Cognitive Behavioral Theory

Theoretical Framework and Application 2: Cognitive Behavioral Theory

About Cognitive Behavioral Theory

Cognitive Behavioral Therapy or CBT is a form of ‘talk’ where subjects or patients can talk about themselves, their realities, their world and other people. In a session with their therapist, patients are able to talk about how things affect them and how what they do or have gone through affects/affected their thoughts, emotions, perspectives and the manner by which they behave. At the heart of the theory is this – talking allows for a reflection, realization, release and a way to make sense of one’s reality so as to change the way one things (the cognitive element) and does (the behavior element). As a ‘Talk’ therapy it is focused on the present, the here and now. While the causes matter, the main idea of CBT is to find ways to help the patient/subject cope, to improve their state of mind for the present. CBT has its roots in the work of Albert Ellis and Aaron Beck who both theorized that learning to identify and replace distorted thoughts and beliefs can change the associated behavior recognized as problematic and even debilitating. Another influence is the work of Ivan Pavlov and BF Skinner on conditioning who theorized that behavior is learned. CBT is the inclusion of these theories into one so that problematic thought and behavior is broken down to smaller parts and are dealt with and resolved to make manageable and resolved.

Philosophies

A client-centered approach, it is also a form of talk therapy but one that is much more intense in terms of intervention. Specific problems are being talked about for the purpose of cognitive and behavioral change. The thing about this approach is it has specific targets – dysfunctional emotions, psychological disorders. Thus, the therapist manages the session so that the client confronts them through talk, in a safe, non-judgmental and comfortable environment. Each talk has a goal – it is structured talk that is focused on the present. Among the disorders it treats are eating, substance abuse, mood, anxiety, personality and psychotic disorders. It can be used for individual and group settings and, where possible, self-help via the application of certain theoretical principles but requires the assistance or involvement of another to bounce off thoughts, ideas, critique situations and establish realizations.

Reflection

This learner personally believes that simply to talk about something is healing. When children feel bad, their parents would sit them down, talk to them, find out how they feel and work with them so that they understand or at least have some kind of handle about the situation they are in, why they are upset, why they feel in a particular way and where needed, to correct their ideas or impressions so that they cope or feel better about things. This learner finds talking to her parents, her friends, her colleagues and now, her partner is essential in establishing connections. While there is a huge difference about the level of intimacy or the connections and the topic under discussion or ideas, issues and transactions negotiated in the talk, a good conversation allows for discursive interaction – a cooperative action of sharing ideas, accepting differences of opinions and weighing what is there from an objective viewpoint so that conflict is averted, ideas are shared and where necessary, problems resolved and new ways of living, working, thinking are created. This learner thinks talk allows one to make meaning of the world – because talking allows people to form ideas and give shape to abstract concepts and opinions. Thus, talk can be therapeutic.

Evidence

One of the world’s most prestigious psychiatry organizations, Britain’s Royal College of Psychiatrists (or RCP, 2014) attest that, “BT can help you to change how you think (‘Cognitive’) and what you do (‘Behavior’). These changes can help you to feel better. Unlike some of the other talking treatments, it focuses on the ‘here and now’ problems and difficulties. Instead of focusing on the causes of your distress or symptoms in the past, it looks for ways to improve your state of mind now.” Because of the present focus, the impact of CBT is often felt immediately and can be applied to a host of problems including anxiety, depression, panic, phobias (including agoraphobia and social phobia), stress, bulimia, obsessive compulsive disorder, post-traumatic stress disorder, bipolar disorder, psychosis, low self-esteem as well as anger issues. The Royal College of Psychiatrists exemplified a simple situation that showcases how corrective thinking is most applicable even in everyday situations as follows:

“You’ve had a bad day, feel fed up, and so go out shopping. As you walk down the road, someone you know walks by and, apparently, ignores you. This starts a cascade of thoughts…” They then go on to describe these thoughts labeled helpful and unhelpful as follows (RCP, 2014):

• Thoughts: He/she ignored me – they don’t like me (unhelpful), He/she looks a bit wrapped up in themselves – I wonder if there’s something wrong? (helpful)

• Emotional Feelings: Low, sad and rejected (unhelpful), Concerned for the other person, positive (helpful)

• Physical: Stomach cramps, low energy, feel sick (unhelpful), None – feel comfortable (helpful)

• Action: Go home and avoid them (unhelpful), Get in touch to make sure they’re OK (helpful)

What is illustrated are 2 thinking results to one scenario where one can impact the self negatively than the other. Since we literally ‘live’ in our heads, it is essentially to trash out our thought process so that we come out of a situation with a more helpful idea and insight of it so that we break the cycle of bad thoughts that bring us down, keep us from doing something good and change the way we feel about ourselves.

