Cognitive Behavioral Therapy
Humans have an ability to create, develop, and actualize themselves as healthy goal-attaining people. However, this being said they also have an ability to structure irrational thinking, inappropriate emotions and dysfunctional behaviours (Nelson-Jones 1995). Each person on this earth has their own internal storage device for gathering thoughts, ideas, beliefs, memories, the list goes on. A persons mind can affect them in so many ways that can’t be seen from the external perspective people take of them.
When a person is experiencing difficulty trying to comprehend what it is exactly that is going on in their head they may approach it in a number of different ways, such as talking to a family member or close friend or perhaps seeking help from professionals who may be able to guide them in the right direction. The latter can sometimes prove to be extremely difficult for some people as they may have prefabricated negative beliefs about seeking such help and may not be open to the idea at all. Patients of psychotherapy can be looked at through a number of different approaches.
One such approach that will be focused on throughout this essay is cognitive behavioural therapy (CBT). Different from the many other forms of psychotherapy cognitive behaviour therapy has been proved scientifically to be effective in hundreds of clinical trials for many different disorders. (Beck 2013). This particular approach is generally more focused on the present whereas other approaches taken can be more orientated towards looking into the past of the client. Cognitive behavioural therapy therefore focuses with the current issues and problems of the client.
It is usually more problem-solving orientated and more restricted by the amount of time limited to treatment. A bonus of effective cognitive behavioural therapy is that patients will develop skills that will aid them to; identify distorted thinking; modify their beliefs; relate to others in different ways, and change their behaviour. These skills can be useful not just after therapy but for the rest of their lives (Beck website). However, by failing to consider the past experiences of a person and only focusing on the here and now can this approach to therapy not have negative consequences towards the thinking or behaviour of a person also?
What happens in peoples past can surely have some form of effect on how that person is thinking or behaving in the present. The purpose of this essay is therefore to consider some of the many aspects of cognitive behavioural therapy, outline the main principles and techniques of this approach to psychotherapy. It will also look to provide any criticisms that can be seen from the literature about this practice. To grasp a better understanding of cognitive behavioural therapy a brief historical overview will be given along with an overview of the approach itself and the main contributors to this practice of psychotherapy.
Ultimately CBT could be seen to have developed as a result of two revolutions within the field of psychology, the behavioural revolution and the cognitive revolution. The former occurred first around the 1940’s when a group of psychologists who had been influenced by the work of Ivan Pavlov set out to redefine psychology as the science of behaviour (Miller 2003). Miller (2003) then goes on to explain how by the mid 1950’s it was the belief that behaviourism would not succeed and if scienti? c psychology were to succeed, mentalistic concepts would have to integrate and explain the behavioural data.
Miller stresses the point of 1956 being the year for the cognitive science for him personally. However it is clear from the literature that it was the approaches of Albert Ellis and Aaron Beck that formulated the most prominent theories and models within the school of CBT (Nelson-Jones 1995). The two schools had gathered momentum and by the 1980’s they had merged together to form what we now know as CBT (Hall 2010). Following is a brief outline of the main works from both Ellis and Beck and an account as to how it can shed some light on the way in which people think or view themselves.
Over the years Ellis has continued to edit the name of his approach. At first, in 1955, he phrased it as rational therapy (RT), in 1961 it became rational-emotive therapy, and in 1993 it changed again to rational emotive behaviour therapy (REBT) (Nelson-Jones 1995). The term ‘rational’ is referring to cognition that is effective in self-helping rather than cognition that is empirically and logically valid (Nelson-Jones 1995). Basically what this means is that the cognition may not make sense or be supported by evidence so long as it helps the person help themselves.
In his work Ellis distinguished between two types of REBT; general and preferential. General REBT aims to teach the client rational or appropriate behaviours while the latter includes general REBT, it also teaches clients how to use powerful cognitive behavioural methods as self-helping skills along with how to dispute self-defeating behaviours and irrational ideas (Nelson-Jones 1995). Ellis’s approach theorizes that people are ‘biologically predisposed to strongly, passionately, and rigidly construct and hold on to their disturbance-creating musts and other irrational beliefs’ (Ellis 1993).
In other words they tend to make similar mistakes due to the fact that they possess an overwhelming potential to be illogical and destructive of themselves and others. Is it also the case that people posses a certain amount of free will in terms of whether or not they make themselves emotionally disturbed (Nelson-Jones 1995). Ellis (1998) uses the example of his sister and how she was in some way responsible for her misery by consciously or unconsciously victimizing herself in relation to ‘what is going on in the world’.
Looking into Albert Ellis’ ABC theory of personality sheds some light as to how people’s perceptions of what is going on around them can affect how they think and behave. ‘A’ is any particular event that might have happened, it is just a fact. ‘B’ then is what that person’s belief about that event is; beliefs can either be positive or negative. Having a negative belief about something isn’t necessarily bad, it is when a person believes in something that is not true they begin to form what Ellis describes as ‘irrational beliefs’.
