Recommended Therapies: 1) CBTs
Cognitive Behaviour Therapy
Cognitive Behavioural Therapy (CBT) is a group of psychological treatments with strong research support. CBT helps people change unhelpful thoughts, beliefs, and behaviours to better manage emotions, cope with challenges, and address mental health issues. The main idea is that our reactions depend more on how we interpret events than on the events themselves. By becoming aware of our usual ways of thinking, we can start to question and change them in a positive way.
CBT is built on the idea that our thoughts, actions, and emotions all influence each other. Changing one can help break negative cycles and improve how we feel and act. Aaron Beck developed CBT in the 1960s. This therapy is practical and focused on finding solutions to specific problems. Therapists work with clients to find and practice helpful strategies to manage issues and reduce symptoms.
CBT works on the idea that unhelpful thinking patterns and behaviours can cause or worsen problems. By learning new ways to think and act, we can greatly reduce symptoms. CBT is a type of talk therapy that teaches coping skills for many emotional issues. It is often the first treatment recommended for various conditions. Studies show that CBT works best when combined with medication for more serious mental health problems.
Cognitive Distortions
Cognitive distortions are mistaken beliefs and thinking habits that make negative feelings and behaviours worse. Examples include overgeneralising, focusing on negatives, ignoring positives, and expecting the worst. By replacing these thoughts with more realistic ones, we can feel better and avoid self-defeating actions. Stress, illness, or long-standing habits can lead to these patterns. If we learn to notice and identify them, we can challenge and change them. Here are some common examples to help you spot and question these thinking errors.
Filtering means paying attention only to certain details, often just the negative ones, and ignoring anything positive in a situation. It's like seeing the world through dark, gloomy glasses.
Black and White Thinking: We see things as all or nothing (good or bad, right or wrong) in black and white thinking (or polarised thinking). We become a perfectionist. If what we want is not perfect or complete, it’s unacceptable. There is no middle ground (nothing in between). We lose our nuanced judgement (with no shades of grey - forbidding complexity). A person with black-and-white thinking sees things only in extremes.
Generalising: Generalising (over-generalising) occurs when we draw a broad conclusion from limited evidence. For example, if we’ve done something wrong once or twice, we accuse ourselves of being clumsy, worthless or incompetent, and we expect such failures to happen repeatedly. A person with this way of thinking may see a couple of unpleasant events as part of a never-ending pattern of defeat.
Jumping to Conclusions: A person who jumps to conclusions assumes they know what others feel and think, or exactly why they acted the way they did. Such a person believes they know how others think, as though they could read their mind (mind-reading). Jumping to conclusions can also manifest as fortune-telling (predicting), where a person believes they know what will happen. For example, someone may anticipate that things will turn out badly in their next relationship and feel convinced that their prediction is already a fact, so why bother dating?
Catastrophising is when we imagine the worst possible outcome and expect things to go wrong. This thinking style focuses on negatives and can also mean downplaying positives, leading to a pessimistic outlook.
Personalising is when we believe that outside events are directly about us or caused by us, instead of considering other reasons. We might think everything others do or say is connected to us, which can lead to blaming ourselves or seeing others as unkind.
The fallacy of control happens when people feel they have no control over their lives or, on the other hand, believe everything depends on them. Both extremes can lead to guilt, depression, and hopelessness. Feeling powerless may cause someone to stop trying to improve things, while feeling overly responsible can lead to frustration and stress when things don't go as planned.
Being judgemental means quickly forming opinions about ourselves, others, or situations without enough information. We might apply our own standards to everything and feel upset when things don't meet them. This critical attitude can lead to blaming, finding fault, and feeling anxious or unhappy, both with others and ourselves.
Blaming means holding others responsible for our feelings or problems, or sometimes blaming ourselves for things beyond our control. For example, saying, “I only did it because you don’t love me,” or “This is all your fault.” In reality, most situations have many causes. Blaming can hurt relationships and make it harder for us to grow and solve problems.
Using words like “should,” “must,” or “ought to” creates pressure and unrealistic expectations for ourselves and others. These words set strict rules for how we think life should be. When these rules are broken, we may feel angry, guilty, or frustrated, even if we meant to motivate ourselves.
Emotional reasoning is when we believe something is true just because we feel it, even if there’s no real evidence. This way of thinking can make other thinking errors worse and can lead us to ignore facts. When emotions take over, we might judge situations based only on how we feel.
