How Cognitive Behaviour Therapy Works - Coursework Example

Analysis and Application of Cognitive-Behavioral Therapy 0 Introduction Cognitive-Behavioural Therapy (CBT) emerged as a widely used and dominanttherapeutic approach in the current times (cited in Rafaeli, 2009). The Psychotherapy Networker (2007 cited in Ryan, et al., 2011) reported that approximately 67% of 2000 helping professionals employ CBT in their practice. The current increase in the use of CBT reflects its efficacy in treating mental disorders. The findings of previous studies showed that CBT is effective in treating mental disorders compared to other approaches (Leichsenring, et al., 2006). CBT pertains to the family of treatment approaches driven to influence dysfunctional emotions, and cognition trough systematic, time-limited, and goal oriented behaviours (Gilboa-Schechtman & Marom, 2009). This paper seeks to discuss CBT, and its application to an individual who is experiencing anxiety in public speaking. It also outlines the techniques in CBT. Lastly, it demonstrates how such techniques of CBT are applied in the therapy session. 2.0 Cognitive Behavioural Therapy (CBT) CBT is defined as a structured therapy, which employs a set of cognitive techniques driven to resolve psychological issues and conflicts in a short span of time. It concentrates on the client’s cognitive distortions and errors, which may lead to the psychological disturbances (Trinidad, 2007; Tarrier, 2006, p.13). The primary goal of CBT is for therapists to identify client’s irrational thinking and help them challenge these various cognitive distortions. Hays (2002 cited in Ryan, et al., 2011) reiterated that CBT acknowledges the need to change or modify the therapy according to particular strengths of the client in order to facilitate change and promote empowerment. Therapists, who employ CBT, teach their clients strategies that can be utilised outside the therapy. CBT puts emphasis on rationality, verbal ability, and assertiveness as tools for facilitating behavioural changes and achieving helpful thinking (Ryan, et al., 2011). Most approaches to CBT employ what is commonly referred as the ABC Model. “A” stands for the actual event while “B” is considered as the belief and “C” is for the consequences. CBT supports the premise that individuals’ beliefs influence their emotions and consequently their behaviour. Thus, it is essential to address problematic beliefs pertaining to a certain event to modify undesirable behaviours and emotions (Dryden, 2008, p.15; cited in Miller, et al., 2010). Therapists who utilised CBT help modify how clients think (cognition) and what they do (behaviour). “Unlike other talking therapies, it concentrates on the ‘here and now’ issues” and difficulties of the clients. It is concerned with looking for means to improve clients’ state of mind instead of dwell into the causes of distress in the past (Whitfield & Davidson, 2007, p.3). It sets itself apart from other approaches as it relies on procedures and principles of the scientific method. Corey (2011, p.371) stressed that the characteristics of CBT, which distinguishes it from other approaches, include (1) the use of behavioural assessment, (2) spell out collaborative treatment objectives, (3) formulate a particular treatment procedure suitable for a certain problem, and lastly (4) objectively assess the outcomes of the therapy. 2.1 Techniques of CBT Cognitive-behavioural therapists integrate various strategies designed to modify both client’s behaviour and thought. This will consequently improve the client’s psychological functioning. Techniques in CBT include monitoring thoughts and behaviours, determining the thoughts and behaviours which need to be modified, setting particular goals, which increase in difficulty, encouraging oneself, modeling new and healthy behaviours, changing negative thoughts to positive ones, and performing homework. These techniques can be undertaken with the absence of a therapist (Plotnik & Kouyoumdjian, 2010, p.568). Researchers consider behavioural interventions as the clinical applications of the learning theory. The most commonly used methods are operant and classical conditioning, which are combined with observational learning (cited in Chapman, 2005, p.8). For instance, cognitive-behavioural therapists teach clients to reward themselves after demonstrating new and suitable reactions to crucial situations. MacLaren and Freeman (2007) stress that skill training may be beneficial among clients. The clients may lack certain skills in practical and interpersonal levels, which block their ability to attain their goals. Relaxation skills, assertiveness skills, social skills, and anger management skills may be beneficial to the clients. Another approach that therapists utilised is “referred to as in vivo desensitisation.” It involves confronting anxiety provoking situations. Clients are exposed to increasingly anxiety-provoking situations until he/she becomes desensitise to these triggers (MacLaren & Freeman, 2007). Meanwhile, cognitive interventions pertain to how clients’ create meaning about situations, beliefs, events in their lives, and the world. The therapists help clients to become aware of unhealthy automatic thoughts, which spring to mind and induce negative personal interpretations. A style of questioning referred as “Socratic dialogue” explores client’s meanings and stimulates other ideas or viewpoints. Clients then assess the accuracy of the alternative behaviours, and consequently adopt realistic and new manner of perceiving and acting (Leichsenring, et al., 2006). 