Cognitive Behavioural Therapy - Research Paper Example

CBT (Cognitive Behavioural Therapy) I. Origin and Development of CBT as a Psychological Therapy Dr. Aaron T. Beck spearheaded CBT during the 1960s as a psychiatrist at the University of Pennsylvania (Heslop, 2008). Here, Beck researched and conducted psychoanalysis to design and perform a number of trials to test psychoanalytic conceptions of depression. In the process, Beck expected these experiments to confirm these preliminary conceptions. However, Beck made contrary discoveries. The origins of CBT exist in three generations. The pioneering generation is a partial avant-garde in the field of psychology against dominant therapeutic conceptions of that era, which were Psychoanalytic and Humanistic concepts (Fox, 2006). Also applied as approaches, the concepts of the first generation entailed interventions centred directly on decreasing challenging manifestations of conduct. These interventions employed methodologies centred on properly explained and stringently confirmed methodical values. Early behavioural therapy was not protected from externally occurring incidents. The cognitive revolution in psychology occurred during the 1960s. Numerous behavioural psychoanalysts found behavioural therapy influencing enough to refer to it as Cognitive Behavioural Therapy by the 1970s (Heslop, 2008). This marked the onset of the second generation of the development of CBT. Psychoanalysts and psychiatrists started the experiential research of how cognitions influenced feelings and behaviour. This approach was revolutionary because it challenged conventional behaviour therapy (Fox, 2006). This revolution entailed concentrating more on the function of conscious cognition in psychotherapy since it was rational to patients and gradually, to many psychological health specialists. The third generation is the most recent development in CBT. This generation recognizes the crucial function of behaviour the same way conventional behavioural therapy or CBT from the second generation. Similarly, third generation CBT recognizes the crucial function of cognitions. However, the revolutionary aspect of this generation centres on control and emotive avoidance (Heslop, 2008). Supporters of these two aspects triggered a reinvestigation of whether attempting to control people’s cognitions and emotions contributes to the solution or is the cause of the problem. Such therapists theorized other nonconventional method to tackle the manner in which people address their cognition. This abstract query sparked renewed attempts for cognitive behavioural professionals to develop their ability to work with the material of their patients’ cognitions and the process of cognition itself (Emerald Group Publishing Limited, 2008). Today, psychotherapists have lowered focus on monitoring people’s internal experiences and presented an eastern strategy to people’s psychological lives. As a result, CBT today lightly relates to diverse contemporary therapies with no particular standards. This approach is perceivable as a philosophical element to cognitive behavioural therapy as introduced by the third generation. CBT therapies spawned by the third generation include CBASP (Cognitive Behavioural Analysis System of Psychotherapy), ACT (Acceptance and Commitment Therapy), MBCT (Mindfulness Based Cognitive Therapy), and DBT (Dialectical Behaviour Therapy) (Heslop, 2008). Most of these therapies integrate the function of recognition and awareness into conventional CBT. This means these professionals want cognitions to assist their patients’ ability to be adaptive. However, certain problems arise at this stage of CBT development. First, determining whether people’s responses to their cognitions are sufficient to result in them leading constant, valuable lifestyles. Second, whether the efforts of third generation CBT professionals to control their patients’ cognitions and emotions consuming all their focus and energy is problematic (Fox, 2006). II. Behaviourism Theories And Concepts The primary assumption of behaviourism is that one should view psychology as a science strictly and research it in a scientific way (Moore, 2011). Another presumption is that behaviourism mainly focuses on behaviour that one can observe in contrast to internal processes such as cognitions. Third, behaviour is the outcome of stimulus, which is a reaction encompassing all behaviour irrespective of how complicated it is. Professionals can decreased this reaction to a modest stimulus with response traits. Lastly, one ascertains behaviour through the surrounding such as conditioning (Foxwall, 2007). Behaviourism comprises two concepts and one key theory: classical and operant conditioning, and the theory of Social Learning. Classical conditioning is a concept pioneered by Ivan Pavlov during the late 1800s (Ledoux, 2012). This concept is a form of learning that involves the association of a stimulus that does not regularly cause a specific reaction with a second stimulus that