Cognitive behaviour therapy (CBT) is a focused approach based on the premise that cognitions influence feelings and behaviours, and that subsequent behaviours and emotions can influence cognitions. The clinician works with individuals to identify unhelpful thoughts, emotions, and behaviours.
CBT Has Two Aspects:
- Behaviour Therapy
- Cognitive Therapy
Behaviour therapy is based on the theory that behaviour is learned and therefore can be changed. Examples of behavioural techniques include exposure, activity scheduling, relaxation, and behaviour modification. Cognitive therapy is based on the theory that distressing emotions and maladaptive behaviours are the result of faulty patterns of thinking. Therefore, therapeutic interventions such as cognitive restructuring and self-instructional training are aimed at replacing dysfunctional thoughts with more helpful cognitions, which leads to an alleviation of problem thoughts, emotions, and behaviour. In this review, metacognitive therapy has been included as part of CBT. Skills training (e.g., stress management, social skills training, parent training, and anger management) is another important component of CBT.5
Dialectical behaviour therapy (DBT) is designed to serve five functions: enhance capabilities, increase motivation, enhance generalisation to the natural environment, structure the environment, and improve clinician capabilities and motivation to treat effectively. The overall goal is the reduction of ineffective action tendencies linked with deregulated emotions. It is delivered in four modes of therapy. The first mode involves a traditional didactic relationship with the clinician. The second mode is skills training which involves teaching the four basic DBT skills of mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. Skills generalisation is the third mode of therapy in which the focus is on helping the individual to integrate the skills learnt into real-life situations. The fourth mode of therapy is team consultation, which is designed to support clinicians working with difficult clients.
Solution-focused brief therapy
Solution-focused brief therapy (SFBT) is a brief resource-oriented and goal-focused therapeutic approach that helps individuals change by constructing solutions. It aims to increase optimism and positive expectancies along with the experience of positive emotions to improve outcomes. SFBT includes using specific techniques such as miracle and scaling questions to draw on clients’ strengths and resources to create new meaning for clients that provides a more positive future outlook.
Schema-focused therapy emphasises identifying and changing maladaptive schemas and the associated ineffective coping strategies. Schemas are psychological constructs that include beliefs that people have about themselves, the world, and other people, and that are the product of how their basic childhood needs were dealt with. Schema change requires both cognitive and experiential work. Cognitive schema-change work employs basic cognitivebehavioural techniques to identify and change automatic thoughts, identify cognitive distortions, and conduct empirical tests of individuals’ maladaptive rules about how to survive in an environment created from schemas. Experiential work includes work with visual imagery, Gestalt techniques, creative work to symbolise positive experiences, limited re-parenting, and the healing experiences of a validating clinician.
Interpersonal psychotherapy (IPT) is a brief, structured approach that addresses interpersonal issues. The underlying assumption of IPT is that mental health problems and interpersonal problems are interrelated. The goal of IPT is to help clients understand how these problems, operating in their current life situation, lead them to become distressed and put them at risk of mental health problems. Specific interpersonal problems, as conceptualised in IPT, include interpersonal disputes, role transitions, grief, and interpersonal deficits. IPT explores individuals’ perceptions and expectations of relationships, and aims to improve communication and interpersonal skills.
Mindfulness-based cognitive therapy and mindfulness-based stress reduction
Mindfulness-based cognitive therapy (MBCT) and mindfulness-based stress reduction (MBSR) are treatments that emphasise mindfulness meditation as the primary therapeutic technique. MBCT and MBSR are used to interrupt patterns of ruminative cognitiveaffective processing that can lead to depressive relapse. In MBCT and MBSR, the emphasis is on changing the relationship to thoughts, rather than challenging them. The aim is to raise awareness at a metacognitive level so that an individual can fully experience cognitions and emotions that pass through the mind that may or may not be based on reality. The goal is not to change the dysfunctional thoughts but to experience them as being real in the present time and separate from the self.
Acceptance and commitment therapy
Acceptance and commitment therapy (ACT) is based on a contextual theory of language and cognition known as relational frame theory. It makes use of a number of therapeutic strategies, many of which are borrowed from other approaches, including CBT. However, ACT focuses on the context and function of psychological experiences (e.g., thoughts, feelings, and sensations) as the target of interventions, rather than on the actual form or frequency of particular symptoms. In ACT, individuals increase their acceptance of the full range of subjective experiences, including distressing thoughts, beliefs, sensations, and feelings in an effort to promote desired behaviour change that will lead to improved quality of life. A key principle is that attempts to control unwanted subjective experiences (e.g., anxiety) are often not only ineffective but even counterproductive in that they can result in a net increase in distress, result in significant psychological costs, or both. Consequently, individuals are encouraged to connect with their experiences fully and without defence while moving toward valued goals. ACT also helps individuals to identify their values and translate them into specific behavioural goals.