Cognitive Behavioral Therapy

Cognitive Behavioral Therapy (CBT) is a psychotherapy based on cognitions, assumptions, beliefs, and behaviors, with the aim of influencing negative emotions that relate to inaccurate appraisal of events. The general approach, developed out of behavior modification, Cognitive Therapy and Rational Emotive Behavior Therapy, has become widely used to treat various kinds of neuroses and psychopathology, including mood disorders and anxiety disorders.

We at WESTERN HEALING know that the particular therapeutic techniques vary according to the particular kind of client or issue.

But commonly include keeping a diary of significant events and associated feelings, thoughts and behaviors; questioning and testing cognitions, assumptions, evaluations and beliefs that might be unhelpful and unrealistic; gradually facing activities which may have been avoided; and trying out new ways of behaving and reacting.

Relaxation and distraction techniques are also commonly included. CBT is widely accepted as an evidence- and empiricism-based, cost-effective psychotherapy for many disorders and psychological problems. It is sometimes used with groups of people as well as individuals, and the techniques are also commonly adapted for self-help manuals and, increasingly, for self-help software packages.

An example will illustrate the process: Having made a mistake, a person believes, "I'm useless and can't do anything right." This, in turn, worsens the mood, leading to feelings of depression; the problem may be worsened if the individual reacts by avoiding activities and then behaviorally confirming his negative belief to himself. As a result, a successful experience becomes more unlikely, which reinforces the original thought of being "useless." In therapy, the latter example could be identified as a self-fulfilling prophecy or "problem cycle," and the efforts of the therapist and client would be directed at working together to change this. This is done by addressing the way the client thinks and behaves in response to similar situations and by developing more flexible ways to think and respond, including reducing the avoidance of activities. If, as a result, the client escapes the negative thought patterns and destructive behaviors, the feelings of depression may, over time, be relieved. The client may then become more active, succeed more often, and further reduce feelings of depression.

The objectives of CBT typically are to identify irrational or maladaptive thoughts, assumptions and beliefs that are related to debilitating negative emotions and to identify how they are dysfunctional, inaccurate, or simply not helpful. This is done in an effort to reject the distorted cognitions and to replace them with more realistic and self-helping alternatives.

Cognitive behavioral therapy is not an overnight process. Even after patients have learned to recognize when and where their mental processes go awry, it can take months of effort to replace a dysfunctional cognitive-affective-behavioral process or habit with a more reasonable, salutary one..

Cognitive Behavioral Therapy

Cognitive Behavioral Group Therapy (CBGT) is a similar approach in treating mental illnesses, based on the protocol by Richard Heimberg. In this case, clients participate in a group and recognize they are not alone in suffering from their problems.

Other types of Cognitive Behavioral Therapy include Dialectical Behavior Therapy, Self-Instructional Training, Schema-Focused Therapy and many others.

CBT has a good evidence base in terms of its effectiveness in reducing symptoms and preventing relapse. It has been clinically demonstrated in over 400 studies to be effective for many psychiatric disorders and medical problems for both children and adolescents. It has been recommended in the UK by the National Institute for Health and Clinical Excellence as a treatment of choice for a number of mental health difficulties, including post-traumatic stress disorder, OCD, bulimia nervosa and clinical depression.

Depression

Negative thinking can be categorized into a number of common patterns called "cognitive distortions" The cognitive therapist provides techniques to give the client a greater degree of control over negative thinking by correcting these distortions or correcting thinking errors that abet the distortions, in a process called cognitive restructuring.

Another cognitive theory of depression is the Hopelessness Theory of depression. This is the latest theory of the helpless/hopeless theories of depression, stating that hopelessness depression is caused by a state of hopelessness. A state of hopelessness develops when the person believes that no good outcomes are possible, only negative ones. The person also feels that he or she has no ability to change the situation to allow for a positive outcome. Stressors (negative life events) are thought to interact with a diathesis (in this case, a predisposing factor to depression) to create a sense of hopelessness.

