Therapy Approaches: Key Differences Explained

Mindfulness

The Wisdom of Mindfulness is ancient. The state of being mindful has been a focus and a practice of ancient Traditions such as Yoga (over 5000 years old) and Buddhism (2500 years old). More recently (in the last 40-odd years), Science has established that the benefits of Mindfulness are immense for building psychological resilience, and for improving physical health and emotional well-being. However, contrary to popular belief, Mindfulness is not meditation, and Mindfulness skills are not unique to Buddhism.

Mindfulness involves actively paying attention to your own inner experience—in the present moment—from the vantage point of an observer who is non-judgementally aware, open, and curious.

Mindfulness skills are now being incorporated into all effective psychotherapies. Mindfulness skills can empower you because they can increase your awareness of all experiences (internal and external, pleasant and unpleasant) in ways that essentially strengthen your capacity to choose how you respond. 

Applied to thoughts, Mindful awareness can help you stay focused in the present moment (what you’re doing) vs. becoming caught up in your thoughts (what your mind is doing). Rather than ‘stopping your thoughts’ or ‘sitting still, eyes closed and meditating’ mindful awareness can be applied to anything you are doing/experiencing—using any or all of your senses—anytime.

Although mindful awareness is important, it is not enough. You can read more about what Mindfulness is, how Mindfulness skills can help you, and the limitations of Mindfulness, here.

Eye Movement Desensitisation & Reprocessing (EMDR) Therapy

EMDR Therapy makes use for Mindfulness. It is a very unique and powerful approach to resolving painful memories originally developed over 30 years ago by Dr Francine Shapiro. EMDR Therapy views all emotional, psychological, and behavioural problems as being related to ‘stuck’ (unprocessed) memories. By identifying and processing these memories safely, a person’s emotional, psychological and behavioural problems also resolve. 

EMDR Therapy is very unique because unlike most talking therapies, it does not require you to speak about what happened in very much detail. Instead of talking about the specific details, EMDR Therapy makes use of bi-lateral stimulation (i.e., both sides of the body). Eye movements are the most common bilateral stimulation used, and these movements are believed to mimic the eye movements of REM sleep (the stage of sleep responsible for memory processing and learning).

After identifying the specific unprocessed components of an event (which requires specialised training in EMDR Therapy), the therapist will ask you to recall specific aspects, with you performing left-to-right eye-movements which are often repeated quickly, in sets of 20-30 (several times), until the memory processing has completed. Often, this can happen quickly depending on the memory, and very little talking about what happened is required. 

Although this may all sound absolutely unbelievable, you may be surprised to learn that EMDR therapy has over 30 years of research supporting its effectiveness, particularly for trauma, but also for many other emotional, psychological, and behavioural difficulties. In fact, EMDR therapy is useful whenever painful memories are causing an individual significant disturbance and/or a negative view about themselves.

 

Quick facts about EMDR Therapy:

• In 2013, EMDR Therapy was recognized by the World Health Organisation as a first-choice treatment for trauma.
• In 2018, the Australian Psychological Society included EMDR therapy as a Level I evidence-based psychological intervention for posttraumatic stress disorder in adults.
• In 2020 EMDR Therapy was included by Australia’s Medicare system as being the only one of two other therapies deemed an ‘acceptable strategy’. (This important because it is the first time any therapy has ever been added to this list by Medicare in the 10+ years the Better Access Scheme has been running).
• There are now dozens of studies with thousands of people with a wide-range of psychological difficulties that indicate EMDR Therapy is also safe and effective when delivered online.  

 

For a list of this research and for a more detailed explanation about how EMDR Therapy works, please read the following article I have prepared.

 

 

Cognitive Behaviour Therapy (CBT)

Cognitive Behaviour Therapy (CBT) is a term for a variety of therapies that create change by focusing on the connection between thoughts, feelings and behaviours. In other words: Thoughts can influence feelings and behaviours – likewise, feelings and behaviours can powerfully affect how we think.

