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Cognitive Therapy (CT) is a “system of psychotherapy based on a theory which maintains that how an individual structures his or her experiences largely determines how he or she feels and behaves” (Beck & Weishaar, 1986 cited by Freeman & Dattilio, 1992). Simply, Cognitive Therapy operates under the assumption that thoughts, beliefs, attitudes and perceptual biases influence what emotions will be experienced and also the intensity of those emotions. Cognitive Therapy was pioneered by Aaron Beck for the treatment of depression (Westermeyer, R). CT is an adaptive theory. Cognitive processes evolved to enhance adaptation to the environment, and hence survival. The basic needs of humans are thought to be preservation, reproduction, dominance, and sociability (Clark & Beck, 1999 cited by Murdock, 2004). The cognitive model proposes that our emotions and behavior are the product of our perceptions of situations (J.S. Beck, 1995 cited by Murdock, 2004). Cognition means both the process and content of thinking, or how you think and what you think (Kovacs & Beck, 1978 cited by Murdock, 2004). Schemas are cognitive structures that we use to organize the barrage of information with which we are constantly confronted (Murdock, 2004). Memories of our experiences are stored and configured efficiently into the schemas. Certain schemas cause behavioral and emotional problems. These schemas are formed early on in life as a function of negative experiences. They are built upon by experiences that occur throughout our lives. We call these schemas dysfunctional schemas, or dysfunctional core beliefs. For example, repeated experiences as a child of inconsistency, harsh criticism, and conditional statements of love, might form a core belief in which the
person feels "flawed." Such a core belief would make this person vulnerable to depression (Westermeyer, R). The core beliefs are the most basic beliefs we hold; they are absolute and hard to modify. The intermediate beliefs are attitudes or rules that are between the core beliefs and automatic thoughts. These beliefs include “should” and “must” beliefs. The automatic thoughts are evaluative statements or images that exist alongside our more conscious thoughts. They can be functional or distressing and tend to be reasonable to the thinker. They are the result of our core and intermediate beliefs. Modes are an integrated network of subsystems (cognitive, affective, motivational and behavioral schemata), which can act in synchrony to produce goaldirected strategies (Beck, 1996 cited by Scott, 2001). Beck & Clark (1997) cited by Murdock (2004) say that there are three major mode categories: primal (most basic kinds of operation and function to meet goals: threat, loss, victim and self-enhancement), constructive (developed through life experiences and serve to increase the life resources available to the individual), and minor (tend to be under more conscious control than the other modes, focus on situations of everyday activities like reading). CT views personality as being shaped by central values (or core beliefs) that develop early in life as a result of factors in one’s environment. These schemas constitute the basis for coding, categorizing, and evaluating experiences and stimuli that an individual encounters in his or her world (Freeman & Dattilio, 1992). The individual current functioning is also influenced by his early life experience because we develop schemas and associated core beliefs in childhood (Clark & Beck, 1999; Persons & Tompkins, 1997 cited by Murdock, 2004).
According to CT, healthy people are those who use information processing that allows them to meet goals of survival, reproduction and sociability. They do not rely on a lot of primary mode processing and do not show a lot of distorted thinking and probably have good problem-solving skills (Murdock, 2004). Psychological problems are perceived as stemming from commonplace processes such as faulty learning, making incorrect inferences on the basis of inadequate or incorrect information, and not distinguishing adequately between imagination and reality (Kovacs & Beck, 1979 cited by Freeman & Dattilio, 1992). Their rules or standards are often too rigid or absolutist like the result of faulty schemas: erroneous assumptions. An example of such schema will be the rotten person schema or what Albert Ellis called a worm schema. This person will be sure that he cannot do anything right and that others hate him (Murdock, 2004). The cognitive distortions are very similar to Ellis’ irrational beliefs. All the work of Albert Ellis in RET has provided support to the principles of CT and impetus to the development of what is now Cognitive Behavior Therapy (Freeman & Dattilio, 1992). The initial goal is to establish rapport with the client. This is very important because it is a collaborative process. The principal goal of CT is to change beliefs that are leading to psychological dysfunction to ones that are more adaptive (Kovacs & Beck, 1978 cited by Murdock, 2004). To help the client to change any distorted perceptions that individuals have of the world and of themselves, this means learning to think differently and to improve their ability to deal with their problems. Assessment is used in a formal and informal way in CT. The initial evaluation generally results in formal DSM-IV diagnosis. Formal assessment involves using
standardized self-report inventories. Informal assessment is done through the sessions asking questions to the clients and establishing goals. In CT the counselor takes an active part in solving the client’s problems. The counselor is an expert who teaches the client first the principles of CT. The counselor needs to be caring, collaborative and competent. The counselor will ask a lot of questions and assign tasks that have to do with the client’s problems. The client needs to work hard to learn about CT first and will have to do homework that is developed with his/her participation to achieve their goals. CT is usually a short-term process and provides a clear structure and focus of treatment and has been very thoroughly researched. In study after study, it has been shown to be very effective. Its focus is on current issues and symptoms versus more traditional forms of therapy, which tend to focus on a person's past history. The usual format is weekly therapy sessions coupled with daily practice exercises designed to help the patient apply CT skills in their home. CT is flexible in the use of techniques. They use cognitive techniques to change the cognitive structures and behavioral techniques in the interest of behavioral activation or to teach new skills. Homework is essential. Questioning is one of the most basic interventions. Socratic questioning refers to asking leading questions so that the client comes to the cognitive therapy conclusion (Murdock, 2004). For example, if a person is upset because a friend isn’t returning a phone call, they may be assuming that the friend is mad or has suddenly decided they hate the worrier and never want to speak to him again. If the person then asks themselves, “Why would they be mad?” and comes up with no reasonable answer, they can then ask, “Is it possible they are just very busy?” Through
