What techniques and strategies are used in cognitive therapy to treat psychological disorders?

Cognitive therapy (CT) is a type of psychotherapy developed by American psychiatrist Aaron T. Beck. CT is one of the therapeutic approaches within the larger group of cognitive behavioral therapies (CBT) and was first expounded by Beck in the 1960s.

Overview

Cognitive therapy seeks to help the patient overcome difficulties by identifying and changing dysfunctional thinking, behavior, and emotional responses. This involves helping patients develop skills for modifying beliefs, identifying distorted thinking, relating to others in different ways, and changing behaviors. Treatment is based on collaboration between patient and therapist and on testing beliefs. Therapy may consist of testing the assumptions which one makes and identifying how certain of one’s usually unquestioned thoughts are distorted, unrealistic and unhelpful. Once those thoughts have been challenged, one’s feelings about the subject matter of those thoughts are more easily subject to change. Beck initially focused on depression and developed a list of “errors” in thinking that he proposed could maintain depression, including arbitrary inference, selective abstraction, over-generalization, and magnification (of negatives) and minimization (of positives).

A simple example may illustrate the principle of how CT works: having made a mistake at work, a person may believe, “I’m useless and can’t do anything right at work.” Strongly believing this then tends to worsen their mood. The problem may be worsened further if the individual reacts by avoiding activities and then behaviorally confirming the negative belief to themself. As a result, any adaptive response and further constructive consequences become unlikely, which reinforces the original belief 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 it. 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 patient escapes the negative thought patterns and dysfunctional behaviors, the negative feelings may be relieved over time.

History

Becoming disillusioned with long-term psychodynamic approaches based on gaining insight into unconscious emotions and drives, Beck came to the conclusion that the way in which his clients perceived, interpreted and attributed meaning in their daily lives—a process scientifically known as cognition—was a key to therapy. Albert Ellis was working on similar ideas from a different perspective, in developing his Rational Emotive Behavior Therapy (REBT).

Beck outlined his approach in Depression: Causes and Treatment in 1967. He later expanded his focus to include anxiety disorders, in Cognitive Therapy and the Emotional Disorders in 1976, and other disorders and problems. He also introduced a focus on the underlying “schema”—the fundamental underlying ways in which people process information—about the self, the world or the future.

The new cognitive approach came into conflict with the behaviorism ascendant at the time, which denied that talk of mental causes was scientific or meaningful, rather than simply assessing stimuli and behavioral responses. However, the 1970s saw a general “cognitive revolution” in psychology. Behavioral modification techniques and cognitive therapy techniques became joined together, giving rise to cognitive behavioral therapy. Although cognitive therapy has always included some behavioral components, advocates of Beck’s particular approach seek to maintain and establish its integrity as a distinct, clearly standardized kind of cognitive behavioral therapy.

Precursors of certain fundamental aspects of cognitive therapy have been identified in various ancient philosophical traditions, particularly Stoicism. For example, Beck’s original treatment manual for depression states, “The philosophical origins of cognitive therapy can be traced back to the Stoic philosophers”.

Application to depression

According to Beck’s theory of the etiology of depression, depressed people acquire a negative schema of the world in childhood and adolescence; children and adolescents who suffer from depression acquire this negative schema earlier. Depressed people acquire such schemas through a loss of a parent, rejection by peers, bullying, criticism from teachers or parents, the depressive attitude of a parent and other negative events. When the person with such schemas encounters a situation that resembles the original conditions of the learned schema in some way, even remotely, the negative schemas of the person are activated.

Beck’s negative triad holds that depressed people have negative thoughts about themselves, their experiences in the world, and the future. For instance, a depressed person might think, “I didn’t get the job because I’m terrible at interviews. Interviewers never like me, and no one will ever want to hire me.” In the same situation, a person who is not depressed might think, “The interviewer wasn’t paying much attention to me. Maybe she already had someone else in mind for the job. Next time I’ll have better luck, and I’ll get a job soon.” Beck also identified the following cognitive distortions, which can contribute to depression: arbitrary inference, selective abstraction, overgeneralization, magnification and minimization.

Types

Cognitive therapy – based on the theory that depression is due to distortions in the patient’s perspectives, such as all-or-none thinking, over-generalization, and selective perception. The therapist initially tries to highlight these distortions, then encourages the patient to change his or her attitudes.

Rational-emotive therapy (RET) – based on the belief that most problems originate in irrational thought. For example, perfectionists and pessimists usually suffer from issues related to irrational thinking; for example, if a perfectionist encounters a small failure, he or she might perceive a much bigger failure. It is better to establish a reasonable standard emotionally, so the individual can live a balanced life. This form of cognitive therapy is an opportunity for the patient to learn of his current distortions and successfully eliminate them.

Cognitive behavioral therapy (CBT) – the most commonly practiced type of cognitive therapy. It is based on the belief that using both cognitive therapy and behavioral therapy is more effective than just one of these types. Very few therapists believe in using just one style of therapy for success any more.