Third Wave Cognitive Behavior Therapy: An Integrative Approach for Women’s Health

At New York Women’s CBT, we value a trauma informed approach to CBT and incorporate third wave CBT techniques including Dialectical Behavior Therapy and Acceptance and Commitment Therapy. Your thoughts are not irrational-they exist for a reason, and are often rooted in traumatic experiences. They are keeping you stuck, and by viewing them as unhelpful we can help you find more healthy and helpful reframes to move forward. We value both rewiring the neural networks with more flexible thought patterns while providing somatic, grounding and mindfulness skills to help regulate your nervous system.

What are unhelpful thought patterns?

Cognitive behavior therapy is an evidence-based highly effective therapeutic treatment for anxiety, depression, and post-traumatic stress disorder. At our office, our team will work together with you to identify unhelpful thought patterns that keep you feeling stuck in anxious feelings, hopelessness, or fear.

Once we name these unhelpful thoughts, we can find evidence to challenge them and create more helpful reframes and dialectical thoughts. Most importantly, these more helpful thoughts are authentic to you. Over time, the goal of CBT introduces flexible, dialectical thoughts that acknowledge both your rational and emotional mind to replace unhelpful thought patterns and change your neural network. Unhelpful thought patterns that keep you in a loop of feeling stuck. These may sound like:

Magnification and minimization/disqualifying the positive:

Minimizing positive events, personality traits, or accomplishments while magnifying negative events or personality traits

Ignoring important parts:

ignoring important facts/details of a situation

Catastrophizing:

Going to the worst possible outcome of a situation

Overgeneralization:

If something bad happened one time, we assume it will happen again and again.

Oversimplifying/magical thinking/“Just World” belief:

Good things should happen to good people, bad things should happen to bad people. Why is something bad happening to me if I am a good person?

Personalization:

The belief that you are responsible or at fault for events outside of your control

Jumping to conclusions/fortune telling:

Assuming the outcome or meaning of an event/situation without evidence; predicting the future

Mind reading:

Assuming others’ thoughts about you are bad/negative without evidence or knowledge

Emotional reasoning:

The belief that feelings are facts; Tip: feelings are always valid- they are not always factual.

“Should” statements:

The belief that things, events, or people should be a specific/certain way. Tip: Helpful reminder that should statements create shame and self-criticism/ judgment.

All or nothing thinking/rigid thinking:

Thinking in rigid or absolute terms, using words such as “forever”, “always”, “never” or “every”

What is cognitive reframing?

Cognitive reframes are helpful replacement thoughts for stuck points or unhelpful thought patterns. Reframes use evidence to challenge the unhelpful thought patterns, which help rewire the neural pathways over time and replace the “stuck” thought.

To create evidence, we use a reframe chart to help gather evidence and organize our thoughts.

Items we can discuss to use in creating reframes may include:

• The situation or event leading up to the unhelpful thought

• Your emotions coming up associated with the thought

• Rating the intensity of the emotions both before and after the cognitive reframing exercise

• Finding factual evidence that supports the unhelpful thought

• Finding factual evidence that challenges the unhelpful thought

• Identifying all relevant cognitive distortions

• Validating your feelings with self compassion and understanding

• Introducing flexibility into your thought pattern

• Identifying phrases that help increase your distress tolerance

  • “I can get through this.”

  • “This is temporary.”

• Identifying phrases that help increase your feelings of acceptance

  • “I accept that this is my reality just for today.”

• Recognizing dialectical thought processes where two opposite feelings or thought patterns are both true at the same time

CBT helps you understand the cycle of thoughts, feelings and behaviors.

Brain imaging scans tell us that humans have about 6,000 thoughts per day. Incredible! However, we can’t expect all of those thoughts to necessarily be helpful. Our thought patterns influence our emotions which impact our behaviors. If we are stuck in a negative feedback loop with unhelpful thought patterns, our emotions will be more intense (ex. Anger, rage, hopelessness) and our behaviors may not align with our values system.

Now, imagine your emotions are like the volume on a stereo. By changing the feedback loop to include a new more helpful cognitive reframe, our emotions may dial down (ex. anger and rage are replaced with frustration and the intensity of hopelessness is much less) and our behaviors are more in alignment with how we view the world, treat others and treat ourselves.

CBT helps get you “un-stuck”.

CBT can help break the cycles of unhelpful thought patterns, rewire the way our brain thinks by creating new neural pathways, and helps turn the volume down on intense or unpleasant emotions. CBT doesn’t completely get rid of unpleasant feelings and that is not our goal in working together. CBT is able to help you thrive in the midst of painful feelings and difficult situations while managing your thoughts, feelings, and behaviors in a more helpful way.

Dialectical Behavior Therapy for Women’s Health and Chronic Illness

Dialectical behavior therapy, DBT, helps build flexible thinking and distress tolerance for intense feelings and sensations. Mindfulness, grounding and somatic exercises are utilized to help regulate the nervous system, enhance the mind body connection and create new coping skills for managing painful emotions. Dialectical thinking is utilized to create flexible thought patterns and embrace what we call the “wise mind.”

