Cognitive therapy is a form of therapy developed by Aaron Beck who suggested that our beliefs and perceptions influence our emotional responses to the world around us. According to cognitive therapy, negative thought patterns cause depression, anxiety and a few other mental disorders. Cognitive Therapy helps patients by making them aware of these beliefs and then working to change the dysfunctional beliefs. Unlike unconscious conflicts or early life traumas as psychoanalysis suggests, cognitive therapies are more goal oriented, in a constructive problem solving approach.
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Cognitive Behavioral Therapy is a psychotherapeutic approach, a talking therapy that aims to solve problems concerning dysfunctional emotions, behaviors and cognitions through a goal-oriented, systematic procedure. The title is used in diverse ways to designate behavior therapy, cognitive therapy, and to refer to therapy based upon a combination of basic behavioral and cognitive research. Throughout this paper we will refer to Cognitive Behavior Therapy as CBT. CBT is effective for the treatment of a variety of problems.
Many clinical problems are best described as disorders of thought and feeling. Since behavior is effectively controlled by the way we think, the most logical and effective way of trying to change maladjusted behavior is to change the unbalanced thought processes that lie behind it. CBT is comprised of both cognitive and behavioral techniques. The premise underlying a cognitive-behavior is that difficulties in living, relationships, general health, etc., have their origin in and are maintained by both cognitive and behavioral factors. Psychological treatment of depression (psychotherapy) can assist the depressed individual in several ways.
To begin with, supportive counseling helps ease the pain of depression, and addresses the feelings of hopelessness that accompany depression. Second, cognitive therapy changes the pessimistic ideas, unrealistic expectations, and overly critical self-evaluations that create and sustain depression . Cognitive therapy helps the depressed person recognize which life problems are critical, and which are minor. It also helps him/her to develop positive life goals, and a more positive self-assessment. Consequently, problem solving therapy changes the areas of the person’s life that are creating significant stress and contributing to the depression. This may require behavioral therapy to develop better coping skills, or interpersonal therapy to assist in solving relationship problems.
At first glance, this may seem like several different therapies being used to treat depression. However, all of these interventions are used as part of a cognitive treatment approach. Some psychologists use the phrase, cognitive-behavioral therapy and others simply call this approach, cognitive therapy. In practice, both cognitive and behavioral techniques are used together.
Once upon a time, behavior therapy did not pay any attention to cognitions, such as perceptions, evaluations or expectations. Behavior therapy only studied behavior that could be observed and measured. However, psychology is a science, studying human thoughts, emotions and behavior. Scientific research has found that perceptions, expectations, values, attitudes, personal evaluations of self and others, fears, desires, etc. are all human experiences that affect behavior. Our behavior and the behavior of others, affects all of those cognitive experiences as well. Thus, cognitive and behavioral experiences are intertwined, and must be studied, changed or eliminated, as an interactive pair.
Brief History of Cognitive Therapy
Many people think that cognitive therapy is a relatively recent development in psychotherapy. However, Albert Ellis published, Reason and Emotion in Psychotherapy in 1962, and Aaron Beck wrote about, The Self Concept in Depression with D. Stein in 1960. To some extent, most or all of the psychodynamic and psychoanalytic theories of depression can be described as having cognitive components.
For example, Freud, in Mourning and Melancholia, published in 1917, suggests that melancholia (depression) can occur in response to an imaginary or perceived loss, and that self-critical aspects of the ego are responsible in part for depression. The main difference between these psychodynamic therapies and cognitive therapies lies in the motivational assumptions made by the therapists, and the techniques used to effect change. Psycho-dynamic theories presume that the maladaptive cognitions arise from specific internal needs (such as the need for affection, acceptance, sexual gratification, etc.), or from unresolved developmental conflicts from childhood.
In contrast, the cognitive therapists presume that the maladaptive cognitions may arise from faulty social learning, or from a lack of experiences that would allow adaptive learning (such as the development of coping skills) to occur, or from dysfunctional family experiences, or from traumatic events, etc. In other words, psychologists using a cognitive therapy approach recognize that psychological problems such as depression can develop from a variety of life experiences, depending on the individual.
In the 1970s, many psychologists began writing about cognitive aspects of depression, identifying different cognitive components that affected depression, and developing cognitive interventions to treat depression. From this base of theory and research came evidence that cognitive therapy was an effective, and perhaps is the most effective, intervention strategy for treating depression. Since the 1970s, the use of cognitive therapy with depression has increased tremendously, and the number of psychologists using cognitive therapy approaches for the treatment of all psychological problems has also grown. As a result, it appears that cognitive therapy has recently appeared on the scene, in only the past twenty years. However, all psychotherapy has cognitive components. One of the major differences between cognitive therapy and other therapy approaches is the treatment interventions used to change human cognitive experiences.
Rational Emotive Behavior Therapy, often abbreviated to REBT, is a psychotherapy that focuses on resolving behavioral and emotional problems by challenging and changing the irrational beliefs on the patient. Once that is figured out, the psychiatrist must enable the patient to lead a happier, more fulfilling life. Developed by Albert Ellis, this form of therapy suggests that the root of the problem is found in problem emotions and behaviors. By making that connection, the psychiatrist’s job is facilitated, and the solution is found in changing irrational beliefs. Ellis believed that outside events cannot cause us to have feelings. Therefore, he created rational-emotive behavior therapy to use as a tool to challenge and change those irrational beliefs.