3.0 CBT as Applied to an Individual with Anxiety Anxiety is considered as an adaptive response for a reasonably dangerous situation. However, anxiety response becomes problematic when it is excessive, causes discomfort to the individual, interferes with daily functioning, and persists over time (cited in King, et al., 2005). CBT can address the individual’s concern with anxiety through illuminating the client’s cognitive distortions. Thus, a client who manifests excessive anxiety in presenting a speech to the public must be made aware of his/her irrational thoughts. The therapist identifies the client’s beliefs, the actual event, and the consequences of the ABC model. The therapist enables the client to dispute his/her irrational thoughts regarding public speaking through role reversal. This technique involves switching the role of the therapist and the client. The therapist who is now a “client” states the beliefs and thoughts that the client was previously presenting. The client will then be asked to dispute these irrational thoughts and beliefs. A client who is suffering from anxiety in public speaking can also benefit from in vivo desensitisation. This is undertaken through repeatedly exposing the client to anxiety provoking situations (Lofrisco, 2011). The therapist asks the client to speak to a small group and the latter to a big crowd until he/she becomes desensitise to these experiences. In addition, the therapist should supplement these techniques with training in relaxation skills and communication skills (Williams, et al., 2006). The therapist will then ask the client to monitor the frequency of the occurrence of irrational thought and record it in a journal. The therapist may also present reinforcements when a client successfully complied to his/her homework. These reinforcements are something that the client finds pleasurable such as watching television, taking a walk, and the like. Meanwhile, if the client failed to accomplish his/her homework then he/she will be subject to penalty (Gosh, et al., 2006). This means that the client undertakes activities that he/she finds unenjoyable such as cleaning, washing dishes, and the like. The therapy session ends when the client successfully eliminated his/her irrational thoughts and consequently replaced it with adaptive cognition and behaviour. He/she must also be equipped with skill and knowledge of CBT techniques in addressing potential re-occurrence of excessive anxiety. In addition, he/she must be able to function well in the society (Ledley, et al., 2010, p.224). 4.0 Advantages of CBT Findings of previous studies indicated that CBT reduces irritability, physical tension, distress, and negativity. In addition, McGovern and Edelstein (2009, p.87) asserted that it allows clients to create a realistic and positive way of feeling, thinking, and acting. Robert Labgreth (cited in Scott, 2009, p.5), writer of Forbes, further added that it teaches clients to transform their negative thoughts into positive ones. CBT is also found effective in addressing co-occurring disorders. The gains facilitated by CBT are sustained long after the therapy ended as compared to medications and other approaches. Thus, clients equipped with CBT skills continue to improve even after the end of the formal treatment (cited in McGovern & Edelstein, 2009, p.87). Butler et al. (2006 cited in Scott, 2009, p.5) reviewed previous studies and found evidence for the long-term efficacy of CBT for panic disorder, generalised anxiety disorder, OCD, and social phobia. 5.0 Disadvantages of CBT Researchers noted that CBT may not be applicable to severe cases and to those clients who are highly resistant. Commitment and high motivation must be manifested by both the therapist and the client (cited in Alladin, 2007, p.35). In addition, some clients may not grasp the cognitive concepts due to their educational and cultural background. Another issue is the concentration of CBT into the role of cognition. CBT supports the premise that cognition precedes affect or emotion. However, Jaynes (1976 cited in Alladin, 2007, p.35) and Barnet (1979 cited in Alladin, 2007, p.35) argued that emotion is independent to cognition. These researchers proposed the “bicameral brain” in explaining and treating emotional disorders. Bicameral cognition refers to conscious assessment of either cognition or affect (cited in Alladin, 2007, p.35). 6.0 Conclusion Researchers defined CBT as a structured therapy that utilized cognitive strategies aimed to address the client’s psychological issues and conflicts in a short period of time. The techniques in CBT include monitoring irrational thoughts, skill training, Socratic dialogue, and the like. Several researchers stress that CBT is effective in reducing physical tension, irritability, negativity, and distress. In addition, studies indicated that CBT has long term efficacy. However, some researchers argued that CBT is not applicable to those individuals who are highly resistant to therapy and to severe cases. Thus, it is essential for the therapist to weigh the cost and benefits of this approach prior to its application. References Alladin, A., 2007. Handbook of cognitive hypnotherapy for depression: an evidence-based approach. USA: Lippincott Williams and Wilkins. 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Cultural considerations in using cognitive behaviour therapy with Chinese people: a case study of an elderly Chinese woman with Generalized Anxiety Disorder. New Zealand Journal of Psychology, 35 (3), pp.153+. Whitfield, G., & Davidson, A., 2007. Cognitive behavioural therapy explained. USA: Radcliffe. Read More