What’s more important: Psychotherapy modalities or the therapist?
If you’re not feeling quite right mentally, you may do a quick Google search to find providers in your area or to see what may help you feel good again. The search results make one thing clear- there are a lot of different paths you can take! Mental health professionals use a variety of therapy modalities to help their patients heal. The modality (or modalities) chosen depend on the patient, the expertise of the provider, and the treatment goals. You may have heard of some of them (cognitive behavioral therapy is a well-known modality), but a lot may be new to you, and that’s okay. While learning about and applying the different modalities is a useful treatment tool, it is important to keep in mind that the provider (and overall care) is more important than the specific theoretical perspectives.. Keep reading for an overview of 4 common modalities and how Modyfi uses them.
Cognitive Behavioral Therapy (CBT)
Our thoughts, interactions with others, and environments can place a heavy influence on our moods and emotions. Oftentimes, our negative thoughts team up with strong emotions that cause us to spiral, shut down, fight, or need to escape.
Cognitive Behavioral Therapy is based on the idea that the way we think causes our emotions and our behavior. Our thoughts are based on core beliefs that we hold about ourselves and the world that were developed during childhood and formative years. These core beliefs may be outdated, unhelpful, or simply wrong.
CBT is an evidence based treatment, meaning it has been researched and proven effective, to treat depression, anxiety, panic attacks, relationships issues, and many other problems. In CBT, we can practice new ways of thinking to change the patterns that lead us towards depression, anxiety and other issues. Think of it as a “rewiring” of the mind and of our perceptions.
How does CBT work?
CBT teaches us to look at the relationship between our thoughts, feelings, beliefs, and behaviors. We break down problematic or overwhelming situations to understand how to think about the situation in a realistic and helpful way. By challenging and changing the way we think, we can change the way we feel and respond. Through CBT, our thoughts and perceptions about the world can be restated in a way that is constructive, rather than destructive. CBT helps direct patients towards helpful problem solving techniques, such as facing fears, instating positive reinforcement, and offering tools to self-regulate.
Cognitive Behavioral Therapy allows for patients to change their thoughts and set more logical goals so that life begins to seem more manageable. Viewing challenges as individual tasks rather than one large obstacle allows for it to be dealt with little by little, until that challenge has been overcome. CBT shows that taking ownership of our feelings and thoughts will lead to more positive behaviors.
Dialectical Behavioral Therapy (DBT)
Every day, we face challenges big and small. Our emotional reactions can often dictate the outcome of these challenges and how they affect us. When we are met with trauma early in life, coping with stress can feel nearly impossible later on. Oftentimes, those who experience trauma go on to feel things so intensely that they struggle to enjoy their lives, or build meaningful relationships. Many people try to manage unstable feelings with actions like intentional self-harm, with the belief that it will release emotional pain. These behaviors can be very dangerous, and that is where dialectical behavioral therapy can help.
Dialectical behavioral therapy, or DBT, is an evidence-based treatment that addresses people’s thoughts about themselves, their life, and their emotional pain. Its name is rooted in the treatment process, first starting with the change of behavior, and then the acceptance that our feelings and interpretations may not represent reality. DBT offers concrete ways to address day-to-day struggles, taking dangerous coping mechanisms, and replacing them with healthy ways to process. This means we can change some of the ways we think and feel about the things we have been through. DBT includes participation in group therapy, individual therapy, and medication management. This can create a caring environment for people who have not always felt cared for. Some DBT groups will even hold a graduation at the end of the treatment, which often marks an important moment for participants.
How does DBT work?
DBT is skills training. It is support oriented, meaning it helps a person identify their strengths and builds on them so that the person can feel better about themselves and their life. Much like Cognitive Behavioral Therapy, DBT is cognitive-based, which means it helps people identify thoughts, beliefs, and assumptions that make life harder. Thoughts like “I have to be perfect at everything” or “my anger makes me a terrible person” can be changed to “I do not have to be perfect at everything to be worthy of love” and “anger is a normal and healthy emotion that everyone experiences”. DBT is collaborative, which means it requires constant attention to relationships between clients and staff. Problems and relationships are worked out together between the therapist and patient through techniques like homework assignments, role-playing, practicing skills, and more. The therapist helps the patient to learn, apply, and master the DBT skills.