Labelling happens when we take one mistake or trait and use it to judge ourselves or others in a harsh, global way. For example, saying “I’m a loser” after a single failure. These labels are usually negative, emotional, and unfair.
Correcting Wrong Beliefs and Assumptions
The first step in correcting our unhelpful thinking is learning to observe our thoughts and become aware of our cognitive distortions. At this stage, it can be beneficial to seek the support of a coach or a therapist. We need to be mindful of our underlying beliefs and assumptions (core beliefs) and that they are just our subjective views, not the objective truth, and we can change them.
Learning about common thinking errors is important because they are easy to pick up but hard to spot in ourselves. Support from a coach or therapist can help us notice and change these patterns. Here are some helpful tips.
Ask clarifying and probing questions.
Get the necessary knowledge about your condition.
Research the subject matter.
Analyse the evidence.
Decide on reflection, not impulse.
What’s important now?
What’s my responsibility in this situation?
What’s possible?
What are the alternatives?
What are my choices?
Who can I turn to, rely on, talk to, and consult with?
What’s the best course of action?
What’s the first thing I need to do? (And DO it with no hesitation.)
Self-Management and CBT
Self-management means taking responsibility for handling your physical and emotional symptoms. This often leads to positive lifestyle changes that help you cope with and overcome mental health challenges. Here are some key steps for effective self-management.
self-monitoring,
goal setting (dream goals and SMART goals),
action planning,
disputing the automatic (habitual) negative thoughts,
regulating the emerging emotions,
managing the environment,
building and using social support,
learning about our condition and its potential treatments,
seeking help (the sooner, the better).
Third Wave CBT
The “first wave” of behavioural therapies was characterised by behaviourism, a school of psychology that introduced classical and operant conditioning and was dominant around the mid-20th century. Behaviourism still significantly influences psychology and the study of behaviours in people and animals. Classical conditioning involves associating an involuntary response with a stimulus, while operant conditioning associates a voluntary behaviour with a consequence. The learner is rewarded with incentives in operant conditioning, while classical conditioning involves no such enticements.
Classical conditioning (a form of associative learning) was first studied by Ivan Pavlov, a Russian physiologist (1849-1936) who experimented with dogs to explore digestion (1897). Pavlov noticed dogs salivating in response to a bell and realised that this was a learned response involving pairing a stimulus (the sound of a bell) with an unconditioned stimulus (the presence of food).
Operant conditioning (a form of instrumental learning) uses either reinforcement or punishment to increase or decrease the incidence of behaviour, where an association is formed between the behaviour and its consequences. B. F. Skinner (American psychologist, 1904-1990) developed operant conditioning to strengthen behaviour, and his writings primarily explain its application to human behaviour.
Albert Ellis and Aaron Beck pioneered the “second wave” of behavioural therapies with cognitive behavioural therapy (CBT), which integrated a person’s thoughts and beliefs with their behaviours and emotional experiences, such as depression.
The “third wave” of cognitive behavioural therapies includes new approaches that have developed since 2004, building on traditional CBT. These therapies focus more on overall well-being and personal growth, rather than just reducing symptoms. The goal is to help people feel more comfortable with themselves and their experiences, by building on strengths and changing how they see themselves and the world.
In third wave therapies, ideas like metacognition, acceptance, mindfulness, personal values, and spirituality are added to traditional CBT. Instead of just looking at what we think or feel, these therapies focus on how we relate to our thoughts and feelings, and the processes behind them.
The third wave of cognitive behavioural therapies utilises many strategies and interventions that complement traditional CBT interventions, such as exposure therapy (systematic desensitisation) and behavioural activation. However, the new approach led to many focused interventions, including Acceptance and Commitment Therapy (ACT), Dialectical Behaviour Therapy (DBT), Mindfulness‐Based Cognitive Therapy (MBCT), Functional Analytic Psychotherapy (FAPT), Meta‐Cognitive Therapy (MCT) and a few others.
To sum up, third wave CBT focuses more on health and personal growth, takes a holistic view of the person, pays attention to context, aims to build skills and abilities, and looks at processes rather than just solutions.
Mindfulness-Based Cognitive Therapy
Mindfulness-based approaches are based on the idea that staying present helps us handle stress and difficult feelings better. Mindfulness makes us more flexible and open. It teaches us to pay attention to what’s happening right now, notice our usual reactions, and respond with openness, compassion, and curiosity.
