Introduction
Cognitive behavioural therapy (CBT) refers to a type of psychotherapeutic approach used to help patients understand their opinions and ways of thinking. CBT treatment employs the use of behavioural and cognitive ideologies. This approach is used in the treatment of numerous psychological disorders; namely, anger, nervousness, and substance abuse (Wilding & Milne 2010, p.60). Through this approach, patients are helped to detect irrationality and rigidity in their thoughts. With the use of this approach, patients are encouraged to think positively and change their unconstructive behaviours. CBT therapy has been effective owing to its simplicity (Wilding & Milne 2010, p.87). The way people behave and perceive things is greatly influenced by their cognitions. For instance, people can be sad, angry, or anxious if they allow negative thoughts to take control of their minds. Based on this concept, psychiatrists have argued that our perceptions and not our situations determine our emotions. Through this, we can suggest that the cognitive evaluation of a circumstance or an incident determines our reactions. Currently, there are numerous methods of CBT. These methods are subdivided into the following types: multimodal therapies, cognitive therapies and rational emotive therapies (James 2010, p.67). Presently, the use of CBT therapy is on the rise. Globally, major mental health hospitals have adopted the therapy. CBT therapy is preferred over other therapies because of its effectiveness and affordability. Researchers and therapists have ensured that the approach meets the ultimate goals of improving patients’ lives through ethical, accessible, and effective ways.
History of CBT
Cognitive behavioural therapy has developed from its original roots to become a broad-based and integrative theory in many areas of the therapeutic practice. Greek Stoic philosopher was the first to mention the use of rational emotive therapy in 55 A.D (Eaton & Davis 1976, p.54). Later on in 121 A.D, Marcus asserted that human problems are caused by our own judgments and not caused by the deities. Other past CBT pioneers include Skinner, Bandura, Watson, Pavlock, Joseph Wolpe and Eysenck (Robertson 2010, p.90). Pavlock noted that dogs salivate before being fed. Pavlov attributed this behaviour to the dogs’ abilities to relate being fed and the environmental cues. Through this, Pavloc concluded that all learning processes are related to the environmental conditions. On the other hand, Skinner became famous following his experiments and analysis on operant conditioning. Skinner suggested that through operant conditioning, behaviours could be altered by changing their penalties. Through laboratory researches, skinner identified how operant conditioning affected ideal communities.
Alternatively, Bandura pioneered the use of social cognitive theory in psychoanalysis. Through his writings, Bandura emphasized the usefulness of thoughts, emotions, and images in psychological evaluations. In general, Bandura’s theory suggests that individuals gain knowledge by observing others. Bandura noted that learning could be broken down into four fundamental functions: motivation, motor reproduction, attention, and retention. Bandura believed that through attention people should recognize what they are watching from other individuals. Similarly, through retention processes individuals must remember what they had observed from other individuals. Equally, through motor reproduction processes individuals must be able to translate what they had observed and what they remember into actions. Joseph Wolpe became the first person to develop a systematic desensitization process (Laidlaw 2003, p.54). In this process, patients are helped to deal with their anxiety disorders. The process employs the use of relaxation processes in tackling anxiety related disorders. Wolpe’s method has been tested several times and found to be working.
In the early 1950s, Dr. Beck and Dr. Ellis became very popular in the psychiatry following the CBT approaches they had developed. Their approaches were developed to encourage patients to think logically, and feel psychologically better. The two doctors were actively involved in clinical psychology and psychiatry. As psychiatrists, the two questioned some basic hypotheses in psychotherapy. Convinced that human problems are best tackled through human solutions, the two psychiatrists began to treat psychological disorders using CBT approaches. Ellis developed his approach after being disappointed by the way the past psychoanalyses were being solved. In the year 1962, Ellis developed a model called ABC model. In the model, A stood for antecedent event, while B stood for belief. Similarly, the word C stood for consequences. Through this model, Ellis argued that if cognition were deficient in the centre of a person’s awareness, he or she would not recognise the deficiency with ease. This implies that people have to be careful to recognise the sequence of their events and response to them. Ellis further stated that CBT diagnosis often requires the patient to behave as a detective to identify and diagnose his or her psychological disorders. Ellis referred to his concepts as self-statements. He argues that self-statements determine the way individuals interpret actions in the contemporary world. Equally, Ellis argued that emotions and behaviours are triggered by perceptions of particular events.
