# Even more powerful than CBT



## franco (Aug 21, 2006)

The title is only to attract attention because I don't want to make big claims without strong scientific and empirical validation. Cognitive behavioral therapy is a very powerful psychological tool to help people with a wide range of psychological disorders. At the heart of CBT is the concept of "cognitive re-appraisal" and "exposure". Cognitive reappraisal is in crude terms a re-assessment of the situation that you find negative in order to have a new perspective where the positive emerges and the negative subsides. Exposure is exposing oneself to the feared situation in order to realize that the fears where unwarranted. These techniques help subjects overcome anxieties (social anxieties also).
New studies comparing CBT techniques with a rather new concept called "Acceptance and commitment therapy" showed that ACT works better than CBT for a big majority of subjects. At the core of ACT is what is called experiential avoidance: Fear is a natural human emotion and some are genetically or/and environmentally predisposed to feel the fear more than others in some specific situations. But what makes life even worse for the fearful subjects is not only the fears themselves, but the distress caused by those fears: the fear of the fear! It's this negative reaction to the negative emotions one has to experience sometimes in certain situations: "I can't tolerate the anxiety that that social situation induces in me" so the subject ends up avoiding certain situations to avoid experiencing the negative feelings. As a result, the subject becomes more and more avoidant of situations which although are stressful, can be very rewarding (social contacts, romantic relationships, career progress etc). ACT teaches people to "feel the fear and do it anyway" (I know it's also a title of a book but I don't think that book is about ACT, it's a very good title though). It's more than just exposure because it's not trying to prove that the situation is not as fearful as one anticipates but it teaches people to put up with their fears, to put up with some pain in order to experience the positive aspects of the situation. It's not really cognitive reappraisal because it's doesn't try to reevaluate a feared situation positively in order to dampen the fear, no, it's basically trying to teach people to ACCEPT the emotion (fear) and to move on despite it.


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## mico (Aug 11, 2006)

Interesting post Franco. 

I believe that there are benefits from most areas of modern psychology, whether it be CBT, ACT, or just a good kick up the backside.


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## franco (Aug 21, 2006)

Hi guys,

I am happy my posts are seen as useful... Like I said and like you already know, one specific therapy may be very good for some, moderately good for others and totally ineffective for a group of people. That's one of the reasons I do not recommend to psychotherapists to stick to only one therapeutic technique. Actually I do not do counseling, I do academic research and based on our research, new techniques come out (or variations of old techniques) that can be used by therapists worldwide. I will probably re-read some of the notes I have on ACT and talk about them to address the request of "michael" later on when I get some time, probably here in this thread. Meanwhile what I recommend to people seeking counseling is to try out different approaches to find out what works best for yous.


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## mico (Aug 11, 2006)

I don't come to this forum much Franco. But been noticing your posts lately, some very useful and interesting stuff there. Good to have someone contributing some positive knowledge!


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## franco (Aug 21, 2006)

> Do you know how ACT is done in order to reduce the fear of the feared situation?


So I reviewed my notes on ACT and I realize it will take many pages to fully explain it completely in all details. For people who are interested you may try to purchase a book. But what I explained about experiential avoidance should be sufficient to give you an idea how it is supposed to work. I'll explain a bit again briefly, in a nutshell:
The main message of ACT is that attempts to suppress or control emotions and thoughts may be futile, while focusing on behavior change in valued directions is a more functional way of living. This is what I would say to a patient: "Being willing to experience your thoughts and feelings, good and bad, can free you up to focus on what really matters in your life. If you are willing to feel happy, sad, anxious, unsure, joyful and any other emotions that come up for you, you can choose the activities that you want to participate in, so that you ultimately choose your directions in life, instead of letting your fear of anxious thoughts and feelings make those choices for you"


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## Thunder (Nov 5, 2003)

The problem with ACT is that no one knows it. I've had 5 therapists and not one of them even knew CBT. I even had one tell me he couldn't help because I knew more about SA than he did. :fall


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## ColdFury (Nov 6, 2003)

Thunder said:


> The problem with ACT is that no one knows it. I've had 5 therapists and not one of them even knew CBT. I even had one tell me he couldn't help because I knew more about SA than he did. :fall


Ditto, I've never met anyone who knew anything about ACT. The only place I've seen it is a few handful of people that seem to talk about it endlessly.


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## James of Maine (Sep 8, 2005)

I've mentioned this before, but the psychologist I saw a few months ago was definitely a CBT true-believer (as much as the p-doc I saw years ago was a pharmaceutical true-believer). I've already made up my mind that it's a bunch of crap--or at least won't work in my case. I'm interested in ACT. In fact it's pretty much how I've gotten by the past ten years (and even gotten seemingly "better" for short periods of time). If I have to do something, and I really have no choice, I just do it, even if I end up embarrassing myself with my nervousness.


