Cognitive Behaviour Therapy can be used to treat people with a wide range of mental health problems. Cognitive Behavior Therapy (CBT) is based on the idea that how we think (cognition), how we feel (emotion) and how we act (behavior) all interact together. Specifically, our thoughts determine our feelings and our behavior. Therefore, negative - and unrealistic - thoughts can cause us distress and result in problems.When a person suffers with psychological distress, the way in which they interpret situations becomes skewed, which in turn has a negative impact on the actions they take. Cognitive Therapy aims to help people become aware of when they make negative interpretations, and of behavioural patterns which reinforce the distorted thinking. Cognitive Therapy helps people to develop alternative ways of thinking and behaving which reduce the psychological distress.
Cognitive Behavior Therapy (CBT) is, in fact, an umbrella term for many different therapies that share some common elements. Two of the earliest forms of Cognitive Behavior Therapy were Rational Emotive Behavior Therapy (REBT), developed by Albert Ellis in the 1950s, and Cognitive Therapy, developed by Aaron T. Beck in the 1960s. Other types of Cognitive Behavior Therapy include Dialectical Behavior Therapy, Self-Instructional Training, Schema-Focused Therapy and many others.
Scenario: Joan and Joanna, two students, are chatting in the common room.
Joan: I’m not going to the party on Saturday…I’m going to stay at home and revise for the psychology exam on Tuesday.
Joanna: Well, I’m going to the party...there’s no point in me wasting time revising because I know I shall fail anyway.
Joan: Why do you always think you will fail? You passed last year’s exam…and if you don’t revise you are not going to do well.
Joanna: It’s all right for you to be so confident…you always do well, but I know I shan’t get the grade I need, so there’s no point my bothering.
Cognitive psychologists such as Meichenbaum (stress–inoculation training) propose that when thoughts are negative and irrational they affect our emotions and behaviour, and that ‘selfdefeating’ thoughts lead to maladaptive behaviour (behaviour that does not help the person cope with his/her life).
Seligman proposed that depressive illness in humans could be the result of learned helplessness, a state of having learned that whatever you do won’t make a difference and therefore you give up trying. This is another cognitive explanation of behaviour.
Main Assumpions:
• Abnormal behaviour is caused by abnormal thinking processes
• We interact with the world through our mental representation of it
• If our mental representations are inaccurate or our ways of reasoning are inadequate then our emotions and behaviour may become disordered
The cognitive therapist teaches clients how to identify distorted cognitions through a process of evaluation. The clients learn to discriminate between their own thoughts and reality. They learn the influence that cognition has on their feelings, and they are taught to recognise observe and monitor their own thoughts.
Ellis proposes that each of us hold a unique set of assumptions about ourselves and our world that serve to guide us through life and determine our reactions to the various situations we encounter. Unfortunately, some people’s assumptions are largely irrational, guiding them to act and react in ways that are inappropriate and that prejudice their chances of happiness and success. Ellis calls these basic irrational assumptions. Some people irrationally assume that they are failures if they are not loved by everyone they know - they constantly seek approval and repeatedly feel rejected. All their interactions are affected by this assumption, so that a great party can leave them dissatisfied because they don’t get enough compliments. According to Ellis, these are other common irrational assumptions:
• The idea that one should be thoroughly competent at everything
• The idea that is it catastrophic when things are not the way you want them to be
• The idea that people have no control over their happiness
• The idea that you need someone stronger than yourself to be dependent on
• The idea that your past history greatly influences your present life
• The idea that there is a perfect solution to human problems, and it’s a disaster if you don’t find it.
Ellis believes that people often forcefully hold on to this illogical way of thinking, and therefore employs highly emotive, techniques to help them vigorously and forcefully change this irrational thinking.
Ellis is a direct and active therapist who tries to persuade clients that the rational-emotive perspective explains their difficulties. He points out their irrational assumptions in a blunt, confrontational and often humorous way, and then he models the use of alternative assumptions e.g. after criticising a man’s perfectionist standards he may say “so what if you got a crap grade on your essay? It was only one essay - no more than that. It doesn’t mean that you are useless!” Homework assignments are given so that clients can observe their assumptions, and to think of ways to test the rationality of these assumptions.
Rational emotive therapists have cited many studies in support of this approach. Most early studies were conducted on people with experimentally induced anxieties or non clinical problems such as mild fear of snakes (Kendall, Kendall & Kriss, 1983) but a number of recent studies have been done on actual clinical subjects and have also found that RET is often helpful (Lyons & Woods 1991).
The ABCs of Irrational Beliefs
A major aid in cognitive therapy is what Albert Ellis called the ABC Technique of Irrational Beliefs. The first three steps analyse the process by which a person has developed irrational beliefs and may be recorded in a three-column table.
* A - Activating Event or objective situation. The first column records the objective situation, that is, an event that ultimately leads to some type of high emotional response or negative dysfunctional thinking.
* B - Beliefs. In the second column, the client writes down the negative thoughts that occurred to them.
* C - Consequence. The third column is for the negative feelings and dysfunctional behaviors that ensued. The negative thoughts of the second column are seen as a connecting bridge between the situation and the distressing feelings. The third column C is next explained by describing emotions or negative thoughts that the client thinks are caused by A. This could be anger, sorrow, anxiety, etc.
