Analysis of The Cognitive Behavioural Therapy with Reference to Other Therapeutic Approaches

Introduction

Since the advancements of medical science from the beginning of civilisation also came advancements of Philosophy/Psychology from the first established civilisations such as the Greeks who were fascinated with personality, specifically Hippocrates who developed his own diagnostic tool based on personality of a person (Kushner, I. 2013).

Personality is the centre of every being in the field of psychotherapy and counselling. The first thing that springs to mind is the word itself and the meaning behind it. ‘Persona’ in Latin meaning mask. Personality has fascinated many psychologists such as Sigmund Freud, Freud, S., & Bonaparte, P. M. (1954), Erick Erickson, Widick, C., Parker, C. A., & Knefelkamp, L. (1978), Carl Jung, Jung, C. G. (2014) , Ivan Pavlov, Pavlov, I. P., &Anrep, G. V. (1960), BF Skinner, Skinner, B. F. (1971), Albert Ellis, Ellis, A. (1962) and Arron Beck (Beck, A. T. Ed. 1979). All of which developed their own ideas and concepts in psychotherapy as well as the personality and how to develop as beings as well in a therapeutic setting.

Furthermore into the future personality became the focus of psychotherapy and how humans develop as they grow. One of the most famous being Freud and his psychosexual development of children which to this day is still studied and reviewed (Simon, W & Gagnon, J. 1969). However Freud’s work being somewhat limiting because of lack of research and more psychologist with doctor patient focussed relationship, there needed to be more client led and client focussed therapies after the world war traumatized soldiers needed treatment and thus the development of many therapies came into development, 2 of these being Cognitive and Behavioural therapies. At the time the 2 being separate therapies developed by Aaron Beck cognitive therapy Beck, A. T. Ed (1979) and later Albert Ellis who created Rational emotive behavioural therapy REBT who came up with the ABC method (Ellis, A. 1991). Acronym for A, activating event, B, belief triggered from the activating event and C, which is the consequence of the above two mentioned.

Cognitive later merging with works of Aaron Beck and Albert Ellis to become cognitive behavioural therapy due to limitations found in both such as to understand behaviour one must understand the cognitive process of the mind and to understand cognition one must understand the behaviour being produced due to the thought process behind the action. Behavioural therapies helped treat neurotic disorders such as anxiety related issues and (OCD) obsessive compulsive disorders Butler, G., Fennell, M., Robson, P., & Gelder, M. (1991) however it did not help with depression as anxiety being neurotic by leading to psychosis resulting in depression as part of the package which was limiting hence psychologists of the time started to combine cognition in therapy to fully understand both the neurotic and psychosis side of depression and get a bigger picture of their clients in the here and now as well as focusing on the clients beliefs, experiences and feelings to help clients recover more fully.

CBT in the current era is a mix of many techniques combined through psychotherapy models and cognitive techniques used to help clients manage their symptoms, problem solve, retrain or restructure of irrational thinking, exposure to fears or phobias, it is also used to help educate clients more professionally known as psychoeducation, Blagys, M. D., & Hilsenroth, M. J. (2002) which helps clients understand and self regulate mental health and general life situations, which also helps with stress regulation and better control future situation in life that may arise. CBT compared to other therapeutic approaches is a short term treatment programme which can be sessions of 6-20 depending on clients needs.

In order for treatment to take place a therapist must understand the mental health illnesses and disorders and the issues clients experience. These mental health illnesses can be a range of different issues such as anxiety, depression or both together and eating disorders which come in many forms. Understanding comes from the root cause of these illnesses and disorders and how to better help clients manage them so they can live happy normal lives. Currently there are many diverse treatments based on what model of therapy can be used in counselling however a comparison will be made in this writing of differences between treatments for 2 of the mentioned mental health disorders and illnesses. Comparison will be based on CBT and Person Centred therapy treatments and how they treat eating disorders and anxiety and depression.

