Treatments for Anxiety: CBT, ACT, CFT, ECT.?!
There’s a lot of “alphabet soup” in the therapy world. So many acronyms your head could spin! It can be confusing as someone seeking treatment to find out that anxiety therapists do not all use the same approach. Some therapists are loyal to one theory, while others are more eclectic. I believe the reason there is so much diversity in the treatment of anxiety is that anxiety can look so many different ways. No one person experiences anxiety in exactly the same way. However, there are some approaches that are particularly well suited to the treatment of anxiety. Each of the treatment theories I will review here are evidenced based. The real task for the therapy seeker is to find out what resonates with you, your personality, and your unique experience. Some will love CBT, others will find it too focused on “proving yourself wrong”. Some think ACT is too difficult, while others find it can bring deep clarity. Continue reading if you are interested in learning a little more about my preferred treatment approaches and how they can be combined for a well-rounded approach to treating anxiety. My hope is you walk away with some insight into each approach so you can make informed decisions when seeking out therapy. This is not an exhaustive list by any means. I may even continue this as a blogging series and cover other treatment modalities in the future. Reach out with your burning questions! I’m here for them!
CBT - Cognitive Behavioral Therapy
CBT is traditionally a short-term form of therapy that can extend into longer term treatment as necessary. CBT focuses on present-time issues and is based on the idea that the way an individual thinks and feels affects the way they behave. Cognitive = they way you think & Behavioral = the way you behave. The goal of CBT is to resolve the problems the person is seeking therapy for by working collaboratively to change clients' thought patterns. CBT uses the concept of cognitive distortions to label thoughts that are unrealistic or not helpful. When it comes to treating anxiety, a CBT approach would involve looking at your anxious thoughts and determining if they are relying on a cognitive distortion, such as all or nothing thinking. CBT rests on the assumption that if you change they way you think (stop relying on cognitive distortions), you’ll have an easier time changing your response to difficult situations. By recognizing an anxious thought as unhelpful or unrealistic, you can break free from the power the thought holds over you. CBT is a widely used approach and is often spoken about as the gold standard of therapy, due to its hefty evidence base. It can be used to treat a wide range of problems such as depression, anxiety and traumatic stress. CBT sometimes gets criticized for being impersonal, not being concerned about the past, and for only focusing on the symptoms. These criticisms are understandable, as you’ll read about how ACT and CFT have come in as a “third-wave” approach that builds off of CBT. However, when done properly, CBT does emphasize the whole person and requires a warm and strong therapeutic alliance and will continue to be useful for its easy to understand techniques.
ACT - Acceptance and Commitment Therapy
ACT is an active approach to therapy that was born out of traditional behavior therapy and CBT. In contrast to CBT, ACT doesn’t try to change thoughts and feelings. ACT works from a perspective that individuals can develop the skills to stop struggling with their inner emotions and, instead, accept that these deeper feelings are appropriate responses to certain situations. ACT helps people develop the skills and awareness necessary to respond to their inner thoughts and feelings as opposed to reacting. When treating anxiety from this approach, we gradually recognize that our worries and symptoms are understandable, which is tremendously helpful because you’ll no longer feel that the worries or symptoms are proof that there is something wrong with you, which tends to increase anxiety. Individuals participating in ACT therapy learn to see their inner experiences in a compassionate way, and also as temporary experiences that should not prevent them from moving forward in their lives. With this understanding, clients begin to accept their issues and hardships and commit to making necessary changes in their behavior. The behavior change is motivated by the client’s deeply held values. By making these changes and living in more alignment with their values, there is often a decrease in anxiety symptoms. However, this is considered a pleasant by-product and not the goal of ACT. ACT helps through fostering a mindful and accepting stance towards the normal ups and downs of life and allows people to move through challenges more wisely.
CFT - Compassion Focused Therapy
According to the Compassionate Mind Foundation, Compassion Focused Therapy (CFT) is: “an evidenced based form of therapy that draws upon our evolved capacity for compassion to facilitate the alleviation of human suffering” (Paul Gilbert). CFT is useful in helping those who struggle with shame and self-criticism that can result from difficult early-life experiences. Many people experience hardships, neglect and emotional isolation that often leads to internalizing a harsh inner voice in order to cope and stay safe. Frequently, the harsh inner voice and lack of support go hand-in-hand with anxiety. CFT also recognizes the impact of unhealthy cultural norms that make it difficult to offer the same compassion to ourselves as we do others. We so often are told that there is something wrong with us, which fuels anxiety further. CFT helps us break out of the idea that anxiety is bad or wrong. CFT teaches individuals to identify and notice self-criticism without blaming themselves. After all, would anyone choose to have a harsh self-critic? Most importantly, it teaches individuals to cultivate skills in compassion and self-compassion, which can help regulate mood and lead to feelings of safety, self-acceptance, and comfort, which are all beneficial for anxiety. CFT marries western and eastern schools of thought and draws from evolutionary psychology, neuroscience, attachment and Buddhist Philosophy. CFT uses a strong and compassion-centered therapeutic relationship to build up individual’s innate capacity for caring and healing. CFT uses mindfulness exercises and guided visualization to help train a compassionate inner voice to be there to respond during moments of difficulty.
Eclectic Therapy Approaches
In my practice, ALT (Aligned Life Therapy, lol), I consider Compassion Focused Therapy and Acceptance and Commitment Therapy as my primary theoretical orientations. I deeply believe that individuals can find alignment with what truly matters to them through exploring our common humanity, innate compassion and inner-most values and then making the necessary changes to bring these qualities into their lives. I draw from other theories that I think have something to offer as well, such as Cognitive Behavioral Therapy, Internal Family Systems therapy, Narrative Therapy, Existential Therapy, Systems Therapy and Feminist Therapy. (I truly could go on!) There are so many beautiful approaches in the therapy world today. I’ve chosen these because they resonate with who I am as a person and as a therapist. They are also shown by clinical research to be effective in my primary treatment areas, Anxiety and self-Criticism, and my secondary areas of trauma, depression, relationship stress and life transitions. My graduate school training also heavily influences how I use each of these theories, because I am a couple and family therapist by training. Therefore, I will always take a systemic view of the problem and focus on how identity, culture and each client’s unique experience of systemic power and oppression influence their mental health. On the personal side, I have been practicing yoga for many years and have long been fascinated and inspired by Buddhist and Yogic philosophy. As you can see, there are so many influences that go into my or any other therapist’s overall approach and style.
Feel welcomed to reach out to me if you have any questions about choosing a therapeutic approach that feels right to you! I am honored to help. Reach out to me here! I currently have a few slots available for new clients seeking online therapy in Pennsylvania.
Warmly,
Julia
