Cognitive Behavioral Therapy (CBT) is a general classification of psycho-therapy that is based on social learning theory. It emphasizes on how an individual’s thinking interacts with how they feel and what they do. Cognition is outlined in three levels: core beliefs, dysfunctional assumptions, and negative automatic thoughts. Core beliefs (schemas) are the deeply held beliefs of an individual about the self, others and the world. Dysfunctional assumptions are the rigid, conditional living rules adopted by people. Negative automatic thoughts are those thoughts that are involuntarily activated in certain situations (Fenn & Byrne, 2013). The approach is based on the view that individuals experiencing anxiety, depression, or anger stressors can be maintained by biased ways of thinking. The patterns of this individual can also be modified through reducing maladaptive and erroneous beliefs. Counselors using CBT approach on their clients are helping them recognize their thinking style. As such, they are able to modify their behaviors through the use of logic and evidence. CBT principles play important roles in case formulation and treatment planning because they have been supported as being effective. The different types and applications of CBT focus on cognitive restructuring, behavior modification and the development of alternative coping skills. Most of them share common principles and elements, such as: brief and time-limited, present centered, though focused, practice and homework and sound therapeutic relationship (Wright et al., 2017).
CBT has two components namely functional analysis and skills training. Functional analysis component is important as it helps a client and counselors assess situations that are high-risk and likely to lead to substance abuse use. Thereafter, provide clients with insights into what may stimulate or trigger the client’s need to use drugs like interpersonal difficulties. Throughout CBT, skills training procedures are widely used in helping clients unlearn their old habits. The habits may be associated with substance use and the individualized training program will help the client relearn or learn healthier skills. Psychological skills can be categorized into affective, distress tolerance, cognitive, curriculum-based skills protocols, and specialized skills training (O’Donohue & Fisher, 2012). For instance, if a therapist has a client struggling with high levels of anxiety especially when taking a test, the use of affective skills trainings will be appropriate. Similarly, having clients with poor skills at social situations, the therapist may decide to look under the section of specialized skills training to help in countering the social deficits of the client.
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The goal of therapists applying CBT approaches is to identify and reduce those habits associated with a drug-using lifestyle. This is possible through substituting with more enduring, positive activities and even rewards to help clients recognize and cope with their urges (Wright et al., 2017). Furthermore, such skills help clients enhance their social support systems, to tolerate their feelings like anger and depression, and improve their interpersonal functioning.
In psychotherapy, the most important factors are the therapeutic relationships that look at the partnership presented by both therapist and the client as they work together in reaching the end goals of the clients. Therapeutic relationships are integral parts for any therapy to be deemed effective and meaningful for clients (Wright et al., 2017). Long ago, CBT was often criticized for ignoring the roles attached to therapeutic relationship. Today, the acknowledgment of the importance of therapeutic relationship in CBT approach presents it in an interpersonal context where previous attachment problems are easily identified. Moreover emotional validation and compassion may also be reflected thereby providing a crucial opportunity for clinicians to modify related psychological difficulties of their patients. Some of the therapeutic tasks valued by a CBT approach are working in the here-and-now, behavioral activation, rationalization, and solving problems. Beck (2011) stresses on the importance of having therapeutic relationships that are warm. By so doing, CBT approach becomes a powerful theoretical model that helps in understanding the causes of and the strategies implemented in overcoming impasses in therapy. The collaboration between the clinician and patient helps in understanding the importance of case validation, conceptualization, victim resistance, emotional philosophies, schematic resistance, schematic mismatch, self-handicapping, and sunk-cost commitment.
Cognitive and behavioral techniques are used in CBT where cognitive looks at changing how a person thinks whereas, behavior changes what they do. Behavioral therapy techniques are geared at changing the unhelpful habitual responses of an individual and positively reinforce their behaviors. Under cognitive techniques we have ‘guided discovery’ and Socratic questioning, which is a method of questioning based on Socrates way that helps students reach their conclusion directly. By using Socratic questions, the patient manages to drawn their focus to something outside their current focal point (Padesky & Greenberger, 2015). Therapists use questions as a way of probing the assumptions of their patients and questioning their reasons and evidence for certain beliefs. This results in therapists highlighting other perspectives and probing implications. By combining these two techniques, a therapist becomes effective considering the human cycle of thought always leads to emotions. This then leads to behaviors, which reinforce the individual’s thoughts and emotions.
Therapeutic techniques used by cognitive therapists include decatastrophizing, reattribution, redefining, and decentering (Jones-Smith, 2014). Decatastrophizing is the use of ‘what if’ technique that helps clients to be prepared for feared consequences thus decreases avoidance. Reattribution is a technique used in testing the clients’ automatic thoughts by introducing alternative causes of events. Therapists using this technique help their clients to fairly distribute the responsibility for a given situation or condition. Cognitive restructuring or reframing is a staple therapeutic process used in CBT in helping clients discover, modify or replace and challenge their irrational (cognitive distortions), negative thoughts. Therapists use this tool because many of our problems are caused mainly by faulty ways of thinking about oneself and the world. Through cognitive restructuring, stress is reduced through the cultivation of more positive and functional thought habits. Therefore, it is a tool that can be applied to a wide range of people who are dealing with different kinds of problems as a result of either internal issues, outside factors, or both (Wright et al., 2017). Decentering technique is used in treating those clients who are anxious and mistakenly believe that they are the focus of other people’s attention.
