Despite the bewildering array of current systems of therapy, when you get right down to it, the most effective ones all emphasize three major interventions: exposure for anxiety, behavioral activation for depression, and assertiveness skills training for most social and interpersonal difficulties.
It must be understood, however, that no matter how knowledgeable and technically skilled a therapist is, unless he or she first develops a strong therapeutic relationship with his or her client, even the most powerful methods may prove ineffective. Indeed, as the late, great Dr. Arnold Lazarus often said, “The therapeutic relationship is the soil that enables the techniques to take root.”
Thus, provided a strong alliance exists between client and therapist, these methods will usually be extremely effective. While a detailed discussion of them is beyond the scope of this post, I hope this “peek through the keyhole” will provide the essential ideas and stimulate further interest.
- Exposure for most anxiety disorders:
In simplest terms, exposure is basically approaching, facing and confronting anxiety triggers rather than avoiding them or escaping from them.
Indeed, all effective therapies for anxiety emphasize an important exposure component whether it's imaginal (i.e., visualized) or actual (what's called in vivo, or "within the living").
When one considers that anxiety is akin to an allergy, it makes perfect sense that exposure works as an effective remedy.
Since anxious people have a heightened, nervous reaction to certain stimuli, it's helpful to think of their anxiety as a sort of psychological allergy. That is, if someone suffers from environmental allergies (like pollen, rag weed, pet dander, etc.), it's because his or her immune system is overly sensitive to those triggers (technically called allergens). So, instead of having a minor or no reaction when exposed to them, an allergy sufferer's immune system launches a dramatic reaction, resulting in the misery of an allergy attack.
In anxious people, however, it's not their immune systems that overreact to the trigger of a "psychological allergen" (i.e., usually a sense of risk, threat, or danger) but their nervous system that leads to the misery of an anxiety attack!
And just as allergy sufferers can be successfully desensitized by exposure to gradually increasing doses of the very stuff they're allergic to, people who suffer from the "psychological allergy" of anxiety can be desensitized, too.
This is accomplished by gradually exposing the anxious person to the very stimuli, situations, or events that evoke his or her anxiety. (In the case of panic, exposure is to frightening body sensations called "interoceptive stimuli"). Over time, the anxious person's nervous system calms down and, just as with allergy desensitization treatment, eventually stops overreacting to whatever used to set it off.
Of course, as is the case with all evidence-based therapy methods, the science of the treatment, exposure in this case, must be wedded with the artistry of psychotherapy. In other words, the science of exposure therapy indicates what the best way to treat anxiety is, but the skill and creativity of the therapist determines how best to do it.
- Behavioral Activation for most depressive disorders:
Behavioral activation therapy (BAT) is, perhaps, the most effective nonmedical intervention for most depressive disorders, especially for mild to moderately severe unipolar depression. BAT simply encourages depressed clients to engage in more general activity, physical movement, and social interaction. This is because when many people become depressed they tend to lose motivation for activities they used to enjoy. Thus, they begin to withdraw, disconnect, and disengage from those previously enjoyable involvements and outlets.
As I often tell my clients, "The head and the heart will follow the feet." In other words, how we act (what our feet are doing) will strongly influence both what we think (our heads) and how we feel (our hearts). Said a bit differently, it is much easier to act your way into thinking and feeling differently than it is to think and feel your way into acting differently.
What's more, clinical research has suggested that when people act depressed (i.e., withdrawn, isolated, and disconnected), it worsens their depression, leading to a vicious circle of disengagement and reduced motivation which results in feeling worse, which in turn leads to even less motivation and more inactivity, etc. Alternatively, research shows that when people manage to reengage in the activities and outlets they used to enjoy—even though they're just going through the motions at first—a virtuous circle begins that usually generates motivation and provides a gradually increasing emotional payoff.
- Assertiveness Training for social and interpersonal challenges:
Assertiveness can be likened to social karate or judo. Just as a master of martial arts possesses the skills to handle a physical attack (i.e., defend, deflect, disarm, disable, etc.), a masterfully assertive person can handle just about any social assault. And just as a black belt knows to exercise appropriate restraint by using only the force necessary to subdue an attacker, masters of assertiveness use only the verbal intensity necessary to protect and defend against an aggressive or hostile person.
The key to assertive behavior is to nonaggressively express one’s likes and dislikes in a manner that takes the other person’s feelings into consideration. Also, in many cases, assertive expression is it's own reward. So, even if the people with whom you're being assertive don't validate your feelings or change their behavior, simply speaking your mind, having your say, and expressing your feelings can pay big emotional dividends.
This is because our minds are “self-reflective.” That is, we notice, evaluate, and judge what we ourselves do (often unconsciously). When our mind notices we have done something positive and self-affirming (like assertively sticking up for ourselves), it rewards us with feelings of pride and personal satisfaction. Alternatively, when our self-reflective mind notices we have done something maladaptive or self-defeating (like not speaking up or having a disproportionate anger outburst), we usually feel unpleasant emotions, such as shame, guilt, or sadness.
For a closer look at these three therapy methods, arguably the most powerful and effective, check out the links below:
Exposure:
https://www.psychologytoday.com/blog/think-well/201503/how-most-anxiety…
Behavioral Activation Therapy:
https://www.psychologytoday.com/blog/think-well/201504/how-most-depress…
Assertiveness:
https://www.psychologytoday.com/blog/think-well/201506/empowerment-and-…
Remember: Think well, act well, feel well, be well!
Copyright Clifford N. Lazarus, Ph.D.
References:
Martell, C., et al. (2010). Behavioral Activation for Depression: A Clinician's Guide. Guilford: New York.
Andrews, G., et al. (2003). The Treatment of Anxiety Disorders. 2nd Edition. Cambridge University Press.
Alberti R., & Emmons, M. (2001). Your Perfect Right: Assertiveness and Equality in Your Life and Relationship. Impact: Atascadero, CA.
