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In order to overcome behavioural problems such as fear or anxiety that may be caused for example by phobias depression etc., individuals interact and communicate with their family members and trusted friends or seek professional help with a counsellor. There are relatively simple forms of psychotherapies that have been practised by individuals for centuries, however therapists have develop an identified more effective strategies for psychoanalysis. One of these approaches is the Cognitive Behavioural Therapy (CBT). This paper will focus on the fear of heights (Acrophobia), whilst discussing the effectiveness of the Cognitive-Behavioural Therapy in treating this phobia, its application in multi-cultural context and an overview on the therapy and phobia on the whole.
According to the American Psychiatric Association (1994), specific phobia is characterised by a persistent fear of specific fear of a situation or object that causes an significant interference or distress with an individual’s life.
Specific phobias are currently divided into four subtypes: situational (e.g. fear of enclosed spaces, flying), natural environmental (e.g. fear of heights, storms, water), animal (e.g. fear of spiders, snakes, dogs), and blood-injection injury (e.g. fear of seeing blood, dental or medical procedures, and injections).
Acrophobia (a fear of heights). Acrophobia is a common phobia which becomes apparent when an individual is on higher altitudes, or example; on a high floor of a building, staircases or escalators. As stated by Aaron T. Beck (1976), this specific fear is generally concerned with falling and being severely injured or killed. Beck (1976), further explains that some individuals will have visual fantasies of falling or experience bodily sensations of falling even though they are securely settled in a safe high place. Others are freighted by thoughts that they might have an uncontrollable urge to jump or the feeling of some external force drawing/pulling them to the edge of the high place.
In cognitive therapy, patients are taught to identify their faulty threat judgements that maintain the phobic reaction. For example, cognitive techniques include cognitive restructuring and guided threat assessments. The underlying cause of phobia is fear, i.e. acrophobic individuals fear falling, which is deeply seated in an individual’s thought (cognitive) process, cognitive therapy can assist individuals overcoming it (Jacques, 2017). CBT will target the fear inducing thought patterns of the individuals and change the chain of responses to such thoughts. It will assist them in identifying such thoughts, replace them with more positive constructive thoughts that result in change in behaviour. Acrophobic individuals have learnt responses to particular situation, CBT will help individuals unlearn such responses.
Furthermore, CBT will assist in altering a person’s attitude and behaviour by focusing on the images, beliefs, and thoughts that are deep-seated in an individual’s subconscious mind.
Cognitive behavioural therapy (CBT) is a psychosocial therapy that assumes that faulty thought (cognitive) patterns cause maladaptive emotional and behavioural thoughts (Naidu & Ramlall, 2016). “The intervention is aimed at altering thoughts to resolve psychological problems and change behaviour’’. CBT is a goal orientated, therapeutic approach, that stares that emotional behaviour disorders are a result of maladaptive learnt response that can be changed to healthier ones through correct training. Integration of thought, feeling and action is the task of cognitive behavioural therapy and counselling. Naidu & Ramlall, (2016), further explain that CBT approach combines aspects of behavioural change and cognitive reconstructing to change the clients dysfunctional/non adaptive behaviour; by inspecting challenging beliefs that support the maladaptive thought patterns and by making use of behaviour therapy techniques. It based on the fundamental principle that changing thoughts and or behaviours can have an effect on symptoms experienced.
According to Naidu and Ramlall, (2016), it was developed in the 1960’s by the key theorists Aaron Temkin Beck and Albert Ellis. CBT was originally create for the intervention with depression, nut it has since been adapted for the use with various conditions and disorders. The cognitive-behavioural therapist will ultimately be interested in knowing how the individual developed the ideas or cognition about reality, chooses and decides from many possibilities, and acts and behaves in relation to reality.
Becks cognitive therapy. Beck’s from of cognitive therapy uses wide range of core strategies incorporating cognitive and behavioural techniques. Some strategies include: cognitive practise to identify roadblocks in thoughts, associating feelings wit behaviours by imagining situations in every detail during the session; reality testing such as finding new ways to respond to negative responses; task assignments, and actively testing out negative thoughts and assumptions.
Meichenbaum’s cognitive-behaviour modification. Meichenbaum’s stress inoculation approach includes verbal self-instructions and relaxation strategies. The individual learn a programmed succession of verbal self-instructions that allow more rational decision making to stimuli (Okun & Kantrowits, 2015).
The goal of CBT is to achieve symptom reduction and improvement the quality of life through the process of replacing maladaptive emotional, behavioural and cognitive responses with more positive responses. These problem behaviours, cognition and emotions have been learned through experiences and therefore can be modified through teaching ways to respond and developing new learning experiences that promote more adaptive patterns and behavioural, cognitive and emotional response (Frank-McNeil et al., 2014). CBT focuses to achieve these changes in a relatively short period of time- focused at being problem focused and time bound.
In continuation, another goal of CBT is to promote long term positive effects that are self-maintaining and equipping clients with tools and their own set of skills for dealing with problematic situations thereby slowly becoming less dependent on their therapist and eventually act independently. The learning experiences and new ways of responding are repeated and practised over a sufficient number of occasions and in different contexts so that they become habitual and preferred methods of responding in future.
A noteworthy advantage of using CBT is that it consumes less time. The results are often seen within five to ten months of using CBT (Jacques, 2017). According to The CBT Clinic, the highly structured format of CBT allows for it to be provided in various forms such as self-help books, groups and computer programmes, and the skills that are learnt in CBT are useful, practical and helpful that can be incorporated into everyday life to help cope better with future stresses and difficult situations, even after the treatment is complete.
On the contrary, issues can occur with the therapist’s technique in explaining, reviewing, monitoring or using homework. The assignments may not be challenging enough, presented in the wrong time or may have no use. According to Kazantzis et al., (2005), the clients may be forgetful, lack motivation and energy, have poor concentration, or a negative attitude to homework. The CBT Clinic states that some critics argue that because CBT addresses current problems, anxieties and focuses on specific issues, it does not address the possible underlying cause of mental health conditions, e.g. unhappy childhood upbringing.
CBT has several strengths in working with individuals from diverse cultural, ethnic, racial and traditional backgrounds. South African context is filled with individuals from diverse cultures, nations, sexualities, religions and faiths, ethnicities, races, genders and ages. If the therapists have full understanding of core diverse background of the client, they can work jointly to change certain beliefs and practises (Corey et al., 2017). CBT is culturally sensitive because it values the belief system a methodical way of self-exploration. One of the great cognitive shifts of this century has been the self-awareness movement of people of colour, women, gay men, lesbians, trans-genders, the deaf, those who face physical; difficulties, the aged and others. Part of what is involved in surmounting discrimination, prejudice, and unfairness is creating a new cognitive view of the self and the ability to alter situations.
In conclusion, this paper has offered an overview of the practise of CBT. It explored the definition and variations of specific phobias and lightly explored acrophobia and CBT on the whole. CBT’ emphasis on structure can offer the new therapist a solid and secure foundation to begin therapy with their client. There is an extensive growing body of research on CBT and a number of therapists who apply CBT as treatment of choice, which further promotes the popularity of the approach. In summary, CBT examines how the client thinks about themself and their world and, if necessary, to help them change those cognitions, and to ensure that the clients acts on those cognitions through behaviour in their daily life.
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