Cognitive therapy is a psychological therapy that assumes that faulty thought patterns called cognitive patterns cause maladaptive behaviour and emotional responses.
Assumptions –
It is a theory that holds that a person’s cognitive functions and beliefs influence or mediate his or her affect (emotion) and behaviour.
Two ancillary assumptions underpin the approach of the cognitive therapist.
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The client is capable of becoming aware of his or her own thoughts and of changing them.
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Sometimes the thoughts elicited by stimuli distort or otherwise fail to reflect reality accurately.
Cognitive theories-
The basic assumption is that maladaptive behaviour is the result of irrational or distorted thinking – the emphasis is on internal thought processes.
Like psychodynamic therapy, cognitive therapy has been employed mostly by people with anxiety and mood disorders.
Albert Ellis states psychological problems stem from irrational and catastrophic thinking.
Examples of irrational beliefs are –
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I must be love approved all of the time.
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Things must always go right.
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I must be competent at everything.
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Life should always treat me fairly.
Cognitive distortions-
Cognitive distortions are faulty admissions and miss-consumption. These are-
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Arbitrary inferences – making conclusions without supporting evidence.
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Selective obstruction – forming a conclusion based on an isolated detail or event.
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Over generalisation – generalising beliefs based on a single incident.
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Magnification or minimisation – pursuing a situation in a brighter or darker light than it actually is.
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Personalisation – the tendency to relate external events to yourself.
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Labelling and mislabelling – portraying your identity based on imperfections and mistakes made in the past and allowing them to define your true identity.
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Polarised thinking – thinking about all or nothing, black or white extremes.
Characteristics of CBT –
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Feelings and behaviour are influenced by thoughts.
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Concise and time-limited.
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The emphasis is on current behaviour.
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It is a collaborative effect between the therapist and the client.
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It teaches us the benefit of remaining calm or at least neutral when faced with difficult situations.
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Based on rational thoughts.
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CBT is structured and directive.
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Based on the assumption that most emotional and behavioural reactions are learned. Therefore, the goal of therapy is to help clients to learn to have those unwanted reactions and to learn a new way of reacting.
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Homework is an important component of CBT.
Assessment and evaluation –
1. Targeting change –
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Environmental situations
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Thoughts or attitudes that he or she needs to reassess.
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Skills or problem-solving strategies.
2. Automatic thoughts –
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Not aware of how stimulation influences our behaviour.
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We are oblivious to what influences how we use a formula to build an effective relationship or the process of remembering.
3. Accessibility of cognitive processes –
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Ability to remember, perceive and attend to conversations.
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Ability to observe and accurately interpret behaviour.
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Adequacy of a person’s knowledge base.
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Problem-solving strategies and their effectiveness.
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Listening for a life theme.
4. Evaluating the person-environment match –
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People’s perceptions of themselves.
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A person’s view of the environment.
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A person’s learning style.
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Current and expected environmental and occupational demands.
Assessment instruments –
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Task checklist
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Becks depression inventory (BDI)
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Stress management questionnaire
Treatment techniques-
Mahoney and Arnkoff identified three major forms of CBT –
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Rational psychotherapy
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Coping skills therapy ( cope with difficult situations)
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Problem-solving therapy
Rational psychotherapy-
There are three types:-
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Ellis rational-emotive therapy (RET)
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Meichenbaum’s self-instructional training (SIT)
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Beck’s cognitive therapy
1.Ellis Rational Emotive Therapy (RET) –
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Albert Ellis established RET in 1955.
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This approach assumes that, through feelings and behaviour, intellect and have a reciprocal cause and effect relationship.
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Ellis agreed with the view that a person’s instincts determine their behaviour.
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He believed that it was the client’s perception of and beliefs about an event that influenced the person’s feelings.
ABC Theory-
The consequences are determined by attitudes, events, or facts that cause or influence a person’s beliefs.
A – Attitude
B – Belief
C – Consequences
Thus, the therapist uses an intervention that disputes the person’s beliefs.
The RET, a type of psychotherapy, aims to assist the person in developing a rational basis for living by disputing the irrational beliefs that cause neurosis.
RET Techniques –
It can be with individuals and groups.
Principles –
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You are responsible for your own emotions and actions.
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Your harmful emotions and dysfunctional behaviours are the product of irrational thinking.
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You can learn more realistic views and, with practice, make them a part of you.
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Take responsibility for your distress.
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Identify your musts.
