Cognitive Therapy was first devolved by Ellis in the early 1950’s when it was called rational emotive therapy (REMT). It was developed as a reaction against the popular psychoanalytic methods in use at the time. Later developed independently by Aaron T Beck in the 1960’ Cognitive Therapy was further developed into its current form by incorporating elements of behavioural therapy and is now known as Cognitive behavioural therapy (CBT)
It has been suggested that different therapies have been informed by a fashionable technological metaphors. The dominant technology in Freud’s time was steam which might explain why “pressure” is used as a metaphor in his theory of the subconscious and. Computers are the dominant technology today which is perhaps why CBT sees our cognitions as a computational process
CBT belongs firmly in the Empiricist camp of philosophical thought because it places our thought processes centre stage in our emotional life and is emphatically based on recordable research based evidence. In essence CBT is a form of psychotherapy based on modifying cognitions, assumptions, beliefs and behaviours with the aim of influencing disturbed emotions. This is done by addressing the way in which a client thinks and behaves in certain situations and then developing a more flexible way to think and respond to those situations. The objective is to identify irrational or maladaptive thoughts, assumptions and beliefs that are linked to debilitating emotions and change them. Aaron Beck (1975) identified “core beliefs” (often formed in childhood) that give rise to “automatic negative thoughts” (ANT’s) that occur in response to situations. CBT therapists believe that clinical depression is typically associated with negative and irrational thinking characterised by ANT’s . (Persaud 2001)
CBT has a good evidence base and has demonstrated in many studies it’s effectiveness with many psychiatric disorders (Gloaguen,V et al 1998). A large study conducted in 2000 showed a higher rate of remission for depressive symptoms (73% for combined therapy vs 48% for either CBT or antidepressant medication alone) when CBT was used in conjunction with antidepressant drug therapy (Keller M et al 2000). The NICE clinical guidelines also recommend CBT as the preferred treatment for choice for a number of conditions including PTSD, OCD, Eating disorders and mild clinical depression.
Negative thinking can be categorised into a number of common patterns called cognitive distortions. These include arbitrary inference, selective abstraction, overgeneralization, magnification and minimisation and help to contribute towards what Beck described as a negative schema or world view (De Souza’s. paradigm scenario) Beck also described a negative triad into which a person’s negative schema fits. In Beck’s theory of depression, a person’s negative view of themselves, the world, and their future; forms a triad caused by the individual’s negative schema and cognitive distortions.
A major aid in cognitive therapy is what Ellis termed the ABC of irrational beliefs in which the client is taught to analyse the process by which they have developed their irrational beliefs. The individual’s thoughts are recorded in a three column table with the following headings.
A Activating event – This column records an objective account of the situation that ultimately led to some type of heightened emotional response or dysfunctional thinking
B Beliefs – In the next column the client records the negative thought (ANT’s) that occurred to him or her
C Consequence – The third column records the clients negative feelings and dysfunctional behaviour that followed.
Developments to Ellis’s ABC of irrational beliefs add further columns which then encourage the client to suggest alternative thoughts and emotional responses. CBT aims to reframe a client’s cognitive response to their environment. After identifying their ANT’s the therapist helps the client change their negative thoughts and challenge their basic assumptions about themselves, the world around them and their future.
An interesting development of CBT is Mindfulness based Ccognitive therapy. In my experience this adds another layer, and certainly made CBT more accessible to me. Whereas CBT seems to stress the “wrongness” of certain thoughts, MBCT helps those who struggle with unhelpful thoughts simply to accept situations as they are, to survive them. This links in with Dialectic behaviour therapy (as I understand it, another variant of CBT). The idea of acceptance is really important, I believe – I feel I am unacceptable enough as it is, with my mental health having been less than robust for some time. To engage in a therapy that teaches me that, while situations may be difficult, I can learn to live with them – and the associated thoughts – and survive them, gives me a greater sense of self worth than the emphasis of “traditional” CBT on “correcting” my thoughts. It has also taught me techniques for finding stillness when things are fraught – a useful skill, I suspect, for anyone.
Nice article E. The linking of the computer generation to the analytical processes of CBT is interesting.
In regard D’s comment, Mindfulness is indeed useful for people who can’t seem to ‘progress’ beyond the situation at that time and helps to act as a calming influence. I regard it as the “Serenity Prayer in Action”:
“Lord, give me the strength to change the things I can;
The courage to accept the things I can’t;
And the wisdom to know the difference.”
I like Mindfulness because it’s as if we give ourselves ‘permission’ to be human.
Absolutely, Mr Ian. I like the analogy.
CBT has been useful to me, but never became “part” of me in the way that Mindfulness has become / is becoming. That extra layer makes allt he difference. There are some interesting statistics starting to be generated of its effectiveness – and of course, the fact that it is designed to be delivered in group settings must make it more cost effective too.
Well the mindfulness component was always a part of Ellis’s original form of Rational Emotive Behavioural Therapy when it incorporated self-awareness. Not sure if it was as direct as DBT mindfulness or maybe one and the same thing.
Anyhow, I’m starting to like all the attention the psychological therapies seem to be getting. Guess this is one time I agree with doing things on the cheap(er)?
Well, if low(er) cost is a feature then maybe it will make it more readily available. That would be good, given that this particular approach seems to work for many. Anything that makes an effective “talking therapy” more readily available has to be a good thing, doesn’t it?
I’ve often advocated the power of talking over the power of medication. Of course, there are time and skills restraints to this but mostly I find it’s the nature of the person doing the therapy that most often leads to it failing.
But anyhow, it seems like Pauline Fowler had it right all along…
I’ll go put the kettle on an’ we’ll all ‘ave a nice cup o’ tea and a natter….
Thanks for the comments on Philosophy of psychiatry (parts 1 & 2). It was actually an essay for a CBT course I have applied for.
I was able to incorporate some of your comments in the final draft. Hope you don’t mind me using you in this way.
As long as we get fully referenced
Mr Ian, the “Serenity Prayer” doesn’t quite work without the word “serenity” in it. Subsituting the word “strength” may be appropriate in certain cases but strength, in my experience, isn’t all it’s cracked up to be (see Taoism, and its wonderful approach to Mindfulness).