A look at 5 different therapeutic approaches and how each different approach can be used to treat negative thoughts and anxiety.

Jason Brien.

When people first seek out mental health treatment, they can quickly become confused and overwhelmed by all of the different therapeutic approaches that are available. There is cognitive behaviour therapy, dialectical behaviour therapy and exposure therapy to name just a few. In a way, mental health treatment is a lot like weight loss treatment. Just like there are a variety of ways to lose weight (exercise, different types of diet, surgery, etc), there are different therapeutic methods designed to treat and manage different mental health concerns or challenges. 

Before committing to any one therapeutic treatment approach, do your research first. It is very important that you find an approach which fits with your values, beliefs, ideals, way of being, etc. If you don’t like or agree with the approach, you will find it that much harder to ‘trust the process’ and thus achieve results. It is also important to remember not to become discouraged if one particular approach doesn’t work. Much like weight loss, people may cycle through several different diets or several different exercise routines until they find the one that gives consistent results. Or they might blend weight loss approaches. 

For the sake of simplicity, I will present a single scenario and then examine how each of the 5 different therapeutic approaches would view the scenario in terms of the negative thoughts and anxiety that has arisen. The scenario is as follows;

You are having your first date in years and at the end of the date, the other person promises to call you the next day to set up a second date. It has been two days and you still haven’t received a call. All you can think about is how much of a ‘loser’ you must be. You can’t shake the belief that you must be ‘undateable’ and you start experiencing intense anxiety as a result.

Cognitive Behaviour Therapy(CBT);

This approach essentially says that your negative thoughts and anxiety about not receiving a phone call after the first date are ‘wrong’. CBT suggests that since your negative thoughts are ‘wrong’, you must change or eliminate you negative thinking if you want to overcome anxiety and improve your future behaviours. CBT characterises negative thoughts as ‘cognitive distortions’ or ‘defence mechanisms’. The cognitive distortion for the dating example might be catastrophizing - assuming the worst. Or it may be personalisation - blaming yourself for outcomes.

Rational Emotive Behaviour Therapy (REBT);

CBT is based on REBT. That is, REBT was developed prior to CBT. This approach seeks to delve deeper into your psyche. REBT is similar to CBT in terms of characterising negative thoughts and anxiety as ‘wrong’ but rather than moving quickly to a cognitive distortion label as in CBT, REBT seeks to understand the WHY behind the negative thoughts and anxiety. To understand how it is you came to the conclusion that you must be a ‘loser’ and ‘undateable’. Is it because your ex used to say these things to you? Is it because you lack self-esteem? REBT suggests that once you discover the underlying reasons behind the negative thoughts your associated anxiety will be reduced.

Dialectical Behaviour Therapy (DBT);

DBT was developed to overcome the shortcomings of CBT- mainly invalidation. DBT founder Marsha L Linehan suggested that CBT was too ‘invalidating’ for people who are extremely sensitive to invalidation - people diagnosed with Borderline Personality Disorder and people with other trauma based conditions. DBT suggests that the negative thoughts and associated anxiety are ‘normal’ but if we wish to manage our lives effectively, we must learn to manage the emotional and cognitive stress and distress the negative thoughts and anxiety causes us. A DBT therapist would teach the client strategies (meditation, relaxation, etc) to manage their stress and distress when they are not receiving the call from their date that they were expecting. 

Acceptance and Commitment Therapy (ACT);

Much like DBT, acceptance and commitment therapy suggests that negative thoughts and anxiety are ‘normal’. ACT proposes that negative thoughts and the emotions attached to anxiety are all just part of the natural flow of life and nothing more. ACT teaches clients to be present with their thoughts and emotions without giving them too much power and without being overcome by them. ACT teaches that when we become present we can begin to take purposeful action to drive our lives forwards. An ACT therapist will help a client to be present with their negative thoughts and emotions and once they have passed, as they inevitably will, they will help the client to formulate a plan to move forward in life - “It’s been a week and they haven’t called. I might set up a date with this other person”. 

Exposure Therapy;

This approach is based on the principles of learning - classical and operant conditioning. Exposure therapy suggests that if the negative thoughts and anxiety persist, and the person with the negative thoughts and anxiety begins to avoid stimulus associated with their date (thoughts, reminders, the restaurant where they had dinner), their negative thoughts and associated anxiety will INCREASE not decrease. An exposure therapy therapist will teach the client that their negative thoughts and anxiety about not receiving the phone call after the date will reduce if they confront and accept the ‘rejection’. This might be achieved via a role play “imagine I am your date. What would you say to me about not calling as promised”?

Although this post examined only negative thoughts and the associated anxiety, the 5 different therapeutic approaches manage other mental health conditions and symptoms in much the same way as described. It can be easy to see how a ‘deep thinker’ may resonate with REBT more than CBT. Likewise, ‘new age’ people might resonate more with ACT. This is why it is important to do your research first and don’t be afraid to try different approaches.  It is also very important to find a therapist with whom you can trust and feel comfortable with.