Cognitive Behavioural Therapy. Critically examine the philosophy and application for one chosen counselling or psychotherapy theory.

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Counselling theories

Cognitive Behavioural Therapy

Critically examine the philosophy and application for one chosen counselling or psychotherapy theory.

Cognitive behavioural therapy (CBT) focuses on the way people think and act, to help them with their emotional behavioural problems (Branch, R and Willson, R 2010: 9-11). Cognitive therapy was developed by American psychiatrist Aaron T. Beck in the 1960’s. His theory aims to treat various patients by changing their perceptions and views. For example if a patient was afraid of car parks due to a traumatic event, and the patient now associates car parks with such trauma. Then cognitive behaviour therapy in this case aims to help the patient stop associating the car park with the trauma but rather of a pleasant event instead (Dickstein, LJ et al 1997: 171). There has been ample research into such taught behaviours especially by B.F Skinner and Ivan Pavlov both of whom researched into conditioning behaviour (Rott, P 2005: 4-5).

Cognitive behavioural therapy is an evidence based psychological approach, practised by a range of professionals, for the treatment of mental health and other personal and family problems (Sheldon, B 2011: 3). The term cognitive behavioural reflects the importance of both behavioural and cognitive approaches to the understanding of human nature.

Cognitive behavioural therapy combines basic theories about how people learn (behaviourism) with theories about the way people think about and interpret events in their lives (cognition), both with its own theoretical assumptions and findings (Kalodner, CR 2011: 193-213).

When Beck was working with depressed patients he noticed that they experienced a series of spontaneous negative thoughts, which he called automatic thoughts. He divided them into three categories: negative thoughts relating to the world, to the self and to the future. Working to identify and challenge these thoughts helped enable patients to evaluate their problems more effectively. (Foreman, EI and Pollard, C 2011: 1-2).

Cognitive behaviour therapy’s approach can be used to solve problems such as sleeping difficulties or relationship problems, to drug and alcohol abuse or anxiety and depression. Cognitive behavioural therapy works by altering people's attitudes and their behaviour (Beaumont, E, Galpin, A, & Jenkins, P 2012: 31-33). ‘The therapy focus on the thoughts, images, beliefs and attitudes that we hold’ (our cognitive processes) and how this relates to the way we behave, as a way of dealing with emotional problems (Branch, R and Willson, R 2010: 9-11).

The historical development of cognitive behaviour can be traced back to the 1960’s when it was established by Aaron Beck (David Westbrook, D and Kennerley, H 2007: 2). However behavior therapy itself was first developed in the early 20th century, followed by a subsequent merging of the two therapies behavioural and cognitive by Beck. This merging had significant impact on psychology, with Cognitive behaviour therapy paving the way for alternative methods to deal with psychological issues such as suicidal thoughts and obsession (Clark, DA 2003: 216). On the whole ‘Cognitive behaviour therapy serves as an umbrella term that encompasses aspects of a number of specific approaches including Beck’s cognitive therapy’ (Ronen, T and Freeman, A 2007: 26).

Cognitive behavioural therapy addresses emotional and behavioural problems by drawing attention to thinking patterns and moods (Wilding, C and Milne, A 2010: 1-50). Most sessions of cognitive behavioural therapy focuses on the here and now because most therapy is concerned with addressing current problems and also what is currently sustaining them. The use of cognitive behaviour therapy has been drawn from Beck’s theory of emotional disorders (Kingdon, DG and Turkington, D 2003: 2).

It is here that Beck realised that the link between thoughts and feelings was very important. He created the term ‘automatic thoughts’ to describe emotional thoughts that might surface in the mind. Beck found that people were not always fully aware of such thoughts, but with therapy could learn to identify and address them. Beck found that identifying these thoughts was the key to the client understanding and overcoming of his or her difficulties (Beck, AT 2003: 15-17).

Operant conditioning is a method of learning that occurs through the rewarding and punishment of behaviors. Through operant conditioning, a link between behaviour and consequence for that behaviour is formed (Bernstein, DA 2010: 205).

Skinners research into operant conditioning led him to study rats' and their reactions to a startling sound, and feeding habits to explore the possibility of learned behaviours. The first part of the study looked at making the rat travel down the runway, Skinner placed food at the end, to satisfy the reward element of the theory. However, in this instance he did not quite ...

