Corin (Cognitive and Behavioral Therapist) (S)

1. #1Behavioral Activation (BA)

   Keys: Behavioral Activation, BA

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   Overview: Behavioral Activation (BA) is a form of short-term outpatient therapy that engages clients in rewarding activities of their own choosing as a way to counter the negative feelings and withdrawal that are typical of depression. BA is a way of changing from the outside in—jump-starting clients back to the kind of life they once enjoyed. Evidence suggests that even in small doses, engaging in a constructive activity is positively reinforcing, not only rekindling interest in and energy for the activity but providing a sense of achievement—enough to disrupt the negative feelings, avoidant behavior, and disturbed mood that keep people trapped in depression, and the avoidant behavior that is the hallmark of anxiety. Under the active guidance of a therapist, clients are assigned to activities they themselves select—whether meeting a friend for coffee, listening to a podcast, or going for a walk in the park—and learn to formulate and accomplish behavioral goals.

   When it is Used: BA is suitable for people with depression who are not at immediate risk of self-harm. Studies indicate that it may be especially useful for those who are chronically depressed. Because it is action-oriented, it can be used to help people who are reluctant to talk about their feelings or do not have the language to do so.

   What to Expect: One of the essential ingredients of BA is understanding that depression works in vicious cycles. A stressful or negative event—such as ending a relationship or losing a job—triggers negative thoughts and feelings and behavioral shutdown. People withdraw from pleasurable social and other activities; the isolation amplifies negative feelings and provides no relief from them, intensifying depression.

   BA Steps: Activity Monitoring: The first step in BA is activity monitoring. clients are provided with worksheets on which they note daily activities and rate the moods each is associated with. Next, clients identify their life values and goals—whether related to work, learning, health and fitness, family, friendship, intimacy, entertainment, or more—as a guide to choosing concrete activities they will focus on adding to their days. They select a mix of those they find meaningful and those that build a sense of mastery, as well as those that bring pleasure. Building Meaningful and Enjoyable Activities: After activity monitoring, clients create daily schedules (a week at a time) in which they build in both meaningful activities and enjoyable ones. The activities deemed pleasant and those delivering mastery will be different for each person, as will the balance of the two kinds of activities. During Therapy Sessions: In sessions, clients discuss how to problem-solve, especially how to motivate themselves when they feel stuck. Between sessions, clients can expect assignments that focus on workarounds for any specific obstacles they encounter in getting things done. And while no one activity will alleviate depression, the effects of building routines of activities and accomplishing goals will build over time.

   How it Works: BA is based on the knowledge that inactivity leads to depression, which leads to more inactivity and deeper depression. BA provides a way of feeling better quickly, directly stimulating improvement in mood through action. In depression, people generally disengage from their routines and withdraw from their environment; as a result, there is no source of pleasant or rewarding experiences to draw on to motivate continued engagement. With BA, the activity itself generates changes in body physiology and chemistry that are mood-enhancing. BA works in more sustaining ways as well—participating in valued activities provides a sense of achievement that counters the negative thinking that keeps depressed people stuck. Over time, clients build a sense of mastery that helps make them emotionally resilient.

2. #2Biofeedback

   Keys: Biofeedback

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   Overview: Biofeedback is a technique that involves monitoring a person’s physiological state and sending information about it back to that individual. The accumulated data allow clients to consciously control aspects of their physiology—using relaxation techniques to slow down heart rate, for example—and this learning is used to help manage symptoms of a variety of medical and psychological conditions.

   When it is Used: Biofeedback may be helpful in addressing anxiety, stress, trauma, insomnia, as well as a range of symptoms.

   What to Expect: Electronic sensors attached to the client provide signals and information on physiological markers. The therapist explains to the client how the signals relate to different physical or mental states, such as feeling more or less stressed. Ultimately, a client can be taught to employ certain techniques, such as mindfulness or breathing exercises, to modulate these states, using the feedback as a guide along the way.

   How it Works: By harnessing real-time information on one’s bodily state and demonstrating how it connects to conscious behaviors (such as thinking about certain images, breathing in a certain way, or relaxing muscles), biofeedback therapy is designed to help clients take more control over the functioning of their bodies. In the course of therapy, they may learn to better manage symptoms linked to the observed physiological activity.

3. #3Cognitive Behavioral Therapy (CBT)

   Keys: Cognitive Behavioral Therapy, CBT

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   Overview: Cognitive behavioral therapy (CBT) is a short-term form of psychotherapy based on the idea that the way someone thinks and feels affects the way he or she behaves. CBT aims to help clients resolve present-day challenges like depression or anxiety, relationship problems, anger issues, stress, or other common concerns that negatively affect mental health and quality of life. The goal of treatment is to help clients identify, challenge, and change maladaptive thought patterns in order to change their responses to difficult situations.

   When it is Used: A large body of research has found it to be either highly or moderately effective in the treatment of depression, generalized anxiety disorder, post-traumatic stress disorder, general stress, anger issues, panic disorders, agoraphobia, social phobia, eating disorders, marital difficulties, obsessive-compulsive disorder, and childhood anxiety and depressive disorders.

