Cognitive-behavioural counselling

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We teach people that they upset themselves. We can't change the past, so we change how people are thinking, feeling and behaving today.

I attempt to focus on the main concepts and critical understanding of the underlying assumptions and therapeutic process of the Cognitive-Behavioural approach. I shall also consider how the cognitive model views that an individual's feelings result from internal messages (Burns, 2000) and that the individual's dysfunctional way of thinking is at the core of emotional disturbance. Whilst external conditions contribute to negative emotions, it is a person's interpretation of these experiences that predominantly affect the emotional responses to that event rather than the event itself (Branch & Dryden, 2008). The underlying principles of cognitive therapy have existed since the ancient Greeks with the idea that our perceptions determine the reality that we experience and this being a focus of Epictetus' (1995 p.12) axiom: ''...men are not disturbed by things but by the views which they take of them'' likening his assertion that cognitive variables interpose and determine emotional responses to events.

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Following-on from Kant's (1782/1988) ''categories of thinking'' which we now call schemas are that our understanding of reality is simply a matter of associations of events; empiricism argued against universal categories in that knowledge was precisely a person's point of view as reality is never directly knowable. This emphasis on a person's experience of the world rather than a category of thinking was derived from Husserl's (1960) phenomenology pertaining to how reality is experienced, known as 'phenomenal experience' and cognitive therapy is a derivative of this tradition {Leahy, 1996). An early artificer of cognitive therapy is Kelly (1955 p.36) who describes how human intelligence is the consequence of conditioned learning and being ''...your construction of your reality''. These constructs proposed a psychopathology based on cognitive processing and Kelly (1955) considered that anger, anxiety, paranoia and depression were all consequences of the individual's idiosyncratic construction of reality or schemas. Kelly (1955) also argued that these constructs are bipolar and introduced the idea of 'constructive alternativism' where individuals differ in their ability to project alternatives or options and this 'constructive alternativism' became an important incursion for Beck's (1979) theory of overcoming hopelessness.

An important antecedent to the work of Beck (1995) was the development of behaviour therapy (Wolpe, 1958; Watson, 1970 & Skinner, 1974) whilst Ellis's (1962) rational emotive therapy considered that pathology was wholly due to the irrational distortions of 'awfulizing' and 'shoulds' earlier envisioned by Horney (1950) as a 'tyranny'. Warren and Zgourides (1991) describe how it is the 'must' thoughts of individuals that create the disorder whilst Craddy (2006 pp.28-29) describes how clients helped considerably by Beck's (1989) cbt are those ''with rigid patterns of thinking...'' and these irrational beliefs are the client's evaluative beliefs, or 'adaptive beliefs' (Beck, 1989) which are expressed in relative terms

Cognitive behavioural therapy (cbt) is one of a variety of 'talking therapies' and is an active and directive, collaborative approach to dealing with emotional disorders with the cbt therapist talking directly to the client and asking direct questions (Branch & Dryden, 2008). CBT as formulated by Beck (1989) assumes that a client's thinking processes influence and are influenced by emotional concerns such as anxiety and depression. Modifying thinking processes during the course of therapy may have a positive effect on the client's emotions, behaviour or underlying concerns. The main idea of the cognitive model being that it is the person's distorted way of thinking that creates the disorder or maladaptive behaviour and disturbed mood. This distorted thinking also called 'irrational thinking' is the cause rather than faulty or maladaptive behaviour as an individual reacts to his or her own distorted viewpoint of the situation Instead of reacting to the reality of a situation (Leahy, 1996). Two aspects of thinking that are pertinent to cbt are thoughts and images or 'automatic thoughts' that occur involuntarily in the stream of consciousness (Beck, 2001) that Ellis (1962) who has emphasised 'irrational beliefs' or evaluative beliefs in emotional disorders described these as underlying beliefs.

Ellis (as cited by Trower, Casey & Dryden, 1988) explicates a model that explains the relationship between thinking and emotions. In accordance with this model known as an 'ABC model', an activating event leads on to emotional and behavioural consequences and these emotional consequences being interposed by beliefs. Ellis (1962) stipulates that the activating event for an emotional upset is often an actual incident or it can also be a memory or an image or a thought about a future even or an emotion such as precipitated by fear such as in a panic attack and this can encourage this outcome to occur.

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Impaired thinking that shows faulty adaption or maladaptive thinking is at the centre of emotional disturbance according to cbt theory. Maladaptive or faulty thinking causes maladaptive or counter-productive behaviour that interferes with everyday life. It is a predominantly held assumption that the behaviour of other people and external infelicitous and undesirable events directly impact on us to feel negative emotions. Whilst it is also true that when negative things happen, people correspondingly feel that way and cbt asserts that these external conditions are conducive to our negative emotions but do not exclusively elicit emotional distress. Ascertaining that a person's interpretations of what he experiences are by definition subjective, these are assumptions or 'guesses' about reality rather than absolutes or 'facts' or evidence-based conclusions. It is how we construe these facts and interpret our experiences and ascertain these incidences in life that resolutely effect our emotional responses to the actual incident itself (Hofmann & Otto, 2008). These may be objectively correct to varying degrees and if a person has persistent negative beliefs undue emotional disturbance is likely to follow negative events and can instigate emotional disorders such as depression if a person has holds a false belief or a 'thinking bias' that he is inadequate and worthless.