The ‘cognitive’ interventions in CBT seek to identify, challenge, and replace unhelpful thinking with more helpful ways of thinking about things. Traditional cognitive interventions aim to change feelings via working with thoughts. For this reason, the cognitive interventions from traditional CBT are really only suited to simple issues, where there is very little distress involved. 

Although CBT is not the only way to work with the mind, the ‘behavioural’ interventions in CBT are common across many other therapies. The most effective behavioural interventions involve exposure therapy and ‘reality testing’. Together, you and your therapist may work as both detectives and scientists: one minute you may be curiously exploring detailed thought-feeling-behaviour patterns; the next, you might experiment with new ways of behaving. 

Although CBT has been the focus of much research attention, it is better suited to mild issues and it is certainly not ‘for everyone’.

 

 

Acceptance & Commitment Therapy (ACT)

Acceptance and Commitment Therapy (ACT; pronounced ‘act’, as in ‘to take action’) was essentially created to help people deal with suffering. ACT is about both acceptance and action.  By practicing ACT, we ultimately become freer to choose how we want to respond: We learn to notice rather than react to difficult thoughts, memories, predictions, emotions, urges, or situations. This frees us up to focus on doing what is truly important.

Unlike traditional CBT (discussed above), which focuses on ‘logic’, changing, and challenging / replacing unhelpful thinking, the ultimate aim of ACT is to free us from the trappings of our reactions by increasing our tolerance for the contents of our mind, our emotions, and our body’s experiences, and to help us clarify what is most important so that we can live with more meaning and purpose.

ACT addresses this not by trying to ‘change’ our thinking (i.e., as in traditional CBT), but rather, by helping us change the way we relate to our thoughts and inner experiences (i.e, thoughts, feelings, imagery, memories, ‘stories’, images, urges, & bodily sensations). So with ACT, the emphasis is not what we think, but how we relate to what we think that is the focus of therapy. 

ACT sees thinking this way: a) thoughts are not always accurate or helpful, b) we can run into trouble when we act as if our thoughts are true, c) we do not need to change our thoughts – we need to change how we relate to our thoughts. This frees us up to be able to think or feel ‘anything’ without it preventing us moving forward.

ACT incorporates many helpful processes including practical aspects from Buddhist Psychology, such as  Mindfulness, Defusion, and Acceptance strategies, with Western Behavioural strategies from decades of research from the Contextual and Behavioural Sciences. These knowledge combines to empower us with a smorgasbord of new workable ways that we can experience our inner worlds and better respond to our life’s challenges.

ACT makes use of skills that encourage its participants to let thoughts and feelings ‘come and go’ (vs holding onto, reacting, or struggling with trying to ‘not’ have them), and ‘defusion’ or distancing skills (being able to look at our thoughts rather than being limited to just seeing the world through the lens of our thoughts) to enable us to increase our tolerance for difficult thoughts, feelings, memories, and/or physical sensations that me may have previously feared or avoided.

In this way, ACT helps us learn skills that free us to have ‘any’ internal experience, which then allows us to break behavioural patterns that keep us struggling, and with the freedom of being able to ‘choose’ what is most important to us, we can respond to current and future situations more flexibly.  By helping us clarify what is most important, and by helping us learn skills that increase our capacity to tolerate whatever shows up inside us, ACT frees us up to live with meaning and purpose.

More and more research supports the use of ACT (and the usefulness of acceptance, defusion, mindfulness, clarifying your purpose, and taking action) across a wide range of difficulties – from depression, poor sleep, chronic pain, and rumination, to fear, anxiety, and chronic avoidance. ACT is also helpful for addictions, compulsions, and other problematic behaviours. ACT can also help with issues affecting relationships such as past trauma, anger and fear. 

 

 

Compassion Focused Therapy (CFT)

Compassion focused therapy (CFT) was developed to deal with the universal human problems of shame, guilt and self-criticism. CFT is an evidenced-based system of psychotherapy developed by Professor Paul Gilbert (who has been awarded Order of the British Empire for his life’s contribution to Psychology) that integrates techniques from Cognitive Behavioural Therapy with concepts from Buddhist Psychology & Mindfulness practices, Evolutionary Psychology, Attachment Science, Affective Neuroscience, Developmental Psychology, and Social psychology.