Some proposed diatheses are attributing negative events to stable and global factors, low self-esteem, and a tendency to believe that negative life events will have severe negative consequences. Such diatheses increase the possibility that a person will experience hopelessness depression.

Attributional style

In 1989, this theory was challenged by Hopelessness Theory. This theory emphasized attributions to global and stable factors, rather than, as in the original model, internal attributions. Hopelessness Theory also emphasizes that beliefs about the consequences of events, and rated importance of events, may be at least as important as causal attributions in understanding why some people react to negative events with clinical depression.

The ABCs of Irrational Beliefs

A major aid in cognitive therapy is what Albert Ellis called the ABC Technique of Irrational Beliefs. The first three steps analyze the process by which a person has developed irrational beliefs. They may be recorded in a three-column table.

1. Activating Event or objective situation. The first column records the objective situation, that is, an event that ultimately leads to some type of high emotional response or negative dysfunctional thinking
2. Beliefs. In the second column, the client writes down the negative thoughts that occurred to him or her.
3. Consequence. The third column is for the negative disturbed feelings and dysfunctional behaviors that ensued. The negative thoughts of the second column are seen as a connecting bridge between the situation and the distressing feelings. The third column C is next explained by describing emotions or negative thoughts that the client believes are caused by A. These could be anger, sorrow, anxiety, etc

For example, Gina is upset because she got a low mark on a math test. The Activating event, A, is that she failed her test. The Belief, B, is that she must have good grades or she is worthless. The Consequence, C, is that Gina feels depressed.

• Reframing. After irrational beliefs have been identified, the therapist will often work with the client in challenging the negative thoughts on the basis of evidence from the client's experience by reframing it, meaning to re-interpret it in a more realistic light. This helps the client to develop more rational beliefs and healthy coping strategies.

Effectiveness of CBT with or without drugs for depression

A large-scale study in 2000 showed substantially higher results of response and remission (73% for combined therapy vs. 48% for either CBT or a particular discontinued antidepressant alone) when a form of cognitive behavior therapy and that particular discontinued anti-depressant drug were combined than when either modality was used alone

The effectiveness of combination therapy is endorsed by the Australian depressioNet group:

Currently the most effective treatment for major (clinical) depression is considered to be a combination of antidepressant medication and Cognitive Behavioral Therapy

For more general results confirming that CBT alone can provide lower but nonetheless valuable levels of relief from depression, and result in increased ability for the patient to remain in employment, see The Depression Report which states: 1000 people attend up to sixteen weekly sessions one-on-one lasting one hour each, some will drop out but within four months 50 people will have lost their psychiatric symptoms over and above those who would have done so anyway. After recovery, people who suffered from anxiety are unlikely to relapse. . . . So how much depression can a course of CBT relieve, and how much more work will result? One course of CBT is likely to produce 12 extra months free of depression. This means nearly two months more of work.

The American Psychiatric Association Practice Guidelines (April 2000) indicated that among psychotherapeutic approaches, cognitive behavioral therapy and interpersonal psychotherapy had the best-documented efficacy for treatment of major depressive disorder, although they noted that rigorous evaluative studies had not been published.

CBT with children and adolescents

The use of CBT has been extended to children and adolescents with good results. It is often used to treat depression, anxiety disorders, and symptoms related to trauma and Post Traumatic Stress Disorder. Significant work has been done in this area by Mark Reinecke and his colleagues at Northwestern University in the Clinical Psychology program in Chicago. Paula Barrt and her colleagues have also validated CBT as effective in a group setting for the treatment of youth and child anxiety using the Friends Program she authored. This CBT program has been recognized as best practice for the treatment of anxiety in children by the World Health Organization.Combining the Biofeedback method with the CBT process is very effective. (( cite-book Biofeedback You Are In Control Editor Dr.Yigal Gliksman,)) ((www.lulu.com/content/1800043)) date 2008. CBT has been used with children and adolescents to treat a variety of conditions with good success.

