Although therapy must be tailored to the individual, there are certain principles common to CBT:
- Therapy is based on an ever-evolving formulation of the patient’s problems
- Treatment requires a sound therapeutic alliance between patient and therapist
- Therapy emphasizes collaboration between patient and therapist and active participation of the patient
- Treatment is goal-oriented and problem-focused
- Therapy primarily emphasizes current problems and potential solutions
- Therapy is a learning process and aims to increase a patient’s problem-solving abilities
- Treatment aims to be time-limited, more often lasting months rather than years
- Therapy sessions are structured
- Therapy teaches patients to identify, evaluate, and respond to their dysfunctional thoughts and beliefs
- Treatment may involve a variety of techniques to change thinking, mood, and behavior
These basic principles apply to all patients. Therapy does, however, vary considerably according to individual patients, the nature of their difficulties, and current life circumstances, as well as their developmental experiences, gender, and cultural background. Treatment also varies depending on patients’ goals, their ability to form a strong therapeutic bond, motivation to change, previous experience with therapy, and their preferences for treatment.
CBT has been found to be effective in more than 1000 outcome studies for a variety of psychiatric disorders, including depression, anxiety, eating disorders, substance abuse, and chronic medical disorders. CBT has also been shown to be effective when used in combination with medication for serious mental disorders, including Bipolar Disorder and Schizophrenia.
Source: Cognitive Behavior Therapy, Second Edition: Basics and Beyond by Judith S. Beck. Guilford Press, 2011.
Dialectical Behavior Therapy (DBT) was originally developed by Dr. Marsha Linehan as a comprehensive treatment program to treat chronically suicidal individuals suffering from Borderline Personality Disorder (BPD). During the past three decades, DBT has been found to be especially effective for individuals with suicidal and other severely dysfunctional behaviors.
Before developing DBT, Dr. Linehan first attempted to apply standard Cognitive Behavioral Therapy (CBT) to the problems of adult women with histories of chronic suicide attempts, suicidal ideation, urges to self-harm, and self-mutilation. After recognizing that standard CBT was not effective with this group of patients, Dr. Linehan and her research team made significant modifications to their approach, incorporating acceptance-based interventions and a “dialectical world view”–recognizing that everything is connected to everything else, change is constant and inevitable, and opposite perspectives can be integrated to form a more accurate perception of reality.
DBT is based on Dr. Linehan’s theory that the core problem in BPD is emotional dysregulation–a patient’s inability to effectively regulate intense emotional reactions. The focus of DBT is on helping patients learn and apply skills that will increase their ability to regulate intense emotions and decrease ineffective coping strategies. DBT typically includes a combination of individual psychotherapy and group skills training. Patients in DBT are asked to monitor their symptoms and utilize new skills on a daily basis. The four areas addressed in DBT skills training include:
- Mindfulness–learning to observe, describe and participate in all experiences while maintaining a nonjudgmental approach, focusing on the present moment and being effective
- Interpersonal Effectiveness–learning to successfully assert your needs and to manage conflict in relationships
- Distress Tolerance–learning ways to accept and tolerate distress without resorting to behaviors that will make the distress worse in the long run
- Emotion Regulation–learning to identify and manage emotional reactions
Randomized controlled trials have demonstrated that DBT is more effective than other forms of psychotherapy in the treatment of BPD and BPD with co-occurring substance abuse. Among other results, these studies found that patients receiving DBT were much less likely to drop out of therapy, were much less likely to engage in suicidal behaviors, had less medically severe behaviors, were less likely to be hospitalized, and had higher scores on global and social adjustment. For patients with co-occurring substance abuse, DBT was more effective than standard treatment in reducing drug abuse. Other research has shown DBT to be effective in treating a variety of other disorders, including chronic depression, anxiety, eating disorders, and substance abuse.
Source: Cognitive-Behavioral Treatment of Borderline Personality Disorder by Marsha M. Linehan. Guilford Press, 1993.
Mindfulness practices have received increased attention in Western psychology during the past several decades, and have been recognized as an effective way to reduce stress, increase self-awareness, enhance emotional intelligence, and effectively handle painful thoughts and feelings. Mindfulness practices have developed through thousands of years of cultural evolution as an antidote to the natural habits or our minds that make life much more difficult than it needs to be.
Mindfulness is a way of relating to life that holds the promise of both decreasing our suffering and making our lives rich and meaningful by attuning us to our moment-to-moment experience and allowing us to understand how our minds created unnecessary anguish. By helping us understand exactly how we create our own distress, mindfulness practices teach us how to let go of painful mental habits and replace them with more useful ones.
Over the past several decades, researchers and psychologists have discovered that both ancient and modern mindfulness practices hold great promise for decreasing many of the most common forms of psychological suffering, including anxiety, depression, substance abuse, and related conditions. Mindfulness practices have also been found to be helpful in improving interpersonal relationships and fostering overall happiness.
The benefits of cultivating mindfulness are far-reaching. By providing an effective way to deal with our common human experiences, it can greatly improve our everyday lives. Mindfulness aims to help us see and accept things as they are, allowing us to come to terms with the inevitability of change and the impossibility of always avoiding life’s challenges. By letting go of our struggle to control events in our lives, we become less likely to get caught in emotional problems like depression and anxiety or stress-related physical problems.
In addition to reducing emotional suffering, mindfulness allows us to experience the richness of our everyday lives. We can actually “smell the roses,” and feel more connected to others and our own experiences. Mindfulness can also allow us to act more wisely and skillfully in our everyday decisions as we become less concerned about the potential negative consequences of our actions and more focused on the bigger picture.
Source: The Mindfulness Solution: Everyday Practices for Everyday Problems by Ronald D. Siegel. Guilford Press, 2009.