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## Stirner (May 16, 2006)

Here is the official homepage for ACT and it seems to be quite comprehensive:

http://www.acceptanceandcommitmenttherapy.com/


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## franco (Aug 21, 2006)

> jamesofmaine Posted: I've mentioned this before, but the psychologist I saw a few months ago was definitely a CBT true-believer (as much as the p-doc I saw years ago was a pharmaceutical true-believer). I've already made up my mind that it's a bunch of crap--or at least won't work in my case. I'm interested in ACT. In fact it's pretty much how I've gotten by the past ten years (and even gotten seemingly "better" for short periods of time). If I have to do something, and I really have no choice, I just do it, even if I end up embarrassing myself with my nervousness.


We are not all the same, we have different genetic makeup, we have different shared/non-shared environmental factors affecting us... so it is no surprise at all that what works very well for some may work less efficiently for others and vice versa.

I said it already and I can't stress enough that the title of my post is misleading: it was only to get attention. I LOVE CBT and I think it is a neat therapy that has been established for quite some time, as much as I love ACT and other methods... Each one has to find out what works best for him and I do not think that CBT and ACt are mutually exclusive: actually you'll be surprised that they do have several elements in common.


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## quietrob56 (Feb 26, 2008)

I wonder if the newer therapies like ACT and Dialectical Therapy have less applicability and more risks than stated by their proponents.


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## yeah_yeah_yeah (Mar 27, 2007)

There are many overlaps between these therapies. The idea of acceptance is a central part of Mindfulness Based CBT and Compassion Based CBT. As I have been saying many times, it seems from these boards that the average CBT practitioner in the States is woefully behind the times on the modern apprach and use of this very powerful mehtod. It seems not one CBT therapist that people have visited on this board use the Clark and Wells method - a total revision of CBT for SA, and in fact many therapists still seem to think that CBT and exposure are the same thing.

Of course this means that for those that are unaware of any other options, they just think that the whole of CBT is a bunch of crap. For SA, the CBT of the mid 1980's IS CRAP. But unless you are paying top dollar, you will not GET the CBT of the new millennium.

Clark and Wells CBT and Compassion based approaches provided the breakthrough that cured my SA symptoms. I do not suffer any problems with SA now and last year my SA was severe. I went through a period of 6 months of not going out at all excpe to work. where I had constant high anxiety, tunnel vision and a swirling head much of the time. I stopped speaking to people. There are no such problems for me now.

Dialectical behavioural therapy is intended mainly for the more extreme Borderline Personality disorder because of the extreme black and white (a dialectic) way these patients view the world, and particularly for reduction of self harmng behaviours. More 'healthy' patients are able to more readily incorporate the grey areas and so CBT, ACT and so on are more iimediately accessible.

The problem is not one of therapeutic approach - it is one of therapist availability and the insurnace programs of the US. Clark and Wells CBT for SA is needed for a good 6 months, usually more, to be effective. A low end US insurance plan will get you anything from 10 sessions with a social worker to a couple of months with a less expereienced therapist.

*Clark and Wells CBT for SA is regarded as the Gold Standard treatment internationally for SA*, however it would seem that uptake in the US has been poor, at least at the less extrotionate end of the market. Comparing Clark and Wells to Traditional CBT is like comparing the DeHavilland Comet to a modern Airbus. There are some common features but overall its an utterly different beast.

My CBT sessions cost me £70 an hour ($140) and they were effective very quickly due to the extensive work I put in and the excellent insight and skill of my therapist. On the other hand an NHS one (National Health Service - free) took 7 months to make me worse than I have ever been.

Its like comparing two top-end tennis rackets and putting one in the hands of Goran Ivanisevic and one in the hands of ... well, me. The racket could be AWESOME but if the person using it has not had the experience and training, or lack basic skills such as empathy, it will not be effective. The days of 'fire and forget' therapy and CBT as non-humanistic are drawing to a close as medical establishments are realising that there is no such thing as 'brief therapy' that can be applied by people with one or two training courses.

I have heard good things about all of these therapies, Id love to hear more about ACT :yes Just make sure you find the best PERSON you can!

"If you can afford it, you can get better". That seems to be the state of therapy these days. As I study more about BPD I am realising that as you progress up the 'mental illness' scale, this fact becomes ever truer.


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## ardrum (May 13, 2007)

*Re:*



Thunder said:


> The problem with ACT is that no one knows it. I've had 5 therapists and not one of them even knew CBT. I even had one tell me he couldn't help because I knew more about SA than he did. :fall


That sounds disturbingly similar to what my therapist said in the last session...

"I think you already know everything and have the answers."