   What to Expect: CBT usually starts with one or two sessions focused on assessment, during which the therapist will help the client identify the symptoms or behavior patterns that are causing them the most problems and set goals for treatment. In subsequent sessions, the client will identify the negative or maladaptive thoughts they have about their current problems and determine whether or not these thoughts are realistic. If these thoughts are deemed unrealistic, the client will learn skills that help them challenge and ultimately change their thinking patterns so they are more accurate with respect to a given situation. Once the client’s perspective is more realistic, the therapist can help them determine an appropriate course of action. CBT usually concludes with a session or two of recapping, reassessing, and reinforcing what was learned. If necessary, someone may return to therapy for periodic maintenance sessions. Along the way, clients will most likely be given “homework” to do between sessions. That work will typically include exercises that will help them learn to apply the skills and solutions they came up with in therapy to real-world situations in their day-to-day life. While clients undergoing CBT will likely not spend a large amount of time exploring their childhood or past, they may still be asked to examine thoughts and behavior patterns that they may find embarrassing or shameful. As in all types of therapy, it is important to work with a therapist with whom one can be open and candid.

   How it Works: CBT integrates behavioral theories and cognitive theories to conclude that the way people perceive a situation determines their reaction more than the actual reality of the situation does. When a person is distressed or discouraged, his or her view of an experience may not be realistic. Changing the way clients think and see the world can change their responses to circumstances. CBT often targets cognitive distortions, or irrational patterns of thought that can negatively affect behavior. Common cognitive distortions include all-or-nothing thinking (seeing everything in black-and-white terms and ignoring nuance), catastrophizing (always assuming the worst will happen), and personalization (believing that the individual is responsible for everything that happens around them, whether good or bad). CBT is rooted in the present, so the therapist will initially ask clients to identify life situations, thoughts, and feelings that cause acute or chronic distress. The therapist will then explore whether or not these thoughts and feelings are productive or even valid. The goal of CBT is to get clients actively involved in their own treatment plan so that they understand that the way to improve their lives is to adjust their thinking and their approach to everyday situations.

4. #4Cognitive Processing Therapy (CPT)

   Keys: Cognitive Processing Therapy, CPT

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   Overview: In CPT, the therapist will help a client who has undergone significant trauma to evaluate his or her thoughts surrounding the trauma, particularly maladaptive or self-blaming thoughts that may be exacerbating PTSD symptoms, and conditions including anxiety and depression that set on in the wake of the experience. The client will then learn to challenge those thoughts and take a new perspective when appropriate. Like some other forms of CBT, at-home work is important for CPT; for example, clients will likely be asked to write an account of their trauma between sessions, to be read aloud in a later session.

   When it is Used: CPT is a viable treatment option for most clients struggling with PTSD. CPT may be particularly beneficial for those who anticipate encountering additional traumatic events as it aims to alter the way clients interpret and process trauma on an ongoing basis. It may not be an ideal treatment for clients struggling with substance abuse or suicidal ideation, or clients with comorbid bipolar disorder. In these instances, another trauma treatment, such as Prolonged Exposure Therapy (PET), is often recommended over CPT.

   What to Expect: Initial sessions are typically focused on psychoeducation that helps the client learn about PTSD and what they can expect from treatment. In subsequent sessions, the client will work with their therapist to identify and explore the ways that trauma may have altered the client’s thoughts and beliefs, affecting both the way they feel and how they act. Specifically, the therapist will help the client pick out thoughts that create barriers to recovery. The client will learn a set of strategies to challenge and modify thoughts that are inaccurate and/or unhelpful and will practice these strategies with the therapist and on their own with worksheets and exercises. Clients may be asked to write about the specific events of their traumatic experience, including any sensory details that they remember, or they may be asked to write more broadly about how their experience makes them feel and how they tend to think about what occurred.

   How it Works: Someone who has experienced significant trauma and has developed PTSD as a result may notice that they think very differently about themselves or their environment than they did prior to the trauma. This is often particularly noticeable in the following five areas: Safety (they may doubt their ability to protect themselves and others), Trust (they may question their judgment and/or the judgment and intentions of others), Control (they may feel unable to control their own life or influence the lives of those they care about), Esteem (they may view themselves and/or others differently, perhaps seeing themselves as “broken” or others as “evil.”), and Intimacy (they may feel incapable of connecting with or being understood by and accepted by others.) These thoughts tend to lead to negative emotions—fear, anxiety, guilt, and anger—and can halt the person's recovery from PTSD. CPT focuses on teaching a set of skills that will help the person challenge these negative thoughts. CPT is based on the social cognitive theory of PTSD, which posits that incorporating a traumatic event into one’s worldview is often counterproductive and may lead to maladaptive beliefs. CPT, therefore, focuses on repairing the damage done by a traumatic event to someone’s beliefs about themselves and the world. By offering specific cognitive restructuring skills, CPT allows an individual to challenge these negative thoughts and interpretations (known as stuck points), gain a healthier perspective about the trauma (for example, “While I can’t trust my abuser, I can still trust other people”), cope better with any future trauma, and move forward with their lives.

5. #5Dialectical Behavioral Therapy (DBT)

   Keys: Dialectical Behavioral Therapy, DBT

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   Overview: Dialectical behavior therapy (DBT) is a structured program of psychotherapy with a strong educational component designed to provide skills for managing intense emotions and negotiating social relationships. The “dialectic” in dialectical behavior therapy is an acknowledgment that real life is complex, and health is not a static thing but an ongoing process hammered out through a continuous Socratic dialogue with the self and others. It is continually aimed at balancing opposing forces and investigating the truth of powerful negative emotions. DBT acknowledges the need for change in a context of acceptance of situations and recognizes the constant flux of feelings (many of them contradictory) without having to get caught up in them. Therapist-teachers help clients understand and accept that thought is an inherently messy process. DBT is itself an interplay of science and practice, a comprehensive and multifaceted therapy designed to help clients cope with extreme emotional suffering and, often, self-injurious behavior.

   When it is Used: Originally developed to curb the self-destructive impulses of chronic suicidal patients, DBT is also the treatment of choice for Borderline Personality Disorder (BPD), emotion dysregulation, self-harm, PTSD, anxiety, and more.

