This is part 2 of a series of articles on different form of psychotherapy. Part 1 can be read here.
Psychotherapy is one of many options available to people suffering from mental health problems, psychological issues or those finding life difficult in general. There are many forms of psychotherapy and it can often be confusing which practitioner to go for.
This series of articles are aimed towards decreasing the confusion so that the reader can make an informed decision. In this post I will discuss the main aspects of CBT (Cognitive Behavioural Therapy).
COGNITIVE BEHAVIOURAL THERAPY
‘Cognitive therapies’ are based on how we mentally process information and ‘Behavioural therapies’ are based on learning theories (Flanagan & Flanagan, 2004). Cognitive Behavioural Therapy (CBT) is the form of psychotherapy which integrates the principles and techniques of both these therapies.
CBT is practiced on scientifically validated principles and research (Sweet, 2010). There are different forms within CBT e.g. ‘Rational emotional behaviour therapy’, ‘Acceptance and commitment therapy’, etc. (Beck, 2011). Since apart from varying concepts and emphasis within therapy, all have the same theoretical basis, and as Moorey (2007) points out, are indistinguishable in practice, therefore I will only discuss the main theory in this article.
Oxford Dictionary (2011) defines behaviour as the way in which “a person responds to a stimulus” and cognition as “the mental action or process of acquiring knowledge and understanding through thought and senses”. It is the process through which we interpret and give meaning to ourselves, our lives and what happens in it.
The CBT model postulates that cognitions or thoughts are ‘functionally interrelated’ to our emotions and behaviour (Roth et al., 2002). Therefore in theory, changing one will change the other two.
Emotional distress is caused by how we define our cognitions or how we behave as a result. Hence, the therapy is aimed at identifying and modifying any detrimental beliefs, thoughts or behaviours which may be taking part in causing the psychological distress. This in turn has the effect of alleviating the emotional suffering. Since we think in the present, the therapy is mostly focused in the present as well (Beck, 2011).
BASIC CONCEPTS:
Schemas
The first concept to understand is of schemas. These are the hypothetical cognitive structures that direct the thought process (Moorey, 2007). They are collection of ideas or core beliefs of the individual, which relate to different subjects in life. The person interprets and responds to the experiences in life, based on these beliefs.
In short, they help us simplify and give meaning to our complex life (Freeman & Freeman, 2005). Our daily behaviour is based on
these schemas. If a negative limiting belief predominates, it can make a person think in a negatively biased or distorted way regarding self or others.
Thought errors
Under psychological stress, there is a tendency to misinterpret and evaluate information in a distorted manner. This dysfunctional manner of thinking is present in all forms of psychological disorders (Beck, 2011). A person may over-generalise based on very little evidence or personalise every event.
When these thoughts arise spontaneously in the mind, without any conscious direction, they are called automatic thoughts (Sudak, 2006). Negative automatic thoughts are more frequent, disturbing and usually unchallenged in emotional disorders (Moorey, 2007). CBT works towards challenging these thoughts.
THERAPY AND THERAPEUTIC RELATIONSHIP:
The main goals of CBT are to identify and modify the dysfunctional thoughts and behaviours in order to remove psychological distress (Corey, 2009).
For example in social anxiety, cognitively this could be done by removing errors in beliefs about ability to socialise. Behaviourally, this could be done by teaching new skills or gradual exposure to the feared situation.
Both the client and the therapist play a mutually active role throughout the process. The goals for outcome of therapy are decided by the client. These goals and progress is reviewed in each session and altered according to the needs of
the client (Beck, 2011).
The therapist primarily acts as an ‘educator’, (Roth et
al., 2002) who explains the client how specific ways of thinking cause psychological problems and result in behaviours that maintain the problem.
The client on the other hand is expected to use the techniques taught. The client is given homework e.g. to keep a record of their common negative thoughts, evaluate and challenge them and then consider alternatives. An example of behaviour related homework in social anxiety may be to participate in social interactions in a gradual manner.
