Cognitive behavioral therapy is a goal oriented psychotherapeutic approach that examines the relationships between feelings, thoughts and behaviors. It examines the patterns of thought that trigger self-destructive actions and what directs the thoughts. The therapy addresses maladaptive behaviors, dysfunctional emotions and cognitive processes through professional systematic procedures (Linehan, 1993). The therapy is based upon a selected combination of basic cognitive and behavioral principles. It makes the acknowledgement that there are some human behaviors that cannot be controlled through rational thinking. The therapy can also be viewed as form of mental health counseling technique directed towards individuals with mental problems. The mentally ill person works with a health counselor (a therapist or a psychotherapist) adhering to preset guidelines and steps of treatment. The steps undertaken are aimed at making the mentally ill person realize his abnormal, inaccurate, inconsistent, irrational and negative lines of thought. The patient is then helped to view the challenging situations in his daily life and develop thought and action patterns that address and respond to them effectively just like a normal person would do. The therapy is not a tool that is only designed for the mentally challenged. It can help anyone learn how to deal with and manage stressful situations in life (Robertson, 2010). The situations include workplace stresses, family problems, business challenges, social problems and stressing school life for students.
The theory behind cognitive behavior therapy is based on the cognitive model that the way different people perceive different situations determines and influences their emotional feelings. For example, a person watching a movie may feel that the movie is good and it has all that he ever wanted in a good movie. Another person who watches the same movie may feel that the movie is outright boring and it does not come anywhere close to being his favorite. The example shows that it is the thoughts of people in particular situations that affect their emotional feelings. The situation does not directly affect their emotional feelings. For people in distress, their thoughts may tend to be unrealistic and their perspectives inaccurate (Basco et al. , 2007). Cognitive therapy helps these people to become aware of their unrealistic and distressing thoughts. They then go through therapeutic sessions that seek to help them change their distorted lines of thought. Once they have learnt how to think realistically they feel better about themselves. The therapy initiates behavioral change and emphasizes on solving the problems facing the patients.
How cognitive behavioral therapy works
CBT works by helping a patient to make sense of various problems in his life. It breaks the problems into smaller parts making it easier for the patient to see how small the problems are and their effects on the patient’s life. In a typical CBT therapy, the problems may be broken into the following parts:
- Emotions
- Thoughts
- Actions
- Physical feelings
- The situation (Event, problem or difficult situation)
Each of these small parts affects the other. How the patient thinks about each of the parts affects how they feel emotionally and physically. The patient should understand that whatever happens in any of the above areas affects the others. He is then taught how to react positively to each of them.
Situations when cognitive behavioral therapy is used
The therapy is of tremendous help to patients with depression. It has proved to be very effective in preventing relapse of symptoms to depressed individuals. Depressed patients are taught how to replace negative thoughts with positive thoughts. The positive thoughts enable them to interpret their environments with positivity. They are also encouraged to include pleasurable activities in their daily activities. For example, they are encouraged to participate in activities like sports and spend more time with people they love. The depressed patients are also encouraged to adopt healthy sleeping patterns. In both bipolar and depression, sleep has been found to be very important. Patients who receive cognitive behavioral therapy in addition to normal treatment with medication recover more quickly than patients who never receive the therapy (Beck, 2011).
Cognitive behavioral therapy is also used in treating anxiety disorders. Patients with anxiety disorders are taught how to test out the beliefs that they associate with their panic attacks. For example, a soldier who suffers panic attacks whenever he sees a gun after his days in the battlefield is taught how to come up with positive responses to guns despite his past traumatizing experiences. He is taken through therapeutic processes and procedures that make him learn that a gun that is not in the enemy’s hands is not dangerous. He can also be shown that it was the same gun that helped him survive through various situations during his days in the battlefield. Patients suffering panic attacks may also have fears that are related to bodily sensations. Helping them develop realistic responses to these situations and sensations helps reduce the intensity and frequency of the panic attacks.