   What to Expect: DBT is present-oriented and skills-based, and clients are asked to practice their skills between sessions. Clients can expect homework assignments, which might, for example, focus on taking specific, concrete steps to master relationship challenges. DBT specifically focuses on providing therapeutic skills in four key areas: Mindfulness (which enables clients to accept and be present in the current moment by noting the fleeting nature of emotions, thus diminishing the power of emotions to direct their actions), Distress Tolerence (the ability to tolerate negative emotion rather than needing to escape from it or acting in ways that make difficult situations worse), Emotion Regulation Strategies (which give clients the power to manage and change intense emotions that are causing problems in their life), and Interpersonal Effectiveness ( which allow a person to communicate with others in a way that is assertive, maintains self-respect, and strengthens relationships - a core principle is that learning how to ask directly for what you want diminishes resentment and hurt feelings). DBT incorporates many of the techniques of cognitive behavioral therapy (CBT). It helps clients recognize and challenge the varieties of distorted thinking that underlie negative feelings and prompt unproductive behavior. For example, clients learn to identify when they are catastrophizing (assuming the worst will happen) in order to avoid acting as if it were the case. They review their own past and present experience for instances of all-or-nothing thinking, seeing everything in extremes of black or white, devoid of the nuance that is more generally the nature of life. Mindfulness training is an important part of DBT. In addition to keeping clients present-focused, it slows down emotional reactivity, affording people time to summon healthy coping skills in the midst of distressing situations. Clients are asked to keep a diary tracking their emotions and impulses, a tool that helps them gain awareness of their feelings, understand which situations are especially problematic for them, and use the information to gain control over their own behavior. In individual sessions, clients review difficult situations and feelings they faced the prior week and engage in problem-solving by actively discussing ways of behaving that might have delivered a positive outcome. In addition, clients typically have access to therapists between sessions for skills coaching if they are in a crisis.

   How it Works: In seeing many mental health conditions as disorders of emotion dysregulation, DBT is focused on emotions and how they feed ineffectual action patterns. Many elements of the therapy are aimed at teaching clients how to recognize, understand, label, and regulate their emotions and how to handle interpersonal situations that give rise to negative or painful emotions. Each week, for individual therapy sessions, clients complete a diary “card” (often done via an app), a self-monitoring form that tracks individualized treatment targets relating to moods, behavior, and skills. Clients identify and rate the intensity of emotions they experience each day—fear, shame, sadness, anger, pain, suicide attempts, and more—and space is provided to discuss emotional experience in more detail if needed. In addition, using a checklist of skills—which also serves as a handy reminder to deploy them—clients note the frequency with which they engaged in positive practices, from self-soothing and radical acceptance to reducing vulnerability and acting in ways contrary to how they felt. After identifying the behavioral targets for a session, the therapist helps the client engage in behavioral analysis, figuring out what led to a specific problem situation the client encountered, including any underlying beliefs or attitudes that surreptitiously reinforce the behavior, and discussing the consequences of the client’s actions. The therapist and client discuss more skillful ways to solve emotional and life problems.

6. #6Exposure and Response Prevention (ERP)

   Keys: Exposure and Response Prevention, ERP

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   Overview: Exposure and Response Prevention (ERP) is a form of cognitive behavioral therapy (CBT) used to treat a variety of conditions, including anxiety, phobias, and eating disorders. It is considered the gold-standard treatment for obsessive-compulsive disorder (OCD).

   When it is Used: Exposure and response prevention is designed to gradually reduce the anxiety that feeds obsessions and compulsions. One way in which this is thought to happen is through a process called habituation, whereby people become less physiologically aroused by triggering stimuli or obsessions after being repeatedly and safely exposed to them. Further, clients with OCD, anxiety, phobias, or eating disorders learn over time that the stimuli, thoughts, and feelings that prompt compulsions are more bearable than they anticipated. They also realize that being exposed to their fears does not actually lead to the outcomes they dread. They come to recognize that they are capable of coping with the triggers without resorting to compulsive rituals.

   What to Expect: Exposure and response prevention can help people manage anxiety-provoking or obsessive thoughts and behavior. It involves two steps. First, clients are directly exposed to stimuli that generally evoke fear, distress, obsessive thoughts, or compulsive, ritualistic behavior (exposure component). Next, they learn therapeutic techniques to help prevent their usual maladaptive response. As a result, they get accustomed to experiencing a trigger but not giving in to the compulsion. This is the response-prevention component.

   How it Works: Exposure and response prevention begins with a thorough assessment, during which the therapist will provide education about the client’s specific condition and identify their unique triggers and the compulsions they provoke. With the therapist’s guidance, the client is systematically exposed to objects, situations, mental images, or other stimuli that trigger obsessions. An important challenge in ERP is the “response prevention” component (learning not to respond to the obsessions with the usual compulsive behaviors). With exposure to increasingly uncomfortable stimuli, clients acquire the ability to tolerate the distress they generate without having to resort to rituals that only wind up perpetuating obsessive-compulsive patterns.

7. #7Forensic Therapy

   Keys: Forensic Therapy

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   Overview: Forensic therapy is concerned with the mental health assessment, evaluation and treatment of clients who are in the legal system for crimes committed. Victims and families may also be involved in the therapy related to the occurrence of crimes. A forensic therapist helps the offender to examine the motivations for their behavior, the actions committed, and take responsibility for them, which may help prevent any future activity. Where possible, a therapist works to prevent recidivism on the part of the offender, and/or evaluates inmates to assess the likelihood that they will commit further crimes.