To a degree, mindfulness-based cognitive therapy (MBCT) is based on the mindfulness-based stress reduction programme (MBSR) developed by Jon Kabat-Zinn (1970s). MBCT was created by Zindel Segal (Ukrainian cognitive psychologist), Mark Williams (clinical psychologist at the University of Oxford), and John Teasdale (Oxford and Cambridge Universities, UK), who used the ICS (Interacting Cognitive Subsystems) theory to explain MBCT.
Interacting Cognitive Subsystems (ICS) is based on the thinking of John Teasdale and Philip Barnard (neuroscience, Cambridge University, UK). They suggested that our minds have two main modes for receiving and processing information (both cognitively and emotionally). The two modes of mind are the “doing” mode (driven mode) and the “being” mode. The doing mode is goal-oriented and is triggered by discrepancies between how things are and how the mind wishes them to be. The second mode, the being mode, is not focused on achieving specific goals but emphasises “accepting and allowing” without any immediate pressure to change anything.
In Barnard and Teasdale’s ICS model (1991), mental health is related to an individual’s ability to quickly switch between the two modes of mind (being and doing). Individuals who can flexibly move between the modes of mind based on environmental conditions are in the most favourable state. The ICS model theorises that the “being” mode is the most likely mode of mind that will lead to lasting emotional changes (and emotional stability). Therefore, to prevent relapse in depression, cognitive therapy must promote this mode. This idea prompted Teasdale to develop MBCT, which supports the “being” mode.
Another component of ICS is metacognitive awareness, the ability to experience negative thoughts and feelings as mental events that pass through the mind rather than as a part of the self. Individuals with high metacognitive awareness can more easily avoid depression and negative thoughts than individuals with low metacognitive awareness. Metacognitive awareness is regularly presented as an individual’s ability to decentre. Decentring is the ability to perceive thoughts and feelings as both impermanent and objective occurrences in the mind.
MBCT is an eight-week group program with weekly two-hour sessions and a one-day class after the fifth week. Most of the practice happens outside class, where participants use guided meditations and work on mindfulness every day. They learn to focus on the present without judging themselves. Mindfulness helps them notice their feelings and understand that holding on to some emotions can be unhelpful.
MBCT was initially developed specifically to target vulnerability to depressive relapse and as an alternative to antidepressant maintenance of depressive symptoms. Throughout the program, patients learn mind management skills that help them heighten their metacognitive awareness, accept negative thought patterns, and respond skilfully. They learn to decentre their negative thoughts and feelings, moving their mind from an automatic thought pattern to conscious emotional processing.
The UK National Institute of Clinical Excellence (NICE) has endorsed MBCT as an effective treatment for the prevention of relapse in depression. Research has shown that people who have been clinically depressed three or more times have found the program significantly helpful. Moreover, the evidence from two randomised clinical trials of MBCT indicated that it reduces relapse rates by about 50% among patients who suffer from recurrent depression. MBCT has also been used to treat physical symptoms and anxieties associated with other diseases, such as diabetes or cancer.
Resources and Further Reading
Claessens, M. (2010). Mindfulness-based third-wave CBT therapies and existential phenomenology. Friends or foes? Existential Analysis: Journal of the Society for Existential Analysis, 21(2).
Brown, L. A., Gaudiano, B. A., & Miller, I. W. (2011). Investigating the similarities and differences between practitioners of second-and third-wave cognitive-behavioural therapies. Behaviour modification, 35(2), 187-200.
Hunot, V., Moore, T. H., Caldwell, D. M., Furukawa, T. A., Davies, P., Jones, H., ... & Churchill, R. (2013). ‘Third wave cognitive and behavioural therapies versus other psychological therapies for depression. Cochrane Database of Systematic Reviews, (10).
Hayes, S. C., & Hofmann, S. G. (2017). The third wave of cognitive behavioural therapy and the rise of process‐based care. World Psychiatry, 16(3), 245.
Teasdale, J. D., Segal, Z., & Williams, J. M. G. (1995). How does cognitive therapy prevent depressive relapse, and why should attentional control (mindfulness) training help? Behaviour Research and Therapy, 33(1), 25-39.
Teasdale, J. D., Segal, Z. V., Williams, J. M. G., Ridgeway, V. A., Soulsby, J. M., & Lau, M. A. (2000). Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. Journal of consulting and clinical psychology, 68(4), 615.
Segal, Z. V., Teasdale, J. D., & Williams, J. M. G. (2004). Mindfulness-Based Cognitive Therapy: Theoretical Rationale and Empirical Status.
Segal, Z. V., & Teasdale, J. (2018). Mindfulness-based cognitive therapy for depression. Guilford Publications.