Must # 1- Demand Yourself: I need to do well and get approval.
(It causes society, depression and a lack of assertiveness)
Must # 2- Expectation from Others: They must treat me fairly.
(It fuels resentment, hostility, and violence.)
Must #3- Demand for Situations: Life must be fair.
(associated with hopelessness, procrastination and addiction.) -
Dispute your ‘musts’.
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Reference your preferences.
Reference #1 – Prefer to do well but if I fail I accept fully.
Preference #2- Prefer You Treat Me Reasonably Well.
Preference #3 – Prefer that life will be fair and easy.
‘ABC’ Worksheet –
A – Activating event (What do you think happened?)
B – Believe in an active event (what did you tell yourself?)
C – Consequences (How did you act?) (How did you feel?)
Irrational beliefs –
Three main irrational beliefs are:-
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Must be exceptionally competent, or I am worthless.
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Others must treat me considerately or they will be absolutely rotten.
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The world should always give me happiness or I will die.
Rational beliefs –
It is not possible for everyone to love and approve of us.
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No one can be perfect.
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Whatever I do, there is a reason for it.
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The universe was not created for our pleasure.
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You can not change the past, but you can learn from it.
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Perfection is not the goal.
The therapist uses his or her skills to argue against these irrational ideas.
These methods used include –
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Cognitive homework
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Bibliotherapy
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Self-statement
When disputing irrational beliefs, the therapist helps the patient to see that it is his view of an event or belief about himself that is causing the patient’s problems, his symptoms, his sense of defeat.
The therapist is the model for the patient.
Imagery and role-playing allow the patient to try out the expression of new thoughts, feelings and behaviours in a safe setting before their expression is found in the real world.
Operant conditioning, self-management principles, systematic desensitisation, biofeedback, relaxation techniques and modelling are behaviour techniques used in RET.
2.Meichenbaum self-instructional training (SIT) –
The goal is that the client stops considering carefully the exact nature of the problem and how the problem will be solved.
Self-teaching – It employs self-tasks. It cooperates with mental and physical demonstrations in the practice of behaviour procedures.
Purposes –
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Strengthen and maintain the client’s intentions for the task.
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Identify the task procedures and behaviour needed to achieve a goal.
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Helps the client to master the task procedure and thus increase self-control.
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Improve the client’s efficient use of behaviour needed in social and task performance.
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Increase the client’s awareness of performance boundaries.
3.Beck’s Cognitive Therapy –
Four assumptions –
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A person’s cognition influences how he or she perceives all events.
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All cognitions are formed as a result of internal and external stimuli, as well as past and present experiences.
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Personal feelings and behaviour are influenced by cognition.
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Therapy can heighten the individual’s awareness of these cognitions and how they influence his or her feelings and behaviour.
Techniques –
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Cognitive techniques –
– Graded task assignment
– Modelling
– Behavioural rehearsal
– Coaching
– Homework
– Stress inoculation
– Cognitive modelling and scripting. -
Other techniques –
– Thought stopping
– Role reversal
– Symbolic modelling -
Coping skills therapy/copying model –
– It emphasizes learning from mistakes and the use of existing methods to facilitate coping with stressful events.
– During training, the therapist helps the client learn those skills that are needed to perform the task.
– It is characterised by problem-solving strategies.
Problem-solving strategies –
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Include task evaluation activity analysis.
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Provide opportunities to practise problem-solving.
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Provide opportunities for self-talk in a variety of contexts.
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Including failure-handling practice.
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Teach the person to identify the possible problem and choose coping responses.
Problem-solving therapy –
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Describe the benefits of skill training.
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Educating the patient on the connection between the presenting problem and the patient’s cognition problem.
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Teaching a system of self-monitoring.
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Teaching a specific method of problem-solving.
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Provide opportunities for modelling, rehearsal and self-evaluation of specific skills as well as the outcomes of one’s performance.
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Providing multiple opportunities.
Stress inoculation –
3-Phases:-
Phase 1 – conceptualisation phase – During this phase, the therapist provides basic information about the stressful situation in layman’s terms.
Phase 2 – skill acquisition phase – skills are acquired through rehearsals.
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Obtain information.
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Learn to do something with this discomfort.
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Positive responses would increase their sense of control.
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Listen to their internal dialogue for adaptive and maladaptive statements.
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With the assistance of a therapist, create a self-statement statement.
Phase 3 – application and follow through.