It sounds very "cop-outty."

I cancelled my psychiatrist appointment and all future appointments. Now I'm seeing the therapist alone, but if this stuff continues, she's next on the chopping block.


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## yeah_yeah_yeah (Mar 27, 2007)

I'm so shocked ... but also glad that I found good, well trained therapists to help me. In the UK IMO you cannot rely on NHS (free) therapists at all. I have dealt with two NHS therapists (one psychodynamic, one CBT) and it seemed that both of them had very little in depth experience or skill. The only way to find good therapy is to pay a lot for it. I think that is very wrong, but its because its long term. Comapnies and Health Services dont want to pay it. Thats why they prefer giving tablets. A £5 prescription charge vs a £few thousand on therapy ...


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## ardrum (May 13, 2007)

yeah_yeah_yeah said:


> I'm so shocked ... but also glad that I found good, well trained therapists to help me. In the UK IMO you cannot rely on NHS (free) therapists at all. I have dealt with two NHS therapists (one psychodynamic, one CBT) and it seemed that both of them had very little in depth experience or skill. The only way to find good therapy is to pay a lot for it. I think that is very wrong, but its because its long term. Comapnies and Health Services dont want to pay it. Thats why they prefer giving tablets. A £5 prescription charge vs a £few thousand on therapy ...


Yeah, cost is definitely a factor.

I can't wait to tell my therapist about quitting Paxil.

So let's see...so far she offers me softball literature that would be on Oprah's booklist, pseudoscientific hogwash, thinks Paxil is a good idea, and says I already have all the answers. Fun times, and I'm still seeing her tomorrow! :eyes


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## yeah_yeah_yeah (Mar 27, 2007)

she must be attractive

is she quite nurturing? i would like that :yes


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## ardrum (May 13, 2007)

Well, she does seem to enjoy talking with me. She's kind of funny at times too. One example of one of her quotations:

"OK, your job...it sucks." - something about hearing a therapist say "it sucks" just makes me practically laugh out loud... particularly after I gave a very detailed explanation of what I dislike about it...then I get the basic summary in two words

I guess I like that I have someone I can see and talk to for an hour where the attention is on me (I have NO other opportunity to do this). I'm always otherwise giving attention to others and trying to obey orders and follow commands.

I think she does seem to genuinely enjoy talking to me too. I actually sometimes make her laugh, although it's not my goal or anything (I'm not trying to be funny, but I might sarcastically describe a particular difficulty or something).


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## yeah_yeah_yeah (Mar 27, 2007)

LOL

I had to admit to myself that I feel attraction to my therapist the other day... not too good but mehh I feel attraction to lots of ladies at the moment. Its like someone plugged my groin back in after 12 months of a power cut.


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## ardrum (May 13, 2007)

yeah_yeah_yeah said:


> LOL
> 
> I had to admit to myself that I feel attraction to my therapist the other day... not too good but mehh I feel attraction to lots of ladies at the moment. Its like someone plugged my groin back in after 12 months of a power cut.


Hmm... So are you going to tell her?

I think my groin's power circuitry is either malfunctioning or, more often, short-circuited and dead.


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## CopadoMexicano (Aug 21, 2004)

I know this thread is from 2006 but im giving it a bump because i think its helpful for those that dont respond well to traditional cbt or psychodynamic therapy.


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## Ericsentropy (Dec 21, 2013)

I like this idea of ACT. I've never heard of it until now. I think acceptance is a crucial part to this as long as not taken overboard. 
I'm seeing a DBT therapist which so far is helping but at a very slow rate. It's an extremely long drawn out process.


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## DavidPT40 (Jun 11, 2006)

Cognitive behavioral therapy (in a nutshell) teaches that excess fear is caused by irrational thinking. The two types of automatic negative thoughts are 'jumping to conclusions' and 'blowing things out of proportion'. Jumping to conclusions is thinking that a negative event that rarely or never happens will happen during the anxiety provoking situation. Blowing things out of proportion is thinking that the results of an event will be unbearable. 

So let me give an example. If you were thinking about public speaking, a 'jumping to conclusions' thought would be "I'll have a nervous breakdown during the speech". Obviously that would be an extremely rare event. A 'blowing things out of proportion" thought would be that the anxiety from speaking would be so great that it would be intolerable. Or that if people noticed you shaking or your voice cracking that you would be ostracized.

So basically, you have to identify these thoughts that are occurring on the periphery of your consciousness, dissect them and figure out why they are irrational.

One of the things I very much dislike about CBT is the extreme amount of recording (paperwork) required. At the very least, it's a part time job. But it's the most effective method out there, it just requires a lot of work.


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## Len Phelbs (Jan 21, 2014)

What are some places that would practice it? is it affliated with any group/therapy school?


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