Cognitive-behavioral therapy

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Cognitive Behavioral Therapy (CBT) is a type of psychotherapy which aims to help people transform their maladaptive thoughts and behaviours into a better state of being. Psychologists task patients to try out different situational coping skills and help patients to acknowledge, then challenge those problematic thought patterns, feelings and behaviors. [1] CBT refers to many types of psychotherapeutic systems that deal with cognitions, interpretations, beliefs and responses. These systems come from strategies commonly used in cognitive therapy and behavior therapy, combining them. [1] This combination is used to identify problems faced in the present and tries to improve the patient's current state of mind. [2]

CBT has emerged as a common treatment for concerns regarding moods. It has become increasingly popular for reasons such as its defined structure and that it is based on common sense.[3] Research shows that CBT is the most effective form of treatment for those coping with depression and anxiety. CBT alone is 50-75% effective for overcoming depression and anxiety after 5 – 15 modules. Medication alone is effective, however, science still does not understand the long-term effects on the brain and body. There is evidence which suggests that CBT may be more cost-efficient in the long run in comparison to medication. Although, a combination of medication and CBT seems to be the most effective in overcoming mental illness. In particular, antidepressants paired with CBT could reduce potential relapses in patients facing depression.[4]

CBT is often recommended for mood-related disorders such as depression and anxiety, but it can also treat personality disorders, post traumatic stress disorder and eating disorders. CBT can take place one-on-one between a therapist and a client, during group therapy, or online.

The History of Cognitive Behavioural Therapy[change | change source]

In the early 1900s, Austrian psychotherapist Alfred Adler’s notion of basic mistakes and their role in unpleasant emotions made him one of the earliest therapists to address cognition in psychotherapy. His work inspired American psychologist Albert Ellis to develop rational emotive behaviour therapy (REBT) in the 1950s. This is now considered one of the earliest forms of cognitive psychotherapy. It is based on the idea that a person’s emotional distress arises from their thoughts about an event rather than the actual event itself.

In the 1950s and 1960s, American psychiatrist Aaron T. Beck noticed that his clients had internal dialogues going on in their minds during analytical sessions. He discovered that the clients appeared to almost be talking to themselves, but they only shared a small part of this kind of thinking with him. For example, a person might have thought to themselves, “The therapist is being very quiet today; I wonder if he’s mad at me?” and then began to feel anxious as a result.[5]

CBT is based on a cognitive model of mental illness which Beck proposed. As shown in the example above, the model suggests our emotions are a result of our interpretations of events. Beck put forward three levels of cognition which are core beliefs, dysfunctional assumptions and negative automatic thoughts. Core beliefs seems to be a common issue in patients, an example is Beck's negative triad. This is composed of what seems to be irrational thoughts about the self, the world and the future.[2] This may be evident in patients facing depression. Beck used his model as a starting point to develop CBT so that we can improve our understanding about emotions and behaviour.

In the 1960s, a number of empirical studies into how cognitions affect behaviours and emotions were carried out. This is known as the cognitive revolution. It emphasised the role that conscious thinking plays in psychotherapy and is known as the “second wave” of CBT.

How it works[change | change source]

CBT targets different kinds of maladaptive thinking. The goal is to recognise unhealthy thoughts and develop them into positive thinking patterns. In that sense, CBT is scientific because irrational beliefs are thought of as theories which are tested to see if they are true. CBT is structured in that it uses an ABC format. A represents the activating event which triggers B, your beliefs. This is followed by C, the consequences, which are your actions. Beliefs are composed of different types of thinking. Some examples include catastrophising where small problems are blown out of proportion and all-or-nothing thinking which involves thinking in extremes.[6] When creating solutions, the therapist and patient need to come to an agreement on attainable goals. They follow a criteria which is characterised as SMART: specific, measurable, achievable, realistic and time-limited. Specific and measurable highlight the science behind CBT as the goals are used to test the "hypothesis". Achievable, realistic and time-limited ensure that the patient makes small stages of progress through the intervention. [2]

Techniques[change | change source]

One of the key reasons why CBT is so effective is because of its interactive nature. This is known as collaborative empiricism; the patient and therapist work together in targeting problems and changing negative mindsets. [2] This means that patients play an active role in improving their mental health which is a key element that distinguishes CBT from other treatments. Therapists encourage patients to be active by setting them tasks. This may be noting down positive moments throughout their day or producing a list of things to complete. CBT combines cognitive and behavioural methods to maximise its effect. Therapists often set their patients homework which challenge their irrational beliefs. When patients feel down because of these beliefs, the therapist can produce this as evidence. An example of a behavioural method is that therapists help their patients to collect evidence that challenges the use of their avoidance behaviours. [2] The techniques aim to prepare patient with the skills they need to target their problems independently in the future.

