NLP and CBT: Comparisons and Contrasts

 

This paper draws comparisons and contrasts between Neuro-Linguistic Programming (NLP) and Cognitive Behavioral Therapy (CBT). The paper will provide an explanation for the mechanisms of therapeutic change utilized by each, offer examples of how NLP techniques can complement CBT and suggest a methodology for scientifically evaluating the effectiveness of NLP approaches.

 

CBT and NLP share common roots in the work of Chomsky, Bateson and others. While CBT followed the tradition of mainline scientific investigation, NLP proceeded as an intuitive, empirical art. NLP is a means of recognizing and replicating patterns in human behavior and perception, and making those patterns available for skill training, behavior modification and study. Both disciplines describe models of behavior in terms of sequences of perceptions, affective responses and reactions. Both NLP and CBT have documented treatments for phobias, trauma, PTSD, anxiety and depression. However, NLP has not been as well-researched as CBT, in part because CBT treatment is focused on highly specific goals so that results can be measured relatively easily. In addition, while CBT emerged from a standard model of psychology, NLP developed outside of the academic and professional arena in the world of personal enrichment.

 

There are a number of differences between a CBT approach to treating a problem and an NLP intervention. In treating depression for example, CBT uses a pre-existing generalized model derived from a synthesis of multiple examples that have been formulated into abstract generalizations. The model directs attention to a specific sequence of behaviors (schemata) — a perception, an emotional response to it, an “irrational” interpretation of the response, and often a “magnifying loop” — with an intervention designed to counter the irrational interpretation. NLP on the other hand focuses on the patient* or client’s unique idiomatic internal sequence of representations — images, internal voices, feelings — that result in the undesirable emotion. As an example, an NLP clinician might determine that a depressed person is obsessively repeating an image of his mother’s recent death resulting in symptoms of “diagnostic depression.” The intervention may focus on that image, assisting the person to alter it in such a way that it no longer produces the negative feelings of depression. We will talk more about this process shortly.

 

One of the signal accomplishments of CBT is the precise identification of schemata characterizing specific disorders such as anxiety, phobias, and OCD. After many years of experimental evaluation, the patterns are well-defined and correspond to clinical experience with consistency. However, the standard CBT interventions have been shown to be less effective than might be expected. NLP would suggest that although CBT has clearly identified the “large-chunk” sequences, it has not accounted for the small changes in subjective experience that code for meaning and affective impact. Because of this, CBT has been unable to take advantage of its own strength: reliable models of behavior.

 

NLP comes to cognitive psychology with a set of enhancements that can increase the efficacy of cognitive interventions by shortening treatment time, increasing sensitivity to individual variations and increasing the utility of cognitive schemata in the treatment of problem behaviors. In short, NLP offers the potential for a full-Spectrum Cognitive Behavioral approach. A selection of NLP enhancements that could greatly improve therapeutic outcomes of CBT include:

 

1. A radically client-centered approach that emphasizes that each individual’s subjective experience is unique.

2. A means of analyzing and manipulating perceptions (subtle variations of color, distance, direction, volume, etc., of representations known as sub-modality distinctions), that ensures the intervention is personally meaningful to the client.

3. Sufficient flexibility for the therapist so that multiple interventions may apply to any schematic intervention.

 

1. Client-centered Approach

Core to the therapeutic approach of NLP are several basic assumptions or presuppositions. The map is not the territory assumes that neither the client’s perception of the world nor the therapist’s represent a universally agreed upon description of reality. For example, if a person says, “I love sports,” they might mean that they enjoy watching 20 hours of various sports on TV every week. However, the map a listener might make of that person’s “love of sports” could be of them playing various sports all year long. The maps we make to represent reality are different from the reality itself. Making this distinction and validating the client’s internal representations significantly improves communication and cognitive therapy. This approach frees the therapist from needing to fit the client’s experience into a predetermined definition such as “rational” and allows the client the freedom to explore alternative ways to describe that experience. It is the therapist’s job to ensure that enough questions are asked so that the client and therapist’s world-views are accurately represented in the two-way process of communication.

 

Every behavior has a positive intention presupposes that even behavior that results in unpleasant symptoms has important meaning and perhaps even survival value from the client’s perspective. This implies that there is a strong motivation for the client to continue the behavior. However aberrant, perverse, or irrational it may seem to the therapist, the ability to understand it from the client’s perspective is crucial. Once the therapist can understand the client’s perspective, and assist her to achieve that positive intention using a different set of behaviors, the shared understanding creates a clear client-generated alternative that will have at least the same motivational impetus as the original behavior.

 

Assuming that every behavior is meaningful in some context, means that it is important to explore and understand the original context of the behavior, or how the client finds a place for it subjectively, in order to develop a more client-centered approach to the therapy. For example, a client that has been raised in a family where only highly emotional requests are honored will sound offensive making requests in a normal social situation. Bringing these often-unconscious contextual differences to consciousness can help maintain the integrity of the intervention and ensures the solution is congruent with the whole client.

