By Rufus Chesoli:
Cognitive behavioral approaches are based on the fundamental principles which theorize that, individual’s emotional and behavioral responses are influenced by the individual’s cognition. CBT recognizes that individual’s cognitive processes are the primary determinants of feelings and actions, when responding to life events (McFarlane and Yehuda 2000). CBT models further explain that cognitive processes facilitate or hinder the process of adaptation. CBT is an approach that is efficacious in the treatment of post traumatic stress disorders.Modern cognitive behavioral therapy is influenced by two therapeutic approaches. The first one being behavior therapy, which was developed by Wolpe in 1950s. The other influence is Beck’s cognitive therapy approach. CBT refers to strategies that relieve psychological suffering through correcting maladaptive and distorted thinking. The basis of the theory is the psychopathological theory. The theory recognizes the relationships among cognitive, emotional, behavioral, somatic systems. The tenets of the theory believe that the cognitive, emotional, behavioral, somatic systems are interrelated. CBT is a complex and subtle intervention that requires understanding and mastery of the social learning perspectives.
CBT is a counseling approach that aims at changing a patient’s unhealthy behavior. This is by examining various assumptions behind thought patterns. Consequently, the approach uses behavior therapy techniques. The behavior therapy approaches are used to modify the resulting behavior of patients. CBT is an approach that gives the patient and the therapist an opportunity to work together in identifying thoughts that cause distress. Once the thoughts are identified the therapist employs the behavior therapies to modify the resulting behavior. The main principles underlying CBT are the idea of looking at different interpretations which people make of events. The behavior part of CBT conceptualizes that someone’s behavior has influence on their thoughts and emotions. The ‘here and how’ principle focuses on what is presently happening rather than past events. The last principle is the interacting systems principle. The principles states that problems should be looked at from the product and construct point of view. The construct stems from different systems such as behavior, emotions, thoughts and physiology (Smith, Segal, and Segal 2012).
Cognitive therapy techniques
Rational emotive behavior therapy
The rational emotive behavior therapy is a construct of Albert Ellis. REBT is the first attempt done systematically to create a psychotherapy approach that is comprehensive. The psychotherapy approach is based upon the cognitive behavioral theory. REBT considers the patient’s irrational thoughts. The technique considers irrational thoughts as the primary basis for psychological problems. Therefore, REBT uses the irrational thoughts of an individual to change the patient. Using this technique, a therapist examines a patient’s irrational thoughts and uses these thoughts to teach a patient to challenge these thoughts. The technique identifies irrational thoughts as harmful and irrational imperatives that are not yet examined. This technique is energetic, confrontational and directive. The therapist then identifies how the individual needs to respond to the hurtful experiences. This is by either rational or irrational experiences
When using REBT technique a therapist identifies an individual’s emotional disturbance. This is by using interviewing skills to get to the bottom of an individual’s hurtful experiences. REBT recognizes that individuals create appropriate emotional consequences when they react to undesirable events in a rational way. Moreover individuals set themselves up for psychological problems when they respond to hurtful events with irrational responses.
The technique identifies the shoulds and musts of accompanying irrational beliefs. The approach requires a therapist to identify the irrational imperatives the create anger, anxiety, depression, low self esteem or professional problems in the patient. The therapist then uses intervention skills to address the irrational imperatives. The therapist does this by making clients aware of how irrational beliefs contribute to their unhappiness. The therapist uses REBT to change the patient’s unrealistic thoughts and expectations of the patient. REBT technique is further used to make clients give up their irrational demands. This is by replacing irrational demands with appropriate and realistic thinking. The skills that therapists need to use are confrontational skills sensitization skills, psycho-educational skills and response prevention skills (Roth and Fonagy 2005).
This technique was developed by Aarron Beck. It rests on the thought that how one thinks determines how one feels and behaves. The technique identifies that dysfunctional thoughts lead to bad consequences. A therapist uses this approach to identify a client’s dysfunctional thoughts. This approach aims at changing client’s dysfunctional world view, self concept, negative thoughts and eventually distorted cognitive processes. Using this approach, the therapist identifies the negative automatic thoughts of a patient (Parsons and Rizzo 2008). Consequently, the therapist uses effective counseling to replace the thoughts with more useful and reality based thoughts. The technique changes a client’s belief system and cognitive distortions. For instance, the cognitive distortions are errors in reasoning. The distortions lead to negative automatic thoughts.
CBT counselors empower the client to consider a variety of explanations for their situations. This helps the clients to restate their problems and have control over the problems. Hence, the client creates strategies that deal with the fearful possibilities that result from automatic negative thoughts (Nathan and Gorman 2002). The cognitive behavioral approach is a very important intervention for treatment of clients with psychological problems. The approach enables psychologists to evaluate key issues facing clients. The analysis is then followed by the development of an effective treatment plan. It is a useful primary therapeutic model in most treatment strategies. The interventions are practical and helpful in the initial phases of treating clients with psychological problems. CBT techniques are vital in treating acute symptoms of psychological disorders. In addition, techniques are important in enabling clients to achieve timely symptom relief and address troubling situations effectively.
