COGNITIVE BEHAVIORAL THERAPY.... CBT

CBT

Cognitive Behavioral Therapy

Cognitive Behavioral Therapy (CBT) is an umbrella-term for psychotherapeutic systems that deal with cognitions, interpretations, beliefs and responses, with the aim of influencing problematic emotions and behaviors. CBT can be seen as a general term for many different therapies that share some common elements and theoretical underpinnings. Cognitive behavioral therapy (also known by its abbreviation, CBT) is a short-term, goal-oriented psychotherapy treatment that takes a hands-on, practical approach to problem-solving.

CBT is widely accepted as an evidence- and empiricism-based, cost-effective psychotherapy for many disorders and psychological problems. It is often used with groups of people as well as individuals, and the techniques are also commonly adapted for self-help manuals and, increasingly, for self-help software packages

Historical Development:

CBT can be traced to early pioneers of psychology, but cognitive counseling, as it is practiced today was developed in the fifties and sixties. Throughout the seventies, the cognitive and behavioral schools were joined by thinkers and practitioners into cognitive-behavioral counseling. Beginning in the eighties and continuing through today, there has been a growing interest in cognitive-behavioral counseling because of its proven effectiveness and because this form of treatment can be administered in a briefer amount of time than traditional psychoanalysis or psychotherapy.

Becoming disillusioned with long-term psychodynamic approaches based on gaining insight into unconscious emotions and drives, Beck came to the conclusion that the way in which his clients perceived and interpreted and attributed meaning—a process known scientifically as cognition—in their daily lives was a key to therapy. Albert Ellis was working on similar ideas from a different perspective, in developing his Rational Emotive Behavior Therapy (REBT). The new cognitive approach came into conflict with the behaviorism ascendant at the time, which denied that talk of mental causes was scientific or meaningful, rather than simply assessing stimuli and behavioral responses. In the 1960s, Aaron T. Beck, observed that during his analytical sessions, his patients tended to have an internal dialogue going on in their minds, almost as if they were talking to themselves. But they would only report a fraction of this kind of thinking to him.

For example, in a therapy session the client might be thinking to him- or herself: “He (the therapist) hasn’t said much today. I wonder if he’s annoyed with me.” These thoughts might make the client feel slightly anxious or perhaps annoyed. He or she could then respond to this thought with a further thought: “He’s probably tired, or perhaps I haven’t been talking about the most important things.” The second thought might change how the client was feeling.

Beck realized that the link between thoughts and feelings was very important. He invented the term automatic thoughts to describe emotion-filled thoughts that might pop up in the mind. Beck found that people weren’t always fully aware of such thoughts, but could learn to identify and report them. If a person was feeling upset in some way, the thoughts were usually negative and neither realistic nor helpful. Beck found that identifying these thoughts was the key to the client understanding and overcoming his or her difficulties.

Beck called it cognitive therapy because of the importance it places on thinking. It’s now known as cognitive-behavioral therapy (CBT) because the therapy employs behavioral techniques as well. The balance between the cognitive and the behavioral elements varies among the different therapies of this type, but all come under the umbrella term cognitive behavior therapy. CBT has since undergone successful scientific trials in many places by different teams, and has been applied to a wide variety of problems.

 However, the 1970s saw a general "cognitive revolution" in psychology. Behavioral modification techniques and cognitive therapy techniques became joined together, giving rise to Cognitive Behavioral Therapy.

Approaches and systems within Cognitive Behavioral Counseling:

Perhaps the most well known approaches and therapeutic systems within CBT include Cognitive Therapy, Rational Emotive Behavior Therapy, Cognitive Behavior Modification, Reality Therapy and Multimodal Therapy. One of the earliest forms of Cognitive Behavior Therapy was Rational Therapy pioneered by Albert Ellis in the early 1950s. Ellis eventually called his system Rational Emotive Behavioral Therapy in the mid 1990s, or REBT. Aaron T. Beck, inspired by Ellis, developed another CBT approach, called Cognitive Therapy, in the 1960s. In recent years, however, cognitive and behavioral techniques have often been combined into cognitive behavioral treatment.

