Evidence-Based Treatments (EBT)
EBTs for Anxiety, Depression, and Behavior/Conduct Problems
When a person's anxiety is triggered, the natural response is to take action. The question is whether or not the actions taken are healthy coping responses or problematic responses. For example, if a person notices a mole and worries that it might be cancerous, then they make an appointment to see a dermatologist to get it checked out. The dermatologist examines it, runs tests, and concludes it is not cancerous. If the thought about the mole pops into the person's head again, they might remind themselves that the doctor already checked it out, and they are fine, and it becomes a fleeting thought that the person is able to let go of. That's a healthy coping response. If, however, the thought about the mole pops into their head again, and they seek out a 2nd opinion, and are told again that it is not cancerous, but then seek a 3rd opinion, 4th opinion, search the internet for literature on moles, and they become so consumed with seeking information about moles that it starts to interfere with their sleep, relationships, and daily functioning, then that's a problematic response to anxiety. Anxiety itself is not the problem, it's the response that feeds the anxiety loop that becomes problematic. Exposure-based and acceptance-based treatments aim to expose the person to what is triggering the anxiety, and then prevent the problematic responses from occurring. First, the problematic responses are identified, then the individual and clinician make specific response prevention plans to move from problematic responses to healthier responses. Helping an individual respond in a new way helps to extinguish the fear or anxiety of the activity or stimulus.
Exposure Therapy with Response Prevention (ERP)
Exposure and Response Prevention (ERP) is the evidence-based treatment used to address OCD. A fear hierarchy is developed where obsession triggers are identified and ranked from easiest to hardest to tolerate. A behavioral plan to reduce engaging in compulsions is also developed. Through developing these hierarchies and plans in treatment, you gain a better understanding of the relationship between the obsession and compulsion, which helps to unearth the core fear that you are experiencing. Exposure (E) is applied to the obsession triggers, and a Response Prevention (RP) plan is used to address the compulsive behaviors. The overall goal is to disconfirm the core fear, which then leads to extinction learning and paves the way for healthy coping responses. Other areas addressed in treatment include motivation level, core beliefs that may need to be addressed before applying ERP, treatment-interfering behaviors, and family/school collaboration or other environmental factors that need to be addressed.
Cognitive Behavioral Therapy (CBT)
Cognitive Behavioral Therapy (CBT) is the evidence-based treatment used to address anxiety and depression, examining the cognitive triad of one’s thoughts, emotions, and behaviors. Many times, people confuse thoughts with emotions. An example can be seen in the following statement: “I feel like I can’t measure up.” In fact, that statement is a thought, not a feeling; the thought is “I can’t measure up” and the feeling or emotions that match that thought might be disappointment, uncertainty, fear. Through CBT, an individual learns to separate thoughts from emotions and gains a better understanding of the impact those thoughts and feelings have on their behaviors, increasing their sense of control and self-efficacy. If a person feels uncertain and thinks “I can’t measure up”, they will be more likely to avoid challenges. The CBT field has researched common Automatic Negative Thoughts (ANTs) that are associated with anxiety and depression. In treatment, we identify what ANTs may be most common for you, explore the core beliefs that fuel those thoughts, engage in behavioral experiments to challenge core beliefs, and help you gain insight that leads to a new, healthier perspective.