Mindfulness-based cognitive therapy (MBCT)?
Mindfulness-Based Cognitive Therapy (MBCT) is designed to help people who suffer repeated bouts of depression and chronic unhappiness. It combines the ideas of cognitive therapy with meditative practices and attitudes based on the cultivation of mindfulness. The heart of this work lies in becoming acquainted with the modes of mind that often characterize mood disorders while simultaneously learning to develop a new relationship with them.
The UK National Institute of Clinical Excellence (NICE) has recently endorsed MBCT as an effective treatment for prevention of relapse of depressive episodes. . Research has shown that people who have been clinically depressed 3 or more times (sometimes for twenty years or more) find that taking the program and learning these skills helps to considerably reduce their chances that depression will return. Evidence from two clinical trials show that MBCT can reduce rates of recurrent depression relapses by up to 50% in some patients (2,3). Another recent study found MBCT to be effective in improving treatment outcomes for patients with generalized anxiety disorders (1).
How does MBCT work?
When you enter a phase in your life during which you are vulnerable to depression, you lose touch with what is going on around you. It may seem as though you have tunnel vision and can only see part of the landscape. You usually don’t notice the moment when a spiral of low mood is starting. Mindfulness practice helps you to see more clearly the patterns of the mind; and to learn how to recognise when your mood is beginning to go down. This means you can ‘nip it in the bud’ much earlier than before.
Losing touch with reality can put a barrier between yourself and the small things in life that might have given you pleasure. This tendency can become extreme in clinical depression, where it is known as ‘anhedonia’ (lack of pleasure from things we used to enjoy). When there is too much to do at work or home, or we are preoccupied on a project, it’s very easy to stop noticing the small pleasures around us.
Consistent mindfulness practices teaches you how to get back in touch with the experience of being alive.
Low mood can bring back negative memories and thoughts from the past and make you worry about the future. While it isn’t realistic to never experience low moods, mindfulness can reduce the frequency and severity of a low mood spell. It helps to halt the escalation of these negative thoughts and teaches you to focus on the present moment, rather than reliving the past or worrying about the future. When you start to feel low, you may react as if your emotions were a problem to be solved, rather than a natural human experience. You might end up over-thinking, brooding, ruminating, and living in your head.
Mindfulness helps you to enter an alternative mindset that is more than just thinking. It teaches you to shift mental gears, from the mode of mind dominated by critical thinking (likely to provoke and accelerate downward mood spirals) to another mode of mind in which you experience the world directly, non-conceptually, and non-judgmentally for what it is in the present moment.
If you have ever experienced depression, you know how frustrating it can feel. It’s understandable that you want to avoid those feelings and that state of mind. At its first sign, you may try to pretend like nothing is wrong. But suppression of symptoms does not work, and oftentimes they come back stronger than ever. Mindfulness takes a different approach. It teaches you to be comfortable with fully experiencing emotions, even painful ones. You’ll gain the courage to allow distressing thoughts and sensations to come and go, without battling with them. Mindfulness allows you to experience a full range of emotions with compassion.
What is Eye Movement Desensitization and Reprocessing (EMDR)?
Many people who suffer from Post Traumatic Stress Disorder, or PTSD can find it difficult to cope with complex symptoms including emotional numbness, social anxiety, and panic attacks. With PTSD, the brain and central nervous system become so overwhelmed that it becomes difficult to process what has happened and what is currently happening. Memories of the traumatic event can reoccur in a more fragmented form, often through flashbacks, intrusive memories, and nightmares. This gives people suffering from PTSD the feeling that they are reliving the event emotionally and physically, over and over again. While some people experience PTSD symptoms immediately after a traumatic event, others may slowly notice their struggles manifest over time. No matter when symptoms start, PTSD can be extremely difficult to navigate. PTSD usually means that painful memories from past events can become a problem in our day to day present lives. The good news is, PTSD is a condition that can be treated.
