Cognitive Behavioural Therapy To Treat Mental Issues
Cognitive behavioural therapy (cbt) was developed by Aaron T Beck in the 1960’s as a treatment for depression. He conducted experiments to test the psychoanalytic theories of the time and found that rather than proving the theory it suggested other factors may be involved. This lead Beck to identify that rather than childhood experiences being the cause of depression it was actually the clients disturbed negative thoughts. CBT as a therapy is usually a short term piece of work, which is structured and focussed on the client's current issues. It aims to help the client identify their disturbed thoughts and feelings and them in conjunction with the therapist explore challenge and change them with the use of exercises and creating new strategies. CBt has shown to be effect for a number of psychological disorders such as depression, anxiety…. (quote). Treatment of any disorder relies on the relationship between the therapist and the client, beck describes (quote) a need for a positive alliance in the relationship as trust is essential to achieving success. Positive alliances are strongly linked to positive outcomes (quote).
Therapist skills will also reinforce this relationship as the display of empathy and warmth as well as thoughtful questions and statements will encourage the client to engage with the therapist and strengthen their relationship. Working collaboratively with the client is central to this therapeutic approach as the client is key to their own understanding, interpretation and solution to the problem. Client's are viewed as the ‘expert’ in the room (quote) and it is the issue that they identify to be the problem that is addressed with the therapist. Issues identified are normally present in the ‘here are now’ rather than dissecting past memories and events saying that at times exploration of past memories may be necessary to help understand what has shaped an individual and potentially impacts on their current state of mind. Sessions are focussed on a specific problem and are goal oriented in nature. The aim psychoeducation for the client helping them to identify evaluate and respond to their dysfunctional thoughts and beliefs and once addressed in therapy they can then use and apply these tools to help prevent relapse or to address new forms of dysfunctional thought. All individuals have automatic thoughts whereby the mind reacts to a stimulus or event triggering a memory, emotion or feeling.
Problems arise for people where the automatic thoughts have negative associations leading to an emotional reaction which can then be the trigger for psychological distress and overtime lead to a psychological illness. Guided discovery and socratic questions aim to help uncover the nature of an individual's automatic thoughts to provide them with a starting point to alleviating their symptoms. Work with the therapist to support the client to explore these associations give them both insight into the cause for the distress and also forms part of the assessment and formulation which will determine the treatment.
Treatment will vary depending on the client and severity of presenting issues however usually this will form behavioural experiments which will test or aim to disprove a person's dysfunctional thoughts and beliefs. These are usually conducted as homework where the person tests their new ways of thinking in the real world so as to help shape them into new concrete ways of being. These basic principles are key to all clients however the focus of the work will depend on the presenting issues for example the emphasis for someone with a panic disorder will be around their catastrophic misinterpretations whereas the modification of personal beliefs and self worth will be more suited to an individual with an eating disorder.
Cognitive behaviour therapy is derived from two popular approaches to psychotherapy in the 19…. Behaviour therapy and the work of …. . Was interested in the processes and connections that went on inside the mind and how associations and subsequent behaviours were learned. Specifically that behavioural response to stimuli. Learning theory and the learned associations between stimulus and response was key to the principle that individuals were able to change unwanted behaviours and emotions by changing how they interpreted the stimulus. (work of…. Systematic desensitisation with anxiety disorders. )Cognitive therapy highlighted the significance of thought, beliefs and interpretations in providing a therapeutic approach. Individually these theories were found to be lacking an effective treatment for psychological issues however when combined to form cbt they developed into a reliable, effective and proven approach. (ref. )The underlying principles of cbt are not exclusive to them and elements are reflected in varying degrees within other approaches. the overarching principle of both the cognitive principle and behaviour principle come together to form a unique and effective treatment. Thoughts, beliefs and interpretation are all cognitive function which strongly influence and individuals behaviour and emotions. It is widely accepted that people will react differently to an event and also a person can also have a different emotional response to similar situation.
Therefor it is not solely the situation that determines the response but the cognition from the individual that elicits the reaction and different cognition will result in different emotions. This concept is not new and can be traced back to greek times where the philosopher epicteus said ‘men are disturbed, not by things, but by the principles and notions which they form concerning things. ’ westbrook pg 5. Similarly the behavioural principle determines that behaviour is key to changing the understanding and emotional response to our environment. Traditional psychodynamic approaches don't focus on the symptoms of a condition but rather it looks at the underlying meaning and unconscious constructs. CBT treatment centers around and individuals symptoms that are causing them distress and the systems that are in place which maintain it. The influencing ‘systems’ on an individual (ref) are believed to be cognition; our thoughts feelings and beliefs, emotion; our emotional state, physiology; or our physical body reactions and behaviour; and how we respond. Is used in analysis of a problem and to identify specific aspect that need addressed in therapy. CBT is tested means to address distress and suffering. It can be empirically tested and theories are developed and re-tested based on its effectiveness resulting in well establish theories. Levels of cognition, negative automatic thoughts, core beliefs and dysfunctional assumptions. NATs are thoughts which we all have if we pay attention to them - they are negative responses to our environment and how we interpret our world. In cbt these nats are key to emotional distress as it is believed that they are strongly linked to our mood and the changes at any point in time.
These naturally occurring thoughts tend to be situation specific and are brief fleeting that they may not always come into a persons conscious thinking. Whether we are aware of them or not we don't question them but simply accept them as fact. Core beliefs are deeply hidden standards that are formed in childhood and reinforced as we grow and develop. They are rarely accessible at the conscious level but underpin all of our thoughts, beliefs and behaviours. They are static in nature and do not tend to vary depending on the situation. Dysfunctional assumptions - rules for living (check)Tend to form the rules by which we live our day to day lives. They are conditional and take the shape of i statements i. e i should… i must… if i…… they are not always as obvious to the person and if they become too rigid or negative can have a significant impact on an individuals view of themselves. These can be addressed in therapy and cbt is a good way to identify and re learn our ways of living to reduce emotional distress.
Cognitions - form 2 different forms - content cognitions (negative thoughts about themselves) and the process of cognitions (show bias in the way that they think). Due to cbt having proven positive result with certain types of emotional conditions, that it is cost effective and can have fast results in improving mood and reducing distress it tends to be the therapy of choice for the NHS. NHS programmes such as improving access to psychological therapies (IAPT) was developed as a response to the growing demand on the national health service from people suffering from mental ill health.
The programme can be split into high intensity therapy as well as low intensity therapy. High intensity takes the form of a more traditional therapy session carried out by a trained therapist however low intensity can be implemented by a health professional who has been trained to deliver the basic principles and techniques of cbt. This can be seen to have a positive impact for individuals as it may reduce the waiting times for treatment for low to moderate client's and also provide high client's with coping strategies aimed at reducing distress until they can be seen by a therapist. Cbt skills and techniques are adaptable so that they can be effectively self taught through the use of workbooks and online websites and apps. These modern and less traditional forms of therapy allow people who are experiencing emotional distress to take their own steps to self help and change their behaviour. The effectiveness of this work needs to be considered and could be seen to be less effective due to not having a therapeutic relationship with a trained professional. However for issues or problems i feel that it can go some way to help alleviate symptoms of anxiety and stress.