   When it is Used: Forensic therapists often work with offenders who have antisocial personalities or psychopathy.

   What to Expect: An assessment may be conducted for the purpose of determining a course of therapeutic treatment or simply to establish facts, such as mental competency, for use in the legal system. When a forensic therapist is assessing an individual for treatment, the emphasis is less on determining the facts of a case and more on identifying the person's problems and deciding on an appropriate treatment plan.

   How it Works: The treatment goal of forensic therapy is to understand what triggers a person to commit a crime and help that person understand their own motivations and take responsibility for their actions. By building this self-awareness, as well as an understanding of the nature and impact of their crime, it may be possible for offenders to change their thinking and behavior patterns so they are less likely to act out or commit crimes in the future.

8. #8Mentalization-Based Therapy (MBT)

   Keys: Mentalization-Based Therapy, MBT

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   Overview: Mentalizing, or the ability to focus on and differentiate between your own emotional state of mind and that of others, and understand how one’s mental state influences behavior, is a normal cognitive function that is limited in those with borderline personality disorder. Enhancement of mentalization and improved emotional regulation are at the core of MBT treatment.

   When it is Used: An inability to mentalize often stems from an insecure attachment to a parent, or abandonment issues early in life. If the client lacks an understanding of their own and other people's feelings, they may have difficulty both regulating their own problematic emotions and behavior and correctly identifying the thoughts and feelings of others. They may not understand the intent behind other people’s behavior, and may respond impulsively and inappropriately in ways that can disrupt their relationships. Mentalization-based therapy can thus be an effective treatment for increasing the capacity to mentalize in people with borderline personality disorder, antisocial personality, addiction, eating disorders, and depression.

   What to Expect: MBT therapists work to create a safe environment in which clients can begin a deep exploration of their own feelings and those of others, ultimately developing their capacity for mentalization. The MBT therapist focuses on the client's present rather than their past. MBT may draw from psychodynamic, cognitive-behavioral, systemic, dialectical-behavior, and social-ecological therapies. However, MBT differs from DBT through MBT's foundations in psychoanalysis, attachment theory, and acceptance.

   How it Works: MBT helps clients to think before they react to their own feelings or to the perceived feelings of others. With an improved ability to mentalize, clients not only process their own thoughts, feelings, and related behaviors differently, but can also better understand that another person’s thoughts, feelings, and behavior may differ from their own interpretation. The goal of mentalizing is for clients to not only better understand themselves but also to improve their theory of mind regarding others, and to think about what may be driving other people’s thoughts and behaviors. Such an ability will help the client avoid misinterpreting another person’s meaning and respond appropriately to them.

9. #9Mindfulness-Based Cognitive Therapy (MBCT)

   Keys: Mindfulness-Based Cognitive Therapy, MBCT

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   Overview: Mindfulness-Based Cognitive Therapy (MBCT) is a modified form of cognitive therapy that incorporates mindfulness practices such as present moment awareness, meditation, and breathing exercises. Using these tools, the MBCT therapist teaches the client to be in the here and now, as well as to help them break away from negative thought patterns that can cause a decline into a mood-disordered state. MBCT can help a person fight off a difficult frame of mind before it takes hold.

   When it is Used: MBCT can be used to help clients prevent relapse into recurring episodes of depression or deep unhappiness. It can also help clients with major depressive disorder, generalized anxiety disorders, bipolar disorder, general emotional distress, and addictions.

   What to Expect: MBCT therapists teach the client meditation techniques as well as the basic principles of cognition, such as the relationship between an individual's thoughts and feelings. Clients are also supported in learning more about their condition, and clients will be given exercises such as breathing exercises and mindful meditation. Clients are encouraged to learn, develop, and introduce the present-moment awareness into their everyday routines.

   How it Works: "For a client who has recovered from a depressive state, ordinary feelings of sadness can sometimes be a powerful trigger for a relapse of depression. Rather than trying to avoid or eliminate sadness or other negative emotions, the client learns to change their relationship with these emotions. Accepting sadness can be executed by practicing meditation and other mindfulness exercises. These activities rebalance neural networks, allowing the client to move away from automatic negative responses, and towards an understanding that there are other ways to respond to difficult situations. In effect, clients learn that they are not their thought patterns. By developing a routine meditation practice, clients can use the technique whenever they start to feel overwhelmed by negative thoughts. When sadness occurs and starts to bring up the usual negative associations that can trigger a relapse of depression, the client is equipped with tools that will help them replace their negative thinking with calmness, compassion, and positive action.

10. #10Prolonged Exposure Therapy (PET)

    Keys: Prolonged Exposure Therapy, PET

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    Overview: Prolonged Exposure Therapy (PET) is a form of psychotherapy for treating clients with PTSD. After a traumatic event, some people experience unwanted thoughts, disturbing nightmares, feelings of hopelessness, depression, and hypervigilance. If clients have these symptoms, they understandably want to avoid thoughts, feelings, and things that remind them of the trauma. The goal of prolonged exposure therapy is to gradually help the client re-engage with life, especially with things they have been avoiding. By doing so, the client's ability to distinguish safety from danger is strengthened, and the client may experience a decrease in their PTSD symptoms.

    When it is Used: PET can be helpful for clients who have experienced or witnessed a traumatic event.

