Therapy can help improve mental wellbeing by providing insight into unhelpful thoughts and behaviours. Yet, despite spending a significant amount of time in therapy, some people find they continue to repeat unhealthy emotional, relational or behavioural patterns.

While psychotherapy can help individuals intellectually understand these patterns, insight alone isn’t always enough to create meaningful and lasting change.

To create long-term change, insight can be paired with tools and therapies that address the nervous system, emotional avoidance, habit loops, and attachment and trauma responses.

Why Insight Alone Doesn’t Always Create Change

Research shows that insight into dysfunctional patterns and behaviours is moderately correlated with positive therapy outcomes. It can facilitate higher levels of self-understanding, positive emotional experiences, and fewer negative reactions to stress and challenges.

However, learned emotional and trauma responses can be triggered automatically by external cues and stressors.

Theories suggest this is because the trauma we experience impacts the body by dysregulating the nervous system and altering brain function, notably in areas of the brain that detect danger.

While we may understand why we feel a certain emotion or respond in a certain way, changing these automatic responses involves translating insight gained through therapy into lasting behavioural change through repetition and emotional learning.

This focuses on helping individuals to manage their emotions, establish healthy relationships, improve decision making, and better handle challenging experiences.

Different treatment modalities can compliment psychotherapy to help build these skills, supporting long-term positive change.

Patterns Often Serve a Psychological Purpose

Our nervous system’s automatic fear responses are shaped by our life experiences and develop to keep us safe from stress and threats. When repeated over time, however, these “fight, flight or freeze” patterns can create unhelpful behaviours, for example, hypervigilance, emotional avoidance or anger.

Childhood experiences can also influence our behaviours, thoughts and relationships later in life, and can increase risk of developing depression, post-traumatic stress disorder (PTSD) and anxiety.

In fact, studies show that adverse childhood experiences such as emotional neglect can contribute to maladaptive relationship attachments and social behaviours, health problems and substance misuse.

Research suggests that we repeat these patterns and behaviours because the brain prefers the familiar over the unfamiliar. This repetition strengthens neural connections in the brain and reinforces these habits and thoughts, whether healthy or unhealthy.

Increasing evidence suggests that unprocessed emotions interfere with neuroplasticity, or the brain’s ability to reorganize neural connections, and that rigid habits can increase vulnerability to the development of mental health conditions and elevate chronic stress.

When Therapy Starts Feeling Circular

Psychotherapy can be an excellent way to understand our emotional and behavioral adaptations, but over time some may feel as though they are going over the same conversations without seeing any further progress.

This form of endless analysis can be a way of intellectualising, rationalizing or avoiding emotions rather than experiencing and processing them, or of ruminating on past experiences, whereby individuals continue to dwell on negative emotions and distress.

Studies show that this type of experiential avoidance can lead to poorer therapeutic outcomes, whereas engaging more deeply with emotions rather than cognition was correlated with improved therapeutic outcomes.

When faced with this looping cycle, individuals can use a variety of therapeutic methods that focus on processing and experiencing emotions, and help to practice new, healthy behaviours, by working through anxiety and cultivating self-compassion.

Why Experiential Therapies Are Getting Attention

Increasing research suggests that experiential therapies which use somatic and holistic methods can contribute to improving therapeutic outcomes by working with emotions, the body and by calming the nervous system.

For example, a study of 43 adults with major-depression who were randomly assigned short-term client-centered (CC) and emotion-focused (EFT) therapies shows that emotion-focused interventions correlated with reductions in symptoms of depression and improvement of self-esteem at 18-months, as well as less depressive relapse.

Further research suggests that somatic methods such as breathwork, mindfulness and EMDR can help process emotions, reduce symptoms of anxiety and better manage challenging experiences.

In recent years, emerging studies and clinical trials suggest that psychedelic-assisted therapy may also hold promise for the management of conditions such as resistant-depression, anxiety disorder and PTSD.

Studies show that psychedelics, including compounds such as psilocybin, can increase emotional insight and processing, as well as induce plasticity in the brain that can help to break old habits and build healthier patterns of thinking and behaving.

For example, an open-label feasibility trial of 12 patients with treatment-resistant depression demonstrated that psilocybin treatment in conjunction with psychotherapy saw reductions in depressive symptoms at three months, as well as marked and sustained improvements in symptoms of anxiety and anhedonia.

Further research shows that changes can be seen in brain networks following one treatment with psilocybin. In a single-blind, placebo-controlled neuroimaging study, researchers found that increases in brain signal complexity predicted psychological outcomes, such as psychological insight and improved wellbeing.

What Actually Helps Create Change

In order to create lasting change in wellbeing, emotional processing needs to take place and the insights gained in therapy must be integrated into new patterns of thought and behaviour.

Research suggests that emotional processing, such as awareness, regulation, and transformation are three major principles of emotional change. For example, a review of 24 studies found that these processes predicted positive treatment outcomes, and a study of 19 people with high self-criticism who underwent 10 to 12 sessions of EFT saw reductions in self-criticism and improvements in depression symptoms.

Working on nervous system regulation is also an important factor. Research shows that therapies such as cognitive behavioural therapy (CBT), mindfulness and trauma-focused therapies elicit positive neuroimmune, autonomic and epigenetic changes in the brain, helping to calm physiological reactions and regulate emotions.

By working through these emotions and learning to better regulate responses, individuals can begin practicing and repeating healthier responses and behaviours.

For example, in a review of 53 studies, researchers found that repeating certain behavioural practices had greater short-term efficacy than medication and “treatment as usual”.

Furthermore, emerging research suggests that psychedelic-therapies create a “critical window” of psychological flexibility following treatment whereby neurons can more easily break old connections and form new ones, helping to foster long-term behavioural change.

By pairing emotional insight gained through psychotherapy with the practice of new habits, behaviours, regulation of the nervous system and emotional responses, individuals can work on developing long-term, meaningful change.

Frequently Asked Questions

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