Dialectical thinking embraces our wise mind and improves our flexible thinking.

Dialectical thinking acknowledges both our emotional mind and our rational mind. Dialectical thinking asserts that two opposite thoughts can both be true at the same time. We tend to live in either the emotional mind or the rational mind-by acknowledging both at the same time, we create more flexible thinking and utilize our “wise mind”.

Distress tolerance tools help manage intense physical sensations and emotions.

Distress tolerance tools are important and accessible activities that can help us ride the wave of intense feelings. We can add mindfulness tools, activities, breathing exercises, visualizations and more to your toolbox to manage the ups and downs of complex women’s health issues.

Acceptance and Commitment Therapy for Women’s Health

The reality slap takes many different forms. Sometimes, it’s so violent its more like a punch: the death of a loved one, a serious illness or injury…at other times the slap is somewhat gentler: that sudden flash of envy when we realize someone else has got what we want; those sharp pangs of loneliness…those painful stabs of failure, disappointment or rejection.

…In each case, we face a big gap between  the reality that we’ve got and the reality that we want. And the bigger the gap, the bigger the pain…[acceptance of this gap] doesn’t mean we deny the pain that is there, or that we try to pretend that it doesn’t hurt. Rather, it means we acknowledge that the pain is there and we also appreciate all that life has to offer.

-Russ Harris, The Reality Slap

Acceptance and commitment therapy, or ACT, aims to use mindfulness and committed actions to help clients live in more alignment with their values, accept difficult and complicated events or feelings and find meaning in the midst of pain. We learn to have psychological flexibility when we embrace the six core tenants of ACT. Here at our New York City therapy practice, we have a warm, compassionate team trained in this treatment modality.

Acceptance does not mean we like something that has happened to us or that we are “okay” with chronic illness. It simply means we are radically accepting of our current reality and taking committed actions for change in the areas of life where we hold control.

The core principles of Acceptance and Commitment Therapy:

1. Contacting the Present Moment

2. Thought Defusion

3. Acceptance

4. Self Awareness

5. Values

6. Committed Action

Contacting the present moment:

It is normal and natural to get caught up in our thoughts and feelings. When we practice mindfulness, we are practicing being present in the here and now. This can be difficult when we are ruminating on the past or worrying about the future. By consciously practicing guided meditations, breathing exercises, or grounding activities, we can engage with the present moment and learn to let our thoughts pass in and out of our minds.

Thought defusion:

Certain thoughts can be very intrusive, strong, and entangled with our own identity. Through meditative exercises, we can learn to take a step back and become an observer of our thoughts. This helps us defuse those thoughts from our identity and observe them simply as words pass through our minds.

Acceptance:

Acceptance means we allow ourselves to open up and make room for emotional pain, loss, disappointment, and hurt. Instead of avoiding our hurt and painful emotions, we acknowledge them and turn the struggle switch off. This doesn’t mean we like or want painful emotions or loss. It doesn’t mean we are okay with our pain. It also doesn’t mean we give up our fight to heal or improve our situation. It simply means we are acknowledging our current reality and the emotions that accompany it.

Self awareness:

Through meditation, we learn to tap into our “observing self” or perhaps our “wise mind” that is full of pure awareness. We make space to observe our thoughts, our feelings, and our emotions without judgment. We can pause in the present moment and collect data on how we are feeling in our minds and bodies.

Values:

Each of us has our own unique value system. No values are better or worse than others. They simply inform us of how we are most fulfilled in this season of life if we are acting in alignment with those values. Values will change throughout the lifetime. It is important to take a values inventory in each new season of life in order to make changes toward meaning and fulfillment.

Committed action:

Committed action means we are taking clear action steps towards our goals in alignment with our values system. You may not be where you want to be in your job, your relationships, or your health journey-but, committed action allows us to take clear action steps each day to get closer to our end goal. I like to say that big changes only happen with a million tiny little things added together over time.

Living in the bullseye and values exploration.

Values are ever-changing in each new season of life. Some may remain consistent, like loyalty or service to others. Some may change with age, such as adventure or playfulness. These may still be important, but other values outweigh them due to life changes, like routine with scheduled vacations and play.

For instance, we may not value the same things in our college years and twenties as we do when we enter our thirties and forties. This is not a bad thing; it simply means you are growing, changing, and shifting your priorities throughout your lifetime. It is a normal and natural process.

Given that our values shift throughout different years of life, it's important to take inventory of what is important in the here and now. Women’s health issues can impact these four major realms of life: work and education, leisure, personal growth and health, and relationships. It can feel like you don’t have control over your life when illness disrupts it-ACT can help us recognize the committed actions in your control and the hard work you are already doing showing up for yourself.

f you are not where you want to be in your journey (aka, living in the bullseye), you have an opportunity to create committed action steps to evoke change. Even in challenging situations like navigating chronic illness or postpartum challenges, you can take committed action steps towards stability.

A= Accept your thoughts and feelings and be present

C= Choose a valued direction

T= Take action