Contextual Behavioural Therapies

At CBT West, we take a contextual behavioural approach to therapy.  The Journal of Contextual Behavioural Science1 describes contextual behavioural science as “a systematic and pragmatic approach to the understanding of behaviour, the solution of human problems, and the promotion of human growth and development”. This is an approach “to the analysis of human behavior that proposes the need for a multi-level (e.g. social factors, neurological factors, behavioural factors) and multi-method (e.g., time series analyses, cross-sectional, experimental…) exploration of contextual and manipulable variables relevant to the prediction and influence of human behavior”.
We use multiple approaches to teach people the skills to help adjust their thoughts, change unhelpful behaviours, accept the things they cannot change, learn to regulate their emotions, and identify their values to enable them to live a more authentic and balanced life.

These approaches use:
Cognitive behavioural therapy (CBT) - This is particularly useful for people who are troubled by intrusive, obsessive and overwhelming thoughts.
Acceptance and commitment therapy (ACT) - This is helpful for those who are overwhelmed by modern life and the multiple demands it places on them.
Dialectical behavioural therapy (DBT) - This focuses on regulation of overwhelming emotions, which can lead to impulsive behaviours.
Creative approaches to teaching skills, using verbal, written, artistic tools - This focuses on translating skills and knowledge into a more accessible formats.
By using an extensive tool box of skills from a range of different therapeutic approaches, clients can change their thinking, learn how to let some things go, accept the things that cannot be changed and live less stressful and more meaningful lives.
See https://www.journals.elsevier.com/journal-of-contextual-behavioral-science/

What is Cognitive Behavioural Therapy

Cognitive refers to our thinking. Behaviours are the actions we take. If we change the way we think and the way we act, we will change the way we feel.

Understanding our triggers
The therapy process is about taking each stressful or difficult situation and breaking it down into triggers. Once we identify our triggers, we can be more prepared when they reoccur in other situations.

Changing how we think:  The cognitive change in CBT happens a bit like this.
First you identify the things that make you feel stressed or anxious, depressed, ashamed, guilty, angry or hurt.  These are called triggers.  You then list all of your thoughts once triggered.  This will help you identify which thoughts need to be changed. Using a thinking error handout will help this process along and can be found in the useful handout section. This will help you identify the negative thoughts that need to be changed. 

Once you have chosen the negative thought you want to change, you then go through a process of asking yourself: is this thought helpful, logical or true. If you answer yes to any of these questions, you will need to have a conversation with yourself, because no negative thought is any of these things and your task is to find the evidence for and against your negative thinking to move onto the next stage.

Once you have some doubt in your mind that your thought is perhaps not working for you, you then change it, reformulate it.  However, you don't just change it to a positive affirmation. This way of thinking can also be a problem when you are faced with a real life crisis. We are looking for realistic, balanced thinking which validates what you are feeling and is believable to you on some level. The new realistic, balanced thought is often much longer than the original negative thought, for example, "I'm must do well" becomes "I will try my best, give things a go and if they don't work out at least I have tried". Over time and with practice your new thoughts can become second nature, shorter and will replace the  old negative thought.

Changing how we behave
When we explore our behaviours in a particular situation we see two things: the short and long term consequences of our actions. These are important to understand as that quick fix to a problem can lead to long term problems. If the "quick fix" is to avoid a situation that is stressful or makes us anxious, it is an "avoidant behaviour". (example). By learning to identify our avoidant behaviours, we can learn to problem solve and find ways to address issues that gives us long term gains. For example, when you give up eating a muffin for morning tea and replace it with a banana, the moment you do not eat the muffin is the long term gain.

Problem solving in three easy steps

Firstly, list all the possible long term fixes, even if they sound like they might not work. e.g " you could go for a walk instead of going to buy a muffin, call a friend, do something at home to delay your going out early".
Secondly, test them to see what works in the long term. e.g "going later you take a banana from home instead of buying the muffin you have made a long term gain.
Thirdly, what works is your solution. e.g. "you didn't eat the muffin that day" going later works for you.
Using this approach means there is no right or wrong answer, just a process of what works for you.

Putting it together
As I say to clients you cannot just change your thinking or behaviour alone it needs to be a combination that each reinforces the other. In other words cognitive and behavioural in this therapy are working as a team for the best possible outcome.

What is Acceptance & Commitment Therapy

Acceptance and Commitment Therapy (ACT) gets it name from one of its core messages: to accept what is out of your personal control, while committing to action that will improve your quality of life. The aim of ACT is to help people create a rich full and meaningful life, while effectively handling the pain and stress that life inevitably brings. ACT  (which is pronounced as the word 'act', not as the initials) does this by:
a) teaching you psychological skills to deal with your painful thoughts and feelings effectively – in such a way that they have much less impact and influence over you. (These are known as mindfulness skills.)
b) helping you to clarify what is truly important and meaningful to you - ie your values - then use that knowledge to guide, inspire and motivate you to change your life for the better. For more information about ACT please visit the ACBS website at https://contextualscience.org/about_act

What is Dialectical Behaviour Therapy

Dialectical Behavior Therapy (DBT) is a cognitive behavioral treatment developed by Marsha Linehan. It emphasizes individual psychotherapy and group skills training classes to help people learn and use new skills and strategies to develop a life that they experience as worth living. DBT skills include skills for mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness. For more information please visit the Behavioral Tech website at: behavioraltech.org/