Cognitive-Behavioural Therapy (CBT)
What is CBT, and how it works?
Cognitive-behavioural therapy (CBT) changed the therapy game in the 1960s by saying we don’t need to root through the painful past and can instead find healing in the present by changing our destructive and inaccurate thoughts. Before this, therapy was most commonly psychodynamic—spending most of its time sorting through childhood.
CBT is very practical and tactical, focused on quickly reducing symptoms of anxiety and depression by making you more aware of unhelpful thoughts and actions. A CBT therapist will give you strategic exercises to build awareness of how your thinking is working against you, replacing negative thoughts with more realistic and helpful ones.
A big focus is on catastrophizing—mistakes of thinking that take ordinary situations and inflate them into inaccurate disasters. It’s absolutely unacceptable to be less than perfect. If I don’t get this job, this is the worst thing that could possibly happen. Being rejected means, I am a complete failure and not good enough.
CBT helps to look at how these automatic thoughts lead us to avoid the world, play small and act in self-defeating ways that confirm our worst fears, leading to even more negative thinking: See? I knew I wasn’t worth it. There is no point in trying.
This approach is popular because change tends to be quick and measurable. Some find, however, that CBT doesn’t get to the ‘root of the issue,’ instead moreso treating symptoms on the surface. In reality, though, most modern therapists using CBT are also able to ‘go deeper,’ working with earlier life experiences as well to help with traumatic processing.
Dialectical Behaviour Therapy (DBT)
What is DBT, and how it works?
Dialectical behaviour therapy was created by Dr. Marsha Linehan primarily to treat Borderline Personality Disorder—a condition which makes emotional balance extremely difficult. It is, however, also helpful for anyone wishing to learn practical skills to regulate their nervous systems and achieve greater balance and control over their lives.
DBT is sort of a modern and upgraded CBT, adding a greater emphasis on mindfulness and tactical coursework. DBT contributes volumes of terms and concepts, such as wise mind, which describes the balance between logic and emotion, as well as techniques to help you spend more time there.
This approach takes commitment to practice regularly and is not something to engage if you’re hoping to just create lasting change in a session or two. Those who commit to a year of DBT often experience very helpful changes in how they relate to their own emotion and are able to live their lives more intentionally.
Solution-Focused Therapy (SFT)
What is SFT, and how it works?
Solution-focused therapies have a few things in common with CBT and DBT in that this approach is practical and focused on improving life as efficiently as possible. SFT takes your attention away from problems, instead focusing on what we can do to make things better right here, right now.
SFT counsellors will often work with you briefly, perhaps in 3-6 sessions, rather than cultivating a long-term relationship. It is common to find SFT counsellors in schools, workplaces and insurance-billable settings that are concerned with creating as much visible change as quickly as possible.
SFT therapies are not often trauma-informed and won’t likely focus on deeper shifts in your nervous system and worldview. This sort of change is a long-term process, whereas SFT tends to be brief and more action focused.
Person-Centred Therapy (PCT)
What is PCT, and how it works?
Also known as Client-Centred Therapy, the late Dr. Carl Rogers’ approach to counselling is the foundational model taught in most graduate training programs. Working with a PCT counsellor means being held in unconditional positive regard. Your therapist, above all else, wants to understand you through judgment-free warmth.
This approach is different from those described so far because it is not based on targets and goal setting. Instead, it has a softness and patience about it based on Dr. Rogers observation that when held in the right conditions, clients naturally discover solutions to their own problems. He also emphasized emotionally corrective experience—moments when old fears surface in the safe therapeutic relationship, helping to spontaneously resolve core fears of rejection, betrayal and abandonment.
You won’t find a lot of therapists who only practice PCT, but you will find that most of them have at least some experience with it since being kind, non-judgmental and learning to see through your eyes is the foundation of quality counselling.
Acceptance and Commitment Therapy (ACT)
What is ACT, and how it works?
Similar to DBT, Acceptance and Commitment Therapy is one of the newer ‘spinoffs’ of CBT—an updated and niche version of cognitive behavioural work. Like DBT and CBT, ACT has an emphasis on noticing thoughts, feelings and actions, as well as mindful awareness.
In this approach, clients are guided to accept the natural reactions of their own personality, commit to a valued direction or intention in life and take action. ACT provides a treasure trove of activities and exercises to defuse thoughts and feelings so you can be consciously aware of ‘what is happening’ instead of being stuck on an animal-like autopilot.
ACT is personally my favourite of the so-called third-wave cognitive behavioural therapies because, to me, it strikes a balance between western thinking and a complete eastern philosophy of how to relate to mind and body. In my own experience, it borders on a spiritual path in its own right.
For context, dialectical behavioural therapy tends to be used for high levels of clinical distress, whereas ACT would more likely be used for folks with more day-to-day emotional difficulties that perhaps feel a bit more spiritually oriented and interested in mindfulness and the philosophy of language (see its founder Dr. Stephen Hayes’ Relational Frame Theory to go far down the rabbit hole).
Mindfulness-Based Therapy (MBT)
What is MBT, and how it works?
Mindfulness-based therapies move even closer to eastern tradition than the ACT, strongly borrowing upon traditional Buddhist practice. While CBT emphasizes changing maladaptive thoughts, MBT is based on accepting them. It takes the stance that all conscious phenomena—thoughts, feelings and sensations—are part of the same process that has become too stirred up. It sees the ‘solution’ in simply passively observing until your system calms down.
Indeed, research has supported that CBT may not even be effective because of changing thoughts, but simply the part of the therapy that have you notice them. This is supported by anyone with a lot of hours logged meditating who has noticed that when thoughts are noticed—or that we notice we are thinking—they tend to spontaneously vanish.
MBT helps entrain the habit of watching thoughts and feelings (or mind-body) to avoid ‘fusing’ with them—that is, thinking we are our thoughts and feelings. MBT is typically taught in classes or workshops and is more of a practice and lifestyle than psychotherapy. Counsellors may not often use this as their entire approach but may have strong elements or emphasis on a mindfulness-based approach.
How to choose the right therapy approach for your goals and needs?
Research and practice support time and time again that it’s less grocery shopping for the right therapy approach, so much as finding someone you click with that guides successful therapy. Further, therapists tend not to be ‘purists,’ so you’ll likely find someone who has training and experience in quite a few approaches.
With that said, if you are quite logical and like things to fit into boxes, Cognitive Behavioral Therapy may be a good fit. If you are experiencing an ‘out of control’ emotion that is sabotaging safety, work and relationships, consider Dialectical Behavioral Therapy.
If you want a briefer therapy that can help to make change quickly, look into Solution Focused Therapy. If the safety of the relationship and the freedom to explore and resolve painful emotions resonate most, consider a Person-Centred Therapist. If you value meditation and have a spiritual inclination, Acceptance and Commitment Therapy or Mindfulness-Based Therapies may be a good fit.
Wherever you end up, counselling is at its best when it helps you loosen your tight grip on control. It’s not about finding the perfect approach—it’s about trusting someone enough to let them help you into a deeper understanding of who you are and what you want.
If you would like a free chat with any of our team, don’t hesitate to reach out.
Carson Kivari is the Founder and Clinic Director of Thrive Downtown, with 17 years of experience helping individuals and couples overcome anxiety, depression, and burnout. He guides clients on a journey of self-exploration and trauma release to find purpose, connection, and safety. Take the first step towards healing and contact Carson today to schedule a session.