Therapy Styles

Patrick Sheehan at The Adaptability Practice primarily utilises Cognitive Behaviour Therapy and Acceptance and Commitment Therapy.

Cognitive Behaviour Therapy

Cognitive Behaviour Therapy (often called by its acronym CBT) is a broad term describing treatment that targets the relationship between how we perceive things in our life (the cognitive) and what we end up doing that may or may not be helpful to us (the behaviour).

The cognitive may comprise of the beliefs we develop over time about ourselves and others, and the things we pay attention to that aligns with those beliefs. The cognitive also involves what we remember in line with these beliefs, and how we feel, all of which are often based on our past learning.

The behaviour is what we say, do and avoid in life, often which is based upon our cognitive experience. CBT comprises of two elements.

  • Working out what we are thinking, paying attention to, and taking action on that may have been learnt over time to help us cope with our conditions growing up. We then tease out which parts here may not be helpful as a way to adapt to what is happening in our lives in the present or the future.
  • Making plans to change or modify some of the more unhelpful ways that we attend, think and act in the world to reduce struggle and help people live more fulfilling lives, whatever that may be.

I often find it to be a very useful approach because, for many people, it is easy to understand and it is a relatively brief approach. A completed treatment can often be carried out within 3-12 weeks for many life problems. It is also useful because once you understand the approach of CBT, it can then be reapplied for future challenges. In short, it provides quite a clear how rather than being primarily focused on the why for dealing with our struggles and changes.

CBT may not be recommended for some people who want an approach based on talking through their issues, because it often has homework and small experiments to try out between sessions. However, the research evidence of its effectiveness for treating anxiety, depression, habit change and many other areas ranges between moderate to strong.

In a meta-analytic review from Hoffman and colleagues (2012) in Cognitive Therapy Research, CBT was shown to be strongly effective in treating:

  • Anxiety and anxiety disorders
  • Post traumatic stress disorder
  • Anger control problems
  • General stress
  • Somatic symptoms
  • Bingeing/purging food problems
  • Insomnia and sleep problems

Additionally, CBT was shown to be moderately effective in treating:

  • Depression
  • Bipolar disorder
  • Alcohol and drug use problems
  • Gambling addiction
  • Reducing relapse on of smoking
  • Handling delusions and hallucinations as an addition to medication
  • Personality disorders
  • Adjusting to pain and chronic pain

Acceptance and Commitment Therapy

Acceptance Commitment Therapy (known often by the acronym ACT) is a variation of cognitive behaviour therapy focused on both change and acceptance. The work done in therapy sessions is to identify struggles and attempts to modify unwanted thoughts and feelings, and instead learn how to apply acceptance to these experiences so that more energy can be placed into life itself.

ACT makes the assumption that thoughts and feelings ebb and flow, and often have little predictive value for long-term life satisfaction and fulfilment. It also assumes that if we align our actions with our values from a big picture perspective, there may be a better chance of living a rich, full meaningful life. ACT is interested in psychological flexibility, which is theorised to be a common factor that is low in many areas of distress and disorder in life. Therapy skills focus on building psychological flexibility – which can be defined as holding our own thoughts and emotions a bit more lightly, and acting on longer term values rather than short term impulses, thoughts and feelings.

A broad number of studies have found evidence that psychological flexibility is low in those who struggle with the following:

  • Worry
  • Anxiety
  • Depression
  • Low quality of life
  • Substance abuse
  • Inability to learn
  • Poor work performance
  • Overall mental illness pathology

The evidence of ACT for treating specific psychological conditions is still in a state of emergence. The treatment has been considered to be “probably efficacious” (probably effective but not conclusively so pending on the completion of large scale studies) for the following conditions:

  • Depression
  • Mixed anxiety
  • Obsessive Compulsive Disorder
  • Psychosis

The number of studies in ACT are increasing dramatically every year, and so we await further evidence about its effectiveness in a range of areas.

In contrast to CBT, I find that ACT is often a useful approach for people who come to therapy with larger questions about meaning, suffering, and understanding one's past. Like CBT it can be brief (3-12 weeks), but ACT can also provide the flexibility to work with deep and complex issues.

Source for evidence: (April, 2018)