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Cognitive Behavioral Therapy and its Importance in the Effective Treatment of Cognitive and Behavioral Problems

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There are many people who continue to suffer depression, fear, anger and aggression but are unaware of the simple remedy in Cognitive behavioural therapy (CBT) to the seemingly complicated problems. Cognitive behavioural therapy (CBT) has proved to be very useful in psychotherapy and is today considered as one of the highly effective methods in the treatment of Cognitive and behavioural problems. CBT teaches the client or person suffering how to change their negative thought patterns and alter their behaviours that are triggered by the thoughts. This paper focuses on how CBT has proven to be one of the major orientations in psychotherapy and represents a unique category of psychologically driven interventions because it is derived from models of human behaviour.

Introduction

Contemporary counselling and psychotherapy offer clients with a wide range of choices in addressing the various and diverse psychological anguish. Though the choices are many and have been proven effective, pinning down the specific reasons to such effectiveness sometimes becomes elusive. As mentioned, there are many approaches to counselling and psychotherapy but it is imperative that the right method is applied in order to achieve the best results possible.

When faced with behavioural problems such as depression, extreme fear, personality disorders, anger or aggression and anxiety, it is common to open up to peers or trusted people in social circles and family members. When the problem is overrated, such cases are commonly referred to a counsellor. However, many parts of the world have been using simple psychotherapy remedies for many years. These remedies are cognitive behavioural therapies (CBT). Therefore, cognitive behavioural therapies are interventions that are collectively in agreement that cognitive factors are behind psychological distresses as well as mental disorders. Therapists in cognitive behavioural therapy work towards the identification and treatment of difficulties that are caused by difficulties mentioned above as well as difficulties in learning and misperceptions (Goldberg, 2001: 139).

Cognitive Behavioural Therapies (CBT)

The origins of CBT date from the time it was used in the treatment of depression. However, as more research was done, other disorders were incorporated as treatable disorders using CBT. Developed by Dr Aaron Beck, the therapy was initially thought to be two diverse therapies but Dr Beck amalgamated the two to form CBT as it is known today.

With the increase in its use, it has been proven to differ from other psychotherapies because it is realistic, focuses on problems at hand; it is collaborative and well structured. Consequently, cognitive behavioural therapies are seen to be developed to address specific contents in mind which means they are ‘disorder specific’ (Beck, 2011).

There are different types of cognitive behavioural therapies such as individual therapies, group therapies, computer programmes and self-help books (Dogaheh et al., 2011: 959).

Aspects of CBT

The main aspects in CBT are pragmatism which helps in identification of specified problems and endeavours at solving them and it is collaborative which means that the therapist works with the client but not necessarily command what is to be done. In addition, CBT focuses on current problems meaning that it is concerned with how a person thinks currently but does not try to solve past problems. Finally, CBT is highly structured in a way that helps he client discuss specific problems with the therapist as compared to spilling out all facts about personal life (Grossman, 2010: 46).

Assumptions under CBT

Therapists in CBT teach or coach clients how to identify deformed cognations using an evaluation process which discriminates personal thoughts from reality. In this process, the clients learn that cognition has an influence on feelings and they are instructed on how to recognise, observe and monitor own thoughts (Cummings, 2010: 826, Petersen, 2015:1).

  • Cognitive approach believes the distortions or ‘abnormality’ originates from defective cognition about others, the environment or the world and self. The distortions in thinking may be as a result of lack of planning or inaccurate information processing.
  • Cognitions cause distortions in the way a person with the cognitive problem perceives things which can be either by irrational thinking or cognitive triads.
  • Humans interact with the world by the way of mental representation about it. It follows that if the mental representations are inaccurate; reasoning becomes inadequate which results in distorted emotions and behaviour.

As Chambless et al. (2001: 702) states, when CBT is administered, the behaviour part in the therapy involves the ‘homework’ part for the client which can be in the form of having a diary on thoughts and the therapist gives tasks to the client in order to help then change irrational beliefs.

The idea behind is that the client is able to identify own unhelpful beliefs and then prove them wrong which is supposed to result in a change of beliefs. As an example, a person who has phobia or anxiety about social settings may be arranged to meet a friend in a public place such as a restaurant or pub for a drink thereby fighting with the phobia through self-determination.

