Cognitive therapies and CBT seek to help people overcome their difficulties by modifying their thinking (cognition), behaviour, and emotional responses.
There are three basic types:
Cognitive Therapy in its simplest form is based on the principle that the process of cognition – i.e., the way in which people perceive, interpret, and attribute meaning in their daily lives – is the key to helping people conquer depression. This approach was first explored by American psychiatrist Aaron T. Beck, who proposed that cognitive distortions – exaggerated or irrational thoughts – could hamper the successful treatment of depression. Instances of distorted or unrealistic thinking include overgeneralisation, selective perception or selective abstraction, personalisation, and an all-or-none attitude.
Overgeneralisation means using isolated cases to make general assumptions, as in the case of stereotypes. Selective perception or selective abstraction refers to making a judgment based on limited information while disregarding other relevant information. A classic example is taking a quote out of context. Personalisation is literally taking things personally, blaming oneself for a situation beyond one’s control. All-or-none thinking views things in terms of absolutes such as “always”, “never”, “every”, and “no alternative”, which makes a situation or mistake appear hopeless or irredeemable.
Clearly, such errors in thinking can lead to harmful consequences if uncorrected. They can either cause stress-related illness or make a situation worse instead of better.
The solution for countering cognitive distortions is called cognitive restructuring. It involves challenging the client’s assumptions and pinpointing the dysfunctional thoughts and perceptions that are causing the problem. The client then learns to substitute healthy, constructive thoughts that produce beneficial effects.
Rational Emotive Therapy (RET) or Rational Emotive Behaviour Therapy (REBT) is based on the principle that irrational thoughts/beliefs are at the root of most problems. This approach was developed by American cognitive-behavioural therapist Albert Ellis, who coined the term “awfulising” to refer to distorted thinking that made a situation appear worse than it actually was. This is especially applicable to perfectionists and pessimists who tend to magnify the negatives and minimise the positives. Magnification and minimisation are two sides of the same coin, highlighting and exaggerating the undesirable aspects of a situation while downplaying the favourable elements. For example, a small failure might be perceived as a bigger failure. RET seeks to establish a reasonable emotional standard to balance such extreme, illogical negative thinking.
Cognitive Behavioural Therapy (CBT), which combines the purely cognitive approach with behavioural therapy, is currently the most widely practiced method. It is based on the principle that learnt behaviour can be unlearnt and subsequently changed by modifying cognitive (thinking) and behavioural patterns.
Behavioural Therapy originally focused on changing specific behaviours while ignoring the impact of thoughts and emotions. This was mainly accomplished through conditioning and reinforcement in nonhuman subjects. Reinforcement was either positive or negative, involving reward or punishment. The two major theories on which simple behavioural therapy was based were those explored by Ivan Pavlov and B.F. Skinner. Pavlov conducted experiments on achieving a conditioned reflex by eliciting an instinctive response, such as salivating upon hearing a bell associated with the appearance of food (whether or not the food actually appeared). Skinner sought to establish new behaviour that had to be learnt because it was not based on instinct, such as pressing a lever to obtain food.
In contrast to early behavioural therapy, modern cognitive behavioural therapy takes into account the effect of thoughts and emotions on human behaviour. Conversely, CBT acknowledges the influence of behavioural changes on improving one’s mood. CBT breaks the vicious cycle of negativity, regardless of a person’s past experiences. Its repertoire includes relaxation exercises, positive self-talk and thought replacement, modelling, aversive conditioning, and systematic positive reinforcement. It is focused on practical application in the here and now, making it highly effective in helping people cope with relationship difficulties and anger management.
Cognitive behavioural therapy has also been found to be most successful in treating mild to severe depression, anxiety, personality disorders, eating disorders, obsessive compulsive disorders, phobias, substance abuse, and weight control. In many cases, it has been found to be more helpful than any other kind of treatment, including antidepressants.
It must be noted that cognitive behavioural therapy is not a quick fix or instant cure. The course involves weekly or fortnightly sessions that can last anywhere from 6 weeks to 6 months or longer, depending on the type of problem and the client’s responsiveness to treatment. CBT requires collaboration between the therapist and the client; it works best in an atmosphere of trust, cooperation, and mutual respect.
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