    What to Expect: Prolonged exposure therapy treatment involves imaginal exposure, directly facing a fear, learning about PTSD, and retraining how the client breathes. The PET therapist will guide the client through a retelling of the traumatic experience(s) that caused them to seek therapy. The client will explore their thoughts and feelings. Through this process of exploration and processing of their thoughts and feelings about the event, this can help the client decrease the unwanted traumatic reminders, as well as feel less distress when recalling the trauma. In PET therapy sessions, the therapist will first ask the client to make a list of the things they have been avoiding (e.g. sounds and places). The client will then create an “exposure hierarchy” by ranking these avoided things based on how much distress they cause the client when encountered. The scale used by the client to rank their distress for each PTSD trigger is the SUDS scale.

    PET Techniques: Breathing Retraining: In breathing retraining, the PET therapist helps the client to focus on taking a deep and slow breath to calm themselves when recalling the traumatic event. This deep and slow breath involves the client breathing through their nose, holding their breath, and exhaling slowly through their mouth. Imaginal Exposure: In imaginal exposure, the client discusses with their PET therapist some events of the trauma. The PET therapist may ask the client to then write down their traumatic experience, and to read the experience out loud.

    SUDS Scale: The Subjective Units of Distress Scale (SUDS) is a self-assessment rating scale that measures how intensely a client experiences distress (e.g. anxiety, anger, or other discomfort). The scale runs from 0 to 100 with 100 being the highest level of distress.

    How it Works: Prolonged exposure therapy is based on associative learning theory: When two things appear together, the brain learns to connect or associate them. This same process is behind PTSD: When trauma occurs, there are many things in the environment (smells, sights, sounds) that the brain associates with the trauma. When clients encounter these things outside of the trauma, the brain expects danger, causing fear and anxiety. to break this association, clients learn to encounter the same PTSD triggers in situations which are safe, thus helping their brains to adjust to what they had previously avoided.

11. #11Rational Emotive Behavior Therapy (REBT)

    Keys: Rational Emotive Behavior Therapy, REBT

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    Overview: Rational Emotive Behavior Therapy (REBT) is a form of psychotherapy that helps clients identify self-defeating thoughts and feelings, challenge the nature of irrational and unproductive feelings, and replace them with healthier, more productive beliefs. REBT focuses mostly on the present to help clients understand how unhealthy thoughts and beliefs create emotional distress, and how this emotional distress in turn leads to unhealthy actions and behaviors that interfere with the client's life and goals. Once identified and understood, negative thoughts and actions can be changed and replaced with more positive and productive behavior, allowing clients to develop more successful personal and professional relationships.

    When it is Used: REBT can help clients struggling with negative emotions such as anxiety, depression, guilt, problems with self-worth, and extreme or inappropriate anger. It can also help clients change stressful and self-defeating behaviors such as aggression, unhealthy eating, and procrastination.

    What to Expect: To help clients manage and overcome difficulties or achieve life goals, the REBT therapist will work with the client to identify the beliefs and rigid thought patterns that may be holding them back. The REBT therapist will then help the client see how irrational these thoughts are, and how they harm the client. Examples of these unhelpful thought patterns are awfulizing and musterbating. Through a variety of mental exercises, the client will then learn how to reduce their negative thoughts and behaviors, and replace them with healthier, more constructive, and self-accepting thoughts. REBT makes use of a variety of methods and tools, including positive visualization, reframing of thinking, the use of self-help books, audio-visual guides, and assigned homework for reinforcement between sessions.

    REBT Concepts: Awfulizing: When a client engages in awfulizing, they view a situation in catastrophic outcomes and have a distorted view of reality that ends in worst-case scenarios. The client may also engage in all-or-nothing, black-or-white thinking that can be unhelpful to them. Musterbating: When a client engages in musterbating, they cause themselves emotional unrest by using absolutist words such as 'must', 'should', 'ought', and 'never'. Similar to all-or-nothing thinking, this prevents the client from discovering other paths that may exist in reality, but are unseen or unrecognized by them in this distorted state of mind.

    REBT ABCDE Model: Activating Event: The external event that activates how the client feels or thinks. Belief: The client's automatic beliefs about the event, themselves, and other people. Consequences: The client's emotional or behavioral responses. Dispute: Occasions or opportunities when the client begins to dispute or question these beliefs. Effective behavior: When the client has successfully resisted irrational beliefs, and changed their behavior.

    How it Works: REBT posits that most clients are not aware that many of their thoughts about themselves are irrational, and these thoughts negatively affect the way clients behave in important relationships and situations. As a result, these thoughts cause clients to suffer negative emotions and engage in self-destructive behaviors. At the same time, clients are capable of challenging and changing their irrational beliefs, if they are willing to do the work. While specific life events may contribute to mental health difficulties, REBT therapists believe that it is an individual’s own faulty and irrational belief system that is at the root of most problems. By letting go of negative thoughts and replacing them with positive beliefs, one is better able to accept one’s self and others. Using the ABCDE model, a skilled REBT therapist works with their client to help them see the connections between the Activating event, Beliefs, and the Consequences. This awareness may help the client understand their irrational beliefs and thoughts, which may mean better and more positive reactions and consequences.

12. #12Reality Therapy

    Keys: Reality Therapy

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    Overview: Reality Therapy focuses on improving the client's present relationships and circumstances rather than focusing on discussion of past events. The approach is based on the idea that the most important need of clients is to be loved, and to feel that they belong, with all other basic needs only satisfied by building strong connections with others. Reality therapy sees behavior as choices, and it teaches clients that while they cannot control how they feel, they can control how they think and behave. By choosing to behave in certain ways, these choices help or hamper the client's ability to satisfy essential needs and to reach their individual goals. This approach uses choice therapy and recognizes that the behaviors chosen are key to the client's accountability and who they are. Ultimately, the goal of Reality Therapy is to help clients take control of improving their own lives by learning to make better choices.

