Cognitive behavioural therapy (CBT) is a form of psychotherapeutic treatment that teaches people how to recognise and alter harmful thinking patterns that negatively affect their actions and emotions.
Cognitive behavioural therapy focuses on changing automatic negative thoughts that fuel emotional issues, depression, and anxiety. Oftentimes, in such mental disorders, the patient can fall into a loop of nativistic thinking patterns that end up worsening their condition. CBT helps identify and target these thoughts, and slowly replace them with realistic and objective thinking.
CBT and Various Clinical Therapies:
CBT is a blanket term which refers to a variety of strategies and methods for dealing with feelings, emotions, and behaviours – structured psychotherapies and self-help manuals are examples of these. CBT is used in a variety of clinical therapies, including the following:
1. Cognitive therapy: The goal of cognitive therapy is to recognise and change distorted or skewed thought patterns, emotional responses, and behaviours.
2. Dialectical behavior therapy focuses on thoughts and behaviors while also integrating emotional control and mindfulness techniques.
3. Multimodal therapy targets psychological issues by addressing seven different but interconnected modalities: behavior, affect, sensation, imagery, cognition, interpersonal factors, and drug/biological considerations.
4. In Rational emotive behavior therapy (REBT), the process involves identifying irrational beliefs, consciously questioning these beliefs, and eventually learning to recognise and alter these thinking patterns.
Some Techniques Involved In COGNITIVE BEHAVIOURAL THERAPY:
1. Cognitive Restructuring- Cognitive restructuring (also known as cognitive reappraisal) is a cognitive behavior therapy technique for recognizing unhealthy thinking patterns and developing more realistic, grounded ways of interpreting difficult circumstances. Tracking thoughts in stressful circumstances, detecting cognitive distortions, and engaging in behavioural experiments to determine if the thoughts are real are all examples of cognitive restructuring strategies.
2. Skills Training: Many people’s challenges stem from a lack of the necessary skills to achieve their objectives. Skills preparation is a cognitive behavior therapy approach used to address certain deficiencies in skills. Social skills training and assertiveness training are all common areas for skill development. Skills training is usually done by direct guidance.
3. Exposure is a technique of cognitive behaviour therapy that helps people approach their fears in a structured way. Fear causes people to avoid circumstances in general. Unfortunately, avoiding dreaded conditions is what keeps people afraid and anxious. People master dreaded situations one by gradual exposure and then move on to more challenging exposure assignments. For certain anxiety disorders, exposure is one of the most effective therapeutic processes available, with a 90 percent efficacy rate.
4. Successive Approximation: This is a cognitive behaviour therapy approach that helps people who are having trouble performing a task, either because they are unfamiliar with it or because it feels daunting. The method works by assisting people in mastering a less challenging task that is close to the more difficult one.
5. Activity scheduling is a cognitive behavior therapy strategy that aims to help people increase the number of actions they should be doing more often. It increases the probability of getting things done by noticing and arranging beneficial habits like meditating, going for a walk, or working on a project. This method is particularly beneficial for people who do not participate in many rewarding activities.
6. Mindfulness Practice: Mindfulness is a Buddhist-inspired cognitive behavior therapy technique. The aim of mindfulness is to help people stop ruminating or obsessing over negative thoughts and instead focus on what is really going on in the present moment. Mindfulness is the focus of a lot of recent psychological studies, and it’s at the cutting edge of psychotherapy. Mindfulness has been shown to be effective in enhancing concentration, pain control, and emotion regulation in studies.
The Assessment Sessions Involved in CBT:
This forms the very first stage of Assessment in CBT. In the initial evaluation, the therapist may wish to get an overview about the variety of topics that are similar to those assessed by many other therapists including the presenting problem, a developmental history, past traumatic experiences, medical & psychiatric history & client’s goals. In the meantime, the therapist may also work towards developing a good working relationship with the client. The therapists may use structured or non-structured interviews to gather specific information about the client.