CBT is also used as a treatment modality for children who have experienced Complex Post Traumatic Stress Disorder, chronic maltreatment, and Post Traumatic Stress Disorder It would be one component of treatment for children with C-PTSD, along with a variety of other components, which are discussed in the Complex Post Traumatic Stress Disorder article.

What is Cognitive Behavioural Therapy (CBT)?

When having counselling it is important to know that different therapists will help you work through difficulties using different approaches and techniques. No one approach works better than all the others in all circumstances and it is important that you find a therapist that you trust and is qualified to help you.

Cognitive behavioural therapy is a counselling technique that is used by many clinical psychologists, psychiatrists and counsellors. Some therapists will specialise in this form of therapy while others will use some of the techniques to help you work through particular difficulties. The therapy is based around helping you understand, manage and change your thoughts (cognitions) and actions (behaviour). This form of therapy has been shown to be very effective for a whole range of things but is particularly effective if you have depression or anxiety.

Why is CBT Effective for Depression and Anxiety?

Depression has a strong effect on the way people think. For example in situations which could end positively or negatively, people who experience depression are more likely to think it will end negatively. In part, cognitive behavioural therapy will help replace negative thoughts for positive ones and also reinforce positive actions.

How Does CBT Work?

Cognitive behavioural therapy works in three ways:

1. It helps you identify and change negative thinking associated with depressed feelings.
   If you are depressed you may feel hopeless, a lack of energy, empty and/or anxious. These feelings make it difficult to think positively about yourself, your relationships with other people and life in general. Cognitive behavioural therapy will help you to look at situations from another angle by reviewing how you managed certain events and situations in your life. Together with a therapist you look at events in your life and talk about all the possible interpretations of those events. Through this negative or unhelpful thoughts are identified along with the possible helpful interpretations of a situation. Through this process you learn how to replace negative thinking patterns with more positive ones this helps you to feel better about yourself, your relationships and life in general.

2. CBT helps to focus on the positive things!
   If you are experiencing depression it is likely that you will not be doing many of the things that you used to enjoy. This can turn into a cycle where doing less fun stuff results in you feeling sadder which in turn makes you feel less like doing something fun. In this situation it is important that someone supports and helps motivate you. Using cognitive behaviour therapy techniques a therapist can work with you to gradually increase the fun stuff in your life and reinforce the positive steps that you are taking.

3. 3. CBT helps to manage your problems.
   Managing problems is part of everyday life but it can feel overwhelming when you have depression. Cognitive behavioural therapy will help give you strategies for managing problems both small and large so they don’t get on top of you.

What is Likely to Happen When You Visit a Therapist who Practices CBT?
At WESTERN HEALING

Usually, cognitive behavioural therapy is structured so that you have regular sessions with the therapist. How often will depend on a number of factors but it will usually be weekly at the start and become less often over time. Many therapists will also agree with you to come for a set length of time. For example you may see them weekly for eight weeks and then see how you go. Reviewing progress is often an important part of the process. The sessions may vary in length but are usually an hour long. It is not uncommon for the therapist to also give you some tasks that you do between sessions.

The first time that you see your psychologist/counsellor talk to them about what may happen with your psychologist or counsellor about what the best arrangement is for you.

How can I help?

As a qualified and experienced psychotherapist I have assisted many people to manage problems that have had a negative impact on their lifestyles and ability to make life choices.

Some examples of these issues are:

• Depression
• Anxiety
• Panic
• Stress
• Grief and Loss
• Offending/Forensic
• Obsessive Compulsive Disorder (OCD)
• Drug and Alcohol Issues
• Low Self Esteem
• Anger Management Problems
• Post Traumatic Stress Disorder (PTSD)

Appointments

To leave a confidential voicemail message ring: 0427290401.
Monday-Saturday

As a professional therapist I recognise the importance of complete confidentiality of the topics covered in session..

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