this method of questioning the assumption, the person realizes that they probably have no reason to be upset about the problem of the unreturned phone call (Unknown author, 2004). Other Cognitive Techniques are: Downward Arrow: to identify core beliefs, the counselor follows a client’s statement by asking, “If so, then what?” Decatastrophizing: to balance their focus on the worst anticipated state by reestimating the situation and asking, “So what’s the worst thing that might occur? And if so, would this be so horrible?” Problem Solving: a list of problems can be made in the first session and every week the client can come with new problems that he/she had during the week, the counselor can give possible solutions and encourage the client to do active problemsolving him or herself. It is helpful to do this on paper with these specific points: problem, special meaning, automatic thoughts and beliefs, response to special meaning and possible solutions. Other techniques are: Idiosyncratic Meaning, Labeling of Distortion, Questioning the Evidence, Examining Options and Alternatives, Reattribution, Advantages and Disadvantages, Paradox or Exaggeration, Turning Diversity to Advantage, Replacement Imagery, and Cognitive Rehearsal. Some Behavioral Techniques: Assertiveness Training: by teaching or modeling for the client desired behaviors in social situations, Bibliotherapy: this is a very strong technique, the client can read a book such as Love is Never Enough, Feeling Good or the Feeling Good Handbook, Own Your Own Life, Talk Sense to Yourself, Woulda, Coulda, Shoulda. Other techniques are: Behavioral Rehearsal, Graded Task Assignments, Activity Scheduling, Thought Recording, Relaxation and Meditation, Social Skills Training, Shame-Attacking Exercises, and Homework.
According to Greg (2002-2005), clients who are comfortable with introspection, who readily adopt the scientist method for exploring their own psychology, and who place credence in the basic theoretical approach of cognitive therapy may be a good fit for CT. Freeman & Dattilio believe that CT is an excellent fit for clients with depression, anxiety or anger management, personal disorders and marital discord. Bush, (2003), thinks that it is also a good fit for mood swings, shyness and social anxiety, panic attacks and phobias, obsessions and compulsions (OCD and related conditions), worry, posttraumatic stress symptoms (PTSD and related conditions), eating disorders (anorexia and bulimia) and obesity, insomnia and other sleep problems, difficulty establishing or staying in relationships, problems with marriage or other relationships you're already in, job, career or school difficulties, feeling “stressed out”, insufficient self-esteem (accepting or respecting yourself), inadequate coping skills, or ill-chosen methods of coping, passivity, procrastination and “passive aggression”, substance abuse, codependency and “enabling”, trouble keeping feelings such as anger, sadness, fear, guilt, shame, eagerness, excitement, etc., within bounds, and over-inhibition of feelings or expression. Cognitive Therapy interests me because I know that most agencies in the field use it. I think that it is a good therapy if your interest is immediate results. It is good also because insurance companies ask for a formal DSM-IV diagnosis. This approach has the best record in outcome research, and is well proven to be effective. What I am not completely in agreement with is that this theory does not take an interest in client’s past. I believe that your past shapes what you are now and that problems in the present may
result from situations from the past, from unfinished situations. I believe that a person can take action in life when they gain insight and realize where the problem came from. Multiculturally speaking, Asian American groups can be a good fit for this theory because with this population the counselor needs to focus on the specific problem and deal with the present or immediate future, not with the past or dealing with deep emotions, and they value authority. It might work also with Latin American populations but the counselor needs to keep in mind that this group is considerate of the opinions of their families. Something common in these groups is that they usually believe in an external power. This theory is an individualistic approach that has emphasis on individual choice. The counselor needs to know about their cultures before trying to act against their beliefs.
Grade: A+ An excellent overview, very thoroughly presented, with good examples of interventions and a very good critical analysis of the theory.
REFERENCES Westermeyer, Robert. What is Cognitive Therapy? http://www.habitsmart.com/cogintro.html Scott, Jan (2001) Cognitive Therapy as an Adjunct to Medication in Bipolar Disorder. http://bjp.rcpsych.org/cgi/content/full/178/41/s164 Bush, John Winston (2003) Cognitive Behavior Therapy: the basics http://www.cognitivetherapy.com/basics.html Mulhauser, Greg. (2002 - 2005) An Introduction to Cognitive Therapy & Cognitive Behavioral Approaches. http://counsellingresource.com/types/cognitive-therapy/ Unknown author (2004) Cognitive Behavior Therapy: A Start To Feeling Better http://www.anxiety-and-depression-solutions.com/articles/howcbtworks.htm Murdock, Nancy L. (2004) Theories of Counseling and Psychotherapy (pp 177-217) Freeman, Arthur & Dattilio, Frank (1992) Comprehensive Casebook of Cognitive Therapy (pp 3-9).
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