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According to Skinner, reinforcement can occur in two ways, which he called positive and negative reinforcement. Skinner did in fact demonstrate through similar case studies that entities/living organisms tend to repeat those behaviours that are followed by positive responses. Whereas they tend not to repeat those behaviours followed by negative unfavourable consequences (Weiten, W et al 2011: 46).

Evidently cognitive behavioural therapy integrates features of Skinners Operant conditioning and behavioural therapy. The idea that positive and negative reinforcement influences behaviour is somewhat successful, this clearly impacted on Beck when he was developing cognitive behaviour therapy, thus incorporating it into his theory. This idea of conditioning if successful could help clients overcome their issues e.g. eating disorders, by changing the way the clients views them self and their idea of what they consider overweight they can in turn overcome that problem.

In the late 1800’s and early 1900’s, behaviourism was starting to explore experimental psychology. One exploration led Ivan Pavlov to develop Classical conditioning which is a reflexive or automatic type of learning in which a stimulus acquires the capacity to evoke a response that was originally evoked by another stimulus.

Pavlov’s early research into this field explored the use of dogs and their digestive habits, later this allowed Pavlov to observe the phenomenon of classical conditioning for the first time (Kalat, JW 2010: 200-201). Pavlov while studying the digestive system of dogs just happened to observe this ‘conditioned reflex’ of the dog’s salvatiory habits. ‘Pavlov immediately recognised the significance of these findings, findings that would ultimately lead him to change the direction of his research to explore this phenomenon’ (Clark, RE 2004: 279-294).This then opened up a whole new field of study, allowing Pavlov insight into understanding the way in which animals learn (Foreman, EI and Pollard, C 2011: 1-2).

In Pavlov’s experiment, he was able to make his dogs salivate not only to food (unconditioned stimulus), but also to the sound of a bell ringing (conditioned stimulus). He did this by presenting the sound of a bell just prior to feeding the dogs. The dogs would hear the bell, then see the food, and salivate. Eventually after the reparation, the dogs would begin to salivate even before they saw the food (conditioned response) they would salivate simply by hearing the bell ring.

They now associated the sound of the bell with the presence of food, despite the food not actually being present. Interestingly, Pavlov noticed in his research that the dogs not only salivated to the sound of the bell, they would also salivate when they saw Pavlov. Being the person, who always provided his dogs with food, incidentally made himself a conditioned stimulus (Coon, D 2005: 261).

‘Pavlov's discovery of classical conditioning remains one of the most important in psychology's history’ (Salkind, NJ 2004: 164-165). By applying the principles of learning theory into shaping the behaviour of first animals and then eventually humans, Pavlov realised that classical conditioning could be used to alter behaviour which might help alleviate psychological ‘disorders’ (Foreman, EI and Pollard, C 2011: 1-2). Clearly Beck agreed with this notion that classical conditioning could indeed be used to alleviate psychological disorders, since Beck actually incorporated the idea of classical conditioning into his own theory of cognitive behaviour.

‘The transfer and maintenance of behavioural and cognitive skills into practical and sustainable real-life application ultimately determines positive therapeutic outcomes’ (Kazantzis, N, and Dattilio, F 2007: 249-251). The use of experiments, research and evaluation in the application and success of cognitive behavioural therapy are crucial. These techniques are aimed in ensuring that no errors or biases occur with the findings of case studies, these case studies enable us to understand the theory and determine its success this is easier to do if there is some sort of scientific or reliable evidence (Kingdon, DG and Turkington, D 2003: 2).

When applying cognitive behavioural therapy to depression, Aaron Beck laid major emphasis on understanding and changing core beliefs as his main approach. Beck considered the role of a therapist as crucial in the treatment. The therapist involves the patient in setting realistic goals and taking responsibilities for their own actions and thoughts. Beck combined Sigmund Freud's psychoanalysis with his own understanding and observations which in turn helped develop the cognitive behavioural therapy.

In addition he developed the Beck Scale for Suicidal Ideation, Beck Hopelessness Scale, Beck Anxiety Inventory, and Beck Youth Inventories to assist in treating all kinds of mental disorders. Beck’s theory must have scientific and empirical evidence which supports his theory successfully. Many Psychiatrists worldwide use Beck’s cognitive behaviour theory and various scales in which to treat patients suffering from depression (Beck, AT et al 1991: 59).

Cognitive behavioural therapy focuses on what people think how those thoughts affect them emotionally and how they ultimately behave. This is why Beck’s theory works seemingly well when applied to patients with anxiety issues. When someone is distressed or anxious, the way they see and evaluate themselves can become negative (Butler, I and Fennell, M and Hackmann, A 2010: 3).