Unlike Ellis, Beck referred to his concepts as automatic thoughts. During his studies, Beck observed that most of his patients depicted internal dialogue. Through this, Beck postulated that there existed a bond between feelings and thoughts. Beck suggested that most people are not fully aware of their emotion-filled thoughts. He argued that people could learn to recognize and report these thoughts. In line with Becks ideologies, Psychiatrists argue that thoughts are not necessarily generated without prior reasoning (Wilding & Milne 2010, p.77). Despite their distinctive similarities, Beck and Ellis developed their approaches independently. The fundamental concept behind their approaches is that distorted cognition is at the centre of psychological challenges. These conditions are believed to be distorted due to the misinterpretations and misperceptions of events and situations. Beck and Ellis observed unique patterns of psychological symptoms, emotional distress, and dysfunctional behaviours.
Since its adoption, in psychiatry, CBT has been widely studied and proved useful in treatment of numerous psychological disorders. Currently, psychologists are conducting more than 500 studies to ascertain its effectiveness. Numerous researches are ongoing to develop cognitive therapies used in treatment of suicide avoidance and schizophrenia. Psychiatrists claim that ongoing researches are aimed at evaluating the effects of cognitive therapy in public health systems.
Assessment process in CBT
In CBT, assessment approaches are sometimes referred to as functional analysis. Unlike the homothetic assessment approaches, functional analysis focuses on understanding the patients’ attributes and diagnosing the causes of their problems. Similarly, functional analysis aims to foster relationships between the psychiatrists and the patients (Segal & Teasdale 2002, p.40). Assessment models are used in the treatment of both health illness and physical illness. Ideographic assessment methods have been employed to treat patients at the individual levels. These models have been found to be helpful in treating patients with chronic psychological conditions. Under these conditions, it has been noted that varying psychological factors have effects on patients with chronic psychological conditions. This situation has been depicted on patients suffering from depression, dysthyma and psychosis.
During the assessment process, several goals are to be fulfilled by the therapists. These aims are based on the mutual processes between the clients and the therapists (Tasman 2003, p.123). Through these mutual processes, therapists should inform their clients on the approaches to be taken during the therapies. As such, therapists should be able to record their clients’ historical information. The clients’ problems should be detailed and represented in terms of their thoughts, emotions, and psychological reactions. Thereafter, the psychiatrists are required to identify the clients’ past factors that have contributed to their current states. Thereafter, therapists should identify current factors helping to maintain the clients’ problems. After this, therapists are expected to develop logical research outlines on how they are to administer their therapy based on the formulations emerging from the assessments. In turn, the clients are required to understand and relate to the collaborative formulations developed by the psychiatrists based on their problems. Through this, the psychiatrists expect them to comprehend their current thoughts, emotions, and feelings leading to their problems. Thereafter, clients should identify the nature of the therapeutic processes developed by the psychiatrists. Accurate assessments are very essential for administering effective CBT therapies. In this regard, appropriate time allocation to every assessment session is considered essential.
Treating anxiety disorders
In contemporary society, anxiety, depression and alcohol disorders co-occur at high rates. As a result, psychiatrists are challenged to come up with effective treatments for patients with such psychological disorders (Stephens.2009 p.42). According to the World Health Organization, anxiety disorders are classified as social, phobic, and generalized disorders. It is noted that most anxiety disorders are related to substance abuse. Although pharmacological treatments of anxiety related disorders have been developed and tested for their efficacy, it should be noted that psychological treatments are the most preferred over pharmacological treatments. During the assessment sessions, psychiatrists should note that there are many reasons to link people with anxiety disorders with substance abuse. Notably, availability of alcohol in our communities should be blamed for the increased cases of anxiety related disorders. Therefore, psychiatrists should establish and diagnose the cause of their patients’ anxiety disorders during the assessment session.
Formulation of Mathew’s case
Mathew is 38 years old. He is unemployed and lives alone far away from his parents. Mathew suffers from diabetes and in the recent past; his doctor referred him for treatment of anxiety and depression disorders, which has affected his medical adherence. His major grievance to the psychiatrist was; “After several consultations with my doctor, he told me that my disease was getting worse due to my anxiety, and that it is time I seek psychiatrist assistance.” After thorough evaluation, Mathew’s therapist developed a comprehensive case formulation. In the case formulation origins, precipitants and treatments of Mathew’s disorders are noted.
