Cognitive behavioral therapy (CBT)
Cognitive behavioral therapy (CBT)
"Cognitive therapy initially addresses symptom relief, but it's ultimate goals are to remove systematic biases in thinking and modifying the core beliefs that predispose the person to future distress." - Beck.
What to expect?
CBT is an approach in which therapist seeks to understand client as an individual. It is not an impersonal approach. Cognitive therapist shares equal responsibilities for what happen in therapy, involving clients in setting goals and session agendas. They also elicits feedback from clients.
How it works?
The therapeutic intervention is of two type: Cognitive Intervention and Behavioral Intervention.
1. Elicitation and identifying automatic thoughts:
a. Providing reasons: The therapist provide reasons for examining the connections between how clients think, feel and act;
b. Questioning: Clients are questioned about automatic thoughts that occur during upsetting situations.
c. Encouraging client to engage in feared activity: Frequently during sessions, the clients are encouraged to engage in feared activities and asked how they are feeling during the activity.
d. Focusing on imagery: Though individual difference exists, clinical observations suggest that many people visualizing scenes react to them as if they are real.
e. Self monitoring thoughts: They may complete a daily record log of automatic thought recording.
II. Reality testing and correcting automatic thoughts:
a. Conducting Socratic dialogues: Questions seek to help clients become aware of what their thoughts are, gradually, clients learn to question themselves.
b. Identifying cognitive distortion: Clients may use three column technique.
c. Decatastrophising: In decatestrophizing the basic question is "So what happens?".
d. Reattribution: Tests automatic thoughts and underlying beliefs by considering alternative ways of assigning responsibility and cause.
e. Redefining: Making problem more concrete and stating them in terms of what the client might do.
f. Decentring: This involves challenging the client's belief that everyone is focusing on them.
g. Imagery techniques: Assisting clients to get a more realistic perspective, through repeated visualization, projecting them in future and looking back on the present situation.
III. Identifying and correcting/ modifying underlying beliefs:
a. Hypothesis testing: Together therapist and client can set up experiments that encourage clients to test the reality of their beliefs.
b. Reliving Childhood memories: By re-creating pathogenic development situations through role playing and role reversal, clients have an opportunity to restructure or modify beliefs formed during childhood.
c. Refashioned beliefs: Therapists might assist the client to refashion their preformed beliefs about themselves and others.
I. Activity Scheduling: A principle of activity scheduling is to state what activities the clients agree to engage in rather than how much they will accomplish.
II. Rating mastery and pleasure: Using 0-10 scale clients can rate the degree of mastery and degree of pleasure they experienced in each activity during the day.
III. Hypothesis testing: Hypothesis testing has both behavioral and cognitive components. (Beck and Weishaar, 2000).
IV. Rehearsing behavior and role playing: Behavior rehearsal can be used to develop client's skills for specific social and stressful situations.
V. Using diversion technique: Clients can be encouraged in activities that divert them from strong negative emotions and thinking with activities like play, socializing etc.
VI. Assigning homework: Homework's purpose is to shorten the time spent in therapy and facilitate the development of cognitive and behavioral skills for use under counselling.
When it is used?
Cognitive-behavior therapies have proven highly effective in treating an array of non-psychotic conditions,including depression, anxiety disorders, eating disorders, drug and alcohol dependence, and sexual dysfunctions. These therapies help people overcome troubling thoughts, feelings, and behaviors and also to prevent relapses after therapy has ended. In addition, cognitive-behavior therapies can help people with psychotic symptoms learn how to manage their symptoms.
Role of a Cognitive Behaviour therapist:
Serving as co-investigator
In cognitive therapy, all of the client's conditions are viewed as testable hypotheses. The therapist and client provide collaborative effort in the scientific endeavor of examining the hypotheses.
Serving as a guide
Therapist can operate as guides to assist clients to discover the themes that run through their present automatic thoughts and beliefs. Another use of guided discovery is, therapists can guide a client in reality testing.
Atkinson, R. L., Atkinson, R. C., Smith, E. E., Bem, D. J., & Nolen-Hoeksema, S. (1996). Hilgard's introduction to psychology (12th ed.). Harcourt Brace College Publishers