Counselling Services Hamilton Ontario

CBT was developed in the 1960s to help treat mood and anxiety symptoms. CBT is a structured treatment that focuses on the role of thoughts and behaviour on psychological and emotional problems such as depression and anxiety, and many other concerns such as trauma or PTSD,  OCD, addictions, eating disorders and insomnia. 

Because it has been around for many decades, CBT is often more commonly known and recommended by doctors, insurers and other professionals. 

CBT is not necessarily more effective than other treatments such as ACT. In fact, research often concludes that other approaches are just as effective as CBT. However, there tends to be more studies on CBT because this therapy modality has been around the longest, and its structure lends itself well to controlled research and group formats. 

In particular, CBT is a therapy that is often delivered in a 'manualized' format, where a specific number of sessions is prescribed and the content and delivery of those sessions may be pre-determined. This is often preferred in hospital or community health settings because of the cost and lostical advantages of delivering therapy in a group format. 

CBT can be very effective for a wide range of concerns such as depression, anxiety, OCD, trauma, eating disorders, alcohol and addiction issues and anger problems as long as patients or clients actively participate in the treatment and complete homework or between-session work. 

CBT interventions focus on helping individuals to become aware of and shift or challenge the content of their negative thinking. Our style of thinking (e.g., when we generalize, catastrophize or discount the positives etc) is known to significantly impact on our mood, feelings and behaviour. An example of an intervention commonly used in CBT is 'thought monitoring', where people are taught to notice and monitor negative thinking styles (at first using a thought record) in order to label their thoughts and then challenge their thoughts with socratic dialogue and/or specific questions.

CBT interventions also focus on behaviour. Behaviour has a significant impact on mood and feelings. By changing our behaviour we can start to change the way we feel and think. For example, behavioural activation is a common intervention used for depression where people are taught structured ways to increase meaningful mastery and leisure tasks in order to improve mood. Another important CBT behavioural intervention is exposure therapy, which is commonly used to help treat anxiety symptoms, including:

 phobias, 

panic symptoms, 

triggers in PTSD, and 

social anxiety. 

Exposure and response prevention is often used to treat OCD symptoms.

For an excellent CBT self-help website, we recommend the Centre for Clinical Interventions, which has a number of free structured CBT workbooks.

References:

Samaen, M., et al., (2020). A clinical effectiveness trial comparing ACT and CBT for inpatients with depressive and mixed mental disorders.

ACT stands for Acceptance and Commitment Therapy. ACT originated in the 1980s with Steven Hayes and is considered a 'new wave' therapy approach that takes a non-pathologizing view of human problems and suffering and incorporates mindfulness principles into its approach.  

ACT is becoming much more widespread an recognized as an evidence-based therapy modality that is effective for a wide range of issues such as depression, social anxiety, general anxiety, trauma, panic symptoms, OCD, alcohol or substance use, and anger etc.

Similar to CBT, ACT recognizes the role of human thinking in human suffering. For this reason, ACT uses many interventions that are focused on assisting with negative thinking, rumination and worry; however, unlike CBT, ACT does not focus on the content of a person's thinking but rather ACT focuses on the relationship we have with our thinking. 

In other words, an ACT-based intervention would not focus on 'how true is that thought?' An ACT-based intervention would focus more on: 'is that thought helpful to you?' For thoughts or thinking that are not helpful to us, ACT teaches us ways of reducing the impact of our negative thinking through techniques such as defusion and mindfulness. 

ACT goes beyond the role of our thoughts by helping us explore and define our values, by increasing our ability to follow-through with meaningful committed actions, and increasing the overall flexibility of our attitudes, beliefs and perceptions of ourselves and others.

A common principle within ACT is the concept of 'psychological flexibility'. Psychological flexibility involves a number of key concepts such as mindfulness, thought defusion, values, committed action, self as context and acceptance. 

Psychological flexibility skills can be trained through ACT-based interventions to improve well-being and reduce vulnerability to mental health and emotional suffering.

Learn more on our website about ACT.

Learn more on our website about Psychological flexibility. 

EMDR is a highly specialized therapy that is primarily used to treat trauma and PTSD and work on the restructuring of disruptive core beliefs such as deep-rooted feelings of inadequacy, shame, disrupted abilities to trust others etc. EMDR is also increasingly being used to assist with other concerns such as anxiety symptoms, depression, and grief.

EMDR involves using of a 'bilateral stimuli' (either eye movement, tactile tapping or sound tones) to activate alternating sides of the brain to tax working memory while processing disturbing memory, sensations and emotions. This process allows for the emotional and neurological resolution of upsetting material, with the aim of lowering the distress associated with a memory or image/cue down to neutral or 0/10 (much of the time within 60-90 minutes).

EMDR is not a matter of simply waving a finger in front of someone's face while talking about their trauma. In fact, EMDR is a highly structured therapy that involves very little talking. EMDR focuses instead on individuals' internal experiences  while working towards emotional and somatic resolution of disturbing memories or experiences that are stuck of fixed within the nervous system. 