The main stance taken throughout therapy is scientific, where both current beliefs and behaviours are questioned, while new alternatives are tested for effectiveness (Sudak, 2006).
Over the course of the therapy the client is taught many skills and is encouraged to become self-reliant. This helps to maintain the changes long-term and prevents relapse after the therapy finishes (Beck, 2011).
RESEARCH:
Beck institute lists over 20 adult psychological conditions that can improve with CBT. Beck reports, that to date over 2000 studies show CBT to be effective for a wide range of psychological disorders.
For example, Gitlin (1995) demonstrated the efficacy of CBT for various forms of depression (Beutler et al., 2001). Various studies e.g. Hollon et al. (1992) and Murphy et al. (1984) have shown that it has effectiveness equal to anti-depressant medication and better outcome compared to no treatment (Law, 2007). Studies like Gortner et al. (1998) and Shea et al. (1992), show that in depression, it reduces the chances of relapse, as compared to medication, over a 2 year period after both treatments have stopped (Kuyken et al., 2005).
Department of Health in its guidelines of psychological therapies suggested CBT for a variety of conditions including depression, anxiety and eating disorders. In this study CBT was found to have best evidence for effectiveness. Likewise, NICE also recommend CBT for depression.
CONCLUSION
CBT focuses on providing therapy which gives the client a relatively fast understanding into the reasons for their psychological distress. With the change in thoughts and behaviour, one can immediately start to see the changes occurring.
This evidence of change may provide added motivation for further change. Nevertheless, this may not be enough. Exploring the past and getting insight into why the issue started in the
first place is essential for complete resolution of the problem.
is closest to the personal preferences and values of the client. For therapies aiming at such goals read the next article in this series.
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References:
- Beck, J. S. (2011) Cognitive behavior therapy: basics and beyond. 2nd edition. New York, The Guilford Press.
- Beutler, L. E, Harwood, T. M. & Caldwell, R. (2001) Cognitive-Behavioral therapy and psychotherapy integration. In: Dobson, K. S. (ed.) Handbook of cognitive-behavioral therapies. 2nd edition. New York, The Guilford Press, pp. 138-170.
- Corey, G. (2009) Theory and practice of counseling and psychotherapy. 8th edition. California, Thomson – Brooks/Cole.
- Feltham, C. (2007) Individual therapy in context. In: Dryden, W. (ed.) Dryden’s handbook of individual therapy. 5th edition. London, SAGE Publications Ltd., pp. 1-26.
- Flanagan, J. S. & Flanagan, R. S. (2004) Counseling and psychotherapy: theories in context and practice – skills, strategies and techniques. New Jersey, John Wiley & Sons.
- Freeman, A. & Freeman S. (2005) Understanding schemas. In: Freeman, A. (ed.) Encyclopedia of cognitive behavior therapy. New York, Springer Science Business Media, Inc., pp. 421-426.
- Kuyken, W., Watkins. E. & Beck, A.T. (2005) Cognitive-Behavior therapy for mood disorders. In: Gabbard, G. O., Beck, J. & Holmes, J. (eds.) Oxford textbook of psychotherapy. Oxford, Oxford University Press, pp. 111-126.
- Law, R. (2007) Depression. In: Freeman, C. & Power, M. (eds.) Handbook of evidence-based psychotherapies: a guide for research and practice. Chichester, John Wiley & Sons Ltd, pp. 315-335.
- Moorey, S. (2007) Cognitive therapy. In: Dryden, W. (ed.) Dryden’s handbook of individual therapy. 5th edition. London, SAGE Publications Ltd., pp. 297- 326.
- Roth, D. A., Eng, W. & Heimberg, R. G. (2002) Cognitive behavior therapy. In: Hersen, M. & Sledge, W. (eds.) Encyclopedia of psychotherapy. Volume 1. USA, Elsevier Science, pp. 451-458.
- Sudak, D. M. (2006) Cognitive behavioral therapy for clinicians:
psychotherapy in clinical practice. Philadelphia, Lippincott Williams & Wilkins.