Main Body

CBT approach looks at more structured and researched approach to treatment based on a systematic focused method of treating clients with various mental health illness and disorders (Persons, J. B. 1989). CBT in treatment mostly helps clients take control and ownership in order for recovery to take place. In therapy therapists would develop rapport with clients and discuss their triggers and defence mechanisms when it comes client illnesses and disorders. However treatment can only be successful with a willing client who is able to put in the work when homework is given by the therapist to educate client on their illness and how the therapy works.

CBT treats many different types of mental health illnesses and disorders few of which being depression, anxiety and eating disorders. Depression is a mental illness, there are various causes for depression some of which come from natural reactions to traumatic experiences from childhood or adulthood, can be defence mechanisms or a pathological reaction and even a cognitive distortion. Depression symptoms can vary from person to person it can be a form of sadness or low mood, an illness where the person looses interest in the world and the things around them that use to interest them, lack of sleep or interrupted sleep, low self-esteem or feeling guilty, lack of energy and fatigue, poor concentration, no appetite and intrusive thoughts or even suicidal thoughts and acts. There are many types of depression but as mentioned they can vary depending on trauma a person goes through in any life event, there is bipolar disorder which can effect mood, Persistent depressive disorder PDD or previously known as dysthymia or just a depressive episode known as major depressive than can last for a short period of time due to life event. 

Anxiety can also be a part of depression, however anxiety is a natural human construct built in through evolution deriving from cave man society or better known as homosapien, our species that helped them survive. It is a response to fear and adrenaline where it helped our ancestors survive and stay hidden compared to our Neanderthals counterparts who went extinct. There are many types of anxiety disorders some of which are panic disorders, general health anxieties or even phobia which can be specific or non specific and also Obsessive compulsive disorders (OCD) post traumatic stress disorder (PTSD), these are just some of the many anxiety disorders. Most common symptoms of anxiety can be butterflies in the stomach, tiredness, shortness of breath, headaches, shaking or palpitations, or even muscle tension. However symptoms can vary from person to person.

There are many types of eating disorders, however generally an eating disorders is where a person have an unhealthy attitude towards food which can impact and take over life to life living due to becoming ill. Eating disorders can involve over eating or eating too little, it can be an obsession with weight and body image influenced through media, environment or personal irrational thinking. Eating disorders like many other mental health illnesses and disorders can affect anyone however they can commonly affect women aged 13 to 17 years of age. Symptoms vary depending on the type of disorder as some can be physical symptoms and some can be more cognitive symptoms, generally symptoms can include, under eating or over eating, having strict rituals or routines around food or even mood swings. Physical symptoms can include dizziness, shakes, nausea, tiredness, struggling to digest food, overweight or under weight. Symptoms with these eating disorders are anorexia, binge eating disorder, bulimia or other specified eating disorders that are rare or unspecified due to conditioned upbringing (Bruch, H. 1974).

CBT would look to treat these illnesses and disorders through various treatment methods depending on the client and their needs. CBT in illnesses and disorders would focus on negative thought patterns that exhibit unhealthy behaviours, how you see yourself and other people in the world around you as well as how your behaviours impact your thought process and feelings. CBT for anxiety, depression and eating disorders would be treated based on what situations trigger behaviours that contribute towards the illness and disorder. A CBT therapist would look to identify situations that create the stressors and conditions within a client’s life that causes the illness or depression. Once these situations are identified the therapist would look at the current thought patterns and distorted perceptions to help treat clients.

Within therapy clients are encouraged to record reactions to life events that trigger their stressors by using journals in order for therapist to identify irrational thoughts and behaviours so that the therapist can challenge the client and break the thought patterns behind them (Attwood, T. 2003). Journals also help clients to self evaluate, reflect and create self awareness in order to manage their thoughts and behaviours in a healthy positive way as well as manage their reactions to life events and external factors that may not be accounted for.

