Beck's Cognitive Therapy for the treatment of Anxiety disorders such as PTSD,OCD andGAD - Term Paper Example

? Beck’s Cognitive Therapy for Anxiety Disorders Today, there are various modalities used as a form of treatment for cognitive behavior disorders. These include psychodynamic, behavior and psychopharmacological treatments. This paper will focus on elaborating Beck’s cognitive behavioral therapy principles and technique. It will also elaborate on the application of the method in different age, gender and culture. Furthermore, this paper will identify the circumstances under which cognitive disorders develop. According to Beck, cognitive disorder and behavior result from negative thinking and beliefs. Moreover, the paper will elaborate how Beck’s technique is applied in the treatment of cognitive disorders. To illustrate on the clinical significance of this form of therapy, various empirical studies done on the subject matter will be analyzed. This will entail studies that have been done across different ages and gender. Of importance, will be the testing of this form of therapy across the various anxiety disorders, such as Post Traumatic Stress Disorder (PTSD), Obsessive Compulsive Disorder (OCD) and Generalized Anxiety Disorder (GAD). SECTION ONE Cognitive Therapy is a therapeutic modality used in the treatment of cognitive behavioral disorders. These include depression, eating disorder, Post Traumatic Stress Disorder, Anxiety Disorder and Obsessive compulsive disorder. This treatment modality was developed in by Aaron Beck, a psychoanalyst. In his formulation, he stressed the significance of thinking and belief systems in determining feelings and behavior (Becks, 2000). Cognitive therapy focuses on understanding distorted behavior and beliefs as well as suggesting methods to change the maladaptive thinking. It also educates the patient on techniques of interacting with others in the society. This paper will focus on discussing the application of Beck’s cognitive therapy method in the treatment of different cognitive disorders. In the beginning, Beck critically analyzed Feud’s concept on “Pre-conscious” theory (Leahy, 1996). According to Feud, depression resulted from outward expressing of anger in the subconscious. In contrast Feud, studied depressed patients in their sleep so as to establish their internal communication. The sleep studies were based on the principle that during this state, the subconscious was depressed. Beck discovered that during sleep, depressed patients would express thoughts of self blame and criticism (Beck, 2000). Furthermore, these patients predicted disaster and failure upon their lives and made negative interpretations in cases where positive ones would be most appropriate. A good example is when a student who has exams the following week begins to think that they can never pass the exams. This leads to generation of negative thoughts, which reflects a lack of confidence and self worth. Beck’s model advocates for cognitive assessment in several levels. The basic levels include automatic thoughts that occur spontaneously, seem valid and are associated with disturbing emotions or distorted behavior (Leahy, 1996). These automatic thoughts are classified according to their distortions, which include mind reading, fortune telling, labeling and personalizing. These thoughts maybe true or false, but the patient lacks sufficient evidence to support them. These maladaptive rules and regulations that govern the individual are referred to as schemas. The schemas are rigid, unattainable, over inclusive and result in vulnerability to future anxiety attacks and depressive episodes. This is because they result in a thought pattern that is rigid and distorted (Paula et al., 2007). The individual channels any new information through this automatic thought process and evaluates it following the underlying distorted assumption. The distorted assumptions are linked to the personal schema thus reinforcing the negative personal belief which confirms the distrust. The personal schema creates a selective attention and memory (Beck, 2000). This means that the individual is likely to recall and interpret information related to the schema thus strengthening it. This means that the depressive and anxiety attacks are based on research and theories that continuously searches for information to confirm that schema. This is referred to as the negative, cognitive shift, where the individual focuses on negative thoughts rather than the positive thoughts (Paula et al., 2007). In contrast to Feud’s theory, Beck focuses on the influence of automatic thoughts on the individual’s behavior and beliefs. Cognitive therapy, therefore, is based on the assumption that individual’s interpretation of information dictates how they feel and behave. This interpretation is spontaneous and altering it would change how one feels about the information. This means that feelings and thoughts of an individual are distinct. The individual’s thoughts about an event dictate their feelings. According to Beck, feelings are the inner emotions experiences as a consequence of a thought. In cognitive therapy, the counselor explains to the patient the relationship between their thoughts and feelings (Beck, 2000). Technique Beck’s Cognitive Behavioral Therapy (CBT) involves various steps in which the patient is actively involved. It aims at correcting distorted information processes, adjusting dysfunctional assumption and beliefs that contribute to the depressive and anxiety states. The first step involves the individual identifying the automatic thought process and the cognitive distortion that results from these thoughts. According to Beck, these automatic thoughts are distorted and marked with