What is cognitive behavioural therapy?
Cognitive behavioural therapy (CBT) combines two different approaches for a practical and solution-focused therapy. The therapy is very active by nature, so you may be expected to take a proactive role within your treatment. This may include completing tasks at home.
The idea behind CBT is that our thoughts and behaviours have an effect on each other. That by changing the way we think or behave in a situation, we can change the way we feel about life. The therapy examines learnt behaviours, habits and negative thought patterns with the view of adapting and turning them into a positive.
Unlike some other therapies, CBT is rooted in the present and looks to the future. While past events and experiences are considered during the sessions, the focus is more on current concerns. During a CBT session, your therapist will help you understand any negative thought patterns you have. You will learn how they affect you and most importantly, what can be done to change them.
Cognitive behavioural therapy looks at how both cognitive and behavioural processes affect one another and aims to help you get out of negative cycles. The emphasis on behavioural or cognitive approaches will depend on the issue you are facing. For example, if you are suffering from anxiety or depression, the focus may be on the cognitive approach. If you have a condition that causes unhelpful behaviour (such as obsessive compulsive disorder), the focus is likely to be the behavioural approach.
This type of therapy is particularly helpful for those with specific issues. This is because it is very practical (rather than insight-based) and looks at solving the problem. Some of the people that may benefit from cognitive behavioural therapy include:
– Those who suffer from depression and/or anxiety.
– People who are suffering from post-traumatic stress disorder (PTSD).
– Those who have an eating disorder.
– Those who have an addiction.
– People who are experiencing sleeping problems, such as insomnia.
– People who have a fear or phobia.
– Those who suffer from obsessive compulsive disorder.
– Those who want to change their behaviour.
In some cases, CBT is used for those with long-standing health problems, such as chronic pain or irritable bowel syndrome (IBS). While the therapy cannot cure such physical ailments, it can help people cope emotionally with the symptoms and lower stress levels.
CBT is also a popular treatment for conditions such as schizophrenia and psychosis. The aim is to identify any connections between your thoughts and feelings and how they affect the symptoms you are experiencing.
What is the aim of integrative therapy?
Integrative counselling aims to promote healing and facilitate wholeness – ensuring that all levels of a person’s being and functioning (mental, physical and emotional health) are maximised to their full potential. Clients must be committed to self-exploration and open to identifying what factors in their life are perpetuating problems, and/or are causing current concerns.
In particular, the integrative approach helps clients face each moment openly and authentically without having formed an opinion, expectation or attitude beforehand. This enables them to better focus on the fears and hurts that limit their psychological freedom, and recognise specific triggers that may be causing disruptive patterns of behaviour.
Through this awareness, integrative therapy helps to create a healthy alliance between mind and body – empowering clients to start setting goals and practising new behaviours that will enable them to move beyond their limitations and discover greater life satisfaction. This will be worked towards alongside other goals that are drawn into therapy through the integration of other approaches. These will all be tailored to the client’s personal limits and external constraints.
The attitude and presence of an integrative counsellor is another crucial element of integrative therapy. It is generally believed that the most effective model requires the therapist to be non-judgemental, interpersonal and intent on establishing a supportive and cooperative relationship with their client. They must also engage in deep, attentive listening without the pre-suppositions that can distort understanding.
This meaningful contract between equals is thought to empower clients – helping them to explore and recognise patterns of behaviour that need to be addressed through change and the setting of new goals. This aspect of integrative therapy is often referred to as the personal integration of therapists – they are committing themselves wholly to their client and their exploration of self.
The core purpose of the person-centred approach is to facilitate the client’s actualising tendency (self-actualisation is the belief that all humans will pursue what is best for them). This type of therapy facilitates the personal growth and relationships of an individual by allowing them to explore and utilise their own strengths and personal identity. A person-centred counsellor will aid this process and provide vital support.
According to Rogers, there are six conditions necessary to enable real change. These are:
• There is psychological contact between the client and the counsellor.
• The client is emotionally upset, in a state of incongruence.
• The counsellor is genuine and aware of their own feelings (congruent).
• The counsellor has unconditional positive regard for the client.
• The counsellor has empathic understanding of the client and their internal frame of reference, and looks to communicate this experience with the client.
• The client recognises that the counsellor has unconditional positive regard for them and an understanding of their difficulties.