According to McFarlane and Yehuda (2000), cognitive behavioral techniques are powerful in focus, with regard to symptom relief and behavioral change. The approaches can be blended with other psychological perspectives to provide practical counseling. Further the can be used to provide information, coach clients to alleviate symptoms. In addition, they help a client to deal with destructive actions they may face. The techniques have few cases of relapse. This is because; the approaches stress the different issues that cause stress and unhappiness. Cognitive behavior approaches are used when patients get to a state of anxiety. Research shows that during anxiety, the approaches are the most preferred interventions. Since, cognitive therapy approaches treat more than the symptoms of a problem. The approaches are best suited in situations where clients are in a state of worry and fear. The techniques allow clients to develop problem solving skills. The therapy enables clients to overcome anxiety during such situations. Moreover, the approaches are crucial for clients facing obsessive compulsive disorders. In addition, the approaches are suited for clients facing anxiety attacks.
Smith, Segal and Segal (2012,) indicate that individual’s facing anxiety attacks improve significantly when exposed to treatment using cognitive behavior approaches. Cognitive behavior approaches are used for people in individual situations or in group situations. In the course of therapy, cognitive behavior approaches are used when clients faces panic disorders, phobias, social anxiety, and generalized anxiety disorders. The techniques are applied to treat clients in situations where, the client has negative thoughts that contribute to anxiety. The underlying assumption that forms the basis of cognitive behavior therapies is that, our thoughts are not external events. The premise is that, our thoughts affect the way we feel. The goal of cognitive behavior therapy is to assist clients to change the unhealthy behavior. The clients are assisted by a therapist to restructure their cognition about certain situations. The clients are assisted to examine the assumptions behind their thought patterns.
Treating a client using CBT techniques in an integrative segment follows the following steps. The therapists will first undertake problem definition and goal setting. Then the therapist needs to access the thoughts of a client by identifying irrational beliefs. Furthermore, the therapist disputes the irrational beliefs and other cognitive behaviors. Afterwards, the therapist assigns to the client home work and tasks. Finally, the therapist re-evaluates the problem goals. When defining the problem and setting goals, the client is told to explain what problems bring them to the therapy. Thereafter, the client is told to enlighten the therapist on what they would like to accomplish through the therapeutic sessions. In the second step, the client’s world is explored through probing and listening. As the client explains their problem the therapist picks out information to identify the irrational beliefs and maladaptive behaviors. During this stage, the therapist educates the client using Elli’s ABC theory. The client is encouraged to conceptualize their problem in terms of the ABC theory. The therapist also introduces the three core irrational beliefs facing the client.
The other step involves disputing the client’s irrational beliefs. The therapist uses CBT techniques to assist the client to individualize and dispute five irrational beliefs. In turn, the client will be in a position to eradicate the emotional and behavioral problems and work towards effectively and efficiently. The techniques used involve teaching the client identify self defeating thoughts; dispute and challenge irrational beliefs; foster the restructuring of cognitive distortions; teach and foster rational self talk; to vie situations in a more favorable way; solving problems; role playing; modeling; implosion; vivo desensitization; becoming educated about the problem; and to teach the client to mange their reaction to stressful situations and change their way of thinking. The last step is for the therapist to assign homework exercises to the client and re-evaluate the problem and the goal (Nathan and Gorman 2002).
The limitation associated with CBT techniques is that although the technique realizes the importance of collaborative relationships. It does not put emphasize on identifying and integrating specific techniques in the helping process. It does not integrate the techniques in fostering collaborative therapeutic relationships.
CBT techniques have strengths associated with their application. The approaches are flexible in meeting individual needs. The techniques are further acceptable in a wide range of substance abusing individuals in clinical settings. In addition, the approaches are grounded in the principles of behavior theory and behavior change. The other strength is that, the approaches are used in a number of treatment modalities. The approaches are compatible with other treatment approaches including family therapy and pharmacotherapy. Furthermore, the approaches emphasize the importance of specifying a variety of treatments to clients. There are a variety of manuals related to cognitive behavioral approaches that provide a high level of technological transfer.
The approaches have a number of weaknesses. The research that evaluates these approaches does not emphasize the importance of isolating and evaluating specific ingredients that are associated with a change in behavior. The other weakness is that, there is a comparative underutilization of cognitive behavioral approaches outside the academic treatment settings. Finally, the approaches lack the emphasize on patient motivation and the procedures that clearly address the patients readiness for change (Parsons and Rizzo 2008).
McFarlane, A. C. and Yehuda, R. (2000). Clinical treatment of post-traumatic stress disorder: Conceptual challenges raised by recent research. Australian and New Zealand Journal of Psychiatry, 34, 940–953.
Nathan, P.E. and Gorman, J. M. (2002). A guide to treatments that work. 2nd edition. New York: Oxford University Press.
Parsons, T. D. and Rizzo, A. A. (2008). Affective outcomes of virtual reality exposure therapy for anxiety and specific phobias: A meta-analysis. Journal of Behavior Therapy and Experimental Psychiatry, 39, 250–261.
Roth, A. and Fonagy, P. (2005). What Works for whom: A critical review of psychotherapy research. Second edition. London: The Guildford Press.
Smith, M., Segal, R. and Segal, J. (2012 October 31st ). Therapy for anxiety disorders; cognitive behavioral therapy, exposure therapy, and other options. Retrieved from http://www.helpguide.org/mental/anxiety_therapy.htm.