Therapeutic Approaches Offered by Bristol Psychology Service Psychologists and Therapists
A range of evidence based psychological therapies are available via Bristol Psychology Services.
- Acceptance and Commitment Therapy (ACT)
- Mindfulness Based Cognitive Therapy
- Eye Movement Desensitisation and Reprocessing (EMDR)
- Cognitive Behavioural Therapy
- Metacognitive Therapy
- Narrative Therapy
- Family and Systemic Psychotherapy
- Couples Therapy
- Mentalization Based Treatment for Families (MBT-F)
- Existential Therapy
ACT is a form of cognitive behavioural therapy which helps clients to let go of the struggle with negative thoughts and feelings so that they are freer to pursue what is important and meaningful to them. Acceptance and Commitment Therapy aims to help clients to become more ‘psychologically flexible’. This means being fully present in the moment, aware and open to internal experience whilst taking action guided by personal values. The therapist will help clients to develop the following 6 processes central to ACT:
- Consciously connecting with what is happening right now (rather than dwelling on the past or worrying about the future)
- Acceptance of thoughts, feelings, or physical sensations (rather than struggling with them, resisting them or avoiding them)
- Distancing, stepping back or ‘de-fusing’ from thoughts, letting them come and go as they (rather than getting attached to them, taking them literally or attaching significance to them)
- A perspective-taking sense of self that observes and notices (rather than always being governed by the often crticial, thinking part of the brain)
- Identification of values that are personally meaningful
- Commitment to taking action that is consistent with personal values
Evidence Base for ACT
ACT has a strong history of empirical evaluation; both outcomes of ACT therapy and processes of change have been researched. There are around 60 randomized controlled trials (the gold standard research method) published or in press. Studies indicate ACT is an effective treatment for a variety of difficulties including anxiety, depression and chronic pain. ACT is a therapy on the American Psychological Association Division list of empirically-based treatments. Further information regarding ACT research can be found on the website of the Association for Contextual Behavioural Science: www.contextualpsychology.org
Mindfulness has been defined as: “Paying attention, on purpose, in the present moment and non-judgementally” (Kabat Zinn, 1990). It is orientation to thoughts and feelings which involves observing inner experiences without attaching to them, but instead accepting them and allowing them to pass.
Mindfulness practice helps us to better understand patterns of thinking and feeling so that we can recognise at an early stage when we start to feel distressed. Mindfulness can help people move away from the tendency to get drawn into automatic reactions to thoughts by increasing awareness that thoughts are just thoughts and not an accurate reflection on reality. By learning to focus attention on what is happening right now, we can avoid being drawn into dwelling on past events, which often brings up feelings of sadness or regret, or thinking about the future, which often triggers anxiety about ‘what ifs’. In learning mindfulness, which encourages an attitude of kindly curiosity towards inner experiences, we can also avoid getting caught in an internal struggle with thoughts and feelings, which can often be counterproductive.
Evidence-Base for Mindfulness
Mindfulness is a well-researched treatment approach with a strong evidence-base for improving mood as well as for reducing the negative impact of pain and health conditions. Comprehensive information on the mindfulness studies, including details of numerous published papers, can be found here: https://bemindful.co.uk/evidence-research/
EMDR is a psychotherapy approach which integrates elements of a number of evidence-based treatments. The approach addresses: i) the past experiences that have triggered trauma symptoms; ii) the resulting self-beliefs, feelings and physical sensations; iv) the positive, adaptive cognitions. Several of the clinical psychologist affiliates of Bristol Psychology Services are EMDR therapists.
Treatment follows a standardised protocol which is only commenced after a careful period of preparation and resource-building. A key element of EMDR treatment is the ‘dual stimulation’ – the client is asked to focus on a bilateral stimulation (e.g. tracking left and right) whist simultaneously attending to past memories and associated feelings and physical symptoms. During that time, clients generally experience the emergence of insight, changes in memories, or new associations.
