I am not a psychologist. But I love learning. That may be a significant reason I thrived at PSI in Chicago: they gave us a good academic overview of the psychological approaches commonly used in addiction treatment.
Cognitive Behavioral Therapy (CBT)
Aaron Beck was a psychiatrist who contributed greatly to the development of CBT. He credited early Stoic philosophers with using CBT-like approaches when they encouraged the use of logic to identify inaccurate beliefs that contribute to negative emotions. CBT grew out of a combination of behavioral therapy (Ivan Pavlov, John B. Watson, Rosalie Rayner, B.F. Skinner and others) and cognitive therapy (Alfred Adler, Abraham Low, Albert Ellis, Aaron Beck).
CBT in essence involves identifying errors in beliefs and thinking, because these dysfunctional beliefs contribute to emotional distress and dysfunctional behaviors. Cognitive distortions often involve magnifying negatives, minimizing positives, overgeneralizing, and catastrophizing.
This article provides a great overview of CBT, as well as numerous CBT exercises.
Common Cognitive Distortions
- Mental Filtering: overlooking positives/focusing on negatives
- All-or-nothing thinking: thinking in terms of “always” or “never”
- Overgeneralization: believing one bad situation translates into all or most situations being bad
- Mind Reading: making assumptions about the thoughts of others
- Personalization: viewing a negative event as being due to you or targeted at you
- Minimizing: something positive happens but you minimize its importance
- Should statements: life should be fair; they should have thought of me
CBT Tools & Techniques
- Journaling: self-reflection; identify thought patterns
- Identify/rethink cognitive distortions
- Cognitive restructuring: reframe thinking based on journaling & ID of cognitive distortions
- Play the script – think through the likely outcome of a decision
- Progressive relaxtion; controlled breathing exercises
- Exposure therapy
Rational Emotive Behavioral Therapy (REBT)
REBT grew out of CBT, and was described by Albert Ellis in 1956. Like Beck, Ellis credited classical philosophers as a source of inspiration, particularly Stoics and Buddhists.
The core of REBT: it is primarily our thinking patterns and beliefs that cause emotional and behavioral problems, not the events or situations that happen to us.
Ellis said too much emphasis is placed on viewing events as good or bad. We have much more control over how we think about events, so this approach is inherently empowering.
Ellis challenges us to identify automatic thoughts we have that are dominated by “should”, “must”, and “ought”. These dogmatic thoughts are often exaggerated, and can contribute greatly to frustration, anger, and sadness.
ABCDEF
The ABCDEF approach to problems is fundamental to REBT.
- A – the activating event
- B – our beliefs about the event/the world/ourselves
- C – emotional and behavioral consequences
- D – dispute your beliefs. Evaluate whether your beliefs about the event are rational or irrational.
- E – effective new beliefs can be formed once irrational beliefs have been uncovered.
- F – new feelings, emotions & behaviors are possible
Disputing Irrational Beliefs
Other REBT Exercises
There are numerous “irrational beliefs” lists out there. The common irrational beliefs many of us have at times are variations on these 3 themes:
- I must do well and be loved or I am no good.
- Others must do the right thing or they are no good.
- Life must be easy and comfortable or it is terrible.
1. Imagine the worst: If you’re having worries about something bad happening, take it all the way to the worst imaginable situation. You may realize a) it’s not likely to get that bad, and b) even if “bad” happens, you can deal with it.
2. Unconditional Self Acceptance
3. Coping skills, such as meditation.
Acceptance and Commitment Therapy (ACT)
Steven Hayes described ACT in the 1980s, and it is also grew from a CBT foundation.
ACT is about accepting uncomfortable feelings, acknowledging that these feelings are a normal reaction to life situations, and committing to changing problem behaviors. The process encourages development of psychological flexibility through these 6 steps:
1. Acceptance. Acknowledge and accept all of your thoughts and emotions rather than deny or avoid them.
2. Cognitive Defusion. Distance yourself from uncomfortable emotions and thoughts to decrease the distress they cause.
3. Being Present, aka mindfulness. Observe your thoughts and feelings without judging or trying to alter them.
4. Self as Context. This is directly out of Buddhism and mindfulness meditation. Become aware that you are not your thoughts or feelings. You are that which is observing and aware of those thoughts and feelings. This type of awareness promotes emotional stability and mental flexibility.
5. Values. As in SMART Recovery, make a list of your most important values and commit to act and live in ways that honor them. (As opposed to allowing your actions to be driven by lesser motives such as avoiding pain, or seeking superficial and transient pleasures).
6. Committed Action. Set goals and develop skills that will keep you acting in accord with your values.
This article reviews ACT and has several exercises.
Dialectical Behavioral Therapy (DBT)
DBT is also considered to be an iteration of CBT. The psychologist Marsha Linehan developed DBT in the 1970s. DBT focuses on:
1. Emotional Regulation: learn to be aware of and to label emotions in a non-judgmental manner. Incorporate activities that increase positive emotions.
2. Distress Tolerance: calmly recognize negative thoughts and emotions, and avoid making hasty decisions or acting in ways that are not based on reflection and values. “Radical acceptance” is a DBT concept referring to complete, non-judgmental acceptance of yourself, how you feel, and the situation you are in.
3. Mindfulness: as in Buddhism and mindfulness meditation, becoming aware that you are not your thoughts and emotions. You are the consciousness that is aware of the thoughts and emotions. Recognizing this and observing the flow of thoughts and emotions in a non-judgmental manner promotes emotional stability and gives one room for reflecting before acting.
4. Interpersonal Effectiveness: Balancing your needs with the needs of others in your life in a way that allows self-respect and care. Communicating effectively and setting healthy boundaries.
I don’t know who sponsors this site, but it’s an incredible summary of DBT and source of relevant exercises.
And a few others
EMDR. Family therapy. Individual therapy. Contingency management.