Cognitive Behavior therapy

Cognitive-Behaviour therapy(CBT)


  


CBT is the outcome of basic behavioural (Thorndike, Pavlo) and cognitive researches (Aaron Beck and Albert Ellis).
          




It assumes that each person has a different thought process associated with every circumstance in life. For instance, while one person may see a “trigger” such as a fire truck and react with optimism saying “I hope there is no emergency,” another person may immediately panic and take on the mindset of “oh no someone has definitely died or lost their home to a fire.” 



CBT  allows patients to self develop (with therapeutic assistance) new thoughts and beliefs that will help them to be productive and overcome issues they may be facing. These self help tools can be utilized in various situations in life where our grid iron belief system or ‘opinions’ are so deeply ingrained that they cause automated and negative responses.

CBT is not distinct therapeutic technique. It includes several approaches - Rational emotive behavior therapy, Rational behavior therapy, Rational living therapy, Cognitive therapy and Dialectic behavior  However, mot CBT have the following characteristics:

Characteristics:
1. Our thoughts cause our feelings and behavior, not external things. So, we can change the way we think to feel/act better even if the situation does not change.
2. CBT is briefer (max 16 sessions) and time limited.
3. CBT therapists believe that the clients change because they learn how to think differently and they act on that learning. It focuses on teaching rational self-counselling skills.
4. It is a collaborative effort between therapist and client. Therapist will listen, teach and encourage, while the client's roles is to express concerns, learn and implement that learning.
5. CBT does not tell people how they should feel.
6.Here therapist encourages clients to ask questions of themselves, like, " How do I really know that these people are laughing at me? ". " Could they be laughing about something else? "
7. 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. Therefore, CBT therapists do not tell their clients what to do -- rather, they teach their clients how to do.
8. CBT assumes  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.  

Applications:

CBT is useful for  anxiety, depression, panic, phobias (including agoraphobia and social phobia), stress, bulimia, obsessive compulsive disorder, post-traumatic stress disorder, bipolar disorder and psychosis. CBT may also help if you have difficulties with anger, a low opinion of yourself or physical health problems, like pain or fatigue. CBT analyzes different cognitive distortions

Cognitive distortions:

The term “cognitive distortion” refers to errors in thinking or patterns of thought that are biased in some way.  They may include:  (A) interpretations that are not very accurate and which selectively filter the available evidence, (B) evaluations that are harsh and unfair, and/or (C) expectations for one self and for others that are rigid and unreasonable.  The more a person’s thinking is characterized by these distortions, the more they are likely to experience disturbing emotions and to engage in maladaptive behavior.  A number of common patterns2 of cognitive distortions have been identified, including: 

1.  All-or-nothing thinking:  Looking at things in absolute, black-and-white categories, instead of on a continuum.  For example, if something is less than perfect, one sees it as a total failure.

2.  Overgeneralization:  Viewing a negative event as a part of a never-ending pattern of negativity while ignoring evidence to the contrary.  You can often tell if you’re overgeneralizing if you use words such as never, always, all, every, none, no one, nobody, or everyone.

3.  Mental filter:  Focusing on a single negative detail and dwelling it on it exclusively until one’s vision of reality becomes darkened. 

4.  Magnification or minimization (e.g., magnifying the negative and minimizing the positive):  Exaggerating the importance of one’s problems and shortcomings.  A form of this is called “catastrophizing” in which one tells oneself that an undesirable situation is unbearable, when it is really just uncomfortable or inconvenient.

5.  Discounting the positive:  Telling one self that one’s positive experiences, deeds, or personal qualities don’t count in order to maintain a negative belief about oneself.  Or doing this to someone else.

6.  Mind reading:  Concluding what someone is thinking without any evidence, not considering other possibilities, and making no effort to check it out.

7.  Fortune telling:  Anticipating that things will turn out badly, and feeling convinced that the prediction is an already established fact.  It often involves:  (A) overestimating the probability of danger, (B) exaggerating the severity of the consequences should the feared event occur, and (C) underestimating one’s ability to cope should the event occur.  B and C are also examples of catastrophizing.

8.  Emotional reasoning:  Assuming that one’s negative emotions necessarily reflect the way things really are (e.g., “Because I feel it, it must be true.” “I feel stupid, therefore I am stupid”). 

9.  Rigid rules (perfectionism).  Having a precise, fixed idea of how one self or others should behave, and overestimating how bad it is when these expectations are not met.  Often phrased as "should" or “must” statements.  

10.  Unfair judgments:  Holding oneself personally responsible for events that aren't (or aren’t entirely) under one’s control, or blaming other people and overlooking ways in which one might have also contributed to the problem.

11.  Name-calling:  Putting an extremely negative and emotionally-loaded label on oneself or others.  It is an extreme form of magnification and minimization, and also represents a gross overgeneralization. 

In addition to the above list which is largely influenced by Aaron Beck’s version of cognitive therapy, Albert Ellis produced a similar list that highlights what he called irrational beliefs (which consist of faulty assumptions and unreasonable rules about life).

Phases 

According to Gatchel et al. (2008), CBT has six phases:

1. Assessment

2. Reconceptualization

3. Skills acquisition

4. Skills consolidation and application training

5. Generalization and maintenance

6. Post-treatment assessment follow-up

Sources:
1. CBT