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COGNITIVE BEHAVIOUR THERAPY (CBT)

 

Biography

 

Aaron T. Beck was born in 1921. He completed his psychoanalytic training in 1958 and started working as an Associate Professor of Psychiatry at the University of Pennsylvania. In his studies on the validation of Freud’s theory of depression, he found that very often instead of anger, themes of loss, deprivation and defeat appeared in the dreams of depressives. He also observed that there is another level of consciousness that reflects what people say to themselves.

Following these observations he developed his Cognitive Behavioural Therapy for depressed patients. This approach eventually became the most widely used cognitive approach to therapy.

Cognitive Theory

CBT is based on the assumption that how one thinks determines how one feels and behaves. Information processing, automatic thoughts and schemas are three types of cognition described by Beck and are assumed to influence a person’s feelings, behaviour and physiology. The so-called cognitive triad of depressives consists of negative thoughts about the self, about the world and about the future.

Beck hypothesised that negative cognitive patterns are maintained by errors in logical beliefs or that they are maintained by value minimising thoughts that lead to low self-esteem, depression and anxiety.

Systematic errors in reasoning are called cognitive distortions and these include:

 Arbitrary inference

Drawing a conclusion that is not really supported by any evidence

 Selective abstraction

Emphasising one small aspect of a situation while ignoring all other aspects

 

Personalisation

Taking responsibility for negative events that are not actually the fault of the individual

Magnification and minimization

Minor negative events are magnified and major positive events are minimised

Over-generalisations

Drawing general conclusions about one’s worth on the basis of very limited evidence

Dichotomous thinking

Categorising experiences in one of two extremes

These logical errors in thinking might appear as “automatic thoughts” of which we are mostly unaware. Beck describes these “automatic thoughts” as personalized notions, triggered by particular stimuli that lead to emotional responses. Therefore, one of the goals of therapy is to bring these thoughts into conscious awareness, thus allowing the patient an opportunity to check their validity.

Therapy Strategies and Techniques

CBT is a goal-orientated, problem-solving, structured approach that requires active participation on behalf of the patient. The goal of CBT is to correct faulty information processing in order to help patients modify assumptions that maintain maladaptive behaviours and emotions.

The following cognitive strategies are central to this approach. They will help the patient identify, examine, reality test and modify incorrect cognition.

Socratic questioning

Designing a series of questions that promotes new learning

Cost-benefit-analysis

Looking at the advantages and disadvantages of holding a particular belief

 Alternative perspectives

E.g. viewing their problem from the perspective of (for example) a close relative

Automatic thought forms

Identifying automatic thoughts and understanding how they influence the patients emotions and behaviours

 Reality testing

Providing evidence for and against the dysfunctional and distorted cognitions

Cognitive rehearsal

Practicing coping in difficult situations through role-play, imagination or in real life

Besides these cognitive techniques, behavioural strategies are used to challenge dysfunctional thoughts, to reduce the physiological components of anxiety and to increase the activity of people who suffer from depression:

 Graded exposure

Step by step exposure that allows the patient to face their fears and anxieties, either in imagination or in real life

 Monitoring activities

Keeping a record of daily activities and rating them on a ten point scale for mastery and pleasure