Evidence-Base for EMDR
EMDR (along with CBT) is recommended in the National Institute of Clinical Evidence (NICE) guidelines for the treatment of PTSD. There is a significant body of research, including 20 randomised controlled trials, indicating the efficacy of EMDR for the treatment of PTSD after a range of traumatic experiences. Further information about efficacy research including full references can be found at: http://www.emdr.com/refs.htm and http://www.emdr-europe.org.
Cognitive Behavioural Therapy is one of the most commonly used psychological therapies. It is a collaborative, goal-focused intervention which helps clients to: i) better understand how beliefs, thoughts and behaviours affect feelings and physical symptoms and ii) change thoughts and behaviours so as to improve emotional well-being. CBT theory suggests that personal experiences (often in childhood) can lead to negative views of ourselves, the world and other people. In certain situations these beliefs trigger negative thoughts to automatically pop into our minds, causing a downward spiral in mood. As an example, if someone says hello to a friend but the friend keeps walk straight past them, they may think “He ignored me, he thinks I’m not interesting” and next time they see this person, they may look away. Over time they may avoid socialising which could lead to feelings of boredom and low mood, thwart opportunities to learn that the interpretation ‘I’m not interesting’ may not be accurate, and serve to confirm beliefs such as “I’m boring”.
During CBT lients are helped to identify, record and challenge unhelpful or inaccurate thoughts (for example “perhaps he didn’t see me”). Effective strategies for managing difficult feelings and unpleasant physical symptoms are also taught including relaxation strategies and paced goal setting. Practical ‘behavioural experiments’ are also important in CBT; these give opportunities to systematically test out predictions in real life scenarios.
Evidence Base for CBT
There is extensive evidence supporting the efficacy of CBT for a range of emotional difficulties. CBT is recommended as a treatment of choice for difficulties such as anxiety and depression by The National Institute for Health and Clinical Excellence (NICE).
‘Metacognitive’ refers to beliefs about thoughts. Metacognitive therapy is based on the idea that emotional distress is caused by particular ways of responding to thoughts, namely worry, ruminating and a bias in attention in which there is a hyper-vigilance towards threat. This therapeutic approach is interested less in the content of thoughts and more in how a person thinks and their beliefs about thoughts.
In metacognitive therapy, people are encouraged to detach from thoughts so that they are aware of the act of thinking itself– this is referred to as ‘detached mindfulness’. Practical techniques are also taught to increase mental flexibility so that there is more choice about the focus of attention.
Evidence base for Metacognitive Therapy
Metacognitive therapy is a relatively new therapeutic approach but it has a growing empirical evidence base and research suggests it may be particularly effective for worry and anxiety. A detailed list of relevant research in this area can be found at the Metacognitive Therapy institute: www.mct-institute.com
As the name suggests, this form of therapy focuses on the meaning people make of their experiences in the stories they tell about their lives. Narrative therapy views people as experts in their own lives and assumes that people have skills and strengths that will help them to alter the relationship with problems in their lives. It is a very non-pathologising approach and client and therapist work collaboratively together. Diagnosis and labels are not important, instead, emotional difficulties are often ‘externalised’ or described as if separate entities, for example a narrative therapist may ask “when anxiety bothers you, what does it have you doing?”, rather than “when you are anxious, what do you do?” This is because anxiety is not viewed as a stable trait but rather as a separate entity. In helping clients to view problems as not part of them, this approach can be very empowering; freeing people from the potentially self-restricting and shaming impact of diagnostic terms. Clients are encouraged to see that they are not confined by their stories, opening up the possibility for change.
Narrative therapy is appropriate for both adults and children. Children can respond particularly well to the creativity of narrative therapy and the externalising approach. The shift in a child is often dramatic when a problem is given a name and its influence mapped out. A child who is ashamed and reserved when adults use words such as “you are very anxious” will quickly engage with enthusiasm in a conversation about the “worry monster”. The child can then rally with indignation against the difficulty, rather than being frozen with shame or overwhelmed by feelings of hopelessness.
