Learning to unlearn negative thoughts and behaviours

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Thomas Verny is a clinical psychiatrist, academic, award-winning author, public speaker, poet and podcaster. He is the author of eight books, including the global bestseller The Secret Life of the Unborn Child and 2021’s The Embodied Mind: Understanding the Mysteries of Cellular Memory, Consciousness and Our Bodies.

As you may recall, last month in this column I wrote about a variety of insight-oriented therapies. Today, we find ourselves four weeks post Halloween and exactly four weeks before Boxing Day. A good time to check out therapies that are focused on here-and-now behaviour and symptom relief (too much candy?).

The new kid on the block is the remarkably successful cognitive behavioural therapy, better known as CBT, and its cousin, dialectical behaviour therapy (DBT).

CBT has its roots in the writings of psychologists Ivan Pavlov, John B. Watson, and B.F. Skinner. They dismissed introspection and personal subjective experience in favour of behaviourism, a psychological theory and practice that centres on observable behaviour and the processes through which animals, including humans, learn or unlearn. It stresses the role of conditioning in shaping behaviour. This perspective was dominant in psychology from the 1920s through the 1950s.

Recently, an academic paper in Frontiers in psychiatry boldly announced that cognitive behavioural therapy is the current gold standard of psychotherapy. [1] CBT therapists prioritize the person’s current life situation, rather than childhood events, family constellations, relationships, or history of present difficulties. The focus is on moving forward to gradually develop more effective ways of coping with life.

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CBT assumes that psychological problems stem from faulty or unhelpful ways of thinking and behaving. In therapy, clients are guided to recognize their distortions in thinking and helped to re-evaluate them in light of reality, thereby learning to cope better. CBT gives clients homework and teaches them how to become their own therapists.

CBT treatment strategies include:

• Facing one’s fears instead of avoiding them by way of systematic desensitization. This is often used for treating specific phobias, intense fears related to particular objects or situations (like animals or water), and other anxiety conditions. The method involves gradually introducing the individual to the source of fear while teaching relaxation or coping strategies while helping them resist engaging in compulsive or avoidance behaviours.
• Token economy. This is a reinforcement system where desired behaviours are rewarded with tokens that can be exchanged for privileges or items. This approach is particularly effective in institutional settings. [2]
• Using role playing to prepare for potentially problematic interactions with others. In the 1970s, after finding that traditional CBT failed to help women with chronic suicidal and self-harm behaviours and borderline personality disorder, American psychologist Marsha Linehan developed dialectical behaviour therapy. [3]

In a recent “state of the science review,” Allison Ruork and colleagues at Rutgers University conclude that the majority of research conducted to date on DBT across populations and settings demonstrates that it is effective at treating the behaviours that it targets. Their review does come with a caveat, “... although DBT has been established as a ‘gold-standard’ treatment for certain populations and behaviors, there is much more research needed to answer critical questions and improve its efficacy.” [4]

Observe that both CBT and GBT are considered by their champions as “gold standards.”

DBT practitioners assert that it is evidence-based for reducing suicidal and self-harm behaviours and improving overall functioning of people with borderline personality disorder. They also assert that growing evidence supports its use in adolescents with PTSD, mood disorders, self-harm risk, substance use disorders, chronic pain, and other conditions where emotion dysregulation is central. [5]

You may have noticed that nowadays everyone describes their approach as “evidence-based.”

Take that with a pinch of salt. Investigate before you commit. What is the evidence? Is it one study on 15 people in New Guinea published in a journal no one has ever heard of, or a metanalysis of 30 studies published in the Lancet?

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Another word that is bandied about is “trauma.” Throughout human history, exposure to traumatic events has been an inescapable aspect of life. Some of the earliest portrayals of what is now recognized as post-traumatic stress disorder (PTSD) appear in literature, for example, in Homer’s Iliad, Shakespeare’s Henry IV, and Dickens’ A Tale of Two Cities, all of which depict the lasting effects of trauma.

The World Health Organization’s data showing that 70 per cent of people have endured trauma such as a life-threatening experience, serious injury, sexual assault, or the sudden death of a loved one, helped establish it as a major global health issue. [6] Adverse childhood experiences have been shown to play a significant role in the development of poor mental and physical health later in life. [7] The official inclusion of PTSD in the Diagnostic and Statistical Manual of Mental Disorders as a psychiatric diagnosis in 1980 represented a tipping point in mental health, acknowledging the lasting impact of extremely distressing external experiences on a person’s psyche.

According to a recent study from the Netherlands [8], eye movement desensitization and reprocessing therapy (EMDR) was conceived to help treat PTSD without requiring patients to repeatedly re-experience their traumatic memories. The therapy utilizes bilateral stimulation, including eye movements, hand tapping, or auditory tones, to activate both sides of the brain and facilitate the processing of traumatic memories.

On the website of Lisa Schlosser, the president of EMDR Canada, I find that the World Health Organization, American Psychological Association, Veteran Affairs Canada, U.S. Department of Veterans Affairs and International Society for Traumatic Stress Studies, among other reputable international and national organizations, recognize EMDR therapy as an effective treatment. [9] I am not familiar with EMDR, but I think that these recommendations sound encouraging.

