Calgary Psychologist, Jaime Borger’s Treatment Approach

CBT, ACT, Mindfulness, CFT

Cognitive Behavioral Therapy

What is Cognitive Behavioral Therapy (CBT)?

Cognitive Behavioral Therapy (CBT) is an evidence-based, short-term, active, goal-oriented treatment. In a nutshell, CBT is premised on the idea that dysfunctional or biased thinking is a common feature of all psychological disturbances. When you learn how to evaluate your thinking in more realistic and adaptive ways, you experience a decrease in negative or unpleasant emotions, and maladaptive behavior. In other words, the way you think (cognition), feel (emotions), and act (behavior), are interrelated, and changing your thoughts can change the way you feel and act. For example, if you were anxious and had difficulty concentrating and finishing a project at work, you might have an automatic thought, an idea that seemed to pop into your mind: “I’m not smart enough”. This thought leads to a reaction: You might feel sad (emotion), and mindlessly browse the internet (behavior). CBT techniques focus on helping you evaluate and modify automatic thinking patterns and underlying beliefs, by encouraging you to step back, look at things differently. A question I might ask to challenge your thought is, “What are the consequences of thinking this?”

CBT is a goal-oriented and problem-focused therapy aimed at helping you develop a healthier perspective, cope with personal challenges, and achieve your goals using practical solutions and strategies.

CBT is present-focused, emphasizing problems in the “here-and-now”, rather than focusing on past experiences. The emphasis is on helping you identify how you interpret and evaluate what is happening in your day-to-day life, and learn how these perceptions influence how you feel and what you do.

CBT emphasizes collaboration and active participation, where you and I are viewed as a team, and you are actively engaged in the goals and process of therapy, completing tasks and homework between sessions.

CBT is educational and aims to teach you how to become your own therapist, learning how to apply skills learned in therapy to your daily life and manage difficulties and emotional upset on your own even after therapy ends.

CBT is time-limited, meaning the course of treatment is brief, usually lasting between 6 to 20 sessions. It is important to keep in mind that the length of treatment can vary, depending on the severity and complexity of your problems—some people can see significant improvements in 4-6 sessions, while others may require more than 20 sessions. CBT can be delivered effectively online, in addition to face-to-face therapy sessions.

How Does CBT Work?

Cognition

Our emotions, thoughts, and behavior are inextricably linked. CBT focuses on helping you identify, evaluate, and modify thoughts and beliefs that have the potential to exacerbate emotional distress. Essentially, you will learn how to ‘step back’ from unhelpful thoughts, and develop skills to generate more realistic and helpful ways of thinking, enhancing your ability to face challenges, make decisions, achieve your goals, and improve your mood.

Behavior

The behavioral side of of CBT (called Behavioral Activation) focuses on helping you to take healthier actions and change behavioral patterns. The aim is to reduce avoidance, inactivity and fear, and increase engagement in enjoyable and meaningful activities. Some examples include self-monitoring of activities and mood, and activity scheduling (e.g. scheduling activities aimed at boosting your mood).

Exposure is a strategy that helps you face an object or situation that elicits fear or anxiety in order to learn more adaptive ways of responding, and to reduce the anxiety and fear associated with the object or situation. In exposure therapy, you are gradually “exposed” to the things (e.g. insects, snakes) or situations (e.g. close spaces, heights) you fear in a safe environment. Gradual exposure to your fears in this way helps reduce your anxiety and avoidance, and cope with your fears more effectively.

Is CBT Effective?

CBT is considered the “gold standard”, and is one of the most studied and effective forms of psychotherapy. More than 2,000 outcome studies have demonstrated the efficacy of CBT for a wide range of psychological issues, including depression, anxiety, post-traumatic stress, eating disorders, anger, insomnia, relationship problems, marital distress, chronic pain, obsessive-compulsive disorder, low self-esteem, ADD/ADHD, diet and exercise, dissatisfaction with life, as well as a host of other psychiatric disorders and psychological problems.

Acceptance and Commitment Therapy

What is Acceptance and Commitment Therapy (ACT)?

Acceptance Commitment Therapy (ACT) is an action-oriented behavioral therapy that aims to maximize your potential to live a rich and meaningful life, while helping you accept life’s inevitable difficulties. ACT is based on the premise that pain is inevitable, but suffering is not. Life involves frustration, disappointment, rejection, loss, and failure, and we continually experience negative emotions such as fear, sadness, guilt, anger, shame, loneliness, jealousy, fear, or rejection. On top of that, we often get caught up in painful thoughts, memories, sensations, or concerns about the future. Unfortunately, many of us respond to painful and/or uncomfortable thoughts, feelings and sensations in self-defeating or destructive ways. Our tendency to dwell on our difficulties, or avoid them (called experiential avoidance), ultimately amplifies our pain and creates suffering (pain + resistance = suffering). Thus, ACT aims to help you learn how to notice, accept and embrace your thoughts and emotions, accept what is out of your control, and commit to action that enriches your life.

