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Cognitive Behavioral Therapy

  • BY HOPEQURE
  • 06 Dec 2018

Cognitive behavioural therapy (previously known as cognitive therapy) is a theoretical framework of psychotherapy, which originated in 1950’s. It continues to grow globally with application in diverse cultures. As the name suggests, CBT identifies the relationship between cognition or thinking and behaviour or action. It is firmly based on a “meditational approach”, whereby our patterns of thinking and perceiving are considered an important influencer (mediator) for behaviour.

Various eminent proponents of CBT during the early 1960’s include Aaron.T.Beck, Albert Ellis, Micheal J Mahoney, Donald Meichenbaum. These individuals are credited with devising the basic principles and methods of CBT.

The framework of modern CBT:

CBT emphasises that an individual’s emotions, behaviour and physiological processes come under the strong influence of their perception of events. As different treatment modalities exist under the umbrella of CBT, the importance placed on each of these elements alters according to the goals of the modality being adopted. A common link between them is the fact that they use the same indices to evaluate change1; behaviour and cognition.

The hierarchy of the cognitive model is best represented by the figure below 2,3,4

SITUATION

AUTOMATIC THOUGHTS

(Covert processes)

REACTION

(Emotional, Behavioural and Physiological)

As explained by the pioneers of CBT, it is not the situation at hand that determines an individual’s response directly, but the way it is interpreted that determines it5. Hence, in any situation, an individual can have different streams of thought. One of these streams is of keen interest to a cognitive behavioural therapist. And that is of the “automatic thoughts”; the rapid, brief, stream of thoughts that are not the result of deliberate efforts. It is this “automatic” flow that an individual is essentially unaware of and hence, might hold certain “hidden” tendencies affecting choices and responses. However, it is not intended to oversimplify complexities of human response processes (emotional, behavioural, etc.). Especially since automatic thoughts are based on beliefs that one forms over their lifetime. But, at the fundamental level automatic thoughts represent the final product that emerges from various factors. It is this cognitive conceptualization that is an essential principle common to all modalities of CBT. It is the blue print of CBT that a trained therapist must build upon.

Modalities of CBT:

The techniques of CBT can be divided into the following6

  • Cognitive restructuring methods
  • Coping skills
  • Problem-solving skills

Each of these therapies follows the tenets of the cognitive framework with individual goals. To elucidate further, cognitive restructuring methods are brought to use when maladaptive thinking patterns or styles are considered as the harbinger of distress. It focuses on altering these maladaptive thinking patterns to bring about change. Coping skills can assist a client in more general ways for example, using humour, creative expressions to deal constructively with stressful events. And lastly, problem solving skills focus on developing a set of strategies, such as level headedness, logical thinking, etc., that come in use when dealing with difficult events.

Evidence Base:

CBT as a psychotherapy is one of most widely used treatments for adults7. There are numerous research studies to bolster its efficacy as a treatment for various psychological conditions (with or without medication) with following conditions (amongst others):

  • Mood Disorder: Unipolar depression. severe depression, bipolar disorder
  • Anxiety Disorder: Obsessive Compulsive Disorder, Panic Disorder, Generalized Anxiety Disorder
  • Eating disorders: Bulimia Nervosa, Binge Eating Disorder
  • Others: Marital Distress, Anger Management.

References:

1. Dobson, K. S., & Dozois, D. (2010). Historical and Philosophical Bases of the Cognitive-Behavioral Therapies. In Keith S. Dobson (Eds.), Handbook of Cognitive-Behavioral Therapies (pp. 3–38). New York: The Guilford Press.

2. Beck, A. T. (1967). Depression: Causes and treatment. Philadelphia: University of Pennsylvania Press.

3 .Ellis, A. (1973). Humanistic psychotherapy. New York: McGraw-Hill.

4. Beck, J. S. (2011). Cognitive therapy: Basics and beyond. New York: Guilford Press.

5 .Beck, A. T. (1964). Thinking and depression: II. Theory and therapy. Archives of General Psychiatry, 10, 561–571.

6. Mahoney, M. J., & Arnkoff, D. B. (1978). Cognitive and self-control therapies. In S. L. Garfield & A. E. Bergin (Eds.), Handbook of psychotherapy and behaviour change: An empirical analysis (pp. 689–722). New York: Wiley.

7. Leichensring, F., Hiller, W., Weissberg, M., & Leibing, E. (2006). Cognitive-behavioral therapy and psychodynamic psychotherapy: Techniques, efficacy, and indications. American Journal of Psychotherapy, 60, 233–259.

Cognitive Behavioral Therapy

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