Other types of Cognitive Behavioral Therapy include Dialectical Behavior Therapy, Acceptance and Commitment Therapy, Self-Instructional Training, Schema-Focused Therapy and many others. Cognitive Behavioral Group Therapy (CBGT) is also a similar approach in treating clinical conditions, based on the protocol by Richard Heimberg.

Characteristics of Cognitive Behavioral Therapy:

Cognitive-behavioral therapy does not exist as a distinct therapeutic technique. The term "cognitive-behavioral therapy (CBT)" is a very general term for a classification of therapies with similarities.  There are several approaches to cognitive-behavioral therapy, including Rational Emotive Behavior Therapy, Rational Behavior Therapy, Rational Living Therapy, Cognitive Therapy, and Dialectic Behavior Therapy.

However, most cognitive-behavioral therapies have the following characteristics:

1. CBT is based on the Cognitive Model of Emotional Response:

Cognitive-behavioral therapy is based on the idea that our thoughts cause our feelings and behaviors, not external things, like people, situations, and events.  The benefit of this fact is that we can change the way we think to feel / act better even if the situation does not change.

2. CBT is briefer and Time-Limited:

Cognitive-behavioral therapy is considered among the most rapid in terms of results obtained.  The average number of sessions clients receive (across all types of problems and approaches to CBT) is only 16.  Other forms of therapy, like psychoanalysis, can take years.  What enable CBT to be briefer are its highly instructive nature and the fact that it makes use of homework assignments. CBT is time-limited in that we help clients understand at the very beginning of the therapy process that there will be a point when the formal therapy will end.  The ending of the formal therapy is a decision made by the    therapist and client.  Therefore, CBT is not an open-ended, never-ending process.

3. A sound therapeutic relationship is necessary for effective therapy, but not the focus:

Some forms of therapy assume that the main reason people get better in    therapy is because of the positive relationship between the therapist and client. Cognitive-behavioral therapists believe it is important to have a good, trusting relationship, but that is not enough.  CBT therapists believe that the clients change because they learn how to think differently and they act on that learning. Therefore, CBT therapists focus on teaching rational self-counseling skills.

4. CBT is a collaborative effort between the therapist and the client:

Cognitive-behavioral therapists seek to learn what their clients want out of life (their goals) and then help their clients achieve those goals. The therapist's role is to listen, teach, and encourage, while the client's roles is to express concerns, learn, and implement that learning.

5. CBT is based on aspects of stoic philosophy:

Not all approaches to CBT emphasize stoicism. Rational Emotive Behavior Therapy, Rational Behavior Therapy, and Rational Living Therapy emphasize aspects of stoicism.  Beck's Cognitive Therapy is not based on stoicism.   

Cognitive-behavioral therapy does not tell people how they should feel. However, most people seeking therapy do not want to feel they way they have been feeling. The approaches that emphasize stoicism teach the benefits of feeling, at worst, calm when confronted with undesirable situations. They also emphasize the fact that we have our undesirable situations whether we are upset about them or not. If we are upset about our problems, we have two problems -- the problem, and our upset about it.  Most people want to have the fewest number of problems possible.  So when we learn how to more calmly accept a personal problem, not only do we feel better, but we usually put    ourselves in a better position to make use of our intelligence, knowledge, energy, and resources to resolve the problem.

6. CBT uses the Socratic Method:

Cognitive-behavioral therapists want to gain a very good understanding of their clients' concerns. That's why they often ask questions. They also encourage their clients to ask questions of themselves, like, "How do I really know that those people are laughing at me?"  "Could they be laughing about something else?"

7. CBT is structured and directive:

Cognitive-behavioral therapists have a specific agenda for each session. Specific techniques / concepts are taught during each session. CBT focuses on the client's goals.  We do not tell our clients what their goals "should" be, or what they "should" tolerate.  We are directive in the sense that we show our clients how to think and behave in ways to obtain what they want. Therefore, CBT therapists do not tell their clients what to do -- rather, they teach their clients how to do.

8. CBT is based on an educational model:

CBT is based on the scientifically supported assumption that most emotional and behavioral reactions are learned.  Therefore, the goal of therapy is to help clients unlearn their unwanted reactions and to learn a new way of    reacting. 

Therefore, CBT has nothing to do with "just talking".  People can "just talk" with anyone.