People with phobias like animal phobia and evaluation phobia (Social anxiety disorder) can also be treated using cognitive behavioral therapy (Linehan, 1993). The beliefs that have made the patients maintain the fears are targeted and addressed by the psychotherapist by way of modification. They are sometimes exposed to the things that they fear with the aim of making them understand that their fears are an imagination since they can be exposed to their fears and go unhurt.
CBT in the treatment of PTSD
PTSD (Post traumatic stress disorder) is a mental disorder that is a sequel to a stressful situation or event of catastrophic or exceptionally threatening nature. Cognitive behavioral therapy is very effective in the management of post-traumatic stress disorder. The therapy helps PTSD victims manage their problems by changing how they think and act (Foy, 1992). Systematic CBT treatment techniques that are trauma focused are used to help PTSD victims come to terms with the event that causes their trauma. During a typical treatment session, a CBT therapist may request the patient to confront the memories by thinking about them in detail. As the PTSD patient thinks about the event, the therapist helps him to cope with the distresses of the memory. He identifies the misinterpretations and unhelpful thoughts held by the patient. He then helps him to cope with them. By using the approach, the therapist helps the patient to come to terms with the event. The patient gains control over his fears and distress about the event by changing how he thinks about it. Some of the thoughts that are eliminated include fear of the event recurring again and self-blame over what happened.
A typical CBT session
CBT sessions can be done with a group of people or individually. They can also be done using computer programs like the ‘fear fighter’ which is for people with panic attacks or ‘Beating the blues’ which is designed for patients with depression. If the therapy is done individually, the patient meets with the therapist for sessions that last between 30 to 60 minutes. The sessions may be up to twenty per week. During the first two to four sessions, the therapist confirms that the patient is fit for the therapy. The therapist seeks to know some details about the patient’s past life if it is necessary. The patient then decides what he needs to deal with in the long, medium and short term. The treatment may begin immediately or at an agreed date. Once the treatment has begun, the problem is broken down to separate parts. The feelings, thoughts and behaviors of the patient are analyzed and then the therapist helps the patient in changing unhelpful thoughts. The therapist then recommends some homework to the patient to help him change the unhelpful thoughts. At each meeting, an analysis on the patient’s progress is done and the therapist suggests to the patient how he can easily accomplish the hard tasks. This is repeated until the patient has fully recovered.
Problems associated with CBT
CBT is a very effective approach but it has its problems too. The therapy is not a quick fix to the patient’s problem. A therapist just advices but he cannot do the therapy for the patient. The patient should be cooperative to realize positive gains from the therapy. In the treatment of anxiety, the patients have to confront their anxiety. This may bring more anxiety but most patients manage to overcome it with the therapist’s guidance (Beck, 2011). The fact that it’s the patient who stays in control of the procedure is another disadvantage. The therapist only arranges the sessions and then the patient decides what he will do together.
Conclusion:
Cognitive behavioural therapy is a very important procedure for patients with mental conditions. It is a very effective result oriented approach. Adequate research in the field has been done and improvements are being done every day based on new observations during interactions with patients. The therapy is unique because it emphasizes cooperation between the patient and the therapist. It does not involve use of medication and therefore it is a good therapeutic approach that is highly recommended for patients with mental conditions.
References:
Cognitive Behavioural Therapy . (n.d.). Retrieved November 11, 2014, from http://www.rcpsych.ac.uk/mentalhealthinformation/therapies/cognitivebehaviouraltherap y.aspx
Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York [u.a.: Guilford Press.
Basco, M. R., & Rush, A. J. (2007). Cognitive-behavioral therapy for bipolar disorder. New York: Guilford Press.
Beck, J. S., & Beck, J. S. (2011). Cognitive behavior therapy: Basics and beyond. New York: Guilford Press.
Robertson, D. (2010). The philosophy of cognitive-behavioural therapy (CBT): Stoic philosophy as rational and cognitive psychotherapy. London: Karnac Books.
Foy, D. W. (1992). Treating PTSD: Cognitive-behavioral strategies. New York: Guilford Press.
