What are some of the therapies used by psychologists? Cognitive Behavioural Therapy and Acceptance and Commitment Therapy

The J&R Clinical Psychologists teamBlog, Clinic Updates, Psychological treatment approaches

When talking with a psychologist, you will likely notice the discussion often ties back to the way you think in a specific situation. For example, a psychologist might ask:

  • In that moment, what thought popped into your mind? 
  • What did you take that decision to mean? 
  • Thinking about that situation, what are you concerned may happen?

Psychologists are interested in thoughts because they are regarded as closely related to the emotions we feel, the choices we make, as well as our overall wellbeing. This is often referred to as the Cognitive Model and it’s foundational to modern forms of psychological intervention. It is rare that we are encouraged to notice our thoughts day-to-day (especially in the midst of a stressful moment) and learning to notice thoughts can be a profound benefit of speaking to a psychologist. Becoming more aware of how we think brings with it a great opportunity to better understand our emotions and actions.

The Next Step

Noticing thoughts is a crucial first step, but it is not the last. Next, we start to consider how to respond to thoughts that aren’t particularly helpful. Two effective and widely used therapeutic approaches that help people respond to unhelpful thoughts are Cognitive Behavioural Therapy (CBT) and Acceptance and Commitment Therapy (ACT, pronounced as the word ‘act’). While these approaches have similarities, there are some important differences. Some people prefer the CBT method and other prefer ACT, and sometimes both will be used during a course of therapy. 

Consider this hypothetical: You’re about to make an important speech in front of people you respect.

Responding to thoughts in CBT

In CBT, we practice noticing thoughts that arise in the situation, particularly those thoughts that lead to feelings like sadness, anger, fear, shame or guilt. We can label these negative automatic thoughts (NATs)negative because of the way they make us feel or behave, and automatic because they happen very quickly, without our intention or even without our awareness. 

In the above hypothetical; a NAT might be “I’m going to look foolish in front of everyone.” In CBT, we’d take a magnifying glass to this NAT; Does the evidence support this? Is this NAT useful? Where does it come from? How might you feel if you challenged the NAT and replaced it with a thought like: 

  • “I feel nervous, but that’s normal, and I have practiced this speech extensively.”
  • “I may feel nervous, but that does not mean I will look foolish”
  • “What is the likelihood that this speech will go as badly as I’m predicting?”

As this process of thought identification and challenging is repeated across different situations, you might notice a pattern of negative thinking, and you can then develop a habit of challenging these negative thoughts as they arise. It is common to find that developing more positive, realistic, or pragmatic thinking habits significantly improves mood and leads to desired reactions to difficult situations.

Responding to thoughts in ACT

In ACT, psychological distress is seen as the outcome of ‘fusing’ with our thoughts. When we fuse with our thoughts we get tangled up in them, and we behave as if they are true. When we’re fused with our thoughts, they can push us around. 

In the above hypothetical, focusing on the mental prediction of embarrassment as if it were a fact would understandably increase feelings of anxiety and may even influence the decision to pull out at the last minute. ACT can help you notice this thought, make space for it, accept it non-judgementally, and then do what is important to you. ACT provides strategies that encourage you to let the thought be there without stopping you from doing what is important to you. Difficult feelings and physical sensations are also approached in a non-judgemental way; ACT provides strategies to encourage acceptance of difficult feelings if they are in pursuit of what’s important to you. In fact, an important part of ACT is asking values-based questions; How would you like to handle difficult situations? What would that say about you? What do you want to stand for in life? These questions can reveal powerful internal drivers for desired change.

If experienced in ACT, the person in the above situation may think to themselves: “I’m noticing my mind is conjuring up images of me looking foolish, and that is causing my heart to race. I’m going to make this speech, even with these unpleasant thoughts and feelings, because being courageous and making this speech are important to me.”

Many Similarities 

These are some of the differences between CBT and ACT. However, it important to note that there are also many similarities. For example, both will involve examining behaviours that contribute to psychological distress, and both utilize specific techniques to better manage cognitions. Most importantly, both have a strong evidence-base for being effective in managing psychological distress. You are always welcome to discuss your preferred type of therapy your psychologist.

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