The educational emphasis of CBT has an additional benefit -- it leads to long term results.  When people understand how and why they are doing well, they know what to do to continue doing well.

9. CBT theory and techniques rely on the Inductive Method:

A central aspect of rational thinking is that it is based on fact. Often, we upset ourselves about things when, in fact, the situation isn't like we think it is. If we knew that, we would not waste our time upsetting ourselves.

Therefore, the inductive method encourages us to look at our thoughts as being hypotheses or guesses that can be questioned and tested.  If we find that our hypotheses are incorrect (because we have new information), then we can change our thinking to be in line with how the situation really is.

 10. Homework is a central feature of CBT:

 If when you attempted to learn your multiplication tables you spent only one hour per week studying them, you might still be wondering what 5 X 5 equals. You very likely spent a great deal of time at home studying your multiplication tables, maybe with flashcards.

The same is the case with psychotherapy. Goal achievement (if obtained) could take a very long time if all a person were only to think about the techniques and topics taught was for one hour per week. That's why CBT therapists assign reading assignments and encourage their clients to practice the techniques learned.

The Art and Science of Cognitive Behavioral Counseling:

The art of this approach is twofold. First, counselors can work with clients to help them discover dysfunctional thoughts from the perspectives of the client’s worldview and not from the counselor’s view of what is rational or functional. Second, counselors can attempt to create a balance in terms of exploring the etiology of dysfunctional thoughts, addressing both intra-psychic forces and postmodern considerations that are reflected contextually between clients sand socio-cultural and political forces in their environments.

Cognitive-behavioral counseling continues the strong tradition in science. In this regard, the cognitive-behavioral school of counseling has the strongest research base of any school of counseling.

KEY CONCEPTS:

CBT perceives psychological problems as stemming from common place processes such as faulty thinking making incorrect inferences on the basis of inadequate or incorrect information. In failing to distinguish between fantasy and reality. Some of the faulty assumptions and misconceptions termed as cognitive distortions are ask follows:

·                     Arbitrary Inferences refers to making conclusions without supporting and relevant evidences. This includes catastrophizing or thinking of the absolute worst scenario and outcomes for most situations.for example you might begin your first job as a counselor with the conviction that you will not be liked or valued by either your colleagues or your clients. You are convinced that you fooled your professors and somehow just manage to get your degree.

·                     Selective Abstraction: it consists of forming conclusions based on as isolated detail of an event. In this process other information is ignored and the significance of the total context is missed. The assumption is that the events that matter are those dealing with failure and deprivation. As a counselor, you might measure your worth by your errors and weaknesses, not by your successes.

·                     Over Generalization: it is a process of holding extreme beliefs on the basis of a single incident and applying them inappropriately to dissimilar events or settings. If you have difficulty working with one adolescent, for example you might conclude that you will not be effective counseling any adolescents. You might also conclude that you will not be effective working with any clients.

·                     Magnification and Minimization: it consists of perceiving a case or situation in a greater or lesser light than it truly deserves. You might make this cognitive error by assuming that even minor mistakes in counseling a client could easily create a crisis for the individual and might result in psychological damage.

·                     Personalization is a tendency for individuals to relate external events to themselves, even when there is no basis for making this connection? If a client does not return for a second counseling session, you might be absolutely convinced that this absence is due to your terrible performance during the initial session. you might tell yourself, “this situation proves that I really let that client down, and now she may never seek help again.”

·                     Labeling and mislabeling involve portraying one’s identity on the basis of imperfections and mistakes made in the past and allowing them to define one’s true identity. Thus, if you are not able to live up to all of a client’s expectations, you might say to yourself, “I’m totally worthless and should turn my professional license in rightly away.

·                     Polarized thinking involves thinking and interpreting in all-or-nothing terms, or categorizing experiences in either or extremes. With such dichotomous thinking, events are labeled in black or white terms. You might give yourself no latitude for being an imperfect counselor. You might view yourself as either being the perfectly competent counselor (which means you always succeed with all clients) or as a total flop if you are not fully competent (which means there is no room for any mistakes.