generalization, mental filter, labeling and personalization. These thoughts occur spontaneously, and the patient may be unaware of their existence. In this situation, the therapist should aim at eliciting various thoughts and assumptions held by the patient concerning different situations (Beck, 2000). The second step involves the evaluation of the cognitive distortions. In this step, the counselor educates the patient on the relationship between thoughts and feelings. At this step, it is paramount that the patients identify their thoughts from facts. The therapist may use the A-B-C technique to help the patient differentiate their thoughts, facts and feeling. This technique allows the patient to understand how an activating event can result in different beliefs and consequences. The patient is asked to record their thoughts daily; then report on how they felt. This step aims at allowing the patient to observe and evaluate their thinking process. This will enable them admit the effects that the distorted thinking process has on their feelings (Leahy, 1996). Although the patients may have strong beliefs regarding a belief, this does not necessarily measure up to 100%. The feelings and emotions vary to a certain degree (Paula et al., 2007). The therapist should engage the patient in measuring their belief towards a specific thought. According to Beck, people experience different degree of feelings and emotions even when they experience the same events. Moreover, the given change to be seen in therapy is a gradual process over which the patient should be able to recognize various degrees of change in their feelings (Beck, 2000). The therapist should guide patient using the scale to grade the degree of their belief. This helps in monitoring the progress of the patient during therapy. The third step involves developing reality testing for their distorted cognition. The patient learns how to evaluate their thoughts in an event. During this step, the patient should learn how to keep records of their activities and thoughts, analyze their assumption and learn alternative interpretations about an event. This will help them identify the effect of positive thoughts on an event in relation to feelings (Lasourcer, 2006). An example is the student who ends up depressed because they believe that they cannot pass the exams because they are not brilliant. Although this is not true, the student fails the exams as they are not able to study. The automatic thoughts result in a maladaptive behavior thus the student is unable to read. The fourth step aims at teaching the patient how to substitute their biased cognition for realistic and accurate interpretation. The counselor educates the patient on sound interpretations of different forms of information. The therapist helps the patient focus on the positive interpretation to an event while suppressing the negative thoughts. This also enables the patient to modify their dysfunctional assumptions and beliefs that increase their vulnerability to cognitive disorders (Lasourcer, 2006). For example, the student who believes that he cannot pass his exams should be taught to be confident in themselves. The final steps involve coming up with methods of changing the maladaptive behavior that accompanies the distorted thoughts. This involves teaching the patient how to behave when encountered by different situations. It also empowers the patient on the way of tackling difficult situation (Lasourcer, 2006). This aims at breaking the cyclic chain that occurs as a consequence of distorted beliefs. Although this is challenging for the patient, the therapist should offer support services to the patient. It is important for the therapist to ensure that the whole process is patient oriented. This means that the therapist only guides the patient in coming up with suggested functional behavior in different situations (Becks, 2000). SECTION TWO Group versus Individual CBT for OCD and Male and Female Dropout Rates Jaurrieta et al (2008) analyse the effects of individual versus group therapy in the management of Obsessive Compulsive Disorder (OCD). They compare the effectiveness of these two forms in a sample at six months and twelve months follow up. In their methodology, 38 subjects satisfying DSM-IV OCD criteria completed twenty sessions of the group and individual CBT. The subjects were then assessed by an Obsessive Compulsive Scale. In addition, they were also tested by the Hamilton Depression and Anxiety Scale at baseline, at six months and at twelve months of follow up (Jaurrieta et al., 2008). There was clinical improvement immediately after treatment. This clinical improvement was maintained at 6 months and also at the twelve month of follow up. The outcomes of the group and individual treatment were found to be the same. It was noted that the dropout rates were higher above the women than men. However, the dropout rates were similar for both group and individual therapy (Jaurrieta et al., 2008). In conclusion, Beck’s CBT is effective in the management of OCD. Group and individual CBT are similar at all stages of patient management and follow up. Group and Individual CBT do not significantly influence the dropout rates. However, being a female influences the dropout rates. This is because women are more likely to drop out than opposite gender. Beck’s CBT in treatment of Late Life Anxiety The first paper chosen is evidence based cognitive behavioral treatment for late life anxiety. The paper focuses on Beck’s Cognitive Behavioral Therapy and its efficacy among the elderly. The research was done by Sorrell, Catherine and Thorp (Ayers et al., 2007). The study reflects on adults having generalized anxiety disorder. There are also samples with mixed anxiety disorders