance and Commitment Therapy (ACT)
Acceptance and Commitment Therapy (ACT) is an empirically supported treatment that focuses on changing the relationship with difficult internal experiences (e.g., thoughts and feelings), and in doing so, allowing us to make real changes in the service of living a full and meaningful life. ACT utilizes acceptance and mindfulness based approaches to help us to break unhelpful patterns and promote more intentional, value-driven responses. This, together with value-based behavior change, helps promote a more flexible way of living.
ACT promotes psychological flexibility not only as a goal of treatment, but also as a way to live a full, meaning-filled life. When we are psychologically flexible, we can hold our thoughts more lightly, make space for emotions and sensations without being driven by them, and move towards what matters. Some key concepts that help promote psychological flexibility are:
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Willingness and Acceptance. ACT states that while some psychological pain is an unavoidable part of life, much of our added suffering comes when we try to avoid, escape, or control this pain. By changing the way we relate to difficult experiences, we can live healthier, fuller lives. ACT promotes willingness and acceptance-based practices to stop struggling against difficult realities, and thus, lessening overall suffering.
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Mindfulness. We can easily become “hooked” by our experiences, and ACT helps individuals gain space and perspective to see thoughts and thoughts, feelings as feelings, physical sensations as physical sensations-- in other words, to experience these as they are, without getting lost in the added judgement and meaning our minds can attach. ACT also helps foster a better present moment awareness. When we are more aware of the present moment, without this added judgement, we have more freedom to make purposefully and intentionally decisions. ACT also explores the ways we can also become fused with our self concept or self story, and treatment can help a person view oneself as a flexible, changing being without being defined by one’s experiences (e.g., you may feel unworthy, but that is not who you are).
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Values. ACT places a strong emphasis on the clarification and exploration of individual values. Values are not goals, but rather make life rich and meaningful, and they help provide direction, particularly in life’s difficult moments. In this way, values are like a compass, they help guide us in the direction of our own choosing, based on what we want our lives to be about. When we know our values, we can then focus on committing to making value-driven decisions.
ACT has a large research base, and has been shown to be highly effective in treating anxiety, depression, and countless other problems.
Compassion Focused Therapy (CFT)
Compassion is the ability to understand, approach, and engage with suffering and distress, coupled with the desire and motivation to alleviate this suffering. Compassion, and the many forms it takes, is a vital part of therapy.
Compassion Focused Therapy is rooted in research in attachment theory, evolutionary science, developmental psychology, and neuroscience. It was developed to work with difficult experiences such as shame, self-criticism, and self-loathing, and is useful for individuals with diverse conditions, including anxiety, depression, and trauma. It can be helpful to integrate CFT into treatment when individuals respond to their difficulties with high levels of shame and blame, or struggle to give or receive compassion.
The CFT model states that we have three emotion regulation systems: a threat and self-protection system (linked to protective emotions such as anger, disgust, or fear), a drive and excitement system (organized around motivators and seeking resources such as food, mates, and status), and a soothing and social safeness system (which promotes connection and safeness). Each system serves a different evolutionary purpose, and as such, is associated with different types of thoughts, emotions, and physical sensations, and motivations.
When individuals suffer with excessive shame, self-blame, or self-criticism, they may have an overactive threat system and struggle to access and activate their soothing system. The goal of CFT is to bring these three affect systems into balance by training the individual to access and strengthen the soothing system through various compassion practices.
Through CFT, individuals learn to strengthen their own compassionate voice to respond to difficulties with a blend of kindness, strength, courage, and wisdom. Through this work, people gain a deeper understanding that much of the pain we experience in life is not of our choosing, but rather the byproduct of factors such as our genetics, upbringing, and social circumstances… and so while this much of this is not our fault, we have the ability and responsibility to help alleviate our suffering.
In CFT, individuals explore the roots of self-criticism and self-attacking behaviors to better understand where these came from-- in other words, to help place these in the context of the individual’s personal developmental history. Treatment will also help individuals see that while these patterns developed for various reasons, they often do not serve the intended function (e.g., criticizing a perceived fault doesn’t actually lead to improvement, but may actually further feed shame). Thus, instead of responding to suffering with blame, shame, and criticism, one can begin to practice compassionate responses that are aimed at reducing suffering.
CFT utilizes mindfulness-based practices, as well as imagery and other cognitive and behavioral interventions, and works to promote compassionate motivation, sympathy and sensitivity, and distress tolerance. It can be integrated with other evidence-based interventions to help optimize treatment.
Mindfulness
Mindfulness itself isn’t a therapy, but has become a vital component of many forms of treatment. In the most general sense, mindfulness is paying attention to the present moment on purpose with non-judgment.
Mindfulness training is attention training. Our attention is movable, like a spotlight: it can narrow in on one area, or widen out to take in a wider perspective. We can focus on experiences inside our body (e.g., thoughts, feelings, sensations), or turn our attention outwards to notice things outside our bodies (e.g., things we experience with our five senses). Our attention may illuminate one area and leave another fade in the background, so while it doesn’t stop existing, it is simply no longer the focus of our attention. Our attention, if left to its own devices, will wander. But we can train ourselves to pay attention on purpose.
We understand the world through the lens of our thoughts. Through therapy, you can explore the thoughts, beliefs, and experiences that shape your perceptions. Mindfulness can help us better understand the existence, content, and influence of these thoughts. Instead of always looking from your thinking, you learn to look at your thinking, and gain a better understanding of how you see the world through the lens of these thoughts. Through mindfulness you can gain a better understanding of unhelpful patterns and loops (e.g., ruminating, worrying), and better understand when you get caught up in them. In other words, mindfulness allows for a better awareness of these loops, and in gaining perspective of the process, you can bring yourself back to the present. By practicing open awareness, we can slow down and even step outside the loop, allowing us to change old patterns and try out new ones.
By becoming attuned to our internal experience, we can observe what’s going on in our minds and bodies right now without getting carried away by it. By better understanding our minds and bodies, we can learn from them, and take better care of ourselves. Mindful practices can help us respond, not react, to our experiences, and thereby make more intentional, informed decisions that lead us to a more value-driven life.
Mindfulness is a key component of many third-wave CBT practices such as Acceptance and Commitment Therapy (ACT) and Dialectical Behavior Therapy (DBT). It is also at the core other evidence based treatments, such as Mindfulness-Based Stress Reduction (MBSR), an approach developed by Jon Kabat-Zinn.