This text aims to give you an introduction to how I see the different approaches that inform my psychotherapy work are combined to create an integrated, mindfulness and compassion based CBT.
Cognitive behavioural therapy (CBT)
We can all see in our own experience that thoughts, emotions, physiology and behaviour are are interconnected. This simple idea is at the heart of CBT - thoughts, feelings and actions all affect each other. If you change any one of these, it will affect the others. This has implications for understanding how our emotional problems are created, and how they can be addressed.
For example, if there is something that is making you feel anxious, you are likely to have anxious thoughts about it, and you might worry about something bad happening. When these worries are going around in your mind, they will most likely generate more anxious feelings. A natural impulse will be to avoid that thing you are worried about, and if you do avoid it, you will feel some degree of relief. But if you keep avoiding it, then it is likely you will begin to feel like the anxiety is getting worse. And then you will start to worry about that! And so the vicious cycle goes on...
People often come to psychotherapy because they are experiencing some kind of difficult emotion - whether that is waves of anxiety or fear, persistent low mood, angry outbursts, or attacks of guilt or shame. In each of these there is likely to be a similar vicious cycle of some kind operating. To get to the bottom of it, we start by asking some simple questions and taking our responses from what we observe - what are you are thinking, what are you are feeling, what do you notice in your body, and what you are doing? We also want to know what responses improve the situation (in the long term, not just the short term) and what makes the problem worse.
This information helps to build what we call a 'formulation' - a shared, working hypothesis of what might be maintaining the problems you want to overcome. This kind of inquiry can help to demystify these overwhelming states, and to understand where they come from and what keeps them going. Contrary to some beliefs, in CBT we often look back to early childhood experiences and relationships to see how they may have contributed to some of the expectations, emotions, and patterns of coping that we are seeing in the current problems.
With this formulation in mind, CBT seeks to intervene in these vicious cycles so they do not keep repeating. By trying out new perspectives, new ways of thinking, or new ways of relating to your thinking, and doing things differently in your life not controlled by these momentary thoughts and feelings, you can start to see what happens to your moods, your relationships, and your experience generally. When you test this theory out in your own experience - what you think and do affects how you feel - you can use this information to inform how you will act going forward in your life. Essentially, CBT trains you to learn about your mind and choose more effective action. In so doing you are becoming your own therapist!
Mindfulness and compassion
In recent decades, several models have emerged within the behavioural and cognitive psychology traditions. They are informed by many disciplines and theories, particularly the research into how and why mindfulness and compassion can help people deal with emotional difficulties. I feel very drawn to these approaches because they add many helpful, empowering tools and a wise and compassionate heart to the clear thinking of CBT.
These models include compassion focused therapy (CFT), acceptance and commitment therapy (ACT), dialectical behaviour therapy (DBT), functional analytic psychotherapy (FAP) and mindfulness based cognitive therapy (MBCT). Each one of these offers a stand alone approach to therapy. Some are aimed at particular conditions or populations. The tools and insights they offer have found their way into many different forms of therapy, including traditional CBT, and other models outside of the CBT tradition, such integrative psychotherapy and psychodynamic psychotherapy.
A mindfulness and compassion based CBT
Changing your relationship to your experience
These approaches often propose changing your relationship to your experience is sometimes more important than trying to change the content of your experience. In ACT and MBCT particularly, the goal of therapy is not so much to control or change experience, but to come into a different relationship with experience, one that is more flexible and responsive, rather than constricted and reactive. Some things can, and sometimes should, be changed (such as speaking up for injustice, or asserting one's needs, or motivating oneself into action). But for other things, particularly our emotions, the most skilful response may actually be bringing curiosity, acceptance and kindness to things as they are. It can be counter intuitive to accept an emotional like sadness or fear, but through experience and practice in mindful awareness, it is possible to come into a different relationship with these emotions, one that has less struggle and more kindness, and thereby less distress and more ease.
In CFT there is a strong emphasis on cultivating a more compassionate relationship to the places of struggle, pain and difficulty in oneself. It is quite common to have an inner critic, always finding fault with what we do and expecting the worst. We often don't notice just how much influence that inner commentary has on us. With compassionate mind training we can learn to really feel into more compassionate perspectives and relate differently to the places of pain that might trigger us into unhelpful behaviour.
Connecting to what matters and taking effective action
A central part of ACT involves clarifying your values and connecting them to your choices and behaviour. When we are get in touch with what matters most to us it can have a very clarifying effect on our priorities and motivation. When we feel like something matters, we will make a commitment to it, and see it through, even if it is not easy. With practice, this can help cultivate an inner compass, so you know when you are on track, being the person you really want to be.
According to the Compassionate Mind Foundation, research has found the core of compassion is actually courage. Rather than it only being a soft and gentle attitude (although it can be that), compassion often needs to be active, strong and resourced. CFT offers a number of ways to build this inner resource, to attune it to the needs of the situation, and thereby become more effective in handling emotional distress.
In FAP, it is recognised that we need to become more aware of what our needs are, and to have the courage to act in response to those. This might involve being clearer about your boundaries with others, or allowing yourself to be seen for who you are. This can require a lot of courage, especially if there have been difficult experiences with that in the past. But with courage and wisdom, it is possible to break out of old, restrictive patterns and show up in the world more authentically.
New skills to handle this 'tricky brain'
ACT, CFT, DBT, FAP, and MBCT all offer a whole host of tools to help us. And we really need this help, because it can be very difficult to manage being human! Our brains have evolved to have powerful imaginations. This has given us an advantage in terms of organising ourselves and solving problems. But this same capacity can get us into trouble - when we imagine something, due to how the brain is structured, it activates other biological processes that would come online if what was imagined was actually happening. That is why worrying that bad things will happen can be so painful - worry activates the fight-flight response in the same way as if a real threat was present.
CFT introduces a number of strategies to help us get more balance in the mind. We tend to default to threat-based processing or resource seeking. But we also have a 'soothing system' that helps to regulate our biological systems down when they have been activated. If we no longer need to defend from a threat, or seek out something like food or shelter, then we can disengage from threat and drive processes and allow the body's natural regulation system to soothe us. All mammals have this system, but ours may not get activated as often because we keep activating threat and drive with our worries, plans and ruminations.
ACT and DBT have a whole host of methods, from mindfulness exercises to metaphors and paradoxes, to help us 'de-fuse' from our thinking, to find more flexible perspectives, and to reconnect with our values. In MBCT there is an invitation to observe thoughts just as thoughts, to disengage from the content, and play with not buying into the 'facts' they appear to be.
Bringing all of these ideas, tools and methods together, we learn how to develop new perspectives that are more flexible, adaptive, compassionate and courageous. This therapy approach is skills-based - drawing heavily upon mindfulness exercises and meditation, imaginative skills, clarifying values and taking meaningful actions. With practice and development of new skills it is possible to come into a new relationship with old hurts and emotional patterns. We can begin to relate to difficulties differently; taking valued, compassionate action in the service of being the person you want to be, deep in your heart.
My therapy approach