Empirical Foundation

Though viewed as a ‘simple’ approach to ‘simple’ psychological problems, to the patient and those affected, CBT offers practical solutions to real problems. It is also important to note that different behavioural and cognitive problems manifest differently with some very severe while others relatively moderate. It is from this foundation that clients deserve the best treatment that can be empirically authenticated and CBT offers this experimentally proved treatment.

According to Black and Hurley (2014: 1244), CBT has tremendous effects on people with cognitive and behavioural problems with the treatment proving to have a powerful positive impact on problems through its approach with the aim of averting behavioural reactions. The ‘replacement’ thoughts are based on facts and gradually expose and accustom the client to feared situations. The positive effects of CBT are based on the teaching of clients on the detrimental importance of maladaptive thinking processes as well as the maladaptive behaviour harboured by the patient. It is the harboured behaviour that instructs the patient in thinking more on facts rather than assumptions. In turn, this creates a powerful influence by affecting the clients’ behaviours in a healthy and positive way.

Therefore, if psychotherapy is to be accorded the seriousness it deserves, it must be based on practical research. It follows that the use of narratives, testimonials or triads cannot be a guide to treatment choices (Butler et al., 2006: 23).

Therapeutic Approach

In order to work effectively, cognitive behavioural therapies as the term suggest combining both the cognitive and the behavioural strategies in helping people with psychological distress. The cognitive part of the therapy helps the affected person become aware of distortions in their thoughts that cause psychological distress while the behavioural part helps the affected person realise the patterns that are used in reinforcing as well as treating them. There are various approaches but each therapist has to evaluate the problem at hand before deciding on the proffered method of administering CBT. In this case, two of these methods are illustrated (Carleton, 2010: 632-800).

The ABC Model

As the name suggests, the model involves three steps in; activating event, beliefs and consequences.

  • Activating events or objective situation which involves recording the objective situation or the event that has a likelihood of triggering a negative emotional or dysfunctional thinking.
  • Beliefs where the client writes down the negative thoughts that have occurred to them
  • Consequences that result from the negative feelings and the dysfunctional behaviour. In this case, the native thoughts in beliefs are the connection between the events and consequences or distressful feelings. Therefore, Consequences are explained by describing emotion and negative thoughts caused by activating events such as sorrow, anxiety and aggression among others (Petersen, 2015:1).

Negative Self-Schemas

The most significant insight of cognitive therapy as originally formulated by Dr Beck over three decades ago is that thoughts act as a go-between between stimuli, such as external events as well as emotions. Therefore, it is the stimulus that elicits a thought, which might be an evaluative decision of some kind which in turn results to an emotion.

According to Haby et al. (2006: 13) and as depicted, it is not the stimulus itself which somehow elicits a direct emotional reaction, but the assessment of or thought about that stimulus. There is empirical evidence which shows that CBT has proven useful and effective for treatment of childhood, adult as well as late-life disorders.

How CBT Works

Cognitive behavioural therapies break down problems into situations, thoughts, emotions, physical feelings and actions. These problems according to CBT are interconnected and affect each other. As an example, when thoughts about a specific situation affect the physical and emotional feelings, there is a reaction to respond to such thoughts and feelings.

CBT is mainly focused at stopping the negative thought cycles which are determined by how a person reacts to different situations which are as a result of the thoughts about a situation. For example in a situation of a broken relationship, the victim might feel hopeless, lonely, tired and depressed which can lead in seclusion. The end result is trapping oneself in a negative cycle which involves feeling self-pity and avoiding people by staying alone. However, instead of accepting this form of thinking, acceptance of the situation and learning from own mistakes as well as choosing to move one will help in having optimism about the future. The optimism in the case above will lead to a better social life which could attract a new social group that can be the source of another relationship.

In essence, CBT aims at stopping the negative cycles by breaking down factors that contribute to bad feelings, anxiety or fear. Through management of problems, CBT helps in changing negative thought patterns by improving personal feelings. Therefore, CBT can help in getting to a point of tackling own problems without therapeutic help.