Cognitive behavioural therapy therapists work alongside the patient to aid them to understand the link between negative thoughts and mood. This empowers people to assert control over negative emotions and thoughts in order to change the way they behave (Loue, S and Sajatovic, M 2004: 176).

As well as depression and anxiety cognitive behavioural therapy can also be applied to patients with eating disorders. 'Cognitive behavioural therapy has been clinically proven as an effective treatment for Bulimia Nervosa, Obesity, and Anorexia Nervosa’ (The Centre for Cognitive-Behavioural Therapy 2006). Recovery from Bulimia using CBT can take anything from four to six months. However with Anorexia sufferers it can take along as one to two years to recover.

Obesity problems are effectively overcome using the method of CBT because both weight loss, and relapse prevention which changes the patient’s thoughts and perception of themselves and what they classify as obese or ‘fat’. CBT therapy addresses the core problems underlying the ‘yo-yo factor’ of weight loss, and helps the patient realises that negative thoughts or thinking are the main contributors to psychological issues (Bray, GA and Bouchard, C 2004).

Cognitive behavioural therapy clearly has both advantages and disadvantages; these are important factors when trying to evaluate the level of success concerning the theory cognitive behavioural therapy. According to Dobson and Dobson ‘cognitive behavioural therapy is... rigid, overly structured and does not take the needs of individual clients into account’ (Dobson, DJG and Dobson, KS 2009: 246-247). Dobson argues that CBT does not take into account the client’s needs, however Wilding asserts that CBT helps patients engage in self healing which will aid them in the long term. ‘Cognitive behavioural therapy is a popular form of psychotherapy that helps people by engaging them in a process of self-awareness and self-responsibility’ (Wilding, C and Milne, A 2010: 1-50).

‘Aaron Beck was a conventionally trained psychoanalyst who faced very serious issues’ (Hall, K and Iqbal, F 2010: 61). This to some extent is true Beck did face issues regarding short term cures. ‘The treatment Beck had trained to deliver was not effective at least in the short term’ (Wilding, C and Milne, A 2010: 1-50). Beck’s theory was not successful short term, serious psychological problems such as eating disorders are manifested through negative mental attitude which there is no short term treatment, and any mental disorder is a long process to recovery.

‘Cognitive behavioural therapy rests on a rational and intellectual theory that ignores the social context of problems’ (Dobson, DJG and Dobson, KS 2009: 246-247). Dobson indicates that CBT does not consider social problems, this is somewhat supported by Wilding and Milne with their assertion. ‘Cognitive behavioural therapy does not readily focus enough on emotions’ (Wilding, C and Milne, A 2010: 1-50). From both assertions it is indicated that CBT on the whole did not focus on social problems but just on the mental disorder itself. Overall it is clear to see that despite many issues and several pitfalls the Beck’s theory is still largely successful and popular. Perhaps one reason his theory is so successful is because this method of therapy is cost effective and there is strong clinical evidence to support its success (Branch, R and Willson, R 2010: 9-11).

On the whole cognitive behavioural therapy has become one of the most influential methods of psychotherapy available. ‘CBT has demonstrated efficacy for a broad range of psychiatric disorders, including depression, anxiety disorders, substance abuse, and eating disorders’ (Pike, K et al 2010: 83-107). Becks combination of both behavioural and cognitive therapy is perhaps what allowed this approach to therapy to become so successful and popular. This along with scientific influences from both Skinner and Pavlov contributed valuable insight and empirical research into human behaviour and the treatment of psychological illness.

When applying cognitive behavioural therapy to psychological illness such as anxiety or depression, it is important to remember that most issues similar to anxiety or depression stem from underlying psychological problems. Beck understood this and would readily treat each patient/client how to effectively purge themselves of these negative thoughts and feelings.

Despite its evidential success when applying cognitive behaviour therapy, Beck did have to overcome great criticism concerning the recovery period. Many critics argued that recovery from such illnesses, were too long. Although this was true and recovery could indeed take up to several months, Beck knew that in order to fully recover from such psychological problems then it there would certainly be no short term cure. The process of recovery is entirely dependent upon the patient’s willingness to help themselves overcome negative thoughts and feelings, which caused such problems in the first place. This deep psychological process could perhaps only take a couple of weeks depending on how quick the patient/client let go of negative thoughts and feelings while replacing them with positive and happy alternatives.

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