While many mental health professionals in Hong Kong provide talk therapy, they might also tailor their modalities to suit specific issues or individual needs. Here we will delineate the approaches of three common modalities: Cognitive Behavioral Therapy (CBT), Emotionally Focused Individual Therapy (EFIT), and Acceptance and Commitment Therapy (ACT). To illustrate, we will use the scenario of a high school student named Jacob, who is feeling anxious about an upcoming test. He worries about not performing well, fears disappointing his parents, and feels overwhelmed by the pressure to succeed in the competitive academic landscape in Hong Kong. Using CBT, EFIT, and ACT, we will explore how these modalities might help Jacob.

Cognitive Behavioral Therapy (CBT)

1. Naming the Thoughts: In CBT, Jacob would work with his counsellor to identify negative thoughts about the exam or himself, such as “I’m going to fail this exam” or “I’ll let everyone down.” The counsellor may also assist Jacob in linking these distressing thoughts to his emotions, allowing Jacob to visualize how and when the emotions occur.

2. Challenging the Thoughts: The counsellor would help Jacob challenge these thoughts by asking questions such as, “What evidence do you have that you will fail or succeed?” or “Have you done well on exams in this subject in the past?” This process could help Jacob reframe his thinking to something more realistic, such as “I have been studying hard” and “I have been receiving good grades in this subject.”

3. Behavioral Activation: The counsellor will then work with Jacob to establish a study schedule and identify activities that can help him reduce stress levels. One of the goals here is to alleviate Jacob’s anxiety surrounding the test and to encourage engagement in behaviors that may lead to better academic performance.

Emotionally Focused Individual Therapy (EFIT)

1. Exploring Emotions: In EFIT, the counsellor might work with Jacob to connect his anxious feelings surrounding the test with his assumption that his parents will be disappointed in the results, and how other feelings such as shame and fear relate to this anxiety.

2. Understanding Emotional Connections: Understanding Jacob’s deeper emotions surrounding his parents’ reaction may bring up how he perceives parental support and self-worth in relation to these feelings. The counsellor might ask questions such as “What do you need most when you're feeling this way?” and “What was your first memory of feeling this kind of pressure?” to explore these deeply rooted insecurities.

3. Integrating Deeper Understanding: The counsellor could work with Jacob to identify and access important figures in his life to confront his current challenges, aiming to reduce his anxious feelings and sense of negative self-worth. This might involve guiding Jacob through self-soothing techniques or using role-plays to help him express his anxious feelings to his parents, thereby facilitating the receipt of support in return and fostering an understanding of how he is being supported.

Acceptance and Commitment Therapy (ACT)

1. Clarifying Thoughts and Feelings: In ACT, Jacob would learn to accept his anxiety rather than fight against it. The counsellor will first guide him to recognize that feeling anxious is a normal part of preparing for an important exam, and to understand that struggling with his anxious thoughts makes the anxiety worse. The counsellor will use multiple metaphors to illustrate these struggles and guide Jacob to distance the temporary feelings and situation from himself.

2. Working Through Anxiety: Jacob will be introduced to various exercises to help him study or confront the test despite these anxious feelings. The counsellor might introduce mindfulness exercises to help him manage his emotions while studying and during the test, or grounding techniques to help him stay focused on the present moment.

3. Values Clarification: The counsellor would work alongside Jacob in identifying his core values, such as his desire to learn and achieve his goals. By focusing on these values, Jacob can be encouraged to concentrate on his goal of performing well academically, rather than being guided by his fear of negative results.

By using CBT, EFIT, and ACT, Jacob can learn to be more effective in managing his anxiety about the test. CBT can help him challenge negative thoughts that fuel his anxiety, EFIT may help reduce anxiety surrounding his own performance, and ACT can guide him in accepting his feelings while focusing on his values. Each approach offers valuable tools that can lead to greater confidence and emotional resilience while also targeting divergent sources of his anxiety and strength within himself. If you are in a similar situation as Jacob or would like to learn more about how these popular counselling techniques could help you, reach out to us at compassionatemindshk@gmail.com, or learn more about how our counsellor James could assist you with his formal training in these modalities.