How Does ACT Work?

Symptom reduction is not a goal of ACT. Rather, it aims to help you understand, explore, observe and accept your thoughts and feelings, rather than fighting, denying, controlling or avoiding them. Ultimately, ACT aims to help you reduce the struggle with, and transform your relationship to difficult thoughts and emotions. The focus is on helping you connect to the present moment, clarify what really matters to you, and make purposeful choices to improve the quality of your life. ACT combines mindfulness and acceptance skills, along with commitment and behavior change strategies to promote ‘psychological flexibility’, or the ability to be open, be present, and do what really matters.

The core psychological flexibility skills are:

  1. Defusion (watch your thinking): not buying into what your thoughts are telling you, and only giving them power when they serve you. A question I might ask, “How is this thought serving you right now?”

  2. Self (the noticing self): noticing that you are more than your thoughts, feelings and stories you tell yourself. Recognizing there is a part of you who “notices” or observes what you’re thinking, feeling, doing, or sensing in any moment.

  3. Acceptance (open up): choosing to be open to your inner experiences-thoughts, feelings, emotions, memories, urges, images, impulses, and sensations-with curiosity and acceptance, instead of avoiding them, denying them, or resisting them.

  4. Presence (be here now): being here now so you can flexibly attend to internal and external events as they occur.

  5. Values (know what matters): Chosen qualities of being and doing. How do you want to show up? What do you want to stand for in life? What really matters to you?

  6. Action (do what it takes): building habits linked to your values-learning how to make choices that align with your values.

Is ACT Effective?

Countless scientific research and over one hundred randomized control trials have supported the efficacy of ACT as an effective way of improving well-being. ACT is empirically supported in the treatment of depression, anxiety, chronic pain, obsessive compulsive disorder, and psychosis. ACT is recognized as an evidence-based practice by APA Division 12, Society of Clincial Psychology, of the American Psychological Association and the National Registry of Evidence-Based Programs and Practices (NREPP) of the Substance Abuse and Mental Health Services Administration.

Mindfulness

What is Mindfulness?

Mindfulness is the ability to maintain moment-to-moment awareness of our thoughts, feelings, bodily sensations, and surroundings, through a curious, accepting and non-judgmental lens. According to Jon Kabat-Zinn, the leading pioneer of mindfulness in the West and founder of Mindfulness-based Stress Reduction (MBSR), mindfulness is synonymous with awareness “that arises from paying attention, on purpose, in the present-moment and non-judgmentally (Kabat-Zinn, 2018, p. xxxiv). Simply, mindfulness is awareness cultivated through purposeful and nonjudgmental attention— being fully immersed in the present-moment with all it’s depths and nuances, in an openhearted way. Paying attention this way enables us to feel more vitality, gratitude, clarity, and joy. Fortunately, mindfulness is a skill that can be learned by anyone.

How Does Mindfulness Work?

As a therapeutic technique, mindfulness can be thought of as a form of mind training that helps us become aware of our thoughts, feelings, moods, and bodily sensations in the present moment, with openness, curiosity, kindness and flexibility—accepting things as they are, without wanting them be different. Mindfulness helps us learn to live in the present moment, instead of getting lost in mental time travel—dwelling on the past or anticipating the future. Paying attention to our moment-to-moment experience—on purpose, with curiosity and acceptance—creates space for difficult thoughts and emotions to arise. It increase choice— about how we respond, instead of reacting in ways that may make things worse. We learn to step back, observing our thoughts and emotions come and go, without being caught up or consumed by them. Paying attention in this way enables us to live fully in the moment, get unstuck from difficult thoughts and emotions, and cultivate a sense of calm and ease.

How Is Mindfulness Practiced?

Mindfulness occurs whenever you are fully present, paying attention to your moment to moment experience. Mindfulness must be experienced to be known, and is best learned through practice.

FORMAL PRACTICE: Formal mindfulness practice is known as meditation. It is to be aware of what is going on—in our bodies, in our feelings, in our minds, and in our environment. It involves an intentional commitment of time (anywhere form one minute to 45 minutes or more almost every day) to focus on meditation. Usually it’s done in physical stillness, either sitting on a cushion or chair, or lying down, and involves consciously focusing one’s awareness on one thing, such as the breath, bodily sensations, emotions, thoughts, or sounds. Practicing formal mindfulness is like going to the mental gym, and can change the physical structure of our brains over time.