Causes and mechanisms
Mathew’s psychotherapist noted that his vulnerability to nervousness was biological. Mathew revealed that his father had also been diagnosed with anxiety and depression disorders. Possibly, Mathew’s condition was worsened by his unemployment status and his medical condition. Due to his anxiety, Mathew has developed some negative habits. Mathew’s pressure from his doctor to adhere to medication procedures might have exacerbated his medical condition. Mathew has withdrawn from his friends, lost his self-esteem and his hope for the future. These negative thoughts have spearheaded Mathew’s depression, nervousness, and suicidal thoughts.
Treatment
After assessment, the therapist opted for motivational enhancement therapy (MET) model as the best approach to treat Mathew’s condition. MET model was chosen due to its effectiveness. The therapist model comprised of three sessions integrated into brief discussions and courses on motivation. The main purpose of this treatment approach was to investigate and determine ambivalence based on Mathew’s behavioural change. This was achieved through patient centred consultations aimed at bringing out change-related comments from the patient.
MET therapy was administered in three phases. During the first phase, the therapists worked closely with Mathew motivating him to change. This phase depended on the appropriate utilization of self- efficacy and building inconsistencies principles between Mathew’s past, present and future. In the second phase, the therapist motivated his patient by encouraging him to refrain from negative thoughts. This phase was accomplished using self- change statements. The main goal of this stage was to identify and develop alteration strategies regarding the patients’ anxiety disorders. In the third phase, the therapist came up with follow up plans for monitoring his client.
Schema Therapy
This is a cognitive development model developed by Jeffery Young from Colombia University. The model Comprises of several therapeutic involvements meant to tackle psychological disorders such as anxiety, depression, and substance abuse disorders. The underlying principle behind this therapy is that schemas are developed at a younger stage in life, and depicted repeatedly throughout an individual’s life. Young outlined four fundamental concepts behind this therapy: schema modes, coping styles, schema domains and early maladaptive schemas. Schema modes concern all things or emotions liable to us (Holdaway & Connolly 2004, p.58). Copying styles refers to the habits individuals adopt in their early life in response to their immediate environment. On the other hand, Jeffrey referred to schema domains as the fundamental requirements of a child. This approach was developed for use in the treatments of a variety of chronic psychological problems.
Acceptance and commitment therapy (ACT)
Acceptance and commitment therapy (ACT) is a cognitive model therapy developed by Steven Hayes. Unlike the other traditional approaches, ACT does not highlight the need to change our distorted thoughts, but rather stresses on the need to alter the messages in our thoughts. Through this therapy, individuals are encouraged to be contented with the way they are. ACT motivates individuals to embrace their internal feelings, and not to allow these feelings affect their daily physical activities. With the appropriate use of this therapy, individuals can be helped to improve on their self- esteem. Similarly, the approach can greatly help an individual improve his or her social life. In general, this act is aimed at encouraging individuals experience the completeness and vivacity in their lives.
Mindfulness-based cognitive therapy
Mindfulness therapy is a cognitive based approach that motivates individuals to be always mindful of their thoughts (Didonna 2009, p.67). By doing so, this therapy expects individuals to evaluate and learn from their own thoughts. The effectiveness of mindfulness therapy relies on the fact that once individuals become aware of their thoughts they will learn about how to manipulate them. Mindfulness therapy challenges individuals to take full control of their own thoughts and reactions to them. In this respect, we are urged to resist all the negative thoughts in our minds, and instead replace them with positive thoughts. By doing so, our brains will learn to resist all self-destructive thoughts. According to Bernard and Teasdale, the developers, human brains have several modes mandated to receive and process information. Bernard and Teasdale asserted that individuals possessing self-destructive thoughts allow only one mode to take control in their minds. For these people to eliminate their self-destructive thoughts, in their mind, they must accommodate other modes in their minds (Seiler 2008, p.73).
Strengths and weaknesses of CBT
As described above, there are several strengths of cognitive case formulation. Unlike other psychoanalytic approaches, CBT is open to revisions. As described by Magee, this approach can be improved to avoid ambiguous refutations (Kingdon & Turkington 2002, p.77). This implies that the approach can be continually developed and improved to fit every situation. By so doing, psychiatrists can freely propose, test, re-evaluate, revise, reject, and create new formulations based on the approach (Kingdon & Turkington 2002, p.78). Another advantage of CBT is its foundation in empirical research evidence. CBT approach has been developed and tested over time by renowned psychological experts. Unlike other approaches, CBT is known to have been tested in laboratories for more than 500 times. Beck suggested that the cognitive approach does not only rely on the theoretical hypotheses, but also on empirical researches. Similarly, CBT approaches are not only time efficient, but also cost effective. Unlike other approaches, CBT utilizes few theoretical and empirical constructs and technical intervention (Branch & Willson, 2010 p.24). Similarly, it should be noted that both clients and therapists comprehend CBT formulations with ease. Owing to this attribute, clients and therapists can easily evaluate the approach, thus enhancing treatment processes.