Evidence Base for Narrative Therapy
There is a growing body of evidence regarding the effectiveness of narrative therapy. Further information about evidence for this approach can be found here: http://www.dulwichcentre.com.au/narrative-therapy-research.html
Family and Systemic Psychotherapy orthe abridged term, ‘Family Therapy’ helps people within a close relationship to safely share and reflect on thoughts and feelings so that they develop a better understanding of each other’s perspectives. Family Therapy aims to draw on people’s combined strengths so as to improve communication and bring about constructive, positive change. Family therapy doesn’t necessarily involve a therapist working with the whole family. Family therapists often work with couples and individuals as well as their wider family members and any other people who are important in the client’s life.
Family therapists may support people around: relationship difficulties including divorce and separation; the impact of illness on the family; family conflict; adjustment at life transitions and difficulties around school and college.
Evidence Base for Family Therapy
The Family Therapy and Systemic Research Centre, based at the Tavistock Clinic (an NHS Foundation Trust and national centre of training) aims to develop, support and promote research in the systemic family therapy. The website for the FTSRC includes an overview of evidence-based research on Family and Systemic Therapy: http://www.uel-ftsrc.org/topics/index.htm
Couples Therapy integrates several evidence based psychological approaches to explore problematic patterns in the relationship and help couples resolve problems. Therapists work with clients to create a shared perspective of their relationship. They may work with a couple to give them strategies to improve their communication, manage their emotions and give them strength and resilience in their problem solving. Therapists may also encourage a couple to reflect on thoughts and feelings and understand how they influence our patterns of interaction. The aim is to address the barriers that have stopped a couple from connecting in the way they used to.
Relationship distress is a common problem and is strongly linked to other psychological and physical health problems. Many couples find difficulties start after a painful event or illness, or following a significant life change. Couples therapy can help with depression and isolation, mental health issues and parenting issues as well as general relationship distress.
Evidence Base for Couples Therapy
Couples Therapy is recommended in the National Institute of Clinical Evidence (NICE) guidelines for the treatment of depression. It has also been evaluated in over 30 randomized control trials and has been found to be extremely effective in treating relationship distress as well as lowering levels of depression and conflict.
Mentalization Based Treatment for Families (MBT-F)
Mentalization Based Treatment for Families (MBT-F) is a therapeutic approach which focuses on improving family life. The main focus of the intervention is on the relationships within a family, and how those might be improved. It supports family members to learn how to see things from different points of view, to talk and think about emotions and thoughts and to understand why family members may behave in certain ways. Research and experience shows that once this happens, communication and the ability to solve problems together will improve in the family.
Families may come to MBT-F with a whole range of difficulties including:
- Angry outbursts and tantrums
- Distressed or troubled children
- Tensions in family relationships
- Coping with loss and bereavement
- Difficulties with making or keeping friends
- Impact of divorce or separation on children
MBT-F is usually conducted over 6 to 10 meetings, most commonly fortnightly.
Evidence Base for Mentalisation Based Threatment for Families
Findings from studies so far indicate that 6 to 10 meetings with an MBT-F therapist can make a real difference for the majority of families working with this approach.
Existential therapy places emphasis on what are considered to be the ‘givens’ or core aspects of being human and the challenges or conflicts that these can pose to human beings. These ‘givens’ are: freedom; meaning; isolation; mortality.
Although we are free to choose many paths in life, for both conscious and unconscious reasons, we can often limit and confine ourselves. Existential therapy helps clients to understand and make sense of the decisions they make, enabling them to focus more on the here and to embrace choices available to them. This can lead to a more fulfilling, meaningful life.
Existential therapists attempt to set aside all preconceptions in order to gain a deep understanding of their clients' experience and in turn help their clients to gain a deep understanding of themselves.
Evidence base for Existential Therapy
The foundations of existential therapy have a solid evidence base. A significant amount of research has focused on the connection between finding meaning or purpose in life and psychological well-being. In addition, the relational approach synonymous with existential therapy is evidenced to lead to good outcomes for clients. Further information on existential therapy can be found at http://existentialanalysis.org.uk/about-the-sea/about-existential-analysis/