It is commonly assumed that human thoughts and not external stimuli as indicated above directly cause emotions and behaviours which are the reason that the cognitive part of CBT relies on thoughts. Different people react and interpret different stimuli in different ways with some interpretations considered predictably more rational as well as more positive than others. It is through exercises that concentrate on thought analysis that clients are able to identify negative and irrational thoughts and then starts replacing them with more positive and rational thoughts. Consequently, automatic thoughts are seen as most powerful in the effects on emotions and behaviours because they are cognitive reactions in situations that generate fear. Therefore, automatic thoughts raise assumptions that affect a human’s core beliefs. It follows that CBT concentrates on the negative as well as irrational beliefs and thoughts in a client’s mind.

Therefore, CBT is based and relies on facts and not assumptions because irrational and negative assumptions do not have factual explanations but have very negative effects because they are upsetting to the psychological health of a person (Hofmann and Smits, 2008: 628).

Effectiveness of CBT

Since its invention, CBT has gained a lot of popularity among psychologists with many published research studies to support it use in cognitive behavioural therapeutic interventions. One of the reasons behind its success has been the adaptation of CBT as an applicable therapy to several disorders as well as other related psychological problems. Despite the extensive research on CBT, there still remain unanswered questions on its effectiveness with regards to different disorders and its long-term effects as well as the authenticity of research aimed at proving its level of effectiveness. The main issue has been the increased effects that arise out of combining BT with other therapies in treatments. However, in order to give answers to these questions, Meta-analysis is used to provide clarity as well as insight on these factors.

According to (Petersen, 2015:1 ), for CBT to deliver fruits, the therapist starts by establishing a relationship with the client which is referred to as a therapeutic alliance in order to identify the problems in thoughts, feelings or behaviour. For effectiveness of the therapy, the relationship between the two should be collaborative. Together, they are able to get to the core of the problem where the therapist understands the difficulties of the client as well as the triggers to such negative effects. In this case, both parties are expected to be experts with the client being an expert in own experiences and life whereas the therapist is an expert in CBT. Therefore, they work hand in hand in developing new ways in which the client is supposed to adopt. After the problem has been identified, it is important to set milestones which are agreeable and practical for effective and positive results to be achieved.

As Ceniceros (2012: 23-32) states, many clients joining CBT are in many times sceptical of its effectiveness because they believe it is not possible to change the way they think since it is fundamental to their being. However, after analysing the irrational and negative thoughts, they are able to learn the significance of the thoughts and how they impact on their behaviour. The therapist teaches the client to look at facts that can be substantiated with tangible evidence that is developed from having an objective perspective. Therefore, with the introduction of the patient to objective as well as factual analysis, CBT assists the client to reduce the negative and irrational thinking.

There is also the behavioural part of the therapy that identifies major behavioural problems that affect the client and manifest themselves mainly by escaping or avoiding certain situations in their lives which work in changing the maladaptive behaviour. In this case, the therapist teaches the client fundamental information on the severe effects of their negative behaviour patterns. As a result, the client may avoid various situations as a result of irrational fear and phobia attached to a specific situation (Tolin, 2010).

Overall Effectiveness versus Individual Effectiveness

Despite the high effectiveness of CBT, different cases manifest in different forms. Additionally, different clients or patients will have different levels of manifestation. As a result, the therapist is tasked with the responsibility of evaluating the level of the problem before deciding on the method to use. It follows that depending on the level of the problem the therapist will decide what course of action for the best treatment.

Considering that the normal course of treatment spans between five to 20 sessions, the progress of the client will guide the therapist on the level of effectiveness of the therapy. Sometimes, the therapy can be administered to a group but in these cases, the therapist should be careful to ensure all the clients get the best treatment to full mental health (Oaklander, 2014: 1).

Advantages and Disadvantages or Limitations of CBT

Using CBT treatment, management of depression or anxiety and reducing the negative effects is possible. However, there are risks that the problem can recur because of the underlying factors that triggered the problem. In this case, it is important to control such triggers with the empowerment made possible by CBT. However, it is important to continue with CBT programmes where the problem is likely to recur. While there is evidence to the effectiveness of using CBT in the treatment of mental health problems, there are some limitations or disadvantages associated with its use (Eriksson et al., 2013: 1814).

