Description: I have been thinking a lot about and posting a lot about anxiety recently — it is a central part of the current times what with COVID-19 and all. I recently finished teaching the section on one of my introductory Psychology courses having to do with Psychological Disorders and Treatment. Our class discussions about cognitive behavior therapy began by considering the three general over-generalizations that make up Becks cognitive triad of negative automatic thinking associated with depression (self as worthless, current world of noxious and the future as bleak) and then turned to the catastrophizing and over focus of negative possibilities associated with anxiety disorders. One question/comment that came up was a version of, “So, clinical psychologists point out people’s biased assumptions and tell them top stop using them?” A simple answer to that question could be “Well yes but how they help people do it for themselves is the cognitive behavioral key to effective treatment.” But the problem with that is that it tends to treat the who business, the client, their anxiety issues, and therapy as an exclusively cognitive exercise. People who have tried to stop bad habits will tell you that it is not all cognitive and that simply deciding to stop does not tend to lead to much in the way of success. To understand why not it is helpful to consider the subjective experience of anxiety at the individual level of someone who is experiencing and trying to come to terms with it. For one such account of anxiety issues read the article linked below and, while doing so, think about what it may be suggesting about cognitive behavioral therapeutic approaches to anxiety.
Source: This Is a Good Time to Stop Fighting Anxiety, Laura Turner, Opinion, The New York Times.
Date: March 12, 2020
I think the most useful line in the article is this one: “Anxiety in inherently irrational – it deals in what-ifs and worst-case scenarios – and so, for me, it did not respond to training my mind”. The anxiety driving systems of our brains are evolutionary much older than the cognitive/rational part of our brains and as such we likely should be open to the possibility that they might, sometimes, hijack our thought processes. Put another way, feeling can be thought about and talked about, but they are not rational, they are feelings and they may not (definitely are NOT) consistently linked to objective reality. So, maybe the assumptions of ACT (Acceptance and Commitment Therapy), while a part of cognitive behavior therapy, provide a usefully broader foundation for helping people with anxiety issues. Worth thinking about, especially these days.
Questions for Discussion:
- What are the central assumptions of Cognitive Behavioral Therapy?
- What is it about recurrent ruminative anxiety that might make it difficult to treat from a standard cognitive behavioral perspective?
- Who might benefit from ACT and why?
References (Read Further):
Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: Model, processes and outcomes. Behaviour research and therapy, 44(1), 1-25. https://scholarworks.gsu.edu/cgi/viewcontent.cgi?article=1085&context=psych_facpub
Powers, M. B., Vörding, M. B. Z. V. S., & Emmelkamp, P. M. (2009). Acceptance and commitment therapy: A meta-analytic review. Psychotherapy and psychosomatics, 78(2), 73-80.
Arch, J. J., Eifert, G. H., Davies, C., Vilardaga, J. C. P., Rose, R. D., & Craske, M. G. (2012). Randomized clinical trial of cognitive behavioral therapy (CBT) versus acceptance and commitment therapy (ACT) for mixed anxiety disorders. Journal of consulting and clinical psychology, 80(5), 750. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4718567/
Zettle, R. D. (2003). Acceptance and commitment therapy (ACT) vs. systematic desensitization in treatment of mathematics anxiety. The psychological record, 53(2), 197-215. https://opensiuc.lib.siu.edu/cgi/viewcontent.cgi?article=1477&context=tpr
Arch, J. J., & Craske, M. G. (2008). Acceptance and commitment therapy and cognitive behavioral therapy for anxiety disorders: Different treatments, similar mechanisms?. Clinical psychology: Science and practice, 15(4), 263-279. https://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.467.7249&rep=rep1&type=pdf
Arch, J. J., Wolitzky-Taylor, K. B., Eifert, G. H., & Craske, M. G. (2012). Longitudinal treatment mediation of traditional cognitive behavioral therapy and acceptance and commitment therapy for anxiety disorders. Behaviour Research and Therapy, 50(7-8), 469-478. https://www.colorado.edu/clinicalpsychology/sites/default/files/attached-files/arch_et_al_2012_cbt_act_mediation.pdf