causes the reaction. Association is the main aspect of classical conditioning. Association is the process a person continually and simultaneously experiences two stimuli and he or she comes to be associated. Classical conditioning’s three common occurrences are generalization, discrimination, and extinction. Generalization happens when stimuli identical to CS (cognitive stimuli) generate the CR (cognitive response). Discrimination is the facility to distinguish between identical stimuli, which is the opposite of generalization. Extinction is the procedure of “unlearning” a learned reaction due to removing the primary learning material (Foxwall, 2007). Operant conditioning is a type of learning wherein the effects of behaviour result in changes in the likelihood that the behaviour will take place (Foxwall). Otherwise known as instrumental conditioning, Edward Thorndike developed this concept during the early 1900s (Ledoux, 2012). Operant conditioning relates to Thorndike’s Law of Effect, which asserts that behaviour that causes a fulfilling effect is right to be practiced once more while behaviour that causes an undesirable effect is right to be discouraged. Thorndike called the fulfilling effect “reinforcement” and the undesirable one “punishment” (Foxwall, 2007). Technically, reinforcement is an effect that raises the likelihood that a person repeat preceding behaviour. Punishment is an effect that lowers the likelihood that a person repeats preceding behaviour. From this deduction, Thorndike realized two forms of reinforcement and punishment: negative and positive reinforcement, and negative and positive punishment. The Social Learning Theory covers behaviourism and is not truly a theory under behaviourism. Both psychological domains concur that experience is vital source of learning. The theory of Social Learning includes the concepts of reinforcement and punishment while accounting for behaviour (Foxwall). Additionally, this theory and behaviourism concur that response is crucial for encouraging learning. Similar to other psychotherapy fields, behaviourism has faced its share of criticism. The most critical argument against behaviourism is that it is a contradiction of Natural Selection by Charles Darwin (Ledoux, 2012). More specifically, operant conditioning contends that raising self-will leads to increased freedom while Darwin contended that human beings are continually improving their lives to acquire self-will. As a result, behaviourism is a direct contradiction of Darwin’s concepts. Two key theories that are common in cognitive psychology today are Vygotsky’s Theory and Piaget’s Theory. Lev Vygotsky emphasized the essential function of social contact in the advancement of thinking patterns and behaviours (Baddeley, 2013). Vygotsky thought that the community has a core role in the course of creating meaning. As a result, Vygotsky’s theory entails an approach of sociocultural nature to cognitive advancement. Vygotsky came up with this theory nearly the same time as Jean Piaget. Piaget made a methodical research of cognitive development for the first time in history in 1936 (Ledoux, 2012). Piaget’s influences were under a hypothesis of cognitive development in children, comprehensive observational research works of thinking amongst children, and a set of simple but innovative experiments to unveil various cognitive aptitudes. The primary aspects of Piaget’s Cognitive Theory are schemas, adaptation procedures that facilitate the transition of one phase to the next, and four phases of development in children (Baddeley 2013). The phases are sensor and motor, preoperational, concrete, and official operational. III. Behavioural Therapy, Cognitive Therapy, and CBT Behaviour, or behavioural, therapy is a treatment that helps to do away with possibly self-harming behaviours (Rachman, 2015). Today, behavioural therapy is not very different from third generation CBT in terms of factors considered and types of emphases. Psychotherapy and psychologists professionals use behaviour therapy to treat anxiety and mood conditions such as depression, OCD (Obsessive-Compulsive Disorder), PTSD (Post-Traumatic Stress Disorder), schizophrenia, and bipolar disorder (Rachman). Behavioural therapy helps sufferers of these illnesses to deal with emotional pain, distress, and social phobias. Methods applied by behavioural therapists are roleplaying, dialogues about coping solutions, respiration and relaxation techniques, positive reinforcement, attention activities, and composing journals. Cognitive therapy forked from first generation behavioural therapy starting from the 1940s (Fox, 2006). Cognitive therapy marked the original inclusion of empirical methods in behavioural therapy. Among the first cognitive therapy theories was Albert Ellis’ REBT (Rational Emotive Behaviour Therapy) in 1957 and 1962 (Fox). REBT suggested that every individual has a distinct series of presumptions regarding themselves and their surrounding that acts as a guide through life. This