For example, Gina is upset because she got a low mark on a math test. The Activating event, A, is that she failed her test. The Belief, B, is that she must have good grades or she is worthless. The Consequence, C, is that Gina feels depressed.
* Reframing. After irrational beliefs have been identified, the therapist will often work with the client in challenging the negative thoughts on the basis of evidence from the client's experience by reframing it, meaning to re-interpret it in a more realistic light. This helps the client to develop more rational beliefs and healthy coping strategies.
From the example above, a therapist would help Gina realize that there is no evidence that she must have good grades to be worthwhile, or that getting bad grades is awful. She desires good grades, and it would be good to have them, but it hardly makes her worthless. If she realizes that getting bad grades is disappointing, but not awful, and that it means she is currently bad at math or at studying, but not as a person, she will feel sad or frustrated, but not depressed. The sadness and frustration are likely healthy negative emotions and may lead her to study harder from then on.
Another way of viewing the ABCs of Cognitive Behavioral Therapy
* A - Activating Stimulus: This is the stimulus that activates the irrational fear or anxiety in the person.
* B - Blank: This is the blank process that lies in between the stimulus and the irrational thinking. The person would have to identify this gap and create a bridge in their thought process in order to be able to be treated.
* C - Conditioned Response: This is the irrational fear or anxiety with which the person has conditioned him- or herself to respond to the stimulus.
The way the treatment works is that, by going back and thinking over what the stimulus was and the irrational reaction to it, and then trying to follow the chain of events that led from one to the other (thereby filling in the blank in between), the person can identify what causes the thinking to become irrational.
For example;
A person walks out of his home and hears an ambulance siren. The person gets anxious from this and runs back into his home. The Activating Stimulus was the ambulance siren. The Conditioned Response was severe anxiety and running into his home. The person now has to fill in the Blank and try to understand what was the exact thought process that went through his mind that caused the irrational response to take place. By bridging this gap in his thought, he is identifying the faulty thought process that caused the extreme response. The person can now work on replacing these faulty thoughts with realistic ones, thereby correcting the undesired chain of thoughts and activating a functional one.
Beck’s approach is similar to Ellis in that it emphasises recognising and changing negative thoughts and maladaptive beliefs. Beck believes that a person’s reaction to specific upsetting thoughts may contribute to abnormality. As we confront the many situations that arise in life, both comforting and upsetting thoughts come into our heads. Beck calls these unbidden cognition’s automatic thoughts. When a person’s stream of automatic thoughts is very negative you would expect a person to become depressed (I’m never going to get this essay finished, my girlfriend fancies my best friend, I’m getting fat, I have no money, my parents hate me - have you ever felt like this?) Quite often these negative thoughts will persist even in the face of contrary evidence.
In addition, Beck identifies a number of illogical thinking processes including:
• selective attention: seeing only the negative features of an event
• magnification: exaggerating the importance of undesirable events
• overgeneralization: drawing broad negative conclusions on the basis of a single insignificant event
These illogical thought patterns are self-defeating, and can cause great anxiety or depression for the individual.
Beck’s system of therapy is similar to Ellis’s, but has been most widely used in cases of depression. Cognitive therapists help clients to recognise the negative thoughts and errors in logic that cause them to be depressed. The therapist also guide clients to question and challenge their dysfunctional thoughts, try out new interpretations, and ultimately apply alternative ways of thinking in their daily lives. Depressed people who are treated with Beck’s approach improve significantly more than those who receive no treatment and about the same as those who receive biological treatments (Hollon & Beck 1994). Beck’s Cognitive therapy has also been successfully applied to panic disorders and other anxiety disorders (Beck, 1993).
• Ellis views the therapist as a teacher and does not think that a warm personal relationship with a client is essential. In contrast, Beck stresses the quality of the therapeutic relationship.
•RET is often highly directive, persuasive and confrontive. Beck places more emphasis on the client discovering misconceptions for themselves.
• RET uses different methods depending on the personality of the client, in Beck’s cognitive therapy, the method is based upon the particular disorder.
1. Model has great appeal because it focuses on human thought. Human cognitive abilities has been responsible for our many accomplishments so may also be responsible for our problems.
2. Cognitive theories lend themselves to testing. When experimental subjects are manipulated into adopting unpleasant assumptions or thought they became more
anxious and depressed (Rimm & Litvak 1969))
3. Many people with psychological disorders, particularly depressive , anxiety , and sexual disorders have been found to display maladaptive assumptions and thoughts (Beck et al 1983).
4. Cognitive therapy has been very effective for treating depression, and moderately effective for anxiety problems.
1. The precise role of cognitive processes is yet to be determined. The maladaptive cognitions seen in psychologically disturbed people could be a consequence rather than a cause.
2. The cognitive model is narrow in scope - thinking is just one part of human functioning, broader issues need to be addressed.
3. Ethical issues: RET is a directive therapy aimed at changing cognitions sometimes quite forcefully. For some, this may be considered an unethical approach.
Making sense of cognitive behaviour therapy (CBT)
Cognitive Beahvioural Therapy (CBT)