15 August 2011

What Is Cognitive Behavioural Therapy

'People are not disturbed by events, but by the view they take of them'. This comment by the Greek philosopher Epictetus two thousand years ago aptly reflects the basic tenet of modern cognitive behaviour therapy (CBT)-that what people believe affects their emotions. CBT is structured, problem-oriented, and set in the here and now, and has rapidly become the treatment of choice for a wide range of mental health disorders.

CBT combines the scientific advances made in one branch of psychology from roughly the 1930-60’s called behaviourism, with the branch of cognitive psychology, which came later around the 1970-80’s. These two branches were combined because psychologists came to the realization that thoughts, behaviors, and emotions are all interlinked as shown in the figure below.

CBT is based on the idea that our thoughts lead to how we feel and how we act and that external things, such as people, situations and events play a much lesser role. Cognitive Behavioral Therapy presupposes that it’s our interpretation of events, rather than the events themselves, that cause the negative emotional and/or behavioral consequences we experience in a given situation.

 Thus, CBT psychologists aim to make people feel better by changing how they think and behave.
CBT is a process of teaching, coaching, and reinforcing positive behaviours. CBT helps people to identify cognitive patterns or thoughts and emotions that are linked with behaviours. Cognitive behavior therapy is generally short-term and focused on helping clients deal with a very specific problem. During the course of treatment, people learn how to identify and change destructive or disturbing thought patterns that have a negative influence on behavior.
Cognitive-behavioral Therapy (CBT) can be applied to virtually any emotional, behavioral or psychiatric condition. It is an effective model for helping, with more research behind it than any other modality of treatment.Because CBT is usually a short-term treatment option, it is often more affordable than some other therapeutic options.
Cognitive Behavioral Therapy (ABC Method) could be described as “as I think, so I feel (and do)!” In any given situation you have:
A. Activating Event – the actual event and the client’s immediate interpretations of the event
B. Beliefs about the event – this evaluation can be rational or irrational
C. Consequences – how you feel and what you do or other thoughts
 The cognitive therapist differs from the behavioral therapist in the sense that the cognitive therapist is interested in “why” negative events have such profound meanings for the patient. For example, although the breakup in a relationship often results in sadness for many people, we differ in the meaning we attach to it. The patient’s schemas (or themes of vulnerability) might lead him to ascribe any number of meanings to a breakup, such as abandonment, unworthiness, helplessness, emptiness, or unlovability.

Origins of CBT

Albert Ellis's rational emotive therapy--which was developed in the 1960's-- was an important precursor to Beck's work and the cognitive-revolution.
Ellis, originally a psychoanalytically-oriented sex and marriage therapist, proposed that pathology was entirely due to irrational distortions such as" shoulds"---"I should be successful at everyone" or "I should be liked by everyone"--- "awfulizing" ("It's awful that I don't succeed") and low frustration tolerance ("I can't stand waiting"). Ellis has proven to be a prolific author, generating books on marriage, sex, substance-abuse, procrastination, and a range of other topics for both popular and professional audiences (Ellis, 1962; 1971; 1973; 1985; Ellis & Grieger, 1977). In the 1970s, a group of cognitive therapists in Philadelphia led by Aaron T Beck listened carefully to what their clients were saying and turned to learning theory and the cognitive revolution to formulate a new theoretical account and therapeutic approach to depression. This first CBT therapy protocol was then subjected to efficacy research of CBT for Depression, which has since been followed with many more trials unequivocally demonstrating that CBT is an effective therapy

Present scenario:

CBT is attracting increasing levels of interest from health care professionals, consumers and families. A variety of factors may contribute to this rise in popularity.

First, recent decades have seen a growing recognition of the high prevalence rates of many psychological problems. Mental disorders negatively affect the quality of life for the person as well as his or her family. Many of these disorders (including depression, anxiety, and alcohol problems) have been shown to respond well to CBT.

Second, we face increased demands for efficient and cost-effective health care services. CBT has the benefits of being structured, effective and, in most cases, relatively brief.

Third, people are increasingly interested in alternatives to medications. In some cases, CBT represents a proven, and sometimes superior, alternative to medication.

In other cases, CBT is a beneficial addition to medication, hastening improvement and helping to maintain improvements over time.