 

2. Analyzing and Manipulating Perceptions

While NLP recognizes the broad categorical definitions in the DSM and the ICD, it has developed

a unique modeling perspective that can account for the almost infinite subtleties of individual

experience that those categories encapsulate. NLP reimagines pathology in terms of client-specific

maps, and patterns of affect and behavior that can be changed. When diagnosing a problem, the

NLP therapist identifies the client’s idiosyncratic internal perceptions that give rise to the symptom

or problem. This is accomplished by careful questioning and observing to “map” out the sequence

of representations (images, internal voices, feelings) that result in the undesirable emotion.

 

A spider phobia, for example, is a specific cognitive representation composed of sights, sounds,

and feelings that can be modeled and changed by manipulating the structure of those perceptions.

For example, the NLP therapist could assist a client to shift a multisensory representation of the

perceived phobic stimulus. Thus a huge, three-dimensional spider, with weight and texture,

climbing up the client’s arm can be altered to a distant, tiny spider, safely contained in a jar. If

accomplished with the highly sensitive client-centered interaction offered by NLP, this kind of

perceptual alteration will generally change the feeling component of the schema and with it the

phobic response.

 

3. Therapeutic Flexibility

There are additional core presuppositions espoused by NLP that provide great flexibility to the therapist.  The meaning of communication is determined by the listener’s understanding and response.  The root of this assumption is that it is not what the therapist intends to say, but rather how the client responds to it that gives the communication meaning.  The therapist must constantly monitor the client’s responses and alter the communication to ensure understanding.  This requires greater flexibility on the part of the therapist in framing communications in a way that takes the client’s perceptual vantage point into consideration.  To improve this flexibility, sound NLP training teaches therapists to “calibrate” the effect their communication is having in the minute physiological (facial, eye, postural, etc.) changes in the listener during communication.

 

Central to NLP-based therapeutic interventions is the premise that if what you are doing doesn’t work, do something different.  This tenet provides the therapist both permission and obligation to change an intervention based on verbal and non-verbal feedback from the client.  This creates the potential for a multiple approach to any problem and an exceptionally flexible and meticulous therapeutic dynamic.

 

Challenging irrational responses.  In CBT, the classical schema for a panic attack or other anxiety disorder is:  an irrational and disproportionate or catastrophizing interpretation of an otherwise unremarkable event.  Anxiety disorders are triggered by an exaggerated sense of the importance of an event or ideation.  A religious person exaggerates the implicit blasphemy in a passing thought, a homophobe over-reacts to an appreciation of the male figure, a person afraid of violence exaggerates a passing violent thought.  In each case the evaluation is typically branded by the therapist as illogical, catastrophizing or otherwise in need of “correction.”  This focus on the content of the response and the clinician’s interpretation is in stark contrast to NLP which takes the client-centered position in meticulously detailing the internal personal representations of those “problems.”  That is, in the client’s internal world, their interpretation of external reality, when perceived from their inner representation of reality is rational:  The client’s perceptions justify their responses.

 

This translates to significantly different approaches to treatment.  When added to CBT-based schemata, the incorporation of perceptual changes implies the recasting of the schema to include the client’s personal experience.  NLP, to the contrary, creates the schema using the client’s perceptual distortions. NLP looks to the structure of the thought; how its internal representation as an image, a voice or a feeling might be distorted in such a way as to be perceived as malicious or dangerous.  Known as sub-modalities, these subtle aspects of perception can be consciously manipulated by the client.  As an example, a simple content analysis of a statement like, “John said I shouldn’t do it,” cannot convey the speaker’s agreement or disagreement with John.  However, add in the tonal sub modality with which John’s name is spoken, and John might become either a scornfully disrespected villain or a respected mentor.

 

Use of sub-modalities.  Sub-modalities are the details of sensory experience that code for salience (or value, whether positive or negative) and intensity.  They include such factors as distance, focus, movement, complexity, intensity, size, speed and position.  Their relationship to emotional impact and salience is well documented.  They operate pre-consciously and with practice can be used to alter subjective experience.

 

An NLP clinician exploring the sub-modalities of the client’s response to the trigger might find that he holds a brightly colored image of the anticipated calamity moving across his imagination that is big, close, and brightly lit.  The client can be taught to practice making the image smaller, moving it into the distance, draining the color from it and even giving it a frame. Practice with other less troublesome stimuli can give the client enhanced confidence in using the intervention on more critical experiences.

 

Alternatively, in the case of a sound stimulus, a client might report the memory of her mother’s voice loudly intoning the same destructive message over and over, from a specific locus in space, close-by, with rasping tonality.  Working with the client to modify the structure of the experience, the clinician might discover that turning down the volume, moving the voice to a different point in space, giving it some distance, and providing it with some melody might transform the voice into a loving reminder that she is loved and needs to be careful.

 

Use of language.  Language is another area where the two approaches to treatment differ. Classical CBT has identified typical patterns of irrational or distorted language that describe the client’s response to the initial stimulus.  These are often stated as judgments about the content of the responses.  NLP also offers specific challenges for language patterns that reflect distorted meanings or perceptions.  However, in contrast to CBT, NLP does not target the rationality of the statement, but rather its structure.

