Cognitive and Behavioural therapy is an approach to mental health issues which uses cognitive and behavioural models to relieve symptoms.
It is usually a time-limited and problem focused approach, with a view to a specific outcome.
The average client will have 10 to 15 sessions with a therapist, each lasting around 45 to 60 minutes each. As with most therapies of this type, this is just a guide figure, and more complex disorders, or compounded disorders may require longer.
At the heart of the cognitive model is the assertion, often highlighted in NLP, that the map is not the territory, and the over use of generalities to understand and describe situations.
What this means is that we all have underlying beliefs and assumptions about the world we live in. We have to have them in order to function efficiently in this world. These are developed as we grow up and learn to manage the world we’re in, based on the culture we’re brought up in.
What cognitive therapy points out, is that people who suffer from abnormal levels of anxiety and depression have distorted and inappropriate assumptions and core beliefs about themselves and the world they find themselves in.
So, whilst someone’s compulsion to avoid red buses may seem irrational on the surface, it is perfectly logical from their viewpoint of the world, based on their core beliefs.
With anxiety problems it is the coming together of excessive danger related thoughts, with inappropriate assumptions and beliefs which creates the problem. Simply stated, it is an over estimation of the perceived danger, and an under estimation of their ability to cope with the situation.
In the case of depression, it is the combination of thoughts of loss and self-devaluation, with distorted assumptions and beliefs which often gives rise to the phenomena.
When an anxiety or depression symptom is triggered, what then follows is a stream of negative automatic thoughts, which often lead to adverse behavioural reactions, which lead to more negative associated thoughts etc. This results in a self-reinforcing destructive loop, which the sufferer finds almost impossible to break, without outside help from a therapy such as CBT.
The negative automatic thoughts are often compounded by self-doubts, negative evaluations and negative predictions about the situation.
The resulting behaviour, is from the unconscious point of view, aimed at self preservation. Unfortunately, the faulty core beliefs and assumptions means that the behaviour is actually self destructive or severely limited.
In a CBT session, the therapist will first assess the nature of the problem, and seek to uncover the core beliefs, assumptions and negative thought patterns.
Based on this assessment, a number of techniques and exercises can be employed to allow the client to re-assess their core beliefs etc., and hence have the opportunity to break the negative cycles, and change their behaviour.
The success rate with CBT is relatively high, when treating anxiety and depression problems. As with almost all therapy of this nature, it is not 100% successful, but since we’re dealing with humans here, that may be an unrealistic aim. Unless of course you’re an obsessive perfectionist, when anything less than 100% success is viewed as a failure.
Cognitive Therapy of Anxiety Disorders, by Adrian Wells. (Wiley, 2007)
© David R. Durham