and symptoms. Evidence for (Beck’s) cognitive behavioral therapy was found. The authors also discuss common assessment instruments. The authors begin by defining the relevance of anxiety in the older adults. Estimated prevalence rates are noted in the older individuals. It is noted that the older in the society have increased incidences of generalized anxiety disorders due to several disposing factors. These include the higher incidences of medical co morbidities, drug use and decreased functional status among this age group. Community prevalence rates of generalized anxiety disorders are estimated at 6%. Medically ill older adults have high incidences of anxiety disorders. In the methodology, the participants in the study were all over 55 years of age (Ayers et al., 2007). They carried a DSM-IV anxiety disorder diagnosis or had subjective generalized anxiety complaints. The study design that was employed was randomized controlled trials. Becks cognitive behavioral therapy intervention was compared to usual care wait list, alternative intervention or placebo. At least one Generalized Anxiety Disorder (GAD) outcome measure had to be reported. Length of treatment covered was eight to twelve sessions. In the results, several outcome measures were included. This comprised Beck Anxiety Inventory, average percentage of the day spent worrying, GAD severity ratings among others. Becks Cognitive Behavioral therapy was found to decrease the incidences of self reports of anxiety. It was efficacious than the usual care or the medical management. A combination of this form of CBT and Medical management was found to have additive effects. Beck’s CBT in treatment of PTSD in Women A second study focused on the efficacy of Becks cognitive Behavioral therapy in Post Traumatic Stress Disorder (PTSD) in women. It was undertaken by Paula, Friedman and Charles. The research starts by mentioning the risk factors for development of PTSD. There has been increasing incidences of PTSD due to war in Iraq and other catastrophes. PTSD is noted to have higher lifetime prevalence in women (9.8%) than in males (3.5%) (Paula et al. 822). The incidence is significantly elevated in retired military women. The research article aimed at measuring PTSD treatment among this population. The study served to compare Beck’s CBT with standard treatment. The sample population that was chosen was 277. Participants were then assigned to Becks CBT (141) or other standard treatment (143) (Paula et al., 2007). The primary outcome measure that was recorded was PTSD severity. Secondary outcomes that were chosen include functioning, co morbid symptoms and quality of life. The duration of treatment was six months. Blinded assessors were used to collect data, both pre and post treatment. It was found out that women who had received Beck’s CBT had increased reduction of PTSD, compared to the women who received other standard therapies (Paula et al., 2007). Those on Beck’s CBT are likely to no longer be classified in the PTSD diagnostic criteria. There are also more likely to achieve total remission than their counterparts. The conclusion is that Becks CBT is a highly effective treatment for female veterans with PTSD. Therefore, implementation of Becks CBT is feasible across a wide range of clinical settings. Beck’s CBT and OCD management To emphasize on the empirical evidence that pertains to Becks CBT, Norton and Price conducted a meta-analytic review of CBT treatment outcome on the anxiety disorders. This study was done in adults. Among the CBT treatment trials that were reviewed, was Beck’s CBT. CBT or in combination with other methods such as relaxation was analyzed. Norton and Prince note the contribution of Abramowitz in 1997. He compares the CBT treatment of OCD with other modalities of treatment (Abramowitz et al., 2005). In this research, expected outcomes included quality of life and number of days without experiencing symptoms. Abramowitz found that Becks CBT is superior to other modalities of treatment when it comes to the treatment of OCD. OCD patients on this form of CBT are more likely to have a good quality of life than their counterparts. They also experience longer duration before experiencing symptoms (relapse) than their counterparts. The study also purports that patients on Becks CBT can experience non recurrence of such automatic thoughts. Beck’s CBT and Generalized Anxiety Disorders In their review, Butler et al. (2006) describe the Gould et al. (1997) research on CBT. They conducted a study that served to prove the efficacy of Cognitive Behavioral Therapy in the set up of generalized anxiety disorders. Various outcome measures were employed. This was so as to compare Cognitive Therapy with other treatment options. These other options included non directive therapy, placebo pill, relaxation techniques and relaxation methods. The outcome measure utilized was a self report measure on worry and anxiety (Butler et al., 2006). However, Butler indicates that the sample size utilized was too minimal to provide a representative number. The preliminary results of the study are strong. Cognitive therapy was found superior to the other treatment modalities. Hence, Beck CBT is more efficacious than non directive therapy, placebo pill or non treatment. The effects of CBT treatment were found to be maintained for over six months after treatment. However, there was no data for the post medical treatment effects. In comparison to applied relaxation, Beck’s CBT was found to have stronger long term post treatment effects (Butler et al., 2006). Current status and Future Challenges of Beckian CBT in Management of anxiety Disorder McManus et al. analyse the current status of cognitive therapy for anxiety disorders. They also