Another method used to assess the client’s thoughts, emotions & behaviours outside the therapist’s office is self-monitoring. Here, the client keeps a record of events, feelings & thoughts throughout his day. One of the most common methods in the Dysfunctional Thought Record (D.T.R.). It has three columns-the first in which the client describes the situation, the second in which the client identifies & rates the emotion & the third to record her automatic thoughts. The use of this thought record provides material for discussion in the next session & an opportunity for clients to learn about their automatic thoughts.
This method is used for obtaining information about cognitions. Having a tone sound at a random interval at home & then recording thoughts in a tape recorder or notebook.
Scale & Questionnaires:
In addition to the above techniques, self-report questionnaires or rating scales can also be used to assess irrational beliefs, self-statements, or cognitive distortions (Whisman, 2008). Structured questionnaires have been developed for specific purposes, such as Beck Depression Inventory (Beck, Ward, Mendelson, 1961), Dysfunctional attitude scale (Weissman, 1979), and many more.
More so than many other theories of therapy, CBT is structured in its approach. The initial sessions deal with the assessment of the problem, development of a good rapport, collaborative relationship & case conceptualization. As therapy progresses, a guided discovery approach is used to assist clients to become aware of their inaccurate or irrational thinking. Other important aspects of the therapeutic process are methods to identify automatic thoughts & the assignment of homework, which is done throughout therapy. As clients reach their desired goals, termination is planned. Also, the clients learn how they will implement everything they have learned once the therapy has stopped.
This is sometimes called “Socratic dialogue” & it helps clients change their maladaptive beliefs & assumptions. The therapist guides the client in discovering new ways of thinking & behaving by asking a series of questions that make use of existing information to challenge the long-held beliefs of the client.
The three-question technique: It consists of a series of three questions designed to help clients revise negative thinking. It leads the client towards more objective thinking.
1. What is the evidence for the belief?
2. How else can you interpret the situation?
3. If this is true, what are the implications?
Much work in CBT takes place between sessions so that skills can be applied to real-life settings, not just the office. Specific assignments are given to the clients. CBT is more of a two-way process & if the client does not complete the homework, this fact can be useful in examining problems in the relationship between client or therapist or dysfunctional beliefs about doing homework assignments.
Although therapists are free to structure their own format adapting to the different client problems, there are certain topics to be dealt with in the therapy session. The therapist checks on the client’s mood & feelings. Usually, the therapist & client agree on an agenda for the therapy session based on a review of events of the past week & on pressing problems that may have emerged. Also, the therapist asks for feedback about the previous session & concerns or problems that the client may have about issues that have occurred since the last meeting. The therapist & the client review homework & collaborate to see how the client could get more out of it. Usually, the major focus of the session is on the concerns the client raised at the beginning of the therapy hour. Feedback from the client about the session is an important element of the collaborative relationship between therapist & client.
The course of treatment usually lasts for between 5 to 20 sessions, with each session lasting 30 to 60 minutes and the client meets the therapist once a week or once every two weeks. As early as the first session, termination may be planned.
Strengths & Limitations of Cognitive Behavioural Therapy:
The primary strength of CBT lies in the fact that it not only helps the individual to overcome their symptoms of the difficulties they are experiencing in the present, but also helps them learn new skills & strategies which they can use with future difficulties.
It has proven to be as effective as medication to treat many mental disorders including anxiety disorders, mood disorders, eating disorders, somatic disorders, sexual dysfunction, addiction, Post-traumatic stress disorder, etc. It does not take much time to show the results, unlike other forms of talking therapy. The focus of this therapy takes on different formats depending upon the client’s difficulties & generally the problems are broken down into five categories of situations, thoughts, emotions, physical feelings & actions. Thus, helping the client to understand the interconnections between these five areas. CBT is useful for almost any age group. Both children & adults can benefit from the therapy when used correctly.
One of the major disadvantages of CBT is that it relies on the will of the patient so, if the patient himself is not willing to come out of his difficulties, then the results of CBT experienced will become limited.
Another thing is it takes plenty of time to complete CBT as there is extra work to do between sessions & also, the client is expected to spend at least 1-2 hours per day working on the therapeutic elements.
The Article Written By: Shazia, Bharti Ramesh, 6th June, 2021.