Therapeutic methodologies:

The particular therapeutic techniques vary within the different approaches of CBT according to the particular kind of problem issues, but commonly may include keeping a diary of significant events and associated feelings, thoughts and behaviors; questioning and testing cognitions, assumptions, evaluations and beliefs that might be unhelpful and unrealistic; gradually facing activities which may have been avoided; and trying out new ways of behaving and reacting. Relaxation, mindfulness and distraction techniques are also commonly included. Cognitive behavioral therapy is often used in conjunction with mood stabilizing medications to treat conditions like bipolar disorder.

Cognitive behavioral therapy generally is not an overnight process. Even after patients have learned to recognize when and where their mental processes go awry, it can take months of effort to replace a dysfunctional cognitive-affective-behavioral process or habit with a more reasonable and adaptive one.

Importance of Negative Thoughts:

CBT is based on a model or theory that it’s not events themselves that upset us, but the meanings we give them. If our thoughts are too negative, it can block us seeing things or doing things that don’t fit – that disconfirm – what we believe is true. In other words, we continue to hold on to the same old thoughts and fail to learn anything new.

For example, a depressed woman may think, “I can’t face going into work today: I can’t do it. Nothing will go right. I’ll feel awful.” As a result of having these thoughts – and of believing them – she may well ring in sick. By behaving like this, she won’t have the chance to find out that her prediction was wrong. She might have found some things she could do, and at least some things that were okay. But, instead, she stays at home, brooding about her failure to go in and ends up thinking: “I’ve let everyone down. They will be angry with me. Why can’t I do what everyone else does? I’m so weak and useless.” That woman probably ends up feeling worse, and has even more difficulty going in to work the next day. Thinking, behaving and feeling like this may start a downward spiral. This vicious circle can apply to many different kinds of problems.

Where Do These Negative Thoughts Come From?

Beck suggested that these thinking patterns are set up in childhood, and become automatic and relatively fixed. So, a child who didn’t get much open affection from their parents but was praised for school work, might come to think, “I have to do well all the time. If I don’t, people will reject me.” Such a rule for living (known as a dysfunctional assumption) may do well for the person a lot of the time and help them to work hard.

But if something happens that’s beyond their control and they experience failure, then the dysfunctional thought pattern may be triggered. The person may then begin to have automatic thoughts like, “I’ve completely failed. No one will like me. I can’t face them.”

Cognitive-behavioral therapy acts to help the person understand that this is what’s going on. It helps him or her to step outside their automatic thoughts and test them out. CBT would encourage the depressed woman mentioned earlier to examine real-life experiences to see what happens to her, or to others, in similar situations. Then, in the light of a more realistic perspective, she may be able to take the chance of testing out what other people think, by revealing something of her difficulties to friends.

Clearly, negative things can and do happen. But when we are in a disturbed state of mind, we may be basing our predictions and interpretations on a biased view of the situation, making the difficulty that we face seem much worse. CBT helps people to correct these misinterpretations.

Effectiveness of Cognitive Behavioral Therapies:

Cognitive Behavioral Therapy has proven in scientific studies to be effective for a wide variety of problems, including mood disorders, anxiety disorders, personality disorders, eating disorders, substance abuse disorders, and psychotic disorders. It has been clinically demonstrated in over 400 studies to be effective for many psychiatric disorders and medical problems for both children and adolescents. It has been recommended in the UK by the National Institute for Health and Clinical Excellence as a treatment of choice for a number of mental health difficulties, including post-traumatic stress disorder, OCD bulimia nervosa and clinical depression. There is good evidence for CBT's effectiveness in reducing symptoms and preventing relapse.

Cognitive Behavioral Therapy most closely allies with the Scientist-Practitioner Model of Clinical Psychology in which clinical practice and research is informed by: a scientific perspective; clear operationalization of the "problem" or "issue"; an emphasis on measurement (and measurable changes in cognition and behavior); and measurable goal-attainment.

The American Psychiatric Association Practice Guidelines (April 2000) indicated that among psychotherapeutic approaches, cognitive behavioral therapy and interpersonal psychotherapy had the best-documented efficacy for treatment of major depressive disorder, although they noted that rigorous evaluative studies had not been published.

Anxiety disorders

For treatment of anxiety, a meta-analysis of 35 studies shows the psychological method of cognitive behavioral therapy to be more effective in the long term than pharmacologic treatment (drugs such as SSRIs), and while both treatments reduce anxiety, CBT is more effective in reducing depression.

