Cognitive Behavioural Therapy (C.B.T)

 

Cognitive Behavioural Therapy (C.B.T)

 

Cognitive Behavioural Therapy, or CBT as it is commonly known, is a system of therapy developed by Aaron Beck of the University of Pennsylvania. It is now widely in use across the western world for treating a number of mental illnesses.

The system is based on Beck’s Cognitive Model of Emotion:

An event –(leads to)– an interpretation of an event –(leads to)– an emotional response

CBT has been described as “a form of psychodynamic therapy – based on emotional and mental responses to external events, in the present and in childhood – that is focused on objectives…… Beck proposes that one’s thoughts about oneself are frequently destructive, and that by forcing the mind to think in certain ways one can actually change one’s reality – it’s a programme that one of his collaborators called “learned optimism.” He believes that depression is the consequence of false logic, and that by correcting negative reasoning one may achieve better mental health. CBT teaches objectivity.”
(The Noonday Demon – An anatomy of depression by Andrew Soloman)

Soloman goes on to say that; “feelings are not direct responses to the world: what happens in the world affects our cognition, and cognition in turn affects feelings. If the patient can alter the cognition, then he can alter the concomitant mood states.”

Aaron Beck recently came to speak at the opening of the Anxiety and Trauma Unit. His presentation explained in more detail how CBT works using Borderline Personality Disorder as an illustration.

The cognitive aspects of borderline personality disorder are shown as:

  • numerous dysfunctional beliefs that are continuously activated
  • any relevant stimulus can make the beliefs operational
  • hyperactive belief determines affect and behaviour
  • lack of constructive/adaptive beliefs

So for example, the sequence of activation that follows Beck’s Cognitive Model of Emotion for someone with Borderline Personality Disorder would work as follows, with each stage leading on to the next:

  1. An event (nobody came to my birthday party) – leads to
  2. a belief (if I am ignored then I am nothing)
  3. an interpretation (I am all alone)
  4. a craving or impulse (I want to die)
  5. “must/should” solution (I have to kill myself)
  6. permission giving (it’s okay to kill myself)
  7. dysfunctional behaviour (serious suicide attempt)

These patients have no resistance to carrying out impulses. Part of the CBT for such a patient would include the therapist asking them in detail about friends who could not attend the party. The patient and the therapist discuss possible explanations (eg; their friend was out of the country on the date of the birthday party). The patient should catch on to these explanations and therefore not jump from stage
(1), the event, to stage (2) and (3) believing that they are being ignored and therefore interpreting this as being all alone, which blocks them before they get on to the further stages of the sequence.

The aim of CBT is for the patient to learn positive control beliefs, for example:

  • If I feel something strongly it is best to think before I act
  • Blaming others makes them defensive
  • Criticising others is likely to hurt them