The advantages of EMDR include not having to talk in detail about the traumatic experience(s), quicker resolution in most instances compared to imaginal exposure or talking about the trauma, and little or no homework.

EMDR is increasingly the modality of choice for complex trauma. EMDR is not only used to target and resolve key memories. EMDR is also used to target and reduce phobias of those memories and other aspects of self (especially dissociated aspects of self or aspects of self that involve internal conflict).

Not everyone can immediately commence EMDR trauma processing. If someone has a history of complex trauma and affect regulation difficulties, we would usually first improve a person's ability to stay in their 'window of tolerance' so that their memories can be adaptively and effectively resolved without re-living or re-traumatization. We do this through other EMDR-oriented interventions such as internal resource development, EMD and 'tip of the finger' processing. We also use traditional skill building (e.g., grounding and DBT strategies). 

We commonly find that IFS can be incorporated into EMDR to help facilitate quicker processing and resolution of traumatic material in more complex situations where complex trauma has occurred, particularly developmental trauma where disruptions in personality structure or self-soothing abilities occurred. 

DBT is another evidence-based psychotherapy that is commonly used to help address distress tolerance difficulties, self-harm behaviours and Borderline Personality characteristics. DBT is sometimes used to help bolster coping skills and affect regulation difficulties amongst individuals with trauma or PTSD in order to help stabilize their symptoms and/or better prepare them for more trauma-focused therapy.

DBT is considered a cognitive behavioural therapy (similar to CBT) and was developed in the 1980s by a psychologist named Marsha Linehan. DBT proposes that some people are more prone to react in more intense ways when exposed to stress or conflict. One reason may be that some people's arousal are triggered and/or accerlerate more quickly than others and then take longer to return to baseline arousal levels.

A primary focus of DBT interventions is to help people to better regulate their emotional arousal levels and/or the intensity of their emotional distress through concrete exercises and practices to build skills. This is achieved through 4 key components: 1) Mindfulness, 2) Interpersonal Effectiveness, 3) Distress Tolerance, 4) Emotion Regulation.

Mindfulness:

Mindfulness involves helping people train their ability to stay focused on the present moment. The core mindfulness skills for staying present taught through DBT include Observe, Describe and Participate. Other skills to advance mindfulness practice include Non-judgmentally, One-mindfully and Effectively.

Interpersonal Effectiveness:

DBT often focuses on amelorating interpersonal disruption by increasing social skills such as assertiveness skills. Skill building is focused on helping individuals to identify their own needs in relationships, say no when desired, and respond more calmly to interpersonal conflict.

Distress tolerance:

An important component of easing suffering involves working towards increased tolerance of things that cannot be controlled, including situations, other's behaviour and our own feelings. Acceptance-based skills are a key component of DBT distress tolerance skills. Self-soothing skills using the five senses is also commonly used to help increase people's ability to self-regulate. These skills are often disrupted in individuals who suffered developmental trauma while those skills were forming.

Emotion Regulation:

DBT if often suggested for people who are frequently irritable, angry, frustrated, or intensely anxious or depressed. To assist with these difficulties, DBT focuses on approaches such as teaching people to notice and label their own feelings, shift out of 'emotion-mind', increase experiences of positive emotions and actively and routinely apply distress tolerance skills such as self-soothing and radical acceptance.

Most of our therapist utilize components of DBT. If you are looking for a more structured DBT program (which includes individual sessions, group therapy and crisis support) then we would recommend St. Joseph's bridge to recovery program as we do not provide between-session crisis support.

References:

https://psychcentral.com/lib/an-overview-of-dialectical-behavior-therapy#Components-of-DBT

IFS was developed by Dr. Richard Swartz in the 1990s and is quickly becoming a modality of choice by an increasing number of psychologists, psychotherapists, and counsellors because of its holistic nature, transformative qualities and applicability to most mental health concerns, including depression, anxiety, self-harm, trauma and PTSD, eating disorders, personality disorders and even psychosis.

Ever notice that you can often feel as if one part of you wants to do something when faced with a decisions, while another part of you does not? For example, part of me wants to read this right now while part of me wants to be doing something else. Or, part of me wants to look for a new job while part of me does not want to.

Ever have the experience of suddenly feeling or acting in a way that doesnt feel like your usual self? Ever notice that when you enter certain contexts you feel sort of like another person or even a different age? For example, you may feel serious and confident in one context while feeling playful and young in another context.

IFS is based on the premise that our psychological and emotional system is complex and multilayered and that our personality is made up of various modes that allow us to adapt to different roles or situations more easily. These varying modes or parts of the personality structure can help to explain why someone may be prone to characteristics such as worrying, quick to anger, avoidant of intimacy, a workaholic, alcohol or substance use, self-harm etc.

A key idea of IFS is that we are born with an underlying 'Self' that has universal qualities such as 'calm', 'curious' and 'compassionate'. Then, as we encounter challenges and adversity in our life (especially ones involving painful core emotions such as deep sadness, fear or shame), we develop 'parts' to our system to help defend or sheild us from those painful emotions and experiences (which are exiled or pushed out of day-to-day awareness).