Fourth, CBT models “consumer focused care”, in which practitioners and individuals work together to build the tools individuals need to make changes necessary to living better.
Fifth, the strategies and skills of CBT can be applied to any of life’s challenges. The strategies and skills a person acquires to manage depression, for example, can also be used to manage chronic pain, control drinking or maintain exercise. The effectiveness of CBT in changing and maintaining changes in behavior makes it very important to consumers and to health care services.

The main key principles of CBT include the following:

Collaboration. In CBT, the psychologist is not the sole authority of the patient’s problem. The psychologist aims to establish a collaborative relationship to help the other person understand their problem through questioning, the testing of hypotheses and beliefs and guided discovery, always with warmth, empathy and genuineness. The psychologist will regularly solicit the thoughts and opinions of the person seeking help. In turn, the role of the client is to ask questions, to learn and implement new ways of thinking and behaving.

Tailored to the individual. CBT does not aim to tell the person how they should think or feel because each of us is an individual with a unique personality and set of experiences. In fact, the client is the best judge of how they feel in the moment and how they would like to feel. CBT aims to tailor therapy to the person’s goals and to help them find the best ways to feel better using what research studies have shown to be effective.

Focusing on the ‘Here and Now’. CBT aims to target the main symptoms or problems that are causing emotional distress in order to alleviate the person’s suffering. Thus, it focuses on the ‘here and now’. Specific techniques and concepts are taught. Once a reduction in symptoms has been experienced, more deep and underlying issues and beliefs can be discussed.

Acceptance of the person. Because each of us is unique, CBT uses both Socratic Questioning and the Inductive Method to help the person understand themselves. The psychologist will ask the client many questions to understand his/her problem and in turn to help them understand themselves and discover things that they may not have been aware of. And because each of us is a distinct and rational individual, CBT does not aim to tell people that their beliefs are wrong. Rather, a logical approach is taken in which evidence is gathered and hypotheses are tested in order to evaluate the person’s reality and thoughts. CBT encourages us to look at our thoughts and beliefs and test them by gathering evidence. If we have missed a fact, assimilating it into our beliefs might lead to a change in our belief. For example, if someone believes that everyone is laughing at them, a CBT approach accepts that this may be true. Evidence is gathered (e.g. Are there times when no one is laughing at you?) and then the belief is re-evaluated.

Structure and education. At the beginning of each session, an agenda is set in order to structure what is to be accomplished and discussed in the current meeting. Agenda items can include psychoeducation, teaching of specific skills or techniques, a review of recent problems, or a review of homework. It is important that both the psychologist and patient set the agenda collaboratively in order for the session to be meaningful and beneficial to the person seeking help.

Teaching of skills and techniques. In CBT, skills and techniques that science has shown to be effective in relieving the symptoms of the target problem are taught to the individual. These focus on changing ways of thinking, as well as how to engage in behaviours that will help change how the person feels.

Brief and time-limited. Research has shown that symptom relief can be accomplished after 10-16 weekly sessions of CBT. In contrast, other types of psychotherapy, such as psychoanalysis, can last years will no end in sight. Although CBT aims to relieve suffering in the shortest time possible, it can last longer than 10-16 sessions depending on the problem. Both the psychologist and client can collaboratively discuss the number of sessions that are required based on how the person is progressing. They can even decide to decrease the frequency of sessions from weekly to bi-monthly or even monthly. Thus, unlike other forms of psychotherapy, CBT aims to have a beginning and an end.

Importance of homework. It is unlikely that just meeting for one-hour per week with a psychologist will lead to any significant change. The real work occurs outside regular therapy sessions when what the client has been taught can be tested and practiced in the real world. The psychologist suggests regular homework exercises in order for the client to practice what he/ she has been learning during therapy. These exercises should be reviewed during the next therapy session in order for you to obtain some feedback. Homework is essential in CBT. Research studies have shown that those who consistently engage in homework exercises achieve quicker and more long-lasting changes than those people who do not.

Becoming your own psychologist. If the psychologist has done a good job, the client should eventually become his own psychologist! This means that the client can identify and apply what he/she has learned if ever any new problems develop in the future. If needed, the client can always schedule ‘booster sessions’ with the psychologist whenever necessary in order to review any material or to get their help.

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