Interestingly, Ellis’s REBT theory was presented nearly a decade before Beck’s Cognitive Behavior Therapy. In 1956, Ellis published “Rational Therapy”. Beck’s approach was introduced until 1967 in “Depression: Causes and Treatment” .Irrational beliefs are a part of the problem in REBT. For example, if a person is involved in an automobile accident and doesn’t like to drive because they feel fear after the event, perhaps REBT would be the best treatment option available. In other words, to enable a person to accept more reasonable beliefs, they must first be made aware of how irrational their generalized beliefs are. The A-B-C-D approach helps us better understand this.
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Ellis based much of his theory on ancient philosophy, and it is especially notable in his A-B-C-D approach. The A stands for activating event. The interpretation of the activating event can be anything that happens in the past, is happening in the present, or will happen in the future that triggers, or activates dysfunctional behavior. B represents the beliefs and the thoughts or emotions that may be brought up based on those beliefs. This could be anger, hurt, or any negative emotions linked to the activating event. The C is the emotional and behavioral consequences. What will happen if I act on my emotions? How will the other person be affected? These are examples of questions one may be asked when analyzing the consequences to an emotion. Finally, the D stands for disputing erroneous beliefs. By disputing, a person can stop oneself of acting impulsively and instead thinking of a better way to handle the emotional distress.
Ellis believed that irrational beliefs can go on undiscovered until they are directly confronted. Using blunt language and teasing patients, he treated his patients and taught them how to behave differently after recognizing the self-defeating thoughts. By doing so, Ellis helped his clients overcome irrational misconceptions about self and about others. Evidently, Ellis used the ABCD approach when treating his own patients. He helped many people with emotional problems and distress throughout his career.
Cognitive therapy displays many types of different ways to resolve certain problems. You can witness how cognitive therapy reflects the change in human cognitive experiences in various ways. By using therapies such as cognitive restructuring, or thought-stopping, the person administering these types of therapies will most likely accomplish to change some human cognitive experiences for the patient that were negative or unwanted to begin with and needed to be altered for the health of the patient.
Cognitive restructuring, also called cognitive re-framing, is the procedure of replacing maladaptive thought patterns a patient may have about themselves, or what people around them think about them, with constructive thoughts and beliefs by learning to dispute and identify maladaptive thoughts. Now being one of the more main techniques used by therapists, cognitive restructuring is used to control and manage depression along with anxiety. Cognitive restructuring can be more easily recognized by the general public as a stress management tool. Stress can pilot to a sequence reaction of thoughts that starts with a small crisis and leads to full-blown anxiety and panic over unrealistic fears which within time, it may lead to depression. We all get ourselves worked up from time to time, but these irrational thoughts can cause excessive stress. With cognitive restructuring, the patient living with those anxieties can learn to control those thoughts, and not just stay positive, but be realistic as well.
Cognitive restructuring which is known as CR, can be a technique used to understand where and what lies behind a person’s negative mood. In the book “Mind Over Mood” doctors Greenberger and Padesky go in greater depth in what it means to use the CR technique and how to recognize those maladaptive thoughts and convert them into more positive spectrum. This means being able to control and understand you as an individual’s anger, depression, or mood that can seem overwhelming and uncomprehending when trying to assist a patient.
The Law of Positive Self-Talk states, “You can change who you are by changing what you say when you talk to your mind.”. This statement simply refers to a technique recommended to patients receiving cognitive therapy known as self-talk. Because internal conversations influence our perceptions, the ability to recognize and shift them greatly helps the individual.
Thought stopping is simply blocking off negative or irrational thoughts by placing a mental conscious road block with a “stop, “. This is a form of coping that goes hand in hand with cognitive restructuring. It may seem silly that a patient or person would cut off their thoughts immediately and turn to a more positive attitude to get away from what causes them harm, but it has shown positive results. The criticism with this technique involves that the individual is only repressing memories, which is only temporarily hiding or covering the problem that will later arise to cause more harm.
In more severely mentally ill patients, this approach cannot be used and those individuals are in need of more assistance from their therapists. On the brighter side, thought stopping is more common with the public with minor problems to block and eventually condition the mind to forget obsessive and phobic thoughts that are not wanted. The gist of why this technique works is simple. By disrupting unnecessary thoughts by commanding them to “stop” , results as a distraction and reminds the person not to continue in negative thought processes.
Some criticisms of cognitive therapy state that the unconscious dynamics of the patient are ignored. Rationalities are said to be overemphasized and the importance and background of the patient are minimized. In other words, situational factors and their possible effects are not acknowledged. Because humans are wired to instinctively feel and to act upon such feelings, applying cognitive therapy can sometimes be difficult as well.
In conclusion, Cognitive Therapy has been known to successfully help many patients. Thanks to the fundamental research of Beck and Ellis, we have been able to consider and apply new concepts into the last few decades. By teaching a patient how to change thought processing, positive results can be observed that affect their likelihood to continue living in a positive direction and overcome difficulties.
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