Acceptance and Commitment Therapy (ACT)
Acceptance and Commitment Therapy (ACT) is an evidence-based treatment involving the process of becoming aware of one's thoughts and emotions, and mindful of what one does with those thoughts and emotions in the moment, specifically if their actions move towards their values or away from them. ACT focuses on six processes through which an individual: learns how to stay in the present (instead of focusing on the past or worrying about the future); has space to identify what is important to them (instead of having unclear values); engages in behavioral experiments to act out what is important to them (instead of being stuck in behaviors that don’t match their values); observes themselves as separate from their problems (instead of being fused with them such as “I’m a worrier” or “I’m a depressive”); mindfully “unhooks” from unhelpful thoughts (instead of staying staying fused with them); learns how to experience events, thoughts, and feelings with willingness and acceptance for what they are (instead of willfully rejecting or avoiding uncomfortable emotions). When you are aware of what you are thinking as the thoughts occur, and aware of your emotions as they start to bubble, then you have more control of your actions. ACT aims to help you commit to your values and the type of person you want to be while tolerating uncomfortable emotions. In terms of anxiety, ACT aims to help an individual learn to follow their goals and dreams in the presence of anxiety. In doing so, you become more effective in tolerating anxiety while pursuing your goals and living true to your values.
Dialectical Behavioral Therapy (DBT)
Dialectical Behavioral Therapy (DBT) is an evidence-based treatment that focuses on helping an individual who feels emotions so intensely that they may react with extreme and ineffective responses that disrupt their sense of self. They can feel out of control, out of touch with others, engage in destructive behaviors, have difficulty tolerating others’ emotions, take a long time to regulate, and feel regret and sadness once back to baseline. Dialectical is a philosophical term that means finding the truth through exploring what is, what isn’t, and reconciling both (thesis, antithesis, and synthesis). In DBT, you learn to accept yourself and events as you are in the present, yet also learn to change how things are by reducing maladaptive behaviors that are self-destructive and interfere with enjoying healthy, interpersonal relationships. DBT focuses on skills training, specifically synthesizing acceptance-based skills (mindfulness and distress tolerance) and change-based skills (emotional regulation and interpersonal effectiveness). By analyzing your behaviors, experiencing reality as it is without judgment, and tolerating crisis situations instead of making things worse, you pave the way to find your true self through learning how to apply actions to gain more emotional control, reduce emotional vulnerability, and manage interpersonal conflicts effectively.
Parent-Child Interaction Therapy (PCIT)
PCIT is an evidence-based intervention for children who have difficult behavioral problems such as not listening to parents' directives, impulse control issues, difficulty with regulating their emotions, and parents are having a hard time parenting their child. PCIT works on fostering the parent-child relationship first (Child-Directed Interaction), and then on fostering child's compliance to parent directives (Parent-Directed Interaction). This approach is solution-focused and typically runs 16-20 sessions. Visit www.PCIT.org to read more about the support for this effective method to treat behavioral issues in children.
Parent-Child Interaction Therapy adapted for Selective Mutism (PCIT-SM)
All ATSA clinicians are Certified Therapists or en route to certification in Parent-Child Interaction Therapy Adapted for Selective Mutism (PCIT-SM)
PCIT-SM is an adaptation of PCIT and involves a specialized approach that combines parent-child interactions to build rapport and self-confidence in both parent and child (Child-Directed Interaction) and provides an ideal foundation from which to step out of one's comfort zone to approach the fear of speaking (Verbal-Directed Interaction). By working with both parent and child, this method treats the child's ecosystem so that they can generalize their talking across people, places, and activities. This method can also be adapted to older ages.
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What is Evidence-Based Practice (EBP)?
According to the APA Dictionary of Psychology, evidence-based practice is “the integration of the best available scientific research from laboratory and field settings with clinical expertise so as to provide effective psychological services… In uniting researchers and practitioners, EBP ensures that the research on psychological assessment, case formulation, intervention strategies, therapeutic relationships and outcomes, and specific problems and patient populations is both clinically relevant and internally valid.”
What are Randomized-Clinical Trials?
According to the APA Dictionary of Psychology, a randomized-clinical trial is “an experimental design in which patients are randomly assigned to a group that will receive an experimental treatment, such as a new drug, or to one that will receive a comparison treatment, a standard-of-care treatment, or a placebo. The random assignment occurs after recruitment and assessment of eligibility but before the intervention. There may be multiple experimental and comparison groups, but each patient is assigned to one group only. Also called randomized controlled trial.”