Another key idea of IFS is that all symptoms have an underlying function that made sense at the time and within the context in which the part of self or characteristic (e.g., anxiety, hypervigilance, panic, numbing, critic etc) developed. 

IFS techniques are used to help explore and uncover this function, and heal the painful core emotions that were experienced and taken on in one's system as a 'burden'. Healing the impact of past events is important because 'burdens' (even when largely out of awareness) often continue to trigger and/or drive part activation when exiled parts of self (parts that took on emotional pain and were pushed out of awareness) are triggered.

Examples of 'parts':

Anxiety (nervousness, uneasiness, tension)

Hypervigilance (always on guard, watching for what could go wrong)

Panic (full-on bodily activation)

Inner critic (catching every perceived mistake or shortcoming)

Task Master (always busy, doing, uncomfortable to slow down)

Perfectionist (high standards must be set or why bother)

Controller (must always be in control no matter what)

OCD (thoughts affect outcomes)

Joker (make jokes when something feels too serious)

Withdrawer (don't get emotionally close to others)

Number (alcohol, drugs, food, gambling, shopping)

Body pain (this is the only way to get you to slow down or focus on you)

Self-harmer (hurt self to shift focus to physical body away from exile or other part)

SI (suicide fantasy to protect from other parts or exiles)

Examples of exiles:

Younger part of self that felt powerless or helpless

Younger part of self that felt fear and/or horror

Younger part of self that felt ashamed (not good enough, not desirable)

Younger part of self that suffered loss (intense sadness or emptiness)

Some key goals of IFS include:

*Access 'Self' energy (a calm, curious, compassionate state) by easing back parts.

*Uncover the protective function of parts and bring into full awareness.

*Reduce inner conflict or polarity between parts (this frees up energy, helps parts ease back and reduces tension and inner turmoil).

*Reduce phobia or fear or underlying painful core emotions (e.g., fear, intense sadness, shame held by 'exiled' parts of self etc. ) in order to clear space for accessing what remains 'stuck'.

*Bring compassion to one's inner suffering.

*Release emotional burdens and/or heal exiled parts of self so that protective parts no longer have to fulfil their ridgid or stuck function.

If you are finding it difficult to change your feelings, thoughts and behaviours no matter what you know or try to tell yourself, consider trying an IFS informed approach to work on the underlying mechanisms for why you feel how you feel and do what you do. 

To learn more about IFS visit the Centre for Self Leadership website and view the videos below.

EFT stands for 'emotion-focused therapy and is used with both individuals and couples to resolve surface emotions (e.g., often anger, frustration, anxiety, depression) and disruptions in attachment by uncovering and processing underlying primary emotions such as fear, sadness and shame or inadequacy. The abbreviation 'EFT' is also sometimes used to refer to 'emotional freedom techniques', which is unique and different from 'emotion-focused therapy'.

EFT is a widely-used humanistic psychotherapy or counselling approach developed in the 1980s and has an evidence-based research base for a variety of concerns such as trauma, anxiety, depression, anger and relationship conflict.  Well known advancers of the EFT model include Les Greenberg and Sue Johnson.

Many (perhaps even most) people enter therapy because of concerns with how they feel and/or behave in response to their emotions. EFT focuses on helping individuals and couples to access, accept, express, regulate, make sense of and transform emotion. Some examples of EFT interventions include 'two-chair' and 'empty chair' work, where experiential exercises are used to access material not normally accessing through talking.

EFT is based on the premise that it is not enough to only learn and understand more about our emotions. EFT proposes that individuals also need to access and experience their emotions in the presence of someone who can provide positive open acceptance of their feelings and guide them to achieve greater flexibility in accessing, experiencing and expressing of their emotions. This process involves helping people to become aware of and experience aspects of themselves that they were not previously fully aware of because those aspects and/or feelings were previously pushed away, dismissed or disallowed.  

EFT for couples:

EFT for couples is based on attachment science and focuses on repairing the attachment bound within the couple. An important part of this process involves helping couples to uncover their 'negative interaction pattern', a recurring negative cycle that the couple engages in throughout their relationship. Once this pattern is identified, it can help the couple externalize their conflict and start to repair the ruptures in their attachment bond so that both can feel more secure in the relationship.

Emotional security within the relationship is key to reducing conflict and promoting attachment, communication and intimacy. EFT argues that attempts in couples therapy to improve communication and problem-solving will be much less effective without first addressing and strengthening the attachment bond. 

EFT couples sessions focus on helping each partner to see the more vulnerable feelings (e.g., hurt, helplessness, fear and sense of inadequacy) underlying surface emotions (e.g., anger, frustration, resentment & contempt). As couples are guided to uncover those underlying emotions in a supportive environment, those emotions can be worked through and responded to in more adaptive ways. Experientially accessing deeper emotion promotes healing and strengthening of the relationship in ways that just talking about 'problems' does not.