Mood disorders

For treatment of depression, a large-scale study in 2000 showed substantially higher results of response and remission (73% for combined therapy vs. 48% for either CBT or a particular discontinued antidepressant alone) when a form of cognitive behavior therapy and that particular discontinued anti-depressant drug were combined than when either modality was used alone.

Insomnia

Cognitive behavioral therapy has been found to be effective in reducing benzodiazepine usage in the treatment of insomnia.

Therapeutic Goals:

1        One of the goals of CBT typically is to identify and monitor thoughts, assumptions, beliefs and behaviors that are related and accompanied to debilitating negative emotions and to identify those which are dysfunctional, inaccurate, or simply unhelpful. This is done in an effort to replace or transcend them with more realistic and useful ones.

2        Its goal is to change patterns of thinking or behavior that are behind people’s difficulties, and so change the way they feel. It is used to help treat a wide range of issues in a person’s life, from sleeping difficulties or relationship problems, to drug and alcohol abuse or anxiety and depression.

View of Human Nature:

Beck contends that people are a product of the interaction of innate, biological, developmental, and environmental factors (Beck & Weishaar, 2005). He also suggests that people have the capacity for self-determination by emphasizing the role of cognitions in mental health.

Therapeutic Process:

The first session of therapy will usually include time for the therapist and you to develop a shared understanding of the problem. This is usually to identify how your thoughts, ideas, feelings, attitudes, and behaviors affect client’s day-to-day life.

Client should then agree a treatment plan and goals to achieve, and the number of sessions likely to be needed. Each session lasts about 50-60 minutes. Typically, a session of therapy is done once a week. Most courses of CBT last for several weeks. It is common to have 10-15 sessions, but a course of CBT can be longer or shorter, depending on the nature and severity of the condition. In some situations CBT sessions can be done by telephone. CBT is one type of psychotherapy ('talking treatment'). Unlike other types of psychotherapy it does not involve 'talking freely', or dwell on events in your past to gain insight into your emotional state of mind. It is not a 'lie on the couch and tell all' type of therapy.CBT tends to deal with the 'here and now' - how client’s current thoughts and behaviors are affecting you now. It recognizes that events in client past have shaped the way that they currently think and behave. In particular, thought patterns and behaviors learned in childhood, However, CBT does not dwell on the past, but aims to find solutions to how to change current thoughts and behaviors so that they can function better in the future.

CBT is also different to counseling which is meant to be non-directive, empathic and supportive. Although the CBT therapist will offer support and empathy, the therapy has a structure, is problem-focused and practical.

            Unlike many traditional counseling processes, CBT focus on outcomes and goals. Results include a briefer counseling process in which the client experiences relatively rapid relief and enduring progress. CBT is a simple model and has proven to be a powerful and successful type of psychological treatment in outcome studies conducted over the past several decades.

Therapists Role:

Therapist role is to teach the client how to become healthier and experience a more satisfying, fulfilling lifestyle by modifying certain thought and behavior patterns. Therapist also focuses on teaching the client more positive ways of thinking about and coping with not only illness but also life events and relationships. The counselor initially attempts to promote a positive relationship by establishing the core conditions identified by Rogers: warmth, accurate empathy, and genuineness. The counselor functions as a guide in the counseling process by helping the client understand the role of cognitions in emotions and behaviors. The counselor also acts as a catalyst by promoting corrective experiences that result in necessary cognitive restructuring and skill acquisition. In this process, counselors avoid the role of passive expert. They instead engage in a process of collaboration with the client with the ultimate goal of eliminating systematic biases in thinking.

Therapist-Client Relationship:

In CBT, the therapist and client work together to identify and change negative thinking and behavior patterns that may contribute to emotional and/or physical illness. The focus in therapy is to alter and change these thoughts or self-talks which express one’s beliefs and perceptions. So therapist and client work in collaboration throughout the therapeutic process.

Clients Experience in Therapy:

The client is encouraged to take an active role in the counseling process in setting goals, recounting cognitive and behavioral reactions to problem situations, and doing homework assignments. For example, if client have social phobia, early in the course of therapy client may be asked to keep a diary of his/her thoughts which occur when they become anxious before a social event. Later on client may be given homework of trying out ways of coping which you have learned during therapy.