    When it is Used: Reality Therapy can help in treading addiction, eating disorders, substance abuse, anxiety, phobias, and relationship difficulties.

    What to Expect: Reality therapy focuses on present issues and current behavior as they affect the client now and will affect the client later. Since reality therapy is solution-oriented, the client will examine how their behavior is interfering with their ability to form stronger relationships and figure out what kind of changes the client can make in their behavior to get what the client wants out of life. The client learns how to reconnect with people from whom the client has become disconnected, and the client also learns how to make new connections. If the client tries to make excuses or blame others for their behavior, the therapist will show the client how that kind of thinking results in behavior that prevents the client from improving relationships and reaching their goals. The client is given the opportunity to learn and practice new ways and techniques in the privacy of the therapist’s office before the client employs them in their life outside of therapy sessions. WDEP in Reality Therapy is used by the therapist to help the client realize the choices available to them, and to help them choose better choices.

    Reality Therapy's WDEP: W: The W in WDEP refers to Wants - what the client has stated they want or seek. D: The D in WDEP refers to Doing - what the client is doing to progress towards their stated wants or desires. E: The E in WDEP refers to Evaluation - the client's evaluation, as well as the therapist's evaluation, of the effectiveness of the client's behavior towards achieving their stated goals with their behavior or choices made. P: The P in WDEP refers to Planning - the therapist helping the client to plan a course of action that changes their behavior in order to help the client achieve the goal or outcome they want.

    Reality Therapy's Five Basic Needs: Power: The first basic need everyone is believed to seek is power, or a sense of self-worth and achievement. Love and Belonging: The second basic need everyone is believed to seek is love and belonging, such as being part of a family, or within a community of loved ones. Freedom: The third basic need everyone is believed to seek is freedom or independence. Fun: The fourth basic need everyone is believed to seek is fun, which includes a sense of satisfaction or pleasure. Survival: The fifth basic need everyone is believed to seek is survival, and the comfort of knowing that one's basic needs of food, shelter, and sex are met.

    Reality Therapy's Seven Habits Supporting Connection between the Client and Others: Support: Through supporting others, it is possible for the client to build stronger relationships with others. Encouragement: Through encouraging others, it is possible for the client to build stronger relationships with others. Listening: Through listening to others, it is possible for the client to build stronger relationships with others. Accepting: Through accepting others despite their differences or flaws, it is possible for the client to build stronger relationships with others. Trusting: Through trusting others, it is possible for the client to build stronger relationships with others. Respect: Through respecting others, it is possible for the client to build stronger relationships with others. Negotiation: Through negotiating with others in times of conflict, it is possible for the client to build stronger relationships with others

    Reality Therapy's Seven Habits Inhibiting Connection between the Client and Others: Criticism: When one criticizes others, it will likely weaken or destroy the client's relationship with them. Blame: When one blames others, it will likely weaken or destroy the client's relationship with them. Complaints: When one complains about others, it will likely weaken or destroy the client's relationship with them. Nagging: When one nags others, it will likely weaken or destroy the client's relationship with them. Threats: When one threatens others, it will likely weaken or destroy the client's relationship with them. Punishment: When one punishes others, it will likely weaken or destroy the client's relationship with them. Bribing: When one bribes others, it will likely weaken or destroy the client's relationship with them.

    How it Works: Reality Therapy is based on the idea that everyone seeks to fulfill five basic needs, and mental health issues arise when any of these five needs are not met. Reality Therapy also is based on choice theory - that it is not possible for clients to change or control others, and the only sensible approach to solve problems is for clients to control themselves and their own behavior. It seeks to help clients make choices that bring them closer towards their life goals by helping clients recognize and develop 'seven habits of connection' that help them connect in their relationships, and avoid 'seven habits of disconnection' that lead to clients losing deep and strong relationships with others. Finally, Reality Therapy recognizes that there exist two worlds - the perceived world which is what clients think reality is, and the quality world being what clients actually want. Low life satisfaction results when there is large gap between the perceived world and the quality world. Through Reality Therapy, better life satisfaction may be attained through bringing both the quality world and perceived world closer together, either by bringing the client's perception of reality closer to what they actually want, or aligning what the client wants with what they perceive reality to be.

13. #13Schema Therapy

    Keys: Schema Therapy

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    Overview: Schema therapy is a type of therapy that targets schemas, a term used clinically to describe maladaptive patterns of thinking that could cause a client to engage in unhealthy behavior, or to struggle to maintain adult relationships. Schemas are thought to develop during childhood, particularly in children whose emotional and physical needs weren’t met. Schemas may also develop in children who were overindulged or whose parents did not maintain proper boundaries. In adulthood, these schemas are thought to influence a client's thoughts and actions in negative ways, leading to behaviors such as avoidance, overcompensation, or excessive self-sacrifice. These behaviors, in turn, can negatively affect relationships and emotional well-being. The aim of schema therapy is to help the client recognize their behavior, understand the underlying cause(s), and change their thoughts and behaviors so that they’re better able to cope with relationship challenges or emotions in healthy, productive ways. Schema therapy combines elements of cognitive behavioral therapy (CBT), psychoanalysis, Gestalt therapy, and related approaches.

    When it is Used: Schema therapy can help clients with Borderline Personality Disorder (BPD), but also anxiety, depression, and eating disorders.