As a practice, it has wide applicability. First, it is applicable to a number of psychological issues and psychopathy because of the nature of the treatment – ‘talking’ and communicating is a human action normally, easily and essentially practiced in a social setting. Additionally, it is not ‘culture-specific’. With talking and communicating part of human practice and expected in social dynamics, culture does not limit its deployability so that dependent upon the cultural knowledge, familiarity and expertise of a practitioner, CBT can be deployed where the practitioner can communicate, talk, reach out and listen to a person or a group. Additionally, it also does not limit itself to age or gender. It is applicable to children, teens, adults and the elderly just as it is applicable across genders.

Application

Margarita appears on the surface to be an accomplished woman. At 26, she is a married woman of Puerto Rican background with an equally successful and supportive husband who is African-American. They have 2 children and both are highly educated. Margarita has an MBA and her husband is an important man in their community. She has previously seen a counselor to help her with her anger outbursts, defeatist, negative and even suicidal thoughts as well as panic attacks and social anxiety. Her goal is to treat them – her anger outbursts, negative thinking and symptoms of anxiety disorder. Thus, her immediate goals are to understand the source of these – the why, when and how – the stimuli that lead to said states of feeling and thinking as well as the thinking patterns that lead to the negative, anxious as well as panicky thoughts. While the flush of emotions might be immediate when the stimulus arises, reflecting on the patterns of through, the source of the panic and the negativity will more than likely help Margarita in controlling and in time manage, mitigate and turn around her problematic thinking.

Since she has enlisted on 6 sessions as a start, with the first 3 sessions allowing for the construction of good rapport; the response and open communication from Margarita signifies the applicability of CBT in her case. She has for instance reflected on the reality that her husband’s kindness and sense of responsibility as well as ability to manage their household and even her outbursts to be likely one of the factors that enables or leads her to anger outbursts. Because of this, the intervention program that this learner would further recommend would be for Margarita to sign on to a more extensive treatment, at the minimum of an additional 6 weeks to 6 months to build on the exploratory CBT treatment and the advances she had had with it so far. In this manner, therapy can focus on specific issues, tie this to real situations she experiences at home, in law school or in social situations to help her break negative thinking and the cycle that such thinking patterns follow. A minimum of 2 sessions per week, from between 30 to 60 minutes is recommended to help her work out unrealistic and unhelpful thoughts and actions and how each, even when insignificant on their own can become a chain of negative thoughts that lead to cycles of anger, negativity and panic.

With Margarita having been raised in the States, this learner believes that her Puerto Rican background does not prove a barrier to treatment. The barrier perhaps will lie in the values she will hold that is important to her cultural background. This can also be one of the issues behind her relationship with her husband who might hold different views than herself which could be contributive to her feelings of anger and social anxiety. The pros of CBT in this case are the applicability of ‘talk’ in both Hispanic and mainstream American culture. Margarita is responding well and in the many symptoms she exhibits, talk appears to provide her the outlet to reflect and make sense of her behavior which is essential for her to function and cope in the here and now. The cons might lie in the many issues she has as talking about them, relating them will require a bit of a while to work out so unless she is prepared to do CBT for some time, the impact might not be as effective as hoped.

Resources:
Editorial Staff (2014). Cognitive Behavioural Therapy. Royal College of Psychiatrists.

URL: http://www.rcpsych.ac.uk/expertadvice/treatments/cbt.aspx
Ellis, A. (2001), Overcoming Destructive Beliefs, Feelings, and Behaviors: New

Directions for Rational Emotive Behavior Therapy, Prometheus Books.

Sauter, F., Heyne, D. & Westenberg, M. (2009).”Cognitive Behavior Therapy for

Anxious Adolescents: Developmental Influences on Treatment Design and Delivery,” in Clinical Child and Family Psychology Review, Vol. 12, Issue 4, pp. 310-355. URL: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2775115/

Stallard, P. (2008). Anxiety: Cognitive Behaviour Therapy with Children and Young People. Routledge Mental Health: Taylor & Francis Group.