How Does Cognitive Behavioral Therapy Work?

How cognitive behavioral therapy works is complex. There are several possible theories about how it works, and clients often have their own views. Perhaps there is no one explanation. But CBT probably works in a number of ways at the same time. Some it shares with other therapies, some are specific to CBT. The following illustrate the ways in which CBT can work.

Learning coping skills:

CBT tries to teach people skills for dealing with their problems. Someone with anxiety may learn that avoiding situations helps to fan their fears. Confronting fears in a gradual and manageable way helps give the person faith in their own ability to cope. Someone who is depressed may learn to record their thoughts and look at them more realistically. This helps them to break the downward spiral of their mood. Someone with long-standing problems in relating to other people may learn to check out their assumptions about other people’s motivation, rather than always assuming the worst.

Changing behaviors and beliefs:

A new strategy for coping can lead to more lasting changes to basic attitudes and ways of behaving. The anxious client may learn to avoid avoiding things! He or she may also find that anxiety is not as dangerous as they assumed. Someone who’s depressed may come to see themselves as an ordinary member of the human race, rather than inferior and fatally flawed. Even more basically, they may come to have a different attitude to their thoughts – that thoughts are just thoughts, and nothing more.

A new form of relationship:

One-to-one CBT brings the client into a kind of relationship they may not have had before. The ‘collaborative’ style means that they are actively involved in changing. The therapist seeks their views and reactions, which then shape the way the therapy progresses. The person may be able to reveal very personal matters, and to feel relieved, because no-one judges them. He or she arrives at decisions in an adult way, as issues are opened up and explained. Each individual is free to make his or her own way, without being directed. Some people will value this experience as the most important aspect of therapy.

Solving life problems:

The methods of CBT may be useful because the client solves problems that may have been long-standing and stuck. Someone anxious may have been in a repetitive and boring job, lacking the confidence to change. A depressed person may have felt too inadequate to meet new people and improve their social life. Someone stuck in an unsatisfactory relationship may find new ways of resolving disputes. CBT may teach someone a new approach to dealing with problems that have their basis in an emotional disturbance.

Techniques:

Cognitive-behavioral therapy integrates the cognitive restructuring approach of cognitive therapy with the behavioral modification techniques of behavioral therapy. The therapist works with the patient to identify both the thoughts and the behaviors that are causing distress, and to change those thoughts in order to readjust the behavior. In some cases, the patient may have certain fundamental core beliefs, called schemas, which are flawed and require modification. For example, a patient suffering from depression may be avoiding social contact with others, and suffering considerable emotional distress because of his isolation. When questioned why, the patient reveals to his therapist that he is afraid of rejection, of what others may do or say to him. Upon further exploration with his therapist, they discover that his real fear is not rejection, but the belief that he is hopelessly uninteresting and unlovable. His therapist then tests the reality of that assertion by having the patient name friends and family who love him and enjoy his company. By showing the patient that others value him, the therapist both exposes the irrationality of the patient's belief and provides him with a new model of thought to change his old behavior pattern. In this case, the person learns to think, "I am an interesting and lovable person; therefore I should not have difficulty making new friends in social situations." If enough "irrational cognitions" are changed, this patient may experience considerable relief from his depression.

A number of different techniques may be employed in cognitive-behavioral therapy to help patients uncover and examine their thoughts and change their behaviors. They include:

Behavioral homework assignments: Cognitive-behavioral therapists frequently request that their patients complete homework assignments between therapy sessions. These may consist of real-life "behavioral experiments" where patients are encouraged to try out new responses to situations discussed in therapy sessions. Working on homework assignments between sessions, in this way, is a vital part of the process. What this may involve will vary. For example, at the start of the therapy, the therapist might ask the client to keep a diary of any incidents that provoke feelings of anxiety or depression, so that they can examine thoughts surrounding the incident. Later on in the therapy, another assignment might consist of exercises to cope with problem situations of a particular kind.

Cognitive rehearsal: The client imagines a difficult situation and the therapist guides him through the step-by-step process of facing and successfully dealing with it. The client then works on practicing, or rehearsing, these steps mentally. Ideally, when the situation arises in real life, the patient will draw on the rehearsed behavior to address it.