analyse the future challenges that may affect this form of treatment. They point out to a research done Emery, Greenberg and Beck (1985). The trio outlined the Beckian Cognitive therapy. They also note that the Beckian CBT development for anxiety disorders is progressive. There is a close link between experimental studies, theory and therapy (McManus et al., 2008). Hoffmann and Smits are also noted to have proven the high efficacy in treatment of anxiety disorders. National Institute for Health Clinical Excellence (NICE) guidelines recommends CBT as the anxiety disorder treatment of choice. Cognitive OCD models highlight on the importance of CBT. This is clearly demonstrated by Roth and Fonagy (2005) (McManus et al., 2008). They indicate that CBT can be employed in OCD that are refractory to alternative treatments. Despite this, severe forms of OCD are usually refractory to CBT. The authors conclude that CBT is an effective method in the management of anxiety disorders as demonstrated by the previous researches. Patients are less likely to drop out from Beckian CBT therapy. This form of treatment also has the highest efficacy rates seen in comparison to other modalities. The research concludes that there remains space for improvement in CBT treatment and anxiety disorders. This is because many patients are unable to attain increased end state functioning; especially for long term follow up. Therapies that focus on changing the metacognitive processes are more efficacious than therapies that try to evaluate the thought contents (McManus et al., 2008). SECTION THREE From the above information, I have sufficient knowledge to conduct the interview. Beck’s CBT is highly beneficial when it comes to the management of anxiety disorders. It has a similar spectrum of action in all age groups. There are no cultural predilections. Beck’s CBT is an indispensable tool when it comes to psychological treatment of Post Traumatic Stress Disorder. It is also invaluable in the management of Obsessive Compulsive Disorder. It has been made a first line therapy by the NICE guidelines (Beck, 2000). This form of CBT can be carried out as an individual or in the group. Clinical trials have not shown any advantage over each other. This means that any of the two forms can be utilized. It has been shown that women are more probable to drop out of OCD treatment by this form of therapy. This research was beneficial in that it has provided with a deep insight into Beck’s approach and its unrivalled efficacy in the management of anxiety disorders. There are gaps that one would fill in before the interview. Efficacy of combination therapy is worth knowing. One would want to know whether the combination of Beck’s CBT with other modalities of treatment is additive. One would also want to know whether there are any unwanted effects that one can suffer from this form of treatment. Conclusion Today there are various modalities used as a form of treatment for cognitive behavior disorders. These include psychodynamic, behavior and psychopharmacological treatments (Lasourcer, 2006). However, research has shown that this treatment modality is successful in the treatment of depression, anxiety disorder in addition to OCD. It is important to consider the age, gender and cultural differences of an individual in the application of this treatment modality. According to gender schema theory, the cognitive distortion relates to feeling skilled, valuing oneself, body image and relationships. Beck’s cognitive method is thus effective in that it allows the individual to understand the negative self-schemas that results in maladaptive behavior (Lasourcer, 2006). Application of cognitive therapy thus involves helping to change the distorted beliefs and behavior as well as empowering the patient. It is also important for the therapist to ensure that the client actively participates in the treatment process so that they can value their opinions. Cultural factors have a significant influence on the patient’s attitude toward the therapist and treatment modality. An individual’s culture plays a key role in influencing their beliefs and behavior. Due to cultural diversity, different cultures have different themes (Beck, 2000). On the other hand, cognitive behavior deals with an individual’s behavior in relation to their beliefs. It is thus important for the therapist to understand the community’s culture so as to deduce their attitude. Reference List Abramowitz, J., & Brett, D. (2005). Cognitive behavioral therapy: Review of meta-analytic findings. Journal of Clinical Psychology. 60 (4), 429-441. Andrew, B. (2006). The empirical status of Cognitive Behavioral Therapy: Review of Meta-analysis. Clinical Psychology Review. 26 (1), 17-31. Beck, S. (2000). Cognitive Therapy: Basics and beyond. NY: Gulford. Catherine, A. et al. (2007). Evidence based psychological treatment for late life anxiety. Psychology and Aging. 22 (1), 8-17. Jaurrieta, N. et al. (2008). Individual versus group cognitive behavioral therapy. Psychiatry and clinical neuroscience. 62, 697-704. Lasoucer, R. et al. (2006). Efficacy of Cognitive treatment for generalized anxiety disorder: evaluation in a controlled clinical trial. Journal of Consulting and Clinical Psychology. 4 (3), 45-56. Leahy, R. (1996). Cognitive Behavioral Therapy: Basic Principles and Application. NJ: Prentice Hall. McManus, F. et al. (2008). Cognitive treatment for anxiety disorder: Current status and future challenges. Behavioral and Cognitive Psychotherapy. 6 (1), 1-10. Paula, S. et al. (2007). Cognitive behavioral therapy for Post Traumatic Stress Disorder in women. American Medical Association. 297 (8), 819-828. Robert, L. (2003). Cognitive Therapy Techniques. NY: Gulford Publication. Read More