There are many techniques used to challenge negative irrational thinking as this helps therapists identify a clients thinking process, few of many are overgeneralisation which helps focus on conclusion that are broad for one event based on the that triggering event Ready, C. B., Hayes, A. M., Yasinski, C. W., Webb, C., Gallop, R., Deblinger, E., & Laurenceau, J. P. (2015), all or nothing thinking McArdle, S., & Moore, P. (2012 which is based on perceptions of the world from a black and white thinking perspective, challenging and focusing on the negative issue of the irrational thought process, rejecting the positive where clients completely reject positive experiences, irrational thinking itself where a client takes everything too personally based on every reaction around them people or things such as its all my fault, self hating, believing that it’s something they did or said, everyone else’s unrelated actions internalising on a personal level Szentagotai, A., & Freeman, A. (2007) and lastly unrealistic ways of making life events seem less valuable that don’t match reality. Once the therapist identifies these thought patterns they look to challenge them and treat anxiety, depression and eating disorders accordingly while the client takes an active part in their treatment to be accountable and heal through self awareness and motivation to become better rather than be controlled by their illness or eating disorder.

In comparison to Humanistic model or person centred therapy created by Carl Rogers Rogers, C. R., & Russell, D. E. (2002) it is none directive and takes a completely different approach to treatment for mental illness and disorders as the person centred model believes that everyone is born good, are trustworthy and have potential to solve their own problems and also have the capacity to self actualise. This is based on Abraham Maslow’s hierarchy of needs Maslow, A., & Lewis, K. J. (1987) where Maslow wanted to understand human motivation and what drives them to do good which resulted in him creating his hierarchy of needs where a person has to meet 4 conditions in order to self actualise. These conditions are Physiological, safety, social and esteem. These 4 conditions need to be met in order for a person to self actualise meaning to fulfil ones potential and find meaning to life. Person centred also lets the client take charge of their own therapy and focuses more on feelings and emotions through trust by creating what is known as the core conditions. Core conditions are Empathy, unconditional positive regard and congruence; these conditions need to be met in order for clients to feel safe and trusting for treatment to take place.

Person centred therapy compared to CBT uses no specific techniques to help clients recover from mental health illnesses and disorders. It currently provides conditions for the client to feel secure and safe in order for them to build a relationship with their therapists and open up to talk about their current issues that have an impact on their mental health or disorders. The person centred therapist would focus on goals for the client by facilitating personal growth and development, help them become more open to experiences and increase self-esteem, take away negative feelings that lead to distress and help the client understand themselves better. Therapy can be broken down into 3 phases where in stage one a relationship is built between the client and counsellor by providing the core conditions, stage 2 is understanding the issue that the client is going through and stage three is facilating the client to create change (Wosket, V. 2008). 

Conclusion

In conclusion CBT therapy and Person centred therapy have a very different and diverse approach to treatment for mental health illnesses and disorders. CBT can only be effective with a willing client who can commit to treatment by cooperating with the counsellor and putting in the work out with therapy sessions, CBT can push clients to be more confrontational when it comes to clients emotions and anxieties which can make some feel uncomfortably emotionally and feel anxious, CBT is focussed on current issues rather than the past or future which fails to account for relapse or returning to previous behaviours and thought patterns and also CBT is focussed more on short term and some clients may need more time due to disabilities such as learning difficulties or processing capabilities.

Person centred itself although more long term it also has its own issues that get in the way of treatment. It can lead the Therapist being more supportive rather than challenging the client Corey, G. (2017), it lacks in technique to help clients problem solve and also doesn’t apply to real world because of unconditional positive regard from the counsellor.

In summary cognitive behavioural therapy is a well structured, researched and systematic model of therapy that is used worldwide to treat mental health illnesses and disorders effectively and quickly however it can be somewhat lacking due to client willingness to participate and fixated for specific clients who want to be challenged and driven to recover.

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