Examples of formal mindfulness practices:

Sitting Meditation: Sitting in an upright, comfortable position (on a chair, on the floor, or on a cushion), place your hands on your legs palms down, or in your lap, palms up, one hand resting in the other (your choice), and spend several minutes just “being” and experiencing stillness. Practice noticing any thoughts, emotions and sensations with curiosity, openness, compassion, and acceptance.

Breath Awareness Meditation: Sitting in an upright, comfortable position, close your eyes and relax. Gently shift your attention away from thoughts and become aware of the sensations in your forehead and around your eyes. Soften and let go of any tension, maybe bringing a slight smile to your lips. Relax into your breath-breathing in, knowing you’re breathing in, breathing out, knowing your breathing out. Notice the feeling of breathing, settling in, and staying with your breath.

Body Scan: The body scan, also known as the “journey through the body” involves focusing your full attention on the entire body one area at a time—noticing whatever sensations arise, accepting them, and sending kind compassionate thoughts to each area of the body. Mindfulness of the body can help you learn how stress and anxiety affect you, explore and be with pleasant and unpleasant sensations, and help you practice being comfortable with pain without trying to change anything.

Mindful Eating: Focusing on mindfully eating a raisin or any other piece of food, noticing the senses of sight, texture, taste, and smell as you eat slowly, paying attention with all of your senses, fully immersed in the present moment.

Sensory Meditation: Sitting in an upright, comfortable position. Gently folding your hands in your lap. Noticing your body as it is. Tuning into any sensations in your body with interest and curiosity. Taking a breath and letting go of the body’s sensations. Now turning your attention to the sounds. Noticing sounds coming and going. Noticing the silence between the sounds. Paying attention to the sounds in an open, nonjudgmental and expansive way.

INFORMAL PRACTICE: involves paying mindful attention to everyday activities. It involves actively paying attention and being fully immersed in whatever we are doing in the moment. For example, walking mindfully, being aware of each step, noticing the sensation of walking, being aware of your feet touching the ground. Expanding your attention to sights and sounds. Fully aware with each step.Make it stand out.

Is Mindfulness Effective?

There is growing body of evidence to support the benefits of mindfulness. Over two decades of clinical research has shown that practicing mindfulness can treat a wide range of mental health concerns, including depression, anxiety, chronic pain, trauma, addictions, stress and burnout. Benefits of mindfulness include stress reduction, less emotional reactivity, less rumination, increased ability to tolerate difficult emotions, increased psychological flexibility and equanimity, boosts to working memory, and improved attention, focus and mental clarity.

Additionally, mindfulness has been shown to enhance the ability to connect deeply with others, and to relate to ourselves and others with compassion and kindness.

Be simple and easy, just rest in awareness.

—Munindra

Compassion Focused Therapy

What is Compassion Focused Therapy (CFT)?

Compassion-focused therapy (CFT) is a type of cognitive-behavioral therapy that integrates concepts from neuroscience, evolutionary theory, and Buddhist psychology. CFT was primarily developed to help people who struggle with difficulties related to shame and self-criticism and often have histories of neglect and abuse. The key goal of CFT is to use compassionate mind training to help people develop a sense of inner warmth, safety and soothing via self-compassion.

How Does Compassion-Focused Therapy Work?

Compassion may be defined as an awareness of the presence of suffering, along with the motivation to prevent or alleviate the suffering. CFT focuses on helping you develop the ability to feel and act compassionately and kindly towards yourself and others. Through compassionate mind training, a collection of techniques that stimulate compassionate ways of thinking, you will learn to become sensitive to your own needs and distress, replace self-criticism, blame and shame with self-kindness, and relate to yourself with warmth and understanding. CFT emphasizes the nature of our “tricky mind” and that much of what goes on in our minds, and contributes to our suffering, is not our fault, but simply part of being human. You will learn to compassionately ‘step back’ from difficult thoughts and emotions, and develop your inner strength, courage and wisdom so you can live a fulfilled life.

Is Compassion-Focused Therapy Effective?

CFT has been researched and applied to a wide range of psychological difficulties, including shame and self-criticism, anxiety, psychosis, anger, mood disorders, and eating disorders.

“If you want others to be happy, practice compassion. If you want to be happy yourself, practice compassion.” 

— His Holiness The Fourteenth Dalai Lama