THERAPIES


Cognitive Behavioural Therapy (CBT):

CBT is an evidence-based, structured, here and now practical approach to treating a wide range of psychiatric conditions such as anxiety, depression, phobias, PTSD, OCD,  eating disorders, substance use problems, to name a few. CBT has also been shown to be an effective adjunctive treatment to medication in serious mental disorders like bipolar disorder and schizophrenia.


In CBT, both the therapist and the client work together to solve problems, to remedy errors in thinking, change unhelpful thinking styles, emotions and actions to more helpful ways of thinking, reacting, coping and doing things. Thus, it is a 'here and now' approach which looks at identifying and working on the impact of our thoughts and feelings on our behaviour.

CBT uses different protocols for different problems and relies on active participation of both client and the therapist in treating the underlying condition. The number of sessions vary between 6 and 18 for one course of CBT. The gap between any two sessions can be anywhere between 1-3 weeks, depending upon the condition being treated. As it is a highly structured talking therapy, it involves the client and therapist agreeing on regular assignments for the client to complete prior to attending the next session. CBT is usually a one-to-one therapy, but it is also suited to be delivered as a group therapy.

 

Acceptance and Commitment Therapy:

Officially pronounced as the word "act" and not as the initials A-C-T is a type of contextual cognitive behavioural therapy with a significant existential component to the model. It is also popular as the "third wave CBT" ( after behaviour therapy and cognitive therapy). The aim of ACT is for an individual to be able to live, rich, full and meaningful life, with the willingness to make room for the pain that inevitably goes with it, a process called increasing ones 'Psychological Flexibility'. Thus, the goal of ACT is not to get rid of your symptoms, but to change the relationship with your symptoms for ever so that they don't hold you back.


Research evidence suggests that ACT is effective for a wide range of conditions including depression, anxiety, stress, chronic pain, borderline personality disorder, PTSD, substance use, schizophrenia,  weight management, smoking cessation, and diabetes.


ACT therapists help their clients learn powerful techniques and skills to deal with painful and difficult emotions, thoughts, memories and urges. Some of the techniques are Mindfulness, Cognitive Defusion, Acceptance, use of metaphors, values-guided path, and taking committed action. It refutes the notion that clients are broken and need to be fixed, but believes in the principle of people being just stuck but not broken. A core component of ACT is Mindfulness. Clients are made familiar with different levels of mindfulness skills. The concept of mindfulness and the meditative exercises used to teach it are derived from traditional Eastern philosophy though the version taught in ACT does not involve any religious or metaphysical ideas.


A single ACT session typically lasts 50 minutes to 1 hour, but it can be shorter or longer depending upon the target problem. The number of sessions are not fixed as ACT can be delivered both as a brief therapy as well as time-limited short therapy similar to traditional CBT.

 

Dielectical Behavioural Therapy (DBT):

DBT is an empirically-supported (meaning well researched in clinical trials) psychological therapy for people with borderline or emotionally unstable personality, especially those with self-harming behaviour or recurrent suicidal thoughts, urges or attempts.  People with borderline personality often have difficulties controlling their emotions or experience intense negative emotions. Sometimes, due to the effect of genes, some brains are simply "hard wired" to experience such emotions, but certain type of childhood trauma such as emotional or physical abuse may also lead to changes in the brain making it vulnerable to experience strong emotions, where in, the individual could be feeling happy one moment and angry and sad the next. Apart from this 'emotional dysregulation', one other thing which DBT believes is related to the development of problems seen in people with borderline personality is 'invalidating environment', that is, experiencing an emotionally unstable childhood environment, e.g., caregivers dismissing your emotions as incorrect or trivialising them , childhood trauma, severe invalidation as in physical or sexual abuse, etc.


Clients enrolled in DBT typically receive three modes of treatment-individual therapy, skills group and telephone coaching. Each individual therapy session is once a week one hour session, but sometimes longer. The clients are required to attend the two-hour weekly skills group for one year. The group sessions involve work on four modules-Emotional regulation, Distress tolerance, Mindfulness, and Interpersonal effectiveness. DBT has been evaluated to be one of the best treatments for borderline personality disorder.

 

Dynamic Therapy:

Dynamic therapy is one of the many types of therapies derived from the work of Sigmund Freud in the late nineteenth century. Since then it has evolved greatly with many types of dynamic oriented therapies e.g. interpersonal therapy, brief focussed dynamic therapy etc. The core commonality of all dynamic therapies is the importance on internal world, the unconscious (aspects of ourselves out of our conscious awareness), psychological defence mechanisms, and interpretation of these. Dynamic therapy is based on the assumption that symptoms individuals present with, such as depression, anxiety etc, are expressions of internal unconscious conflicts. Such painful hidden conflicts are thought to originate in early life experiences. Psychological defence mechanisms (ways of thinking, interpreting or behaving in certain set of circumstances) which individuals develop to deal with inner conflict and pain serve to contain the distress initially, but become limiting and counter-productive when circumstances change. Dynamic therapists help individuals to understand and gain insight into their difficulties by interpreting the link between their behaviour and their unconscious feelings. Some ways to do this are to look at developmental origins of a person’s difficulties, exploring underlying conflicts and mal-adaptive defence mechanisms and identifying recurring patterns in relationships. Such strategies help individuals gain insight into their difficulties and develop ability to minimise emotional pain for a better life

 

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