Behavioural Therapies are a group of therapeutic interventions that focus on identifying and changing potentially self-destructive or unhealthy behaviours. Based on the principles of behaviourism, a theory of learning which states that all behaviours are learned through interaction with the environment, these therapies are grounded in the belief that all behaviours are acquired and can therefore be changed.
Research supports the effectiveness of behavioural therapies in treating various psychological conditions. By focusing on the behaviour itself and the factors that maintain it, these therapies offer practical approaches to complex problems. The skills and strategies learned through behavioural therapies can provide lasting benefits, helping individuals to change their behaviours and improve their quality of life.
Cognitive Behavioural Therapy, or CBT as it is more generally known, is a popular model of psychotherapy that emerged when practitioners began to combine the theory and practice of two previously distinct — behavioural and cognitive — approaches. Widely researched, evidence has accumulated to indicate CBT’s effectiveness in helping many people with a variety of psycho-social problems. Originally applied to the treatment of anxiety and particularly depression, this “talking therapy” is also used in related conditions, such as obsessive-compulsive disorder (OCD), with a variety of phobias, as well as in recovery from addiction.
CBT stands apart from other traditions such as psychoanalysis and psychodynamic psychotherapy in that its focus is very much in the here and now. It is a highly structured intervention, as opposed to adopting the more free-form approach of those models which look to make sense of and resolve the detrimental influence on the current life of the unconscious and the past. It grounds itself in realism and practicality. Central to the process is the active problem-solving, solution-finding collaboration between the therapist and client.
This approach posits that each of us hold several ‘core beliefs’ – things that we believe to be 100% true 100% of the time about ourselves or the world. These beliefs are built up through our experiences, and then alter how we perceive the things that happen to us in life. These beliefs can be helpful (“I am capable”, “I am smart”, “People are generally trustworthy”) or harmful (“I am unlovable”, “Nobody cares about me”, “People will hurt you if you give them the chance”). By challenging harmful beliefs, and replacing them with helpful beliefs, we then change our way of perceiving and interacting with the world, ultimately resulting in reduced suffering, and improving our overall life experience.
Often referred to as a “third-wave” psychotherapeutic approach, ACT builds on the concepts introduced by CBT but introduces the more modern concepts of awareness and mindfulness. By expanding and building on the principals of earlier behavioural therapies, ACT represents a relatively new approach to addiction and mental health that has gained attention over the past 20 years.
This approach builds on the philosophical concept of stoicism, and essentially posits that our suffering in life is not caused by the events that happen around us, but by our perception of those events, and the feelings that are associated with those perceptions. To go further, our mind is not often in the ‘here and now’ when we experience feelings like sadness or anger in response to specific events – we are thinking about things that have or have not happened in the past, or that will or will not happen in the future. By learning to objectively observe our thoughts and reactions, radically accept reality for what it is, release the illusion of ‘control’ over circumstances, and remain mindful and present in the ‘here and now’, we can learn to reduce our suffering and improve our overall state of emotional wellbeing.
ACT ultimately encourages a compassionate and non-judgmental approach to one's internal experiences while promoting meaningful action aligned with personal values. It is often used to address a variety of mental health concerns including anxiety, depression, stress, chronic pain, and addiction.
DBT is a very skills-based therapeutic approach, focusing mainly on teaching distress tolerance skills, interpersonal skills, and emotional regulation. These skills support patients in coping with overwhelming emotions without resorting to harmful coping strategies and responding with opposite action to build a repertoire of healthy coping strategies.
There is a strong emphasis in this therapy on a collaborative therapeutic relationship, with therapists often coaching their clients in how to apply DBT skills in real-life situations. While DBT was originally designed to be used specifically with patients with borderline personality disorder (BPD), it is now more widely utilised for other patients suffering from mood disorders, eating disorders, and suffering from addiction. The structure and skills-based nature of DBT makes it particularly helpful for individuals struggling with emotional dysregulation, impulsivity, and difficulties in interpersonal relationships.
Of course like everything at which we want to improve, practice is required until the new approach becomes almost second nature. Behavioural therapies often involve ‘homework’ or ‘therapeutic assignments’ that therapists task the patient with in order to practise and hone their new skills.
Like any change in belief, or change in behaviour, the strength and efficacy of behavioural therapies lies primarily in the motivation of the patient to make those changes. During your individual and group sessions, therapists do not aim to tell patients what to do, only to provide them with the skills and tools they need to make choices that are in line with their vision for their best life.
