Cognitive behavioural therapy
Cognitive behavioral therapy (or CBT) is a psychotherapeutic approach that aims to solve problems concerning dysfunctional emotions, behaviors and cognitions through a goal-oriented, systematic procedure. CBT refers to therapy based upon a combination of basic behavioral and cognitive research.
Background to CBT
Siddhartha Gautama otherwise known as Buddha, was one of the first to teach that our perception of the world comes from within, and we cannot escape the inevitable. So instead we must pay attention to the now by being in the moment and not judging, and by being kind to oneself and others. It is concerned with cause and effect and how good and bad behaviour has an effect on our future.
Using these ideas in CBT has developed the idea of useful and adaptive thinking and problematic or maladaptive thinking – as well as using mindfulness as a method of focusing attention away from rumative thinking.
Socrates – the Greek philosopher – used a form of enquiry that was insightful and purposely brings out the values, beliefs and meanings of the answers given. Open questions that find out what lies at the heart of the problem. This form of questioning is used in scientific enquiry and used extensively in CBT to try and understand why people do or think a certain way.
Immanuel Kant – realised one could break down the way one fits into the world at large as objective – the reality of the world (as Noumena) and the subjective – the way things appear – how we individually perceive the world (as he called Phenomena)
We cannot truly perceive the real world as we all have different backgrounds, understandings and influences that colour our perception. He popularised the notion of Schema, which is taken up in CBT where patterns of behaviour over a period of time are recognised and may need to be changed to get desired results.
Schema is an individuals view of the world. It is the accumulation of knowledge to make up a framework of understanding. It is information processing that enables us to classify information and to anticipate events. How the person behaves is much to do with how they experienced events in the past. Because no two people will have the same experiences, no two people will respond in the same manner.
In a depressed person their perception of themselves will tend to be negative, “who wants to be with me, I feel miserable” so they avoid social situations because they perceive no one wants to be with them, while they feel that way, and so it becomes a self fulfilling prophesy because they have withdrawn. If people make positive remarks, quite often it will be responded to with a negative response such as “what do they want?” or “They’re only being nice to me – but I don’t deserve it”.
By pushing away the very thing that will make them feel better, depressed people can become more isolated and become convinced no one cares – so the cycle continues.
A depressed person is more likely to ruminate on a number of core beliefs, such as “I’m unlovable” for example, and this becomes a focus for negative self-hypnosis. Their attention being drawn to events that support their belief, and ignoring contradictory information.
Modern Roots
The modern roots of CBT can be traced to the development of behavior therapy in the early 20th century, the development of cognitive therapy in the 1960s. The therapeutic approaches of Albert Ellis and Aaron T. Beck gained popularity among behavior therapists.
Today due to the fact that measured outcomes have helped show good results, it is currently the therapy of choice for the NHS, though SFBT is gaining ground here.
The particular therapeutic techniques vary within the different approaches of CBT according to the particular kind of problem issues, but commonly may 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, mindfulness and distraction techniques are also commonly included.
In areas such as phobias, it is usually accepted to expose the person to the thing that is causing the anxiety slowly over a period of time and the person gets used to it slowly. The fast phobia technique of NLP has largely overwritten this technique as it helps scramble the panic template we’ve engrained in our minds.
CBT has it's place in psychotherapy and can be useful if a person has limited resources, such as the elderly, those with serious physical illness and children.