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Sydney Clinical Psychologist Centre, Suites 13 - 14, Level 4, 229 - 231 Macquarie Street, SYDNEY NSW 2000

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Cognitive Behavioural Therapy

Cognitive Behavioural Therapy (CBT) refers to a therapeutic style and approach that has been developed since the late 1960’s which was derived from behaviourism and learning theory. Cognition means the content and process of thought. Behaviour refers to real world action, that is, what we do. CBT is a therapeutic approach that is aimed at developing a detailed understanding of the thoughts, thought processes, consequent emotions and behaviours that underpin mental disorders and conditions.

At Sydney Clinical Psychologist Centre we provide cognitive behavioural therapy in a number of forms which have been validated by research.

Traditional Cognitive Behavioural Therapy

We practice traditional cognitive behavioural therapy that focuses on identifying the cognitive distortions that underlie mental disorders or conditions. A common example of such a distortion is the “mindreading” cognitive distortion. Consider this scenario, you ring a friend and they don’t call you back right away. You start to think things like “I’ve done something wrong” or “they think I’m no good” or “they don’t want to be my friend anymore” and feel anxious or sad. Your friend eventually calls you back and tells you that they lost their phone, or were too busy to call you, or there was some emergency and your relationship is just as it always was. Jumping to the conclusion that they thought something negative about you is an example of mind reading, or guessing what goes on in the minds of other people. The reality is we do not know what other people really think, and we can only know what people tell us about their thoughts. People with depression and anxiety tend to engage in mindreading and over-estimate the negative thoughts other people are having about them as well as the real world value of these thoughts. This can play a maintaining role in their depressed mood or anxiety. Programs of cognitive-behavioural therapy have been developed for a wide range of mental disorders and conditions and target the specific patterns of thought and behaviour that play a role in the onset and maintenance of the condition.

Acceptance and Commitment Therapy

Newer “third wave” cognitive behavioural therapies include the mindfulness based therapies such as Acceptance and Commitment Therapy (ACT, pronounced like the word “act”). This approach is based on relationship frame theory, which argues that because of the cognitive capacities that underpin language, humans flexibly overgeneralize properties attributed to events, and so can relate to thoughts as if they were real world events, and change the relationship to real world events by their thoughts. This has a double edged effect in that humans, who like other creatures, wish to avoid distress and may engage in thought and language mediated strategies to distort the experience of distress, and distort the relevance of a behaviour in the context of the event in which it occurs. Similarly, a person can become absorbed in thought and language in the experience of their mind rather than focusing on the real world and the most adaptive behaviour available to them. As a cognitive behavioural therapy ACT works to shift past attachment to behaviours that are not working by detaching from the thinking and emotion and by surrendering to these experiences, and focusing on producing more adaptive behaviours that are in line with the persons over all values.

Returning to the previous example about telephoning a friend and them not answering immediately, the ACT approach would encourage accepting that the friend did not return the call and that the accompanying emotions of feeling of sadness or anxiety, compassionately recognizing that the source of suffering is the idea that immediate contact with your friend represents the goodness of the relationship and if you think this it makes sense that you are upset and allowing this thought to pass, and to commit to being open to the friend if they should contact you because you value being a good friend and being non-judgmental.

The ACT approach has been adapted and formulated for a wide range of mental disorders and conditions and research is emerging to validate these approaches with promising results. It focuses on helping people to be open to experience, that there is a part of the self that is enduring and aware beyond the immediate distressing situation, that there is an alternative to the suffering that comes from being fused with ideas about events and by focusing on the present moment we can engage in action that is consistent with our own values.

Schema Therapy

The third kind of cognitive behavioural therapy offered at Sydney Clinical Psychologist Centre is the Schema Therapy approach. Schema Therapy is aimed at helping people who have repetitive patterns of thought and behaviour that are maladaptive and usually extreme and that have their origins in early life. The initial phases of schema therapy involve mapping the early experiences and the patterns of behaviour that stem from them and learning to identify when these learned patterns become activated. The second phase of schema therapy involves re-experiencing these events from early life either in imagery or role play, and learning alternative patterns of behaviour. The final phase of therapy involves behavioural pattern breaking in present life.

Schema Therapy is aimed at producing change at a deep level, and often involves a longer course of therapy. To return to the example used above, the schema therapy approach would focus on how the unavailability of the friend to immediately take a telephone call activated the abandonment schema. The abandonment schema was learned when as an infant, if an adult was not available to answer your crying, a fundamental need would be being frustrated resulting in the feelings of emptiness that typify the abandonment schema. By looking at a schema flashcard made in therapy, you would reassure yourself that just because your friend is unavailable does not mean that your friendship has been broken and that no one cares about you, and that as an adult you can care for yourself and reassure yourself that you are alright, and do engage in a self-care behaviour rather than persisting in recalling your friend repeatedly, cutting off the relationship with your friend, or harming yourself by smoking, drinking or engaging in some other unhelpful behaviour.

Cognitive Behavioural Therapy is a sophisticated and scientifically validated form of therapy that has been demonstrated to produce clinically sound outcomes for a wide number of mental disorders and conditions. At Sydney Clinical Psychologist Centre we are committed to the expert practice and research of cognitive behavioural therapy.

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