guide determines each individual’s responses to the different situations they face daily. In 1967, Beck introduced his cognitive theory that had an approach similar to that of Ellis’ REBT (Fox). Beck stressed the recognition and alteration of destructive cognitions and maladaptive principles. Beck thought negative cognitions cause psychological illnesses and was especially interested in discovering the reason people suffer depression. One overall CBT assumption is that abnormality originates from negative thinking about other people and the surrounding. Second, such thinking elicits distortions in the manner that people view their surroundings. Ellis proposed that this change in view occurred through illogical cognition while Beck said it is the thinking triad. Third, people interact with their surrounding through their psychological image of it (Emerald Group Publishing Limited, 2008). One strength of CBT is its profound appeal as a model that concerns with human thinking. A second strength is that professionals can always subject CBT to experimentation. A limit of CBT is that professionals are yet to determine the defined function of cognitive procedures empirically. Another limit is CBT’s narrowness in range as a model for psychological therapy (Heslop, 2008). IV. CBT for Depression Beck’s findings compelled him to search for other means of theorizing the cause and nature of depression. Beck discovered that depressed people underwent flows of negative cognitions that appeared to surface spontaneously. Beck called these cognitions “automatic thoughts” that applied to these people, their surroundings, and future (Fox, 2006). As a result, Beck pursued a clinical strategy to help people with depression that started with identifying and assessing their automatic thoughts. Consequently, Beck established that patients thought more rationally than before the assessment. Thinking rationally allowed Beck’s patients to act more functionally. Beck’s therapy led to long-lasting change when patients altered their fundamental principles regarding themselves, their surroundings, and other individuals (Rachman, 2015). A. Evidence for CBT as a Psychological Therapy and its Effectiveness on Depression Beck’s findings serve as the earliest form of evidence of the effectiveness of CBT on treating depression. Numerous more studies have been conducted on the same account that include similar variables and approaches while many others added or excluded the same variables and approaches. Collectively, these studies establish that CBT is mostly effective for modest or mild depression (Rachman). Some individuals with depression only require CBT to be cured while others need a combination of other forms of psychotherapy and medication too. CBT helps depressed people reform harmful cognitions patterns by assisting them in interpreting their surrounding and interactions with other people in a helpful and logical manner. CBT also helps a depressed person acknowledge issues that possibly add to his or her depression and assist the person to alter behaviours that might be aggravating the depression (Heslop, 2008). A study by Graeme Whitfield and Chris Williams outlined problems present in the provision of psychotherapeutic interventions, not simply within professional services, but daily medical practice as well (Whitfield and Williams, 2003). Whitfield and Williams explore a number of primary papers on medical effectiveness and focus on depression. The goal of Whitfield and Williams’ study is to identify available sources of outcome information and explore fields like service provision and training needs. The study argues that literature on CBT has ignored these fields for long and a methodical review is long overdue. The study notes that the past of psychological therapies as characterized by well-planned outcome research works (Whitfield and Williams). These research works are accompanied by the unwillingness of numerous psychologists to accept concepts like diagnosis and conflicts about the nature or significance of outcome events and occasionally, the advantages of proof-based strategies. Another study by Christian Otte attempted to determine the present state of evidence of the effectiveness of CBT on anxiety disorders (Otte, 2011). Otte’s study notes that former, diverse literature explored the efficiency and value of CBT for grownups with anxiety conditions. The past few years has witnessed the publication of meta-reviews carried out quantitatively to scrutinize the evidence of CBT as an effective therapy for anxiety disorders (Otte). These recent studies employ various inclusion standards like control measures or form of research setting. After analysing and discussing the present state of empirical proof for CBT as a treatment for depression, Otte establishes the therapy’s value in randomized, measured tests. Otte established that CBT’s efficiency in naturalistic environments in the treatment of depression in adult participants (Otte). However, the study encountered