Understanding Psychotherapy Through Research: CBT, Radical Acceptance, The Body Keeps the Score and Trauma Treatment

This article is general information to aid understanding. It does not replace treatment. If trauma memories are unsettling your daily life or you are thinking about harming yourself, please see a mental health professional. In an emergency, contact your local emergency number or a crisis line (in the US, call or text 988).

Cognitive behavioural therapy (CBT): the loop of thoughts, feelings and actions

Aaron Beck (Beck et al., 1979) observed that depressed people were caught in automatic thoughts that interpreted themselves, the world and the future negatively, and developed cognitive therapy. Adding behavioural techniques produced today’s cognitive behavioural therapy (CBT).

The core of CBT is finding the links you can change in the loop of situation → thought → feeling → action, and practising.

• Thought records: write down the situation, the thought that came up and how intense the feeling was when your emotions swung strongly.
• Spotting cognitive distortions: notice common thinking traps such as “I made one mistake, so I always fail” (overgeneralisation) or “Everyone must hate me” (mind reading) (Burns, 1980).
• Alternative thoughts: weigh the evidence and rewrite the thought as a more balanced statement.
• Behavioural experiments: test in small ways whether a feared prediction actually comes true.

When Hofmann et al. (2012) reviewed 269 meta-analyses, CBT had especially strong evidence for anxiety disorders, somatic symptoms, bulimia, anger and stress. It is not equally effective for every problem, however, and some studies find it roughly on par with other treatments for depression.

Radical acceptance: the skill of no longer fighting

“Radical acceptance” is a core skill in Marsha Linehan’s dialectical behaviour therapy (DBT) (Linehan, 1993). It means fully acknowledging “this is how it is” about a reality you cannot change, even if you don’t like or agree with it, to reduce the suffering that comes from fighting reality. The meditation teacher Tara Brach linked it to Buddhist meditation for a wide audience in Radical Acceptance (2003).

Acceptance and commitment therapy (ACT), in a similar vein, helps people accept uncomfortable thoughts and feelings rather than struggle to eliminate them, and act according to what they value (Hayes, Strosahl & Wilson, 1999). A meta-analysis of randomised trials found ACT effective for anxiety, depression, chronic pain and more (A-Tjak et al., 2015).

Acceptance is not the same as giving up. It means changing what you can and spending less energy on what you can’t. If you’re curious how you treat yourself, OIYO’s self-compassion test may help.

The Body Keeps the Score and the evidence for trauma treatment

The psychiatrist van der Kolk’s The Body Keeps the Score (2014) resonated widely with its message that trauma lives not only in thoughts but in bodily reactions and sensations. It introduced approaches such as yoga, somatic methods that attend to bodily sensation, and EMDR.

From the research, it can be summarised like this:

• Treatments with the strongest evidence: for post-traumatic stress disorder (PTSD), prolonged exposure, cognitive processing therapy, trauma-focused CBT and EMDR have been confirmed effective in multiple meta-analyses (Cusack et al., 2016).
• Somatic Experiencing (SE): a small randomised trial found reduced PTSD symptoms (Brom et al., 2017), but there are still few studies.
• The body’s role: it is widely accepted that trauma is entangled with bodily responses such as arousal, sleep and pain. Some claims in the book, though, have been criticised as running ahead of the research, so when choosing treatment, discuss evidence-based methods with a professional first.

Summary at a glance

Treatment	Core idea	Level of evidence
CBT	Practise changing the loop of thought, feeling and action	Strong for anxiety, stress and more
Radical acceptance (DBT)	Acknowledge unchangeable reality to reduce suffering	Evidence as a skill within DBT
ACT	Accept and act on values	Moderate effects across several problems
PTSD treatments	Exposure, cognitive processing, EMDR and others	Confirmed in multiple meta-analyses
Somatic Experiencing	Working through bodily sensation	Early stage; more research needed

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References

• Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive Therapy of Depression. Guilford Press.
• Burns, D. D. (1980). Feeling Good: The New Mood Therapy. William Morrow.
• Hofmann, S. G., Asnaani, A., Vonk, I. J. J., Sawyer, A. T., & Fang, A. (2012). The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognitive Therapy and Research, 36(5), 427–440.
• Linehan, M. M. (1993). Cognitive-Behavioral Treatment of Borderline Personality Disorder. Guilford Press.
• Brach, T. (2003). Radical Acceptance: Embracing Your Life with the Heart of a Buddha. Bantam.
• Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and Commitment Therapy. Guilford Press.
• A-Tjak, J. G. L., et al. (2015). A meta-analysis of the efficacy of acceptance and commitment therapy for clinically relevant mental and physical health problems. Psychotherapy and Psychosomatics, 84(1), 30–36.
• van der Kolk, B. (2014). The Body Keeps the Score. Viking.
• Cusack, K., et al. (2016). Psychological treatments for adults with posttraumatic stress disorder: A systematic review and meta-analysis. Clinical Psychology Review, 43, 128–141.
• Brom, D., et al. (2017). Somatic Experiencing for posttraumatic stress disorder: A randomized controlled outcome study. Journal of Traumatic Stress, 30(3), 304–312.