The emotional and behavioural consequences that are formulated from the persons belief of the activating event is ‘C’ (Jorn 2009). Ellis’s theory will be looked at in greater detail when considering his approach and how it helped the field of cognitive behavioural therapy. For now let us take a look at the work of another great contributor to this field of psychotherapy. In Beck’s early years he found himself in a position where psychoanalysis in America did not work. People that had gone to seek help for being miserable remained miserable.
The message of American psychoanalysis at this time was to ‘allow the patient’s time to shave off the awkward square pegs of their personalities in order that they fit into the round holes created by society’ (Hall 2010). Beck questioned however, why not actively stimulate this process instead of waiting for something to change (Hall 2010). During the 1960’s Beck was a psychiatrist at the University of Pennsylvania. It was during this time that his research led him to examine the psychoanalytic concepts of depression.
His work led him to discover that people who are depressed tend to have negative thoughts that may pop into their heads at any given time (Beck Website). These are cognitions labelled by Beck as ‘automatic thoughts’. In order to understand automatic thoughts it is first necessary to grasp the idea of schemas. Beck et al (1990) observe that schemas are the cognitive structures that organize a person’s experiences and behaviour; the beliefs and rules of the person are what the schema is made up of, and they ultimately determine the content of the thinking and behaviour.
Information processing is based on fundamental beliefs embedded in schemas. It is because of these schemas that people have unique vulnerabilities and sensitivities that predispose them to psychological distress. People’s schemas and beliefs influence the way the process data about themselves (Nelson-Jones 1995). Automatic thoughts are more deeply buried than schemas but they reflect the content of a person’s schemas. There are nine significant characteristics of automatic thoughts outlined by Nelson-Jones (1995), they are; 1.
That they are a part of a person’s internal monologue. This is how and what we say to ourselves. 2. Automatic thoughts can take the shape of either; words, images, or a combination of both. 3. These thoughts occur quickly usually at the edge of awareness. 4. They come before emotions. This is because people’s emotional responses to each other’s actions follow from how they interpret the action rather that the action itself. 5. If people assume these thoughts are accurate they are more likely to believe them. 6.
Even if a person tries to block out these thoughts they will occur again due to a reoccurring quality they have. 7. Automatic thoughts can have an effect on a person’s gestures, tone of voice, and facial expression even though they may not be expressed verbally. 8. Automatic thoughts can be concurrent with more subtle thoughts underlying more obvious thoughts. 9. The fact that these thoughts are usually difficult to identify does not mean can’t. In fact counsellors can train their clients to pinpoint these thoughts with some accuracy.
Having looked into the history of CBT it is now necessary to examine some of the main principles and techniques of this type of therapy. When taking a cognitive-behavioural approach counsellors and therapists asses their clients, and then intervene to help them change the particular aspects of thinking and behaving that sustain their problems (Nelson-Jones 2002). Within CBT it is seen as an essential necessary condition for the client and therapist to have a collaborative relationship. CBT therapists should work alongside their client to achieve the necessary goals.
Both client and therapist each bring something to the table, it is necessary for them to work together to achieve therapeutic change. Unlike other practices the client assumes the role of equal partner in agenda setting, problem solving, and generating self-reflective exercises (Austin et al. 2010). As shown early through the work of both Ellis and Beck a person entering CBT may more often than not view their thoughts and feelings as facts and unshakable truths such as, ‘I know I am a stupid person’(Austin et al. 2010).
The role of CBT is then to help the client view such thoughts, not as fact, but as a believable explanation that should be put to tests and revised as needed (Austin et al. 2010). In order for clients to get the best possible results they are encouraged to account for all the evidence when deciding on the validity and accuracy of their thoughts. In other words they should consider everything that occurred before finalizing their opinion on any particular subject. Empiricism is the view that personal beliefs are based on evidence gathered from our senses.
Dryden (2012) explains how the principle of empiricism in CBT guides the way that clients are encouraged to test out their beliefs, thinking styles, and behaviours in the real world. A person may make an assumption that they are not popular amongst colleges because they do not make an effort to talk to him or her. In turn that person may try to the best of their ability to avoid awkward situations with the colleges. However, perhaps that person didn’t make much of an effort either and now by avoiding the others, has isolated themselves.
Until that person tries to make contact with these people they will never know how they actually feel about them. Effective CBT empowers the client to adopt an empirical approach for themselves; to test for evidence against their long-held beliefs and assumptions (Dryden 2012). Perhaps after CBT the person who isolated themselves will be able to approach one of their colleges, even it is something simple such as small talk. That person should then be able to tell from their experiences if their original beliefs were true or if it was all just in their head.
Empiricism is not just solely for the benefit of the client, it is used in many aspects of CBT. The therapist monitors the outcomes in individual cases; services evaluate their outcomes against multiple cases, and the theories underpinning CBT are tested against evidence in research studies (Dryden 2012). Another prominent principle within CBT is rationalism. This is based on the philosophy that a person’s feelings and behaviour can be explained through how they think. Rationalism is used within most approaches of CBT, an example of it being used could be a client seeking treatment for a panic disorder.
