How We Practice -- Our Modalities

Our approach has been developed from an integrative (eclectic) mix of several orthodox theories but the core of our approach is one-on-one ACT (Acceptance and Commitment Therapy), as well as Group Therapy. In our experience, this double-pronged approach is particularly effective. And our approach has been refined even further - certain of our groups embody Group Exercise followed by Group Therapy, which ensures that clients are mobilised, socialised and 'out there'.

How We Have Developed Our Modalities

ACT (Acceptance and Commitment Therapy) - the corner-stone of our total approach to the anxiety and mood disorders
CBT (Cognitive Behavioural Therapy) - we use several elements of this well-known modality but do not use any of the cognitive elements of CBT
Narrative Therapy - we use elements of narrative therapy to buttress our approach to deconstructing language and seeing language as a cognitive trap
Logotherapy - we use elements of logotherapy therapy in our approach to values - an integral part of ACT
Existential Therapy - we use elements of existential therapy in our approach to values - an integral part of ACT
Mindfulness Meditation - is an crucial part of what we offer - because mindfulness forms one of the cores of ACT
Exercise - is an important part of what we offer generally - as a motivator and mobilising agent
Group Therapy - is uniquely placed to offer the more immediate benefits of group support and group normalisation

The goal of Acceptance and Commitment Therapy is to assist clients to consistently choose to act effectively, by encouraging concrete behaviour based on clients' values, notwithstanding difficult or troubling circumstances, thoughts or emotions. It is a relatively new model of behavioural treatment which stresses acceptance of people's internal experience - you will experience both pleasant and unpleasant thoughts and emotions - but the focus is on eventual behavioural change. Avoidance of internal experiences perpetuates and reinforces more avoidance strategies and therefore, based on commitment to values and goals, this modality seeks to foster quiet acceptance of these internal experiences as opposed trying to avoid them. Thus, whenever anxiety and depression threaten to unseat or derail people's lives and ambitions, Anxiety Management Services offers our unique approach to managing these circumstances. To this end, AMS has developed and combined multiple resources - augmented ACT - to encourage and facilitate individuals in reaching their full potential at home and in the workplace.

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How have we integrated the above therapies?

ACT (Acceptance and Commitment Therapy) forms the bedrock of our therapy since, in our view, this approach is the most effective approach in the treatment of the anxiety and mood disorders. ACT forms part of the so-called third wave of behaviour therapy which has arisen from within the cognitive and behavioural traditions. Whereas CBT aims to challenge negative thoughts and beliefs and to dispute irrational thinking (stinking thinking), ACT which is usually more experiential than didactic, places great importance on cognitive defusion, acceptance, mindfulness, on commitment to values, on mindfulness, cognitive defusion, spirituality and so on. This modality shifts away from the cognitive and to this end, relies strongly upon metaphor and experience - on the here-and-now. The aim of ACT is not to influence the content of our thoughts; rather, it is to change their context. If we are able to change the way we understand thoughts and feelings - and just accept them - we are less likely to be controlled by such thoughts and feelings. Verbal and cognitive processes are contextually controlled so changing the context is the crucial approach, a process called 'disidentifying with thoughts' or 'defusion'.

A key element to ACT is relational framing, which tightly links language and cognition. They are both dependent on relational frames. In essence, language often moves away from merely describing certain stimuli, to actually being able to trigger the very stimuli it seeks merely to describe. This then establishes a cybernetic feedback loop which becomes increasingly difficult to break. Trying to correct negative thoughts by using language to effect the correction (CBT), paradoxically may often intensify such thoughts. ACT therefore places importance on accepting such thoughts, emphasising mindfulness of the here-and-now experience. And acceptance of thoughts and feelings is emotionally facilitated through the establishment of goals and values and commitment to such goal and values.

Anxiety Management Services has taken elements from CBT to initially begin our approach to ACT as well as utilising key CBT elements of exercise and relaxation. Hence our emphasis on group walking and on meditation. We have looked to narrative therapy in our ACT approach to de-contextualising language. We encourage clients to experience thoughts and emotions from a different perspective - initially to tell themselves and others a different narrative - and from this perspective, we gently explore the differentiated meanings of these thoughts and emotions, both in terms of how they may be experienced and what they mean existentially. We feel this to be a particularly effective approach to de-contextualising language and facilitating acceptance. Since an important part of ACT involves the notion of mindfulness, in order to develop this awareness in clients, we teach mindfulness meditation and hold meditation groups to heighten clients' mindfulness or awareness of various thoughts or emotions.

We have drawn on logotherapy (meaning therapy) and existential therapy in working with our clients in their establishment of their values and goals and in their commitment to such values and goals since we believe values and goals are essential components to life.

We combine customary one-on-one therapy with group therapy. Group therapy is an important part of our approach because the group experience is powerful and usually offers both immediate and profound relief from the anxiety and mood disorders. People are accepted into a group for 12 weeks and they are quickly able to feel that they are not alone in their misery. The group holds them and can form a crucial part of their support systems. And the greater value of the group experience lies in the fact that the group, which is a mirror of clients' lives outside the group, is a safe environment in which to experience and be experienced. Within this framework, real change happens.

Finally, we mention that some of our groups involve formal exercise as well. We walk for 40 minutes, which is then followed by about one and a half hours of formal group therapy. This requirement ensures that clients are mobilised, that they actually do exercise, that they actually are socialised. This offers powerful positive reinforcement - and the effects of exercise and meditation cannot be over-emphasised.

For us, ACT is not a stand-alone modality. It forms the mainstay of our approach, but we have felt the need to augment it through drawing on various disparate but crucial elements from other forms of therapy.