Advantages

  • CBT is very instructive and accords the clients capacity to understand how to deal with tier problems in a rational and confident manner. As mentioned above, with the likelihood of recurrence, the client is already empowered to have control and administer the already learned solutions in dealing with the problem. Therefore, the skills can be incorporated in daily life in coping with difficulties even after finishing the programme.
  • CBT is short-term: The programme does not take a long period to administer and can be completed in an average of sixteen sessions. However, the more advanced mental problems require more sessions.
  • The structured nature of the programme means that it can be administered in different formats such as groups, computer programmes or self-help reading material. It follows that the sessions are not necessarily chatting or ‘shrink’ sessions thereby eliminating the stigma associated with mental health.
  • CBT emphasises on getting better as compared to feeling better. This means that the programme aims at correcting the problem which has lasting effects on the health of the client.
  • Cognitive behavioural therapies are cross cultural: Considering that the methods are empirically founded, they can be administered indiscriminately on any human being. This means that CBT is founded on human behaviour regardless of race, religious or any other background.
  • Cognitive behavioural therapies are empirical: Being empirical illustrates that CBT is highly substantial because they can be and are well researched in order to have clearly defined techniques. It follows that CBT can be examined through scientific researches.

Limitations

Though highly praised, CBT has its limitations which are mainly associated with treatment processes. Of major concern is the capacity to instil positive thinking but lacking the capacity to actualize such positivity in the client. While the therapist can try by all means to help a client, there cannot be results without the cooperation of the client. It follows that the client must play their part in the path to recovery. Cooperation means that the client has to fully take part in every therapy as well as do their ‘homework.’ Therefore, CBT is not a quick fix despite being highly praised to be fast and effective (Good et al., 2010: 21).

Additionally, because of its structured nature, CBT is not suitable for people with complex mental health problems or learning difficulties. Clients with treatment resistant depression as well as those with personality disorders or even both are not recommended to CBT. In cases where the mental problems are complex, CBT cannot work without administering antidepressants to the patient which proves the limited capacity of CBT.

With its focus on current problems, CBT does not look at the foundation or background of the problem. With the focus on specific issues, CBT does not address the underlying cause of psychological problems which form the basis of the treatment process.

CBT also focuses on the client’s capacity to change themselves in thought, feelings and behaviour but does not address the secondary problems that can have an effect o the treatment process. These secondary problems can be family or systems related and have drastic effects on the health of the client (Johnsen and Friborg, 2015: 754).

Criticism

As mentioned above when getting in the programme, many people are sceptical because they believe it is not possible to change the core of their beliefs and thinking patterns. Others allege that the therapy does not reflect reality and does not alleviate their bad feelings. There are also claims on the ‘pettiness’ of the programme where the therapist simply tells the client that a thing is wrong which is seen as trying to caricature the approach. This can be equated to critiquing the client centred approach by insinuating that the therapist simply allows the client to discuss whatever they wish to discuss and attract no judgement which would result in difficulty in discussing the problems. On the other hand, the therapist is accused of leading the client using questions that are directive and biassed towards their recommendations (Kirwan-Taylor, 2002: 24).

Conclusion

It is a fact that CBT is a highly developed and well-proven and therapy. Through testing, it has been confirmed to be an effective therapy on treatment of clients with behavioural and cognitive problems. It is also important to note that CBT is a treatment of choice for moderate and severe cases on cognitive and behavioural problems. In order to the treatment to work effectively, a high level of collaboration is required between the client and the therapist. In the treatment of mental health problems, CBT targets multiple areas that have potential in being vulnerable in order to provide intervening measures.

As mentioned above, CBT embarks on teaching the client to self-administer solutions to their problems which make it pragmatic. By teaching the client on the importance of maladaptive thinking as well as behaviour, the client is able to see the negative aspects of such thinking and start developing new beliefs which result in mental health. There are several advantages associated with CBT such as being well structures, having empirical substance and the short period it takes to administer. On the other hand, it also has limitations such as the high dependency in collaboration between the therapist and client. Additionally, it is limited to current problems without looking at the history of the client whereas past cases could be the triggers to current problems.

Cognitive behavioural therapies have proven practical with reasonable substance attached to its use. It is out of this that it is highly reliable in obsessive-compulsive disorders, panic disorders, phobias and post-traumatic stress disorders among others. As more research is done on CBT, new information will be provided in the enhancement of the therapy for better mental health.

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