    What to Expect: Over time, therapists aim to help clients identify their schemas, recognize how they react to them (reactions known as “coping styles”) and learn what they can do differently to get their needs met in healthy, adaptive ways. Coping styles may change over time, even as the underlying schema tends to remain the same. It’s also possible for a client to display more than one coping style in response to the same schema. Once schemas and coping styles have been identified, the therapist will likely use a range of techniques to change the schemas themselves and/or replace unhealthy coping styles with adaptive behaviors. This is done through a range of cognitive, emotional, and behavioral techniques. Cognitive approaches, for example, may ask the client to look for evidence for and against the schema and directly challenge its veracity. Behavioral techniques might include role-playing common situations that trigger the schema, acting out an adaptive response instead of resorting to the maladaptive coping style. Clients may be asked to complete homework between sessions. This may include looking over flashcards that challenge the schemas or keeping a record of experiences that trigger them (often called a “schema diary”), which may be reviewed in session to help clients track their progress and identify situations that require different behavioral responses.

    Types of Schemas: Disconnection and Rejection: This is the client's belief that others cannot be relied on for emotional support, or that they are isolated from others in society. Impaired Autonomy and Performance: This is the client's belief that they are doomed to failure, or that they cannot handle the responsibilities of daily life alone. Impaired Limits: This is the client's belief that they are superior and entitled to special treatment. Other-directedness: This is the client's belief that the needs of others should always take precedence over the client's own needs, or that the client should always surrender control to others in most or all situations. Overvigilance and Inhibition: This is the client's belief that expressing emotions will lead to negative consequences, or that the negative aspects of life always trump the positive aspects.

    Unhealthy Coping Styles: Surrender: A client with this coping style will give into the schema or accept it as fact, and may behave in self-destructive ways as a result. A client with a schema telling them they deserve to be mistreated, for example, may put up with abuse or not complain when treated unfairly. Avoidance: A client with this coping style goes to great lengths to avoid triggering the schema. To do this, they may engage in distracting behaviors such as substance use, or they may avoid entering relationships or situations that could set the schema off. They may, as a result, struggle to get close to others or experience personal growth. Overcompensation: A client with this coping style will try to 'fight' the schema by deliberately behaving in ways that are counter to it. While deliberately questioning a schema can be healthy or even a part of the therapeutic process, the coping style of overcompensation often leads to negative outcomes. For example, a client trying to overcompensate for a schema that tells them that they’re worthless may try to instead be ultra-successful, which can lead to burnout, dissatisfaction, or strained relationships.

    How it Works: In schema therapy, it is theorized that maladaptive thinking patterns formed in childhood can interfere with healthy functioning in adulthood. By that targeting these thinking patterns directly, schema therapists can help clients combat persistent negative feelings, learn more adaptive ways of navigating the world, and strengthen or rebuild the relationships that may have been harmed by their unhelpful schemas. Schema therapy relies on a strong therapeutic relationship in which the client feels comfortable and emotionally safe. Schema therapy emphasizes empathic confrontation, in which the therapist responds to the client’s schemas and behaviors, no matter how maladaptive, with empathy and understanding, while encouraging the client to see the need for change and offering the tools to do so. Schema therapists also engage in what’s called 'limited reparenting' in which they attempt to meet some of the client’s emotional needs that went unmet in childhood. A client who only rarely received emotional support from their caregivers, for example, may benefit from a therapist offering unconditional compassion and validation, while a client who experienced neglect or abandonment may benefit from a therapist who offers consistency and stability.

14. #14Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)

    Keys: Trauma-Focused Cognitive Behavioral Therapy, TF-CBT

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    Overview: Trauma-focused Cognitive Behavioral Therapy (TF-CBT) addresses the mental health needs of clients suffering from the destructive effects of early trauma.

    When it is Used: TF-CBT can help clients that have suffered sexual, physical, or mental abuse. It can also help clients who have developed PTSD, depression, or anxiety.

    What to Expect: Cognitive behavioral techniques are used to help modify distorted or unhelpful thinking and negative reactions and behaviors. Learning to challenge invasive thoughts of guilt and fear can help a client to reorganize their thinking in a healthier and happier way. This can involve psychoeducation, teaching the client coping skills, gradual exposure, cognitive processing, and caregiver involvement.

    Core Features of TF-CBT: Psychoeducation: This involves the therapist teaches the client about the normal reactions to traumatic experiences. This can help the client reduce feelings of guilt or culpability for what happened. Coping Skills: These involves the therapist teaching the client relaxation exercises such as deep breathing, mindfulness, acceptance, identifying and redirecting thoughts, as well as other methods of calming themselves. Gradual Exposure: This involves the therapist gradually introducing to the client memories of the traumatic experiences with the goal of reconditioning the client's response to triggers and easing the client's emotional distress experienced. Cognitive Processing: This involves the therapist teaching the client skills to regulate their emotions, as well as recontextualize unhelpful feelings and thoughts.

    How it Works: Early trauma can lead to guilt, anger, feelings of powerlessness, self-harm, acting out, depression, and anxiety. Post-Traumatic Stress Disorder (PTSD), which affects children and adults, can manifest in a number of ways, such as negative recurring thoughts about the traumatic experience, emotional numbness, sleep problems, difficulty concentrating, and extreme physical and emotional responses to anything that triggers a memory of the trauma. By integrating the theories and techniques of several therapeutic interventions, TF-CBT can address and improve the symptoms of post-traumatic stress in clients. The goal of the treatment is to help the client develop a sense of safety and security, as well as to help the client repair their social skills or develop healthy social skills.

15. #15Written Exposure Therapy (WET)

    Keys: Written Exposure Therapy, WET

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    Overview: Written Exposure Therapy (WET) is behavioral psychotherapy designed to relieve the distress associated with traumatic memories and PTSD. Exposure therapy is a well-established treatment for anxiety and post-traumatic stress disorder (PTSD), in which clients are gradually exposed in a safe way to what they fear so that they no longer experience overwhelming distress in its presence and no longer need to avoid what they fear. In WET sessions, the therapist guides the client to bring to mind the traumatic experience and write in detail about the thoughts and emotions they had at the time of the event.