Out of these, the following three are known as the ‘core’ or ‘active’ conditions:
Congruence – the counsellor must be completely genuine.
Unconditional positive regard – the counsellor must be non-judgemental and valuing of the client.
Empathy – the counsellor must strive to understand the client’s experience.
A variety of factors can affect an individual’s ability to flourish, including low self-esteem, a lack of self-reliance and very little openness to new experiences. The person-centred approach recognises that an individual’s social environment and personal relationships can greatly impact these, so therapy is offered in a neutral and comfortable setting where a client can feel at ease, authentic and open to learning about themselves. In this way, the approach offers individuals the opportunity to counteract past experiences that affected conditions of worth (the circumstances under which we approve or disapprove of ourselves).
Other related changes that can be cultivated from this therapy include:
• Closer agreement between an individual’s idealised and actual selves.
• Better self-understanding and awareness.
• Decreased defensiveness, insecurity and guilt.
• Greater ability to trust oneself.
• Healthier relationships.
• Improvement in self-expression.
• Overall a healthy sense of change.
What is mindfulness?
The Mental Health Foundation has reported that anxiety and depression are the two most common mental health issues within the UK; something that could, in part, be attributed to busy modern lives. Multitasking and juggling commitments has become commonplace, with many people feeling as if they aren’t truly present in their own lives.
Mindfulness is a specific way of paying attention to what is happening in our lives in the present moment, as it truly is. Of course it won’t eliminate life’s pressures – but with practice it can help us take notice of (and hopefully stop) negative, habitual reactions to everyday stress.
The most common way this technique is practiced is through mindfulness meditation. This usually involves practitioners focusing on sights, sounds and physical sensations while trying to reduce ‘brain chatter’. Some people struggle with mindfulness meditation at first, finding it hard to focus their attention, but this is to be expected and may require practice. Practicing the technique regularly can help people take a step back, acknowledge their ‘brain chatter’ and view it accurately and without judgement.
Other forms of mindfulness practice may involve physical movement. Exercises such as yoga and Tai Chi both involve meditative movements that can help improve physical self-awareness and quiet the mind.
While these types of mindfulness practices are useful for everyone, those with mental health concerns such as anxiety and depression may benefit from a more structured therapy that incorporates mindfulness, such as mindfulness-based stress reduction or mindfulness-based cognitive therapy.
Benefits of mindfulness
Since the concept of mindfulness arrived in the west in the 1970s the claimed benefits have been substantiated by several clinical studies. The aim of mindfulness is to help individuals do the following:
70% reduction in anxiety
ongoing reduction in anxiety
fewer visits to the doctors
increase in disease-fighting antibodies
better quality of sleep
fewer negative feelings, including tension, anger and depression
improvements in physical conditions such as chronic fatigue syndrome and psoriasis.
The evidence has been so strong in fact that nearly three-quarters of GPs have said they feel all patients would benefit by learning mindfulness meditation.
Further studies into the role of mindfulness in the workplace are showing that it could improve productivity, decrease sickness absence and generally improve workplace well-being.
What else can mindfulness help with?
We have already discussed how mindfulness can be used to help people cope with issues such as stress, anxiety and depression, but what other issues could mindfulness help with?
Mindfulness-based therapy for insomnia looks to integrate behaviour therapy and sleep science with the meditation practices of mindfulness. The goal is to help increase awareness so individuals recognise and react accordingly to the mental and physical states that occur with chronic insomnia.
While initially, the idea of paying more attention to your physical sensations when you suffer from chronic pain may seem counter-intuitive, it is thought that mindfulness can help. The idea here is that instead of focusing on the negative thought patterns that emerge upon feeling the physical sensation of pain, sufferers should view their pain with curiosity. This is so the pain is experienced accurately as sometimes our minds can over exaggerate pain. Mindfulness for chronic pain is also thought to help teach individuals to let go of any expectations or future worries and instead focus on the present, dealing with physical/emotional reactions in a calm manner.
Treating negative behaviours such as addiction can be complemented with mindfulness-based cognitive therapy as this looks to make the individual more aware of their emotions and how to deal with them, while simultaneously breaking harmful thought patterns.
Mindful eating is a useful practice that involves individuals taking time to experience their food and all the sensations surrounding eating. This can help those with disordered eating see food in a different light, as well as helping them to recognise when they are physically hungry/full without any associative emotions.