Compassion is defined in CFT as a ‘sensitivity to the suffering of self and others with a deep commitment to easing and preventing or alleviating it’. However, Self-Compassion can require great courage because, although most people are extremely eager to ‘alleviate’ their suffering, they are often insensitive to (or want to avoid) the causes. Basically, many of us want to get to the ‘fix’ without caring for the parts of ourselves that are injured or need our care. This is because of several understandable reasons, including developmental and societal factors. 

For example, one of the most common barriers to developing Self-Compassion is our own “inner critic” which has origins in our early emotional learning (our developmental history). Similarly, in societies that encourage us to compete with each other, compassion is often mistakenly viewed as a weakness. For these reasons, ‘striving to achieve’ and ‘bullying ourselves’ with self-criticism, shame, fear, and hostility often seem to come more naturally to us.

Research has found that developing a more compassionate mind (via Compassionate Mind Training, a core feature of CFT) increases our capacities to support ourselves (and others), increases our capacity to endure setbacks and hardships (i.e., it increases resilience and ‘coping’), builds self-confidence, helps us create meaningful and caring relationships, and ultimately improves our relationship with our inner world. Compassionate Mind Training can also lower anxiety and hostility and can promote greater mental and physical well-being. Again, this requires a commitment to increasing our sensitivity to the causes of our suffering so that we are ultimately more capable of being able to act to prevent and/or alleviate any future suffering. 

In summary, CFT is particularly useful for responding effectively to powerful emotions (in ourselves and others) such as shame, anger, fear, sadness, and self-criticism.

 

 

Emotionally Focused Therapy (EFT) for Couples

Emotionally Focused Therapy (EFT) for couples is a form of therapy that focuses on adult relationships and attachment/bonding. The therapist and clients look at patterns in the relationship and take steps to create a more secure bond and develop more trust to move the relationship in a healthier, more positive direction.

EFT focuses on the present, including focusing on patterns of communication as they are happening, to makes changes in the ‘here and now’. There are three stages of EFT. The first is to help couples to self-regulate and de-escalate the negative cycle of interactions, and to help them see and understand what is happening in their relationship. Generally problems relate to unintended consequences caused by insecurities and distancing. The next stage of EFT is to restructure interactions, wherein the therapist helps clients discuss their fears in the relationship, using language that doesn’t push the other away. Clients learn to turn toward each other and discuss their needs and they become more open and responsive to each other. In the third stage of EFT, the therapist helps clients see how they got stuck in their negative patterns and points out how they could change those patterns and can continue these types of conversations (themselves) in the future.

A lot of the important work in EFT draws from Attachment science which strongly influences how we function in relationships (and is the most well-researched area in psychology). Unsurprisingly, EFT is the Gold Standard approach for working with couples. There is over 30 years supporting its effectiveness and it is the most successful couples therapy approach in the world.  

To learn more about Attachment, including how it affects how we function in relationships, I have prepared the following article.  

 

 

Exposure Therapy

Exposure Therapy is the most effective therapy for anxiety disorders and other problems that are typically being maintained by avoidance. When people are fearful of something, they often avoid the feared objects, activities, situations and/or engage in rituals to make themselves feel “safe.” Although avoidance and rituals may help you temporarily reduce your feelings of fear and anxiety, over the long-term it can lead to undesirable outcomes such as feeling trapped and hopeless and it can also make your feelings of anxiety become even worse. Exposure therapy was developed to help people confront and overpower their fears by breaking their fear-avoidance pattern. 

Exposure therapy helps you gradually and strategically (i.e., in combination with skills from the therapies above) confront the very situations and objects you are avoiding. After helping you to build up a strong skill set of soothing and calming strategies, exposure therapy safely and gradually brings you in contact with previously avoided situations (while controlling rituals, compulsions, and other superstitious or safety behaviours). This leads you to important learning and re-evaluating regarding how likely the predicted / feared consequences would be to occur, how bad the consequence would be, and how you could cope differently should these consequences happen. 