Effective CBT in this instance would help the client to realise that it is their beliefs about the harmful effects of their bodily sensations that is driving the panic attacks (Dryden 2012). By showing the client that is their own beliefs causing the effects they can then gradually become more and more aware of how they are thinking and how to control it. Although some CBT therapy recognises the importance of understanding how ones past experiences shape their present beliefs, behaviours, and thinking, it is mainly concerned with working on the problems the client is currently experiencing (Dryden 2012).
Techniques such as ‘thought catching’ are used to assist the client in noticing thoughts that pass through their mind as they occur. For example, when a client is confronting a particular fear in therapy the focus is on the feeling of anxiety. This should help the client tolerate the feeling better and also show them how the intensity of that emotion reduces over time (Dryden 2012). Within CBT, patients are encouraged to formulate their problems as they result from negative thoughts.
As a result of the treatment they are then supposed to replace these negative thoughts with more realistic ones using an empirical approach (Hall 2010). However when someone is of a persistently negative nature and undermines the therapy itself can it be seen to be effective? After all one of the founding points of CBT is to replace the negative thoughts. If they are still occurring for a person about the therapy itself it could be said that it defeats the purpose of the work of both therapist and client. Unlike other psychotherapy practices CBT places some emphasis on treating the client speedily.
Since the therapy is focused on self-helping and getting the client to grasp a better understanding of the situations they come across in their day to day lives. The client is not subject to a certain amount of sessions and may attend therapy until they feel they have acquired the goal set by the treatment (Bannink 2012). If a therapist accepts the statement of the clients problem at the start of the treatment then they must also proceed to end treatment when the either the client or therapist believe that the needs of the person receiving treatment have been sufficiently met (Bannink 2012).
The treatment should help the person to learn to deal with problems they may encounter in the future not just previous issues that were present before therapy. Although CBT does take some consideration for early experiences its main focus is on the present. If we look at another approach, psychoanalysis, it becomes clear that the early experiences of a person are seen to affect them on later life. The aim of psychoanalysis is to strengthen the client’s ego by lifting childhood repressions (Nelson-Jones 1995).
Freud argued that mental disorders came about as result of mainly traumatic childhood experiences, stressing that a major cause of these disorders was down to indulgence and frustration that occurred during the crucial early stages of development (Millon 2004). Early events establish intensely ingrained defence systems that lead to people reacting to new situations in a similar light as to how they reacted to situations that occurred in the past. These defence systems reoccur throughout life and result in progressive maladaptive behaviour and character disorders (Millon 2004).
If CBT is as focused on the present as we believe it to be, can it be said that it removes this type of cognition from a person’s mind? Ellis would argue that people should just forget their ‘godawful past’ (Ellis 1988). This is because the emphasis is much more on how people sustain their irrationality rather than how they originally acquired it. The past cannot be undone and it is seen to be counterproductive to focus excessively on how people feel about the past (Nelson-Jones 1995). Also people may not particularly want to talk to the therapist about their past.
Instead of using all of their energy focusing on what problems may have caused the particular disorder they focus on how to overcome and deal with it. As noted earlier cognitive behaviour therapy has been proved scientifically to be effective in hundreds of clinical trials for many different disorders. The people that can be treated from such therapy range from people with boarderline personality disorders, juvenile delinquents, and those who are mildly disturbed (Nelson-Jones). An important aspect of any counselling is that the client does not relapse following the termination of therapy.
CBT puts great focus on relapse prevention. Clients are educated on a number of things such as; anticipating and developing strategies to deal with future problems and setbacks, reality-testing their interpretations as self-help skills, and the homework given to them during therapy not only builds their skills for real life during counselling it also prepares them to manage on the own afterwards (Nelson-Jones 1995). Everyone experiences difficulties in their life that they may or may not be able to deal with.
Sometimes we view, what others may see as a minor problem, as an obstacle that we cannot overcome. Such negative thinking not only hampers the mood or behaviour but also decreases the chances of a person getting through such issues. CBT offers people a chance to turn over a new leaf and begin to view things differently than they may have viewed them before. The client and the therapist work together to find the solution that will be best suited for the client’s disorder and then work together to achieve the goal that was set prior to treatment.
Through this type of therapy people are not only getting through issues that occurred prior to therapy, or even during, but also afterwards when the treatment has ended. CBT gives people skills that they can use afterwards in their everyday lives. It encourages people to examine their thinking and to look for evidence when making assumptions about a particular issue. Though there is not much emphasis on the person’s previous experiences during the duration of therapy it seems that by focusing on the present the therapy will be more effective in improving issues that people may encounter in the future. Yes the past is important to all of us but how many times have we been told by family or peers to not ‘dwell on the past’. We can only achieve our goals by looking forward and learning from previous mistakes that we have made.