The central idea of a cognitive therapy is that a person's emotional reactions and behaviour are strongly affected by their cognitions which constitute the thoughts, beliefs and interpretations that they have about themselves that fundamentally is the meaning that the person gives to events in their lives. However, it follows that if an emotion arose due to a particular event then the same emotion would have to result for everyone who experienced that particular event. What actually happens is that people react differently in varying degrees to similar events. Any existential event in one person's life will inevitably not produce the exact emotional state in another person and cbt posits that there must be another agent

Kelly

He begins by making the observation that human psychology is essentially anticipatory challenging the contemporary behaviourist viewpoint that human intelligence was the consequence of conditioned learning. He proceeds to reason in an analytic fashion about the consequences that this observation must have for understanding human experience and intelligence. Kelly's work became the cornerstone of Social Psychology throughout the 1960s until in the late 1980s new theories of social psychology based on attribution theory came into vogue.

The title is used in diverse ways to designatebehavior therapy,cognitive therapy, and to refer to therapy based upon a combination of basicbehavioralandcognitiveresearch.[1]

Anxiety Disorders: A Rational-emotive Perspective (Psychology Practitioner Guidebooks) (Paperback) Allyn & Bacon (Jun 1991) byRicks Warren(Author),George D. Zgourides(Author)

The main idea of the cognitive model is that it's the individuals way of thinking that creates the disorder (abnormality), and that it's the distorted and irrational thinking that is the cause rather than maladaptive behaviour Warren and Zgourides (1991) describe that it was the 'must' thoughts of these individuals that create the disorder, for example 'I must perform well otherwise it will be awful'.

Kovacs and Beck (1978) underlined some key ideas of the cognitive model, they said that 'from commonplace processes such as faulty learning, making incorrect inferences on the basis of inadequate or incorrect information, not distinguishing adequately between imagination and reality'. From this we are able to create a bond between behaviourists and cognitive approaches to define abnormality.

The purpose of this paper is to investigate the pros and cons of cons of Cognitive Behavioral Therapy, and determine if the approach this discipline presents may have productive effects for individuals that are afflicted by emotional duress / depression, due to the causal factor of institutional racism, which is the Achilles heel of American society, and has been the heart beat for in differential treatment between the races for several centuries.

Definition

Cognitive-behavioral therapy is an action-oriented form of psychosocial therapy that assumes that maladaptive, or faulty, thinking patterns cause maladaptive behavior and "negative" emotions. (Maladaptive behavior is behavior that is counter-productive or interferes with everyday living.) The treatment focuses on changing an individual's thoughts (cognitive patterns) in order to change his or her behavior and emotional state.

Purpose

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Theoretically, cognitive-behavioral therapy can be employed in any situation in which "there is a pattern of unwanted behavior accompanied by distress and impairment. It is a recommended treatment option for a number of mental disorders, including affective (mood) disorders, personality disorders, social phobia, obsessive-compulsive disorder (OCD), eating disorders, substance abuse, anxiety or panic disorder, agoraphobia, post-traumatic stress disorder (PTSD), and attention-deficit/hyperactivity disorder." The writer believes racism is a common phobia that can have many debilitating mental, and physical affectations on the receiver, such as depression, inferiority complexes, animosity and the sting of discrimination has in some instances led to violence. Constructive change is realized through positive, progressive thought, self esteem building education, applying proactive coping skills, mentoring, and positive communication efforts.

Precautions

"Cognitive-behavioral therapy may not be suitable for some patients. Patients who do not have a specific behavioral issue they wish to address and whose goals for therapy are to gain insight into the past may be better served by psychodynamic therapy. Patients who undergo CBT must also be willing to take a very active role in the treatment process. Cognitive-behavioral intervention may be inappropriate for some severely psychotic patients and for cognitively impaired patients (for example, patients with organic brain disease or a traumatic brain injury), depending on their level of functioning." Cognitive Behavior Therapy hereinafter referred to as (CBT) combines two very effective kinds of psychotherapy -cognitive therapy and behavior therapy. The concept of CBT was pioneered by psychologists Aaron Beck and Albert Ellis in the 1960s. "Cognitive Therapy assumes that maladaptive behaviors and disturbed mood or emotions are the result of inappropriate or irrational thinking patterns, called automatic thoughts. Instead of reacting to the reality of a situation, an individual reacts to his or her own distorted viewpoint of the situation."

Cognitive Behavioral Therapy (CBT) is a form of psychotherapy used in the treatment of adults and children with depression. Its focus is on current issues and symptoms versus more traditional forms of therapy which tend to focus on a person's past history. The usual format is weekly therapy sessions coupled with daily practice exercises designed to help the patient apply CBT skills in their home environment. Behavior Therapy incorporates and applies a variety of techniques which aim to solve problems by bringing measurable and observable change to the client's behavior, altering behavior patterns in specific areas which are currently dysfunctional. The treatment is modified to meet the individual needs of the prospective patient. Cognitive-Behavioral Therapy, offers several other diverse approaches, which include Rational Emotive, Rational Behavior Therapy, Rational Living Therapy, Cognitive Therapy, and Dialectic Behavior Therapy, but for the purpose of this paper our emphasis will concentrate on the principle concepts of each theory (pro / con), key figures involved, and any opposing or unsubstantiated viewpoints.

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Cognitive models have achieved increasing popularity as theoretical frameworks for depression. One of the more prominent models is the hopelessness theory of depression (Abramson, Metalsky, & Alloy, 1989), a diathesis-stress mode! in which the outcome is a specific set of depressive symptoms constituting the subtype of hopelessness depression (HD).

  • Abramsoti, L. Y. , Metalsky, G. I., & Alloy, L. B. (1989). Hopelessness depression: A theory-based subtype of depression. Psychological Review, 96, 358-372.