 

Here’s an example of the difference:  An Obsessive Compulsive client might assert the irrational belief that “Whenever I’m in charge, things go wrong.”  In contrast to CBT, NLP does not target the rationality of the statement, but its structure.  Instead of challenging the entire statement, NLP, using the Meta-model, examines its elements point by point in order to explore information that the client may have lost awareness of.

 

Thus the phrase, “Whenever I’m in charge…” is identified as a universal quantifier; it is linguistic form that implies no other possibilities.  The therapist might challenge it by asking questions like “Every time you are in charge?  Every single time?  Has there never been a time when you were in charge and things did not go wrong?”  It can also be challenged by asking for counter-examples:  “Can you tell me about a time when you were in charge and nothing went wrong.”  Such challenges help clients bring into consciousness beliefs about themselves and the world that are painful or limiting and replace them with more productive beliefs and perceptions.

 

In full agreement with CBT’s idea of thought-action-fusion, the Meta-model also recognizes cause-effect distortion; the idea that one unrelated thought can and must give rise to a subsequent and often unwanted action.  The client above may believe that the mere act of “thinking I’m in charge” will make things go wrong.  This pattern is challenged by asking the client how he knows this will happen or how many times she has actually experienced this chain of events in the past.

 

In the Meta-model, the word ‘things’, is an example of unspecified referential index.  Because the actual “thing” is not specified, there is no way to test for its truth-value.  If unchallenged, it will remain a controlling element of the client’s belief about himself.  The NLP intervention is to ask for the missing information:  “What specific things go wrong when you’re in charge?” and requiring precise examples.  As examples are provided, they too can be explored for their validity.

 

The Phrase “… things are more likely to go wrong…” exhibits a lost comparative and is challenged by asking:  “More likely than what?”  or even, “More likely according to whom or what standard?”  Once again the client’s language is brought back to him in an effort to clarify the meaning and to encourage a less distorted experience of the world.

 

The meta-model is non-judgmental.  It can always be presented gently, as a means for clarifying and further understanding the client’s model of the world.  When it is used this way—just gentle, respectful probing that helps the client to expand the borders of their world-map—there is little room for resistance.

 

Other interventions.  Continuing to work with the same schema, it might happen that the simple sub-modality intervention is insufficient and the image, sound or feeling continues to return to its pathogenic form.  In this case, NLP provides a series of possible interventions.  One of the more familiar ones might involve the use of anchors, conditioned responses, to bring to bear some positive affect to the structure of the schema.  While the focus of this paper is on use of NLP’s sub-modalities and the meta-model, it is important here to point out that other many NLP interventions have been created for a wide range of psychological problems.

 

Evaluating the Effectiveness of NLP

CBT schemata are validated by their ability to describe generalized response patterns where the specific internal representations producing those schemata are unknown.  CBT has documented a number of well-validated models of common pathologies.  This library of general patterns provides the NLP community a jumpstart on the creation and testing of effective techniques from its unique client-centered perspective.  Unlike CBT that uses an intervention based on a generalized template, NLP custom designs an intervention for each case by identifying a target behavior, describing its structure, and then designing possible modifications likely to result in problem resolution.  The NLP formulation must always contain the internal steps or process by which the client “does the problem.”  NLP-based therapeutic interventions are validated when changes in the internal representations causing the problem result in problem resolution.  This client-centered approach, however, makes evaluating NLP-based clinical interventions using typical scientific methods difficult.  What is needed is an approach using measurement tools appropriate to NLP’s client centered format so that the results clearly and more easily yield scientific validation.  The following outlines such an approach:

 

Provide a standard DSM or ICD 10 diagnosis but make the target of the treatment the client’s self-described problem and a clearly defined emotional and behavioral treatment goal (desired outcome).  Then, using a questionnaire, have the client rate the severity of the problem and the results of treatment.  For example, “On a scale of 1 – 10, how does this problem negatively impact your everyday function?” or “On a scale of one to ten, how often do you experience behavioral symptom x?” and “On a scale of one to ten, how well have your emotional and behavioral goals for treatment been met?”  By standardizing the subjective evaluation questionnaire and collecting pre- and post-treatment data from thousands of NLP-trained therapists, the data could be assessed across a large sample of case studies and used to evaluate the subjective effectiveness of NLP interventions for any broad diagnostic category.  This would create a statistically relevant database on the efficacy of NLP-based treatment.

 

Conclusion

The preceding discussed the interface between NLP and CBT and some of the scientifically validated tools from NLP.  It suggested that insights from NLP might give rise to a full-spectrum, client-centered CBT.  This short introduction does not begin to plumb the depths either of NLP or CBT.  It does, however, point the way to positive practices, with strong scientific support that may serve to enhance the already formidable record of CBT into a full-spectrum set of clinical tools.

 

Richard M. Gray, Ph.D., and Frank L. Bourke, Ph.D.

See the original paper that this article was based on, NLP and CBT: Towards a full-spectrum cognitive behavioral psychology, in the Spring 2014 issue of Contemporary Psychotherapy with its extensive bibliography at www.researchandrecognition.org and http://contemporarypsychotherapy.org.

 

*For simplicity, the term “client” will be used throughout this paper.  The concepts are equally applicable to “patients.”

 

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