Therapeutic Approaches

Cognitive Behavioral Therapy (CBT) is an intervention based on the interaction between feelings, thoughts, and behaviors.  In therapy, we examine and modify patterns of thoughts and behaviors.  As a result, we tend to see changes in emotions. 

Let’s consider this example:  Susan is extremely nervous about giving a presentation at work because she is afraid of making mistakes in front of her boss and coworkers.  She began to feel very tense a few days before the presentation and the night before she could not sleep at all thinking: “I will embarrass myself in front of others. I will fail in the presentation and lose my job.”  This constitutes an example of anxious self-talk that leads to anxiety, depression, guilt, and dread. On the morning of the presentation, she experiences a panic attack and calls her boss and apologizes for not going to work.  

How does CBT work?  The first step is increasing awareness of our own thoughts and how they impact the way we feel and behave.  The following step includes modifying the distorted unrealistic thoughts and replace them with more rational ones.  In the example Susan is encouraged to identify more realistic thoughts, such as: “It is okay to be nervous in a presentation.  Everybody makes mistakes and that is not the end of the world.  It is unlikely that I lose my job because of one presentation that did not go perfect.”  Subsequent steps involve learning multiple skills to manage anxiety and deal effectively with panic attacks.  In therapy Susan can acquire numerous coping strategies, like breathing exercises, progressive relaxation, tapping techniques, and visualizations.  It is highly recommended that she practice these strategies not only prior to a stressful circumstance, but on a regular basis.   Another important step of therapy is practicing facing fears, gradually and systematically, increasing the client's tolerance of discomfort.  Regarding this example, circumstances are created in session that allow Susan to purposely practice making mistakes.  Incorporating all of these strategies acquired in therapy allows individuals like Susan to learn that these threats are not as big as they believe and that they are able to cope with them effectively. 

Mindfulness- It is the practice of fully focusing the mind on experiences (such as emotions, thoughts, and bodily sensations) that are happening in the now.  Mindfulness can involve breathing practice, mental imagery, awareness of body and thoughts, and relaxation exercises.

Acceptance and Commitment Therapy (ACT)-This is a type of psychotherapy that helps individuals to manage the difficulties that life brings by acquiring skills to stay in the present, Accepting own responses, Choosing a direction that matches individual goals, and Taking action.  It also addresses the commitment to making changes and establish plans to move closer to those goals.  

Dialectical Behavioral Therapy (DBT)-This is another type of therapy that employs a cognitive-behavioral approach and that is particularly beneficial for individuals that react in a more intense manner toward certain emotional situations.  DBT incorporates two types of skills that promote that individuals manage difficult circumstances: Acceptance and Change Skills.  These skills include four main dialectical strategies that help individuals interact adequately with others, develop problem solving skills, and face difficult circumstances adequately.  The four modules of DBT are the following:  Mindfulness, Distress Tolerance, Emotion Regulation, and Interpersonal Effectiveness.  

Applied behavior therapy is used for modifying maladaptive behaviors in children and adolescents. Treatment involves teaching clients different methods of responding to situations more adequately.   Main strategies involve rewarding positive behavior and punishing negative behavior. 

Habit Reversal (HR) is a type of behavioral treatment used to reduce repetitive behaviors such as hair pulling and skin picking.  

Specific Skills Trainings are also provided such as:  Anger Management, Social Skills Training, Parenting Skills Training, and Assertive Communication.