Eye Movement Desensitization and Reprocessing, or EMDR, is a non-traditional form of psychotherapy that was developed in the 1980s. It is an evidence-based treatment, meaning research has shown it to be effective for treating PTSD. EMDR facilitates the brain’s natural mechanisms for healing. During EMDR sessions, a trained therapist will work with the patient to set treatment goals. Breathing exercises or other relaxation methods may be taught prior to EMDR sessions to help keep the patient calm and comfortable. As the patient tells the story of their trauma to their therapist, they watch something physically in front of them, such as a waving pencil or moving lights, as well as sounds and tapping.
How does EMDR work?
https://drarielleschwartz.com/how-does-emdr-therapy-work-dr-arielle-schwartz/#.X2S0_pNKjlw
The movements and sounds are to distract and calm the patient as they walk through their experience. It desensitizes the patient to the story, so that processing the trauma becomes easier. This later opens up the opportunity for the patient’s feelings and emotions about the event to change as well. Following EDMR sessions, the way people see themselves and their memories can be dramatically shifted. We call this point in the treatment reprocessing. It means that over time, the memories that once had power over the patient become less and less powerful. A major draw to EMDR is that it does not take a long time to work. EMDR lets people live fully in the present instead of ruminating about the past. This can be used as a stand-alone treatment or be integrated into other treatments.
There is emerging evidence to suggest that EMDR can be used as a treatment for conditions besides PTSD, such as psychotic or affective states, and an additional treatment for chronic pain (4).
What modes of therapy does Modyfi offer?
In the uncertain times we are in, it is vital to ensure that distressing thoughts, feelings, beliefs and behaviors do not go unchecked. Whether you’re reliving past trauma or worrying about the future, we want to help you live fully in the present. Modify providers work to stay abreast of the latest news and evidence concerning mental health research and treatments. Our practitioners work with the patient to identify areas of concerns, set goals for treatment, and select which mode or modes of treatment will work most effectively. Mental health professionals are trained in multiple modalities, so it is more important to focus on choosing a quality therapist that is the right fit for you than to spend too much time thinking about the specifics of psychotherapy methods. The right provider for you will make you feel comfortable, secure, and confident in your ability to heal. When you’re ready to begin, reach out to make an appointment with a member of our team.
Ghahari, S., Mohammadi-Hasel, K., Malakouti, S. K., & Roshanpajouh, M. (2020). Mindfulness-based Cognitive Therapy for Generalised Anxiety Disorder: a Systematic Review and Meta-analysis. East Asian archives of psychiatry : official journal of the Hong Kong College of Psychiatrists = Dong Ya jing shen ke xue zhi : Xianggang jing shen ke yi xue yuan qi kan, 30(2), 52–56. https://doi.org/10.12809/eaap1885
Kuyken, W., Byford, S., Taylor, R. S., Watkins, E., Holden, E., White, K., Barrett, B., Byng, R., Evans, A., Mullan, E., & Teasdale, J. D. (2008). Mindfulness-based cognitive therapy to prevent relapse in recurrent depression. Journal of Consulting and Clinical Psychology, 76(6), 966–978. https://doi.org/10.1037/a0013786
Teasdale, J. D., Moore, R. G., Hayhurst, H., Pope, M., Williams, S., & Segal, Z. V. (2002). Metacognitive awareness and prevention of relapse in depression: Empirical evidence. Journal of Consulting and Clinical Psychology, 70(2), 275–287. https://doi.org/10.1037/0022-006x.70.2.275
Valiente-Gómez, A., Moreno-Alcázar, A., Treen, D., Cedrón, C., Colom, F., Pérez, V., & Amann, B. L. (2017). EMDR beyond PTSD: A Systematic Literature Review. Frontiers in psychology, 8, 1668. https://doi.org/10.3389/fpsyg.2017.01668