Uses[change | change source]

Cognitive-behavior therapy can be effectively used as a short-term treatment centered on helping people with a very specific problem and teaching them to focus on present thoughts and beliefs.[7]

  • Addictions[8]
  • Anger issues
  • Anxiety
  • Bipolar disorder
  • Depression[9]
  • Eating disorders
  • Panic attacks
  • Personality disorders
  • Phobias
  • Problems with stress

Why it's effective[change | change source]

CBT is now increasingly recommended because it is successful in changing the patient's way of thinking. As previously mentioned, it's effective because patients participate in improving their mental health. They are encouraged to be proactive by acting as their own therapist. This means that once the sessions are over, patients are left with the skills they need to manage their problems. Furthermore, it works because the patient and therapist develop a healthy relationship. It is built upon understanding, cooperation and empathy. [2] Therapists show patience when patients struggle to identify their negative thoughts or when adopting new coping mechanisms. Compromise is also a key element in this relationship, if a strategy is not working, they are willing to work together to find a better solution. It is also effective because CBT focuses mainly on the present. It does not dive into the patient's past because CBT aims to improve the patient's current state of mind.

Criticisms[change | change source]

Despite its popular recommendations, CBT has faced criticism. Arguably, CBT fails to focus on the patient as a whole.[3] This may be because CBT focuses solely on the patient's present. By ignoring the patient's past, therapists may be overlooking the origin of their maladaptive thinking. This makes it difficult to identify solutions if the therapist ignores the underlying issue. Furthermore, CBT is known for its interactive element. This may be counterproductive in patients who face mood-related disorders which are associated with reduced energy levels such as depression.

Revisions[change | change source]

Since the emergence of CBT, several revisions and models have been made. One example is the Five Areas model. This model was created because traditional CBT tends to use complex terms which may be unsuitable for some patients or colleagues who do not specialise in CBT. The Five Areas model aims to be more versatile by using language that can easily be understood. In that sense, this model is not a new approach. Instead, it is a revision of standard CBT. The Five Areas model specifically focuses on five key elements, hence the name. These are life situation, altered thinking, altered emotions, altered physical feelings and altered behaviour. [4]

References[change | change source]

  1. 1.0 1.1 Yale, Susan Nolen-Hoeksema, (2014). Abnormal psychology (Sixth edition. ed.). ISBN 978-0-07-803538-8.CS1 maint: extra punctuation (link)
  2. 2.0 2.1 2.2 2.3 2.4 2.5 Fenn, Miss Kristina; Byrne, Dr Majella (2013-09-06). "The key principles of cognitive behavioural therapy:". InnovAiT. doi:10.1177/1755738012471029.
  3. 3.0 3.1 Gaudiano, Brandon A. (2008-02-01). "Cognitive-behavioural therapies: achievements and challenges". Evidence-Based Mental Health. 11 (1): 5–7. doi:10.1136/ebmh.11.1.5. ISSN 1362-0347. PMID 18223042.
  4. 4.0 4.1 Williams, Chris; Garland, Anne (2002/05). "A cognitive–behavioural therapy assessment model for use in everyday clinical practice". Advances in Psychiatric Treatment. 8 (3): 172–179. doi:10.1192/apt.8.3.172. ISSN 1355-5146. Check date values in: |date= (help)
  5. "Cognitive-behavior therapy use in de-addiction". American Addiction Centers. Retrieved 2020-11-14.
  6. Branch, Rhena; Wilson, Rob (2019). Cognitive behavioral therapy for dummies (3 ed.). Hoboken, New Jersey: John Wiley & Sons Inc. pp. 14–15, 23–30.
  7. "What can CBT help with?". Retrieved 2021-04-21.
  8. "Alcohol & Drug Rehab". Laguna Treatment Hospital. Retrieved 2020-11-14.
  9. "Coping with OCD during the Coronavirus (managing intrusive thoughts)". UK Addiction Treatment Centres.

Other websites[change | change source]