In the late 1990s and early 2000s, there gradually arose the concept of trauma-informed care and trauma-informed therapy. [10] As Coral Muskett, a mental-health nurse from Tasmania, rightly put it, “The trauma-informed approach is based on a thorough understanding of how experiencing trauma influences an individual’s neurological, biological, psychological, and social development”. [11]

I believe that all therapists worth their salt are familiar with the effect of trauma on a person’s body-mind health. Repeated references by a therapist to offering “trauma-informed care” strikes me as “carrying coals to Newcastle.” Enough virtue signalling.

Now, for something very different, let’s take a big jump into Chinese medicine and acupuncture. As you probably know, Chinese medicine teaches that meridian points in our bodies are areas of the body through which energy flows. If there are barriers to this flow, imbalance of energy develops which can cause disease or sickness.

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Gary Craig, founder of Emotional Freedom Technique (EFT), is an ordained minister of the Universal Church of God in Southern California. He is a dedicated student of “A Course in Miracles.” In the 1990s Craig developed his technique of tapping – utilizing points along the body’s energy meridians based on Chinese medicine. Tapping on specific pressure points while reframing what’s concerning a person is said to ease their negative emotions or stress.

On his website he proclaims, “The Palace of Possibilities, is the home of EFT (Emotional Freedom Techniques) and Optimal OEFT. These dramatic innovations speed up and greatly enhance conventional healing methods.” You will be pleased to know that his courses are “instant delivery with 30-day money back guarantee.”

To be fair, EFT is easy to learn and practise on your own, painless, cheap or free, less time-consuming than other types of therapy and drugless, therefore, no side-effects to worry about. It aligns perfectly with our age that looks for quick, effortless and simple remedies to complex issues.

Many therapists and particularly life coaches have responded to these new social norms by treating the symptoms, not the cause. They make their approach sound scientific using acronyms like OCD instead of obsessive-compulsive disorder, ADHD instead of attention deficit hyperactivity disorder, etc., and employ commonly known references to the body like meridians or REM sleep while often emphasizing their warmth and open-arms policy. Their websites overflow with adulation from satisfied clients.

No matter what you are looking for, if you can name it, there are a dozen or more life coaches on the web who will address it. There are date coaches, marriage coaches, breakup coaches, end-of-life coaches. Some are very good and helpful. Others, like in any other profession – inept and potentially, harmful.

So here are some caveats:

• Not everyone who introduces themselves as doctor and/or has a PhD after their name is a doctor of psychology. They could have a PhD in many other subjects unrelated to psychology or medicine.
• Anyone can call themselves a therapist, counsellor or coach. It’s up to you to find out what their credentials are.
• The field of therapy is full of well-intentioned people. But not all of them are aware of the limits of their competence.
• In other words – buyer, do your own diligence.

Ask yourself, what do I want to gain from therapy? Is it symptom relief ASAP or symptom relief while also addressing underlying issues for as long as it takes? Then choose the therapy and therapist who is both trained to deliver it and a person of integrity.

Personally, I take a dim view of therapy focused on symptom suppression without an exploration of the underlying causes. I favour a psychotherapy that takes our unconscious seriously and is grounded in humanism, philosophy, and science with a touch of spirituality.

Next month I shall conclude my trilogy on psychotherapy with an exploration of electrotherapeutics, the high-voltage quest to fix the errant mind.

References

1. Leichsenring, F., & Steinert, C. (2017). Is cognitive behabehaviouralrapy the gold standard for psychotherapy? The need for plurality in treatment and research. Jama, 318(14), 1323-1324.
2. Rivier University: An Introduction to Behavioral Psychology
3. Linehan, M. M., Korslund, K. E., Neacsiu, A. D., ... & Murray-Gregory, A. M. (2015). Dialectical behavior therapy for high suicide risk in individuals with borderline personality disorder: a randomized clinical trial and component analysis. JAMA psychiatry, 72(5), 475-482.
4. Rizvi, S. L., Bitran, A. M., Yin, Q., & Ruork, A. K. (2024). The state of the science: Dialectical behavior therapy. Behavior Therapy, 55(6), 1233-1248.
5. Hernandez-Bustamante, M., Cjuno, J., Hernández, R. M., & Ponce-Meza, J. C. (2024). Efficacy of dialectical behavior therapy in the treatment of borderline personality disorder: a systematic review of randomized controlled trials. Iranian Journal of Psychiatry, 19(1), 119.
6. Kessler, R. C., Aguilar-Gaxiola, S., E. J., Cardoso, G., et al. (2017). Trauma and PTSD in the WHO world mental health surveys. European Journal of Psychotraumatology, 8 (Suppl. 5), 1353383.
7. Anderson, F., Howard, L., Moran, P., & Khalifeh, H. (2016). Childhood maltreatment and adulthood domestic and sexual violence victimisation among people with severe mental illness. Social Psychiatry and Psychiatric Epidemiology, 51(7), 961–970.
8. Hofman, S., Hafkemeijer, L., de Jongh, A., & Slotema, C. W. (2025). Eye Movement Desensitization and Reprocessing Therapy in Persons With Personality Disorders: A Randomized Clinical Trial. JAMA network open, 8(9), e2533421-e2533421.
9. Schlosser, Lisa
10. Paterson, B. (2014). Mainstreaming trauma. In Conference paper, Psychological Trauma Informed Care, Stirling.
11. Muskett, C. (2014). Trauma-informed care in in-patient mental health settings: A review of the literature. International Journal of Mental Health Nursing, 23(1), 51–59.