ü  Journal: Clients are asked to keep a detailed diary recounting their thoughts, feelings, and actions when specific situations arise. The journal helps to make the patient aware of his or her maladaptive thoughts and to show their consequences on behavior. In later stages of therapy, it may serve to demonstrate and reinforce positive behaviors.

ü  Modeling: The therapist and client engage in role-playing exercises in which the therapist acts out appropriate behaviors or responses to situations.

ü  Conditioning: The therapist uses reinforcement to encourage a particular behavior. For example, a child with ADHD gets a gold star every time he stays focused on tasks and accomplishes certain daily chores. The gold star reinforces and increases the desired behavior by identifying it with something positive. Reinforcement can also be used to extinguish unwanted behaviors by imposing negative consequences.

ü  Systematic desensitization: client imagine a situation they fear, while the therapist employs techniques to help the client relax, helping the person cope with their fear reaction and eventually eliminate the anxiety altogether. For example, a client in treatment for agoraphobia, or fear of open or public places, will relax and then picture herself on the sidewalk outside of her house. In her next session, she may relax herself and then imagine a visit to a crowded shopping mall. The imagery of the anxiety-producing situations gets progressively more intense until, eventually, the therapist and client approach the anxiety-causing situation in real-life (a "graded exposure"), perhaps by visiting a mall. Exposure may be increased to the point of "flooding," providing maximum exposure to the real situation. By repeatedly pairing a desired response (relaxation) with a fear-producing situation (open, public spaces), the patient gradually becomes desensitized to the old response of fear and learns to react with feelings of relaxation.

ü  Validity testing: Clients are asked to test the validity of the automatic thoughts and schemas they encounter. The therapist may ask the patient to defend or produce evidence that a schema is true. If the client is unable to meet the challenge, the faulty nature of the schema is exposed.

Initial treatment sessions are typically spent explaining the basic tenets of cognitive-behavioral therapy to the patient and establishing a positive working relationship between therapist and patient. Cognitive-behavioral therapy is a collaborative, action-oriented therapy effort. As such, it empowers the patient by giving him an active role in the therapy process and discourages any overdependence on the therapist that may occur in other therapeutic relationships. Therapy is typically administered in an out-patient setting in either an individual or group session.

Cognitive Behavioral Therapy

(ABC Model)

Cognitive Behavioral Therapy (ABC Model) could be described as “as I think, so I feel (and do)!” Understanding it is as simple as A B C.

Activating Event – the actual event and the client’s immediate interpretations of the event

Beliefs about the event – this evaluation can be rational or irrational

Consequences – how you feel and what you do or other thoughts

In the charts above and below (from counselingresources.com) you can see how that when a negative event happens, one can interpret it positively or negatively. How one interprets it affects how one feels, thinks and behaves.  

Examples

Situation One – Negative Perspective

A - Mary is walking down the street, and her friend Sarah walks right on by.

B – Mary thinks, “Oh Sarah is such a jerk.”

C – Next time, Mary ignores Sarah.

The “B” may or may not be true. Here is another possibility.

Situation Two – Positive Perspective

A - Mary is walking down the street, and her friend Sarah walks right on by.

B – Mary thinks, “Oh that Sarah, always distracted.”

C – Mary calls out, Sarah apologizes for missing her, and they go for coffee!

As you can see, the role of the counselor in cognitive behavioral therapy is to challenge false beliefs – what I call...

The Lies We Tell Ourselves

These distortions in our thinking including:

1. Black-and-White - Thinking or either / or thinking.

2. Making Unfair Comparisons – usually in the negative

3. Filtering – honing in on the negative, forgetting the positive.

4. Personalizing - The Self-Blame Game

5. Mind-Reading – thinking we know what others think (negatively)

6. Catastrophising – imagining the worst case scenario

7. Overgeneralising – “I always mess up…”

8. Confusing Fact with Feeling – “If I think or feel this way then my thoughts/feelings must be correct'.

9. Labeling – I’m a loser vs. I made a mistake.

10. 'Can't Stand it is' – being unnecessarily intolerant

Meichenbaum's Self-instructional Approach:

Psychologist Donald Meichenbaum pioneered the self-instructional, or "self-talk," approach to cognitive-behavioral therapy in the 1970s. This approach focuses on changing what people say to themselves, both internally and out loud. It is based on the belief that an individual's actions follow directly from this self-talk. This type of therapy emphasizes teaching patients coping skills that they can use in a variety of situations to help themselves. The technique used to accomplish this is self-instructional inner dialogue, a method of talking through a problem or situation as it occurs.