There are also chief behavioral techniques used to foster cognitive change such as homework, exposure therapy, diversion techniques, hypothesis testing, activity scheduling, behavioral rehearsal and roleplaying. Homework is assignments that give opportunities to clients to apply CBT techniques between sessions. They focus on self-monitoring, effective time structuring, and procedure implementation that helps in dealing with actual situations. Diversion techniques are the use of activities like social work, visual imagery and physical activity that help in reducing a patient’s strong emotion and decrease their negative thinking. Hypothesis testing is where both behavioral and cognitive components are applied and the technique ensures that formulated hypothesis is specific and concrete.
Activity scheduling is a technique that provides structure and this encourages the involvement of clients. For example, depressed clients can rate their degree of pleasure and mastery of certain activities to see that they are not depressed at the same time, but on varying levels of the day. Through such measures, clients are able to contradict the stated beliefs stating that they cannot enjoy anything. Through the structuring process, clients are able to see that the activity takes planning.
Designing an effective psychoeducation group entails having strong theoretical foundation that will evolve into a highly interactive experience for participants. The experience is intended to foster in participants growth and development. The experiences brought forth specializations in guidance/psychoeducational that has continued to prevent the development of debilitating dysfunction with increased coping skills. A structured group model is a growing concern used in educating people with cognitive disturbances, substance abuse, and psychiatric disorders like depression among others. Having such a sampling group, it demonstrates the broad efficacy and appeal of using psychoeducational groups to serve as primary and supplemental treatment modalities. Designing such psychoeducational groups demand they be meaningful and effective. Therefore, the first step is to ensure that the groups have a predetermined plan and goals. The topics for the psychoeducational group are predetermined and should use discussion stimulus leads, highly structured series of questions, and structured activities. Groups that have specific time frames are those that promote specific goals within a framework that is planned to suit the needs of the international structured groups.
Psychological problems like depression and anxiety are ever-widening in range and this has seen the application of CBT grow tremendously. Eating disorder uses the application n of CBT approaches in treating patients suffering from bulimia nervosa (BN). Cognitive therapists have managed to develop a trans-diagnostic understanding of eating disorders. BN is a DSM-IV criterion where an individual has an over-concern with shape and weight and the compensation for binge eating is self-induced vomiting, fasting, and even purging or excessive exercise. Clinically, body mass is estimated using body-mass index (BMI) and people with an eating disorder are tracked using their BMI. There are clients who weigh themselves excessively and for therapists, this is tackled as a form of reassurance. There are also those who are reluctant and are an early sign of potential retraction from treatment, which is an obstacle that needs early implementation of an intervention. Behavioral experiments can be applied in such instances but is limited to those clients unable to weigh themselves. Therefore, for bulimia nervosa, CBT techniques provide clients with useful management tools (Wright et al., 2017). Behavioral rehearsal are also applied in CBT for instance, reduced anxiety can be managed by clients through practicing breathing training. Furthermore, panic can be overcome and avoided through the use of exposure protocols or other strategies that would stop compulsive rituals.
CBT has also been applied to the criminal justice system and this has helped in decreasing the number of individual’s returning to prisons. In such instances, CBT has managed to change the client’s negative thoughts and is reforming them into productive people in the community. The success of this approach, CBT, requires an individual to be actively involved and thus, it is a problem-specific approach that is goal-oriented. CBT gives focus to the client’s present-day challenges, behaviors, and thoughts. Since CBT is a collaborative therapy, it eventually helps the client to become therapist by evaluating their individual behavior. This is done after time elapses for conducting therapeutic sessions. An individual’s way of thinking and behavior can stand in the way of their positive outcomes and thus, CBT approach comes in to transform such thoughts. For instance, depressed individuals have their perceptions and interpretations distorted. CBT then comes into play by giving focus to challenging the automatic thoughts of a depressed individuals and comparing them with reality. An individual who manages to change their way of thinking decreases their distress levels and can function in ways more likely to benefit those around them. The acquisition of new coping skills by the individual results in solving problems easily in a manner that is constructive. Such problem-solving techniques results in lowering stress levels and leaves them feeling in control of their situation. Therefore, reduces their risk of having negative mood swings.
References
Beck, J. S. (2011). Cognitive Behavior Therapy: Basics and beyond . New York, NY: The Guilford Press.
Fenn, M. K., & Byrne, M. (2013). The key principles of cognitive behavioral therapy. InnovAiT , 6(9), 579-585.
Jones-Smith, E. (2014). Theories of counseling and psychotherapy: An integrative approach (2nd ed.). Thousand Oaks, California: SAGE Publications.
O’Donohue, W. T., & Fisher, J. E. (2012). Cognitive behavior therapy: Core principles for the practice . Hoboken, New Jersey: John Wiley & Sons.
Padesky, C., & Greenberger, D. (2015). Mind over mood: Change how you feel by changing the way you think (2nd ed.). New York, NY: The Guilford Press
Wright, J.H., G.K. Brown, Thase, M.E., & Basco, M.R., (2017). Learning cognitive-behavior therapy: An illustrated guide (2nd ed.). Washington, DC: American Psychiatric Association Publishing