Unlike other psychoanalytic therapies, CBT has a lot to offer. With its attractive, efficient therapy, most psychiatrists have preferred approach to other approaches. Equally, the therapy has been claimed to treat varied psychological disorders untreated by other approaches. Similarly, the approach has become famous among psychiatrists for its standardized steps and approaches in treating particular psychological disorders.
Despite its effectiveness, in the treatment of several psychological disorders, CBT has been over criticised by several critics (Foreman & Pollard 2011, p.123). Critics claim that the approach has a distinctive procedure for administering treatments. As a result, the critics argue that not all patients, problems, or symptoms can be accounted for using a single approach (Crane 2009, p.50). Another weakness of the CBT formulation approach is its ability to be influenced by therapists’ prejudices and biases (Segal & Teasdale 2002, p.50). During the assessment sessions, a therapist can develop theoretical concepts with little empirical support. In such circumstances, the assessment will add little or no value to the client. Critics have also opposed the CBT concept for ignoring the usefulness of an individual unconscious process. In turn, critics argue that equal weight need to be directed at individuals’ conscious and unconscious processes for better treatments. In addition, CBT has been criticized for its dependence on basic entities such as beliefs and desires. Many psychologists have criticized the reliance on these entities in psychology. Several critics have alleged that the entities are not necessary in psychology.
It should be noted that CBT therapy like most psychological therapies has detailed steps to be followed for effective treatment (Crane 2009, p.56). In this regard, clients should understand the effectiveness of their treatment depends on their association with the therapists. As a result, therapists are advised to form strong connections with their patients to motivate their levels of concentrations. For instance, when therapists are treating clients with anxiety disorder they usually experience several challenges from these clients (Donohue 2001, p.200). When treating anxiety disorders, therapists are required to advise their clients on various ways of confronting the vice. However, in the process of these assessments patients tend to feel more anxious.
Another major weakness of cognitive behaviour therapy is its continuing doubts about its clinical significance. Critics argue that the approach’s effectiveness has been overemphasized based on its laboratory success, rather than on clinical success. The opponents noted that there are a few cases where the approach’s effectiveness has been based on the contemporary situations. As a result, the critics suggest that those advocating for the approach should provide substantial evidence on the approach’s effectiveness based on the contemporary clinical trials.
Although the CBT approach is believed to be comprised of distinctive structured approaches, it has received numerous criticisms for its generalised concepts. Most CBT psychiatrists are expected to be informed on how their clients will respond to their sessions. This assumption has been contentious since most clients will respond differently to the therapy (Gelder & Geddes 2005 p.32). Critics have suggested that the assumption should be abolished. In turn, psychiatrists should let commonsense evaluate responses to the therapies by clients. It is argued that through their commonsense clients will discover new behaviours and ways of thinking after the treatment.
Conclusion
Although cognitive behavioural therapy (CBT) has been heavily criticised, it should be noted that unlike other psychological approaches the approach is a very dominant tool in psychiatry. To reduce its criticisms, more researches need to be done on the approach (Branch & Willson, 2010 p.30). Through these investigations, more attention should be focused on the issues criticised by the opponents. As such, the researchers should major on eliminating biases and prejudices associated with the therapists. Similarly, the researchers should get rid of unnecessary assumptions, and develop a clear understanding between psychology and cognitive science (Donohue 2001, p.220).
Based on the available evidence, treatments based on CBT approach are effective in reducing cases of psychological disorders (Branch & Willson, 2010 p.34). Similarly, current researchers have suggested that various benefits can be achieved with the use of this approach. This implies that all psychiatrists should advocate for the adoption of this approach to ascertain the researchers’ claims (Donohue 2001, p.230). In the future, psychiatrists should look forward to more CBT related approaches in the treatment of psychological disorders. In this respect, CBT offers several opportunities for those who want to develop it further (Donohue 2001, p.234). Similarly, CBT therapists are advised to find other associated therapies that can be supplemented with the therapy for effective treatments. Through this, other functionalities for this approach should be emphasized. As such, more research needs to be done to identify whether the approach can treat other psychological disorders such as trauma and depression. By doing so, researchers and therapists should ensure that the approach meets the ultimate goals of improving the patients’ lives through ethical, accessible, and effective ways (Briers 2009, p.67).
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