Preparation:

Patients may seek therapy independently, or be referred for treatment by a primary physician, psychologist, or psychiatrist. Because the patient and therapist work closely together to achieve specific therapeutic objectives, it is important that their working relationship is comfortable and their goals are compatible. Prior to beginning treatment, the patient and therapist should meet for a consultation session, or mutual interview. The consultation gives the therapist the opportunity to make an initial assessment of the patient and recommend a course of treatment and goals for therapy. It also gives the patient an opportunity to find out important details about the therapist's approach to treatment, professional credentials, and any other issues of interest.

In some managed-care clinical settings, an intake interview or evaluation is required before a patient begins therapy. The intake interview is used to evaluate the patient and assign him or her to a therapist. It may be conducted by a psychiatric nurse, counselor, or social worker.

EVALUATION:

Strengths:

1.      Cognitive behavior therapy undoubtedly has much in its favor. It is an attractive, efficient therapy that is relatively easy to learn and deliver and produces good results in many instances. In addition, cognitive behavior therapy researchers have set standards in detailed descriptions of their methods (“manualisation”), monitoring of adherence, and tailoring treatments to specific disorders that have had a major impact on psychotherapy practice and research generally. Cognitive behavior therapy is the therapy to beat, and this has sharpened the minds of psychotherapy researchers worldwide.

2.      It has a rational basis in applied learning theory and is not that difficult to carry out. With its relatively short time scale and the systematic structure of its interventions, it lends itself to, and does relatively well in, controlled trials against its more protracted or idiosyncratic rival therapies. It is cheap and often cheerful, in the sense of not insisting on a cathartic show of misery as part of the therapeutic ritual. Patients often like it.

3.      The strength of cognitive behavior therapy is its broad application in many settings, not just psychiatric, and with many different client groups and at different levels of expertise.

4.      Cognitive behavior therapy is not just about psychiatry nor is it just a set of theoretical techniques. It has a strong theoretical base in the discipline of psychology, which informs treatment development through a scientific understanding of both normal and abnormal mental functioning.

5.      Furthermore, cognitive behavior therapy is collaborative—the patient is an equal, and information is shared.

6.      The focus on symptoms in cognitive behavior therapy and in randomized controlled trials promotes a particular “fit,” and Jeremy Holmes rightly argues that this gives cognitive behavior therapy a head start over other psychotherapies

Cognitive behavior therapy is particularly dependent on compliance, and the method wins patients' cooperation. It is ineffective in non-compliant patients.

Limitations of cognitive behavior therapy:

1.      CBT does not suit everyone and it is not helpful for all conditions. client need to be committed and persistent in tackling and improving your health problem with the help of the therapist. It can be hard work. The 'homework' may be difficult and challenging. Client may be taken 'out of his/her comfort zone' when tackling situations which cause anxiety or distress.

2.      Cognitive behavior therapy works well in university based clinical trials with subjects recruited from advertisements, but the evidence about how effective it can be in the real world of clinical practice is less secure. In the London depression trial, for example, couple therapy performed better than antidepressants for treating severe depression in patients living with partners, but cognitive behavior therapy came nowhere, having been discontinued early in the trial because of poor compliance from a particularly problematic (but clinically typical) group of patients.

3.      Linehan argues that standard cognitive behavior therapy for patients with conditions as complex as borderline personality disorder is unlikely to be effective.

SUMMARY:

There are actually several kinds of Cognitive-Behavioral therapies (spelled behavioural in British English), and they all employ the same general premise: in contrast to the psychodynamic emphasis on insight into unconscious motivation, the cognitive-behavioral therapies emphasize the ability of people to make changes in their lives without having to understand why the change occurs. As such, these therapeutic techniques usually take much less time and are therefore less costly than psychodynamic psychotherapy.