Exposure Therapy has been demonstrated to be a particularly effective treatment or treatment component for problems involving avoidance because of anxiety, including:

• Excessive worries about social situations (Social Anxiety Disorder)
• Persistent, excessive or unrealistic worries (Generalized Anxiety Disorder)
• Obsessive thoughts and repetitive behaviours that you can’t seem to control (Obsessive Compulsive Disorder)
• Panic attacks (Panic Disorder)
• An intense, irrational fear of everyday objects, animals, or situations (Specific Phobia)

Because avoidance leads to the maintenance of so many psychological and emotional difficulties, Exposure therapy is not just for anxiety – it is also well-suited to any behaviour involving strong urges. This is often where strong emotions are also at play, such as: procrastination (the urge to ‘put things off until later’); the urge to call an ex-partner after a break up; or for compulsive or addictive behaviours such as gambling, substance use, or excessive technology use.

 

Functional Analytic Psychotherapy (FAP)

Functional Analytic Psychotherapy (FAP) is a behavioural approach to psychotherapy with a specific relationship emphasis in which problematic behaviours that show up live in the therapy session are identified and are shaped towards greater effectiveness. Although it may seem surprising, often these very same problematic behaviours show up outside of the therapy room.

FAP focuses on improving the interpersonal behaviours that are necessary for you to create and maintain close relationships and experience a more fulfilling interpersonal life. In FAP therapists provide you with honest feedback and reinforcement – in the moment – about identified adaptive behaviours.

Early in therapy, you will be asked to identify your treatment goals, dreams, and deepest desires, and what you feel compelled to move towards to in your life. From this discussion, behavioural targets are collaboratively determined. Specifically, which old problematic behaviours are maintaining your current “stuckness” in life and what new adaptive behaviours would move you towards the life you desire and the person you desire to be? FAP ties in well with ACT and CFT approaches.  

 

Dialectical Behaviour Therapy (DBT)

Dialectical Behaviour Therapy (DBT) is a highly effective treatment for a wide range of issues including anxiety, depression, addiction, impulsivity, relationship problems, post-traumatic stress disorder (PTSD), and eating disorders. It has its roots in Cognitive Behavioural Therapy (CBT) and Buddhism and focuses on helping you develop practical skills that help you self-regulate in times of high stress. DBT’s emotion regulation skills compliment many other therapies, such as ACT, CFT, and Exposure therapy. 

 

Schema Therapy

Schema Therapy is an integrative approach to treatment that combines the best aspects of CBT, experiential, interpersonal and psychoanalytic therapies into a unified model. Schema  Therapy has shown good results in helping people to change negative patterns that they have lived with for a long time, even when other methods have been largely unsuccessful.

In contrast to traditional CBT which focuses on the current problem (e.g. current problematic thoughts / feelings), Schema Therapy is a more in depth in that takes into account a person’s developmental history and emotional learning. By identifying the core unmet needs from you childhood, Schema Therapy helps you uncover and work with the unhealthy beliefs that are biasing your current thoughts, feelings and reactions.

 

Motivational Interviewing

Motivational interviewing therapy that was developed to help people navigate feeling ‘stuck’, ‘blocked’, or ‘ambivalent’ about change. It focuses on helping you clarify ‘what’s in it for YOU?’ as far as making a change you are thinking of making is concerned. Motivational interviewing techniques can be used in conjunction with all of the approaches listed above, and also anytime where you feel stuck, demotivated, or unclear in your direction. 

 

If you would like to discuss how therapy might be able to help you (or if you are curious about working in a specific way that is not listed here), please contact me to discuss things further. I also recommend you read the article ‘How to Get the Most Out of Therapy‘ to help you get clearer on your own motivations and expectations for embarking in therapy, regardless of whether or not we work together.