More on CBT

I’m a cognitive behavioural therapist so I’ll mainly be posting information about this type of therapy. But not exclusively! Therapy is an extremely broad domain and there is a form of therapy suited to everyone! Here is some in-depth information about CBT that will maybe get you interested in this type of therapy.

Cognitive behavioural therapy is one of the most widely used methods of therapy. There are several approaches that are categorised cognitive therapies, examples include Rational Emotive Behaviour Therapy (REBT) began by Albert Ellis in the 1950s, Cognitive Therapy (CT) began by Aaron Beck, Multimodal Therapy by Arnold Lazarus, as well as other approaches that have been categorised as cognitive in nature are Eric Bernes, Transactional analysis and Glassers Reality Therapy.

These approaches are broadly understood to focus on cognitions as the main causative factor in human behavioural problems. A therapist using CBT seeks to modify cognitions by the use of cognitive, emotive and behavioural techniques so that a client’s symptoms can be alleviated.

The major premise in CBT is that human behaviour is a result of biopsychosocial factors in human beings, that is, how a person thinks and feels will influence how he/she acts, and these are in turn affected by the individual’s genetics (the ‘bio’ part) and his or her social context. Thoughts and feelings combine with beliefs, assumptions and perceptions to produce goal-directed actions.

Functional and Dysfunctional Thinking

In CBT individuals are seen as either thinking in a functional or dysfunctional way. Functional thinking is also referred to as rational thinking and consists of thoughts that are flexible, logical, self-enhancing, relationship enhancing and consistent with reality.

Irrational thinking refers to thoughts that are rigid, demanding, self-condemning beliefs, self and other depreciation. Thus thoughts lead to development and maintenance of problems because according to Ellis people are not disturbed by the situations they experience in life but by the inflexible and extreme views that they hold about their personal situations. The disturbance that results is experienced as cognitive, emotional and behavioural problems that block one from achieving their goals, feelings of being immobilised, persistent emotional extremes that linger on and on, distortion of reality and illogical ways of evaluating self.

Psychological Disturbance in Cognitive Behavioural Therapy

Although there are many approaches with CBT, there is agreement that the thinking processes of a person are the main problem area and are therefore the point of focus. One way of examining thought content is by using the REBT approach. This approach identifies two main processes that maintain symptoms, that is; (i) Ego disturbance where the client holds irrational beliefs about his or her self and (ii) Discomfort disturbance where the client maintains irrational beliefs about their emotional comfort (i.e., “it’s horrible to feel sadness” or “I must always feel happy”).

These forms of disturbance are often a result of inferences and evaluations that we form about events occurring in our lives. As noted earlier, these inferences or thoughts about events can be rational or irrational. When someone is disturbed, some of the irrational inferences that will distort the reality of the person are, for example, engaging in black and white thinking where things are seen as either good or bad, right or wrong, or with no middle ground.

Another distortion involves reasoning in an emotional way i.e. ‘I am a failure and that is how others see me’. The person may also personalise issues where he or she takes the blame for the wrong things happening around him or her often without evidence. The person may also attribute negative motives to normal everyday behaviours like thinking ‘she ignored me…I must have done something to make her angry’.

These are some of the inferential thinking styles that often lead to uncomfortable symptoms. Other thinking problems we engage in are: being too demanding on self and others, exaggerating or minimising consequences of an event, negative self-evaluation based on some standard or measure of worth or desirability. Often such a standard or measure is applied holistically, for example, ‘I failed my term examinations, therefore am a total failure’.

The other major problem area in thinking involves core beliefs. These are beliefs that an individual uses to make decisions in their everyday life. The core beliefs function as rules or assumptions that underlie every decision one makes.

The assumptions one has are reflected on the inferences that an individual makes about a situation, for example, a person may think “I am unhappy because of events that I cannot control, so there is nothing I can do”.

We may also function under a series of self-mode rules like; ‘to be worthwhile in life, I must achieve success without failure. Or ‘no man is self-sufficient I must always look for someone stronger to rely on to succeed’.

Behaviour Change in People

CBT approaches focus on helping people to understand the connection between emotions, thoughts, and behaviour. The main work of the therapist will be helping individuals discover and examine their core beliefs and the inferences they make because of these personal beliefs.

Albert Ellis developed the ABC format for this purpose. The therapist uses an episode in a client’s life and applies the ABC format to the experience. In this format, ‘A’ is the activating event, ‘B’ is the belief the client has about the situation and ‘C’ is the consequence. The client is helped to understand that the consequences at ‘C’ are not caused by the activating event ‘A’ but by the beliefs at ‘B’. The therapist teaches the client the technique and typically assigns homework to the client in the form of monitoring his/her behaviour using the model.

The client is then taught how to Dispute and change the irrational beliefs at B and replace them with more rational beliefs. The dispute leads to a desired new effect in terms of feelings and desired behaviour E and eventually further actions that are desirable to client F.

Thus the ABC format is extended to include D, E, & F, to help the client to learn how to change problematic thinking process to more effective thinking processes.

Cognitive Behavioural Therapy – Therapeutic Process

The role of the therapist in CBT involves engaging the client in a way that will support the client’s behaviour change by instilling a sense of hope and understanding of the client’s problematic situation.

The therapist then assesses the client’s problem situation focusing on the client’s view of the problem, their personal history, the extent of the problem, and relevant personality factors, biological factors, secondary benefits and related clinical disorders.

The client and therapist determine a set of objectives toward change. Appropriate behavioural strategies and techniques are employed to alleviate the client’s problems.

During the process of change, continuous evaluation is carried out to monitor progress in relation to the techniques being applied. The client is also prepared for possible outcomes, both negative and positive so as to avoid discouragement if relapse occurs.

Positive reinforcement is regularly used by the therapist to reinforce positive changes in the client’s life and outlook.

Cognitive Behavioural Therapy Interventions

Therapists using CBT need to be conversant with a wide range of strategies available in this approach. The therapist typically uses whatever strategy will work for the particular client.

Some of the available strategies include cognitive techniques, imagery techniques and behaviour techniques. Examples of cognitive techniques are rational analysis to help clients learn to dispute beliefs that are irrational, and reframing, which helps clients see negative episodes in a more positive way.

Examples of imagery techniques are: postponing gratification which is used to counter a tendency to low tolerance to frustration – clients thus learn to delay enjoyable problematic behaviours like smoking.

Examples of behavioural techniques include stimulus control where the client is asked to learn about the connection between events and their consequences, a client who has trouble sleeping can be asked to stay awake until he or she becomes drowsy after which he or she will sleep naturally.

Through stepping out of character, a client can be asked to do the opposite of a behaviour that is a problem (e.g. a shy person can be asked to ask a stranger what time it is). Therapists can also teach clients the skills that are lacking in their life (e.g. social skills for shy people and assertiveness skills for clients who have a problem in interpersonal relationships).

Areas of Application

This approach to therapy has the widest range of usage in the therapeutic setting. Some of the areas of application include addictions, sexual problems, personality disorders, anxiety problems, mood disorders, eating disorders, substance abuse and alcohol problems, anger management, pain management, stress management and child, adolescent and family problems.

These issues can be addressed using various methods like individual counselling, family therapy and group work.

Bibliography

Froggatt, W. (2005]. A Brief Introduction to Rational Emotive Behaviour Therapy (3^rd ed.). Stratford Lodge: New Zealand.

Froggatt, W. (2009). A Brief Introduction to Cognitive-Behaviour Therapy. Stratford Lodge: New Zealand.