methodological problems that caused the size of effect of CBT hard to approximate. A more recent study by Jens Thimm and Liss Antonsen tested the efficacy of CBT on depression during “routine practice” (Thimm and Antonsen, 2014). The researchers conducted background review of literature written on CBT and noticed a shortage of studies conducted on CBT for routine care processes. As a result, Thimm and Antonsen used hospital data for 143 patients getting CBT treatment routinely and incorporated 88 of them in the study’s outcome reviews. The study realized that these patients’ dropout rate was 17.5% with a reduction of 10 on a BDI-II (Beck Depression Inventory) scale (Thimm and Antonsen). The study associated this decrease a pre-treatment and post-therapy dropout and steadying for three months. From the main results, Thimm and Antonsen deduced that group CBT for depressed patients is deliverable in routine practice environs with positive outcomes. At the same time, the study noted that many patients dropped out or did not heal from group CBT (Thimm and Antonsen). A meta-analysis by Conal Twomey, Gary O’Reilly, and Michael Byrne intended to measure the effectiveness of CBT for depression during primary care (Twomey, O’Reilly, and Byrne, 2015). The study chose CBT because of its increasing popularity, application in primary care, and diverse implementation formats. Exploring the efficacy of CBT for depression in primary care served as a turn in the many studies conducted on CBT in dedicated services. Twomey, O’Reilly, and Byrne used CBT-oriented RCTs as the key method for their metal-analysis (Twomey et al.). Findings showed multi-modal CBT was more efficient than therapy without primary care and ordinary primary care therapy for depression symptoms. In addition, the study established that multi-modal CBT and primary care with ordinary therapy is more efficient than primary care with ordinary therapy for depression symptoms. These findings led the researchers to deduce that raising the delivery of CBT for primary care is justifiable if CBT’s economic feasibility is taken into account (Twomey et al.). The evidence base for CBT psychological therapy shows that it is an effective and valuable form of treatment for depression. CBT’s history makes up a slow development process full of empirical findings pointing to its effectiveness in diverse care settings. CBT owes its credibility to theories established by its pioneers and developers during the early and mid-1900s. Beck, Piaget, Vygotsky, and Pavlov spearheaded CBT in the form of behavioural therapy and cognitive therapy, which later on forked cognitive psychology and behaviourism. Irrespective of these developments and revolutions, there is a need to provide more findings to serve as groundwork for future evidence-based psychological interventions for treating anxiety disorders such as depression. References Baddeley, A. (2013). On applying cognitive psychology. British Journal Of Psychology (London, England: 1953), 104(4), 443-456. doi:10.1111/bjop.12049 Emerald Group Publishing Limited. (2008). Cognitive Behavioural Therapy Explained. International Journal of Health Care Quality Assurance, 21(4). Fox, D. (2006). Cognitive behavioural therapy. Update, 72(1), 26-28. Foxwall, G. R. (2007). INTENTIONAL BEHAVIORISM. Behavior & Philosophy, 351-55. Heslop, K. (2008). Cognitive behavioural therapy. Practice Nurse, 35(4), 42-47. Retrieved from http://search.proquest.com/docview/230433698?accountid=458 Ledoux, S. F. (2012). Behaviorism at 100. American Scientist, 100(1), 60-65. Retrieved from http://search.proquest.com/docview/1009904053?accountid=458 Moore, J. (2011). BEHAVIORISM. The Psychological Record, 61(3), 449-463. Retrieved from http://search.proquest.com/docview/887915346?accountid=458 Otte, C. (2011). Cognitive behavioral therapy in anxiety disorders: current state of the evidence. Dialogues Clinical Neuroscience, 13(4): 413–421. Rachman, S. (2015). The evolution of behaviour therapy and cognitive behaviour therapy. Behaviour Research and Therapy, 64(1): 1–8. Thimm, J. and Antonsen, L. (2014). Effectiveness of cognitive behavioral group therapy for depression in routine practice. BioMed Central Psychiatry, 14(1): 292. Twomey, C., O’Reilly, G., and Byrne, M. (2015). Effectiveness of cognitive behavioural therapy for anxiety and depression in primary care: a meta-analysis. Family Practice, 32 (1): 3- 15. Whitfield, G. and Williams, C. (2003). The evidence base for cognitive–behavioural therapy in depression: delivery in busy clinical settings. Advances in Psychiatric Treatment, 9(1): 21–30. Appendix Figure 2: Beck’s first behavioural therapy model Figure 1: Beck’s revised model, cognitive therapy Figure 3: Pavlov’s classical conditioning concept model Figure 4: Operant Conditioning Figure 4: A simple representation of the Social Learning Theory Figure 5: Piaget’s theory, stages of cognitive development in children Figure 6: Vygotsky’s Theory model Figure 7: A detailed model of Ellis’ REBT Read More