    When it is Used: WET can be effective for clients experiencing PTSD or PTSD symptoms, such as intrusive thoughts, flashbacks, disturbing nightmares, feelings of hopelessness, depression, and hypervigilance.

    What to Expect: Before undergoing WET, the client seeking treatment is evaluated by the therapist to determine whether they are a suitable candidate - the client must have no suicidal thoughts. The therapist and client then decide on a specific traumatic life experience that will be the focus of WET. After this has been decided upon, the therapist first educates the client about trauma, PTSD, and WET. The client is then asked to write about the trauma as the therapist provides memory prompts. Subsequently, the therapist provides feedback on what was written and helps the client focus on particularly significant aspects of the trauma memory. The therapist guides the client to write about the trauma and prompts them to access feelings as well as facts. Finally, the therapist encourages the client to focus their writing on the effect which thet traumatic event has had on their lives. Each WET session begins with a check-in whereby the therapist and client discuss any changes in symptoms or in the traumatic memory itself. The therapist also measures PTSD symptoms using a PTSD checklist.

    How it Works: Writing about a disruptive experience, and focusing especially on the feelings pertaining to the event as well as the event’s emotional impact, can reduce the physiological arousal and negative feelings experienced by clients. This is because writing calms the minds of clients haunted by emotional upheaval by allowing them to approach their traumatic experience and make sense of it. As clients write about the specific traumatic life experience that caused them PTSD and is the subject of therapy, clients are encouraged to provide as much detail as possible about their thoughts and feelings at the time of the experience. The writing is personal, free-form, expressive, and informal. Yet, it enables clients to process the distressing experience, link feelings to events, and make meaning of them.

16. #16Applied Behavior Analysis (ABA)

    Keys: Applied Behavior Analysis, ABA

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    Overview: Applied Behavior Analysis (ABA) is a type of therapy frequently applied to children with autism and other developmental disorders that focuses on imparting skills in specific domains of functioning, such as social skills, communication, academic and learning skills, motor dexterity, hygiene and grooming, and more. Tailored to individual needs, ABA is delivered in a variety of settings, including school, home, clinic, and other community settings. The goal of treatment is to help children function as independently and successfully as possible.

    When it is Used: ABA is commonly practiced as a therapeutic intervention for individuals with autism. According to the Center for Autism, ABA helps people with autism improve social interactions, learn new skills, and maintain positive behaviors. ABA also helps transfer skills and behavior from one situation to another, controlling situations where negative behaviors arise and minimizing negative behaviors. ABA can also help aging adults cope with the losses that come with age, like memory, strength, and relationships. For young and old, ABA can help individuals manage some of the lifestyle challenges that accompany many mental and physical health conditions.

    What to Expect: When working with an ABA therapist, clients will determine which behaviors require change, set goals and expected outcomes, establish ways to measure changes and improvements, evaluate where they are now, learn new skills or learn how to avoid negative behaviors, regularly review their progress, and decide whether or not further behavior modification is necessary.

    ABA Techniques: Discrete Trial Training (DTT): The therapist breaks skills into small (discrete) units, and teaches them one by one, with the appropriate reinforcement as each unit is mastered. For example, in teaching speech skills, one unit may be devoted to producing the vocal sound S. The therapist will typically ask for the desired behavior, reward the correct response, and repeat the process until the sound is produced spontaneously. DTT may be used for teaching communication skills, social skills, motor skills like writing letters of the alphabet. Modeling: Modeling is a technique in which the therapist presents an example of the desired behavior, either personally demonstrating it or providing a video or audio recording of the desired behavior. The learner is then asked to imitate the target behavior. For example, in teaching social skills, a learner might be shown a video of a person saying thank you when given a toy or other object, and then asked to repeat the behavior as the teacher hands them an object. Picture Exchange Communication System (PECS): The therapist uses pictures to teach communication and vocabulary skills to the client. The client, working with a set of cards having pictures of foods or other objects, gives the therapist a picture of a desired object. In exchange, the therapist provides the object shown in the picture. The technique can be used with children who do not have speech skills as a way for them to communicate their needs. But it is also used to expand the communication skills of those who can speak and teach them how to express their wants and needs in socially adaptive ways as they progress through increasingly sophisticated vocabulary and sentence structure. Reinforcement Systems: The therapist uses methods to teach the client the consequences of engaging in specific behaviors and activities, with the purpose of increasing the likelihood such behaviors will be repeated in the future. For example, one method of reinforcement might be a token system. A client earns tokens as a form of reward for accomplishing a target behavior. Those tokens may then be used in exchange for some desired activity, such as access to a specific toy or computer game, which functions as a backup reinforcer. All desired behaviors are broken into smaller steps, and as each step is learned, the client is rewarded for carrying out the target behavior successfully. ABA therapists typically conduct training to parents and caregivers, to that behavioral progress occurs outside the clinical setting. For every behavior where change is desired, the therapist identifies the ABCs—the antecedent, the behavior, and consequence of the behavior. The antecedent is what prompts the person to act. The behavior is the response itself, which could be an action or verbal expression, which the therapy aims to change. The consequence is what immediately follows the behavior.

    How it Works: A trained behavior analyst assesses a person’s needs and ability level and designs a bespoke program of therapy with specific treatment goals typically focused on several skill areas. These include communication, social skills, self-care, play and leisure, motor skills, and learning and academic skills.

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