Cognitive Behavioral Therapy (CBT)
WHAT IS CBT?
Quoted from the Beck’s Institute
Cognitive behavior therapy is one of the few forms of psychotherapy that has been scientifically tested and found to be effective in hundreds of clinical trials for many different disorders. In contrast to other forms of psychotherapy, cognitive therapy is usually more focused on the present, more time-limited, and more problem-solving oriented. In addition, patients learn specific skills that they can use for the rest of their lives. These skills involve identifying distorted thinking, modifying beliefs, relating to others in new ways, and changing behaviors.
THE THEORY BEHIND CBT
Quoted from the Beck’s Institute
Cognitive behavior therapy is based on the cognitive model: the way we perceive situations influences how we feel emotionally. For example, one person reading this website might think, “Wow! This sounds good, it’s just what I’ve always been looking for!” and feels happy. Another person reading the same information might think, “Well, this sounds good but I don’t think I can do it.” This person may feel sad and discouraged. So it is not the situation that dictates how people feel emotionally, but rather, their response to that situation. When people are in distress, their perspective is often inaccurate and their thoughts may be unrealistic. Cognitive behavior therapy helps people identify their distressing thoughts and evaluate how realistic the thoughts are. Then they learn to change their distorted thinking. When they think more realistically, they feel better. The emphasis is also consistently on solving problems and initiating behavioral change.
Quoted from the Beck’s Institute
Cognitive therapists, being both practical and collaborative, can discuss the advantages and disadvantages of medication with you. Many patients are treated without medication at all. Some disorders, however, respond better to a combination of medication and cognitive therapy. If you are on medication, or would like to be on medication, you might want to discuss with your therapist whether you should have a psychiatric consultation with a specialist (a psycho-pharmacologist) to ensure that you are on the right kind and dosage of medication. If you are not on medication and do not want to be on medication, you and your therapist might assess, after four (4) to six (6) weeks, how much you’ve progressed and determine whether you might want a psychiatric consultation at that time to obtain more information about medication.
MOST ESSENTIAL COMPONENTS OF CBT TREATMENT
From Allen Beck (downloaded on August 20, 2015)
It is important to remember that cognitive behavior therapists use a different formulation for each psychiatric disorder. We use this formulation in conceptualizing the individual patient, which is an essential component to developing a sound therapeutic relationship, setting goals, planning treatment, and selecting interventions. Building trust and rapport with patients from the very first contact, demonstrating accurate empathy, sharing the conceptualization with the patient (and making sure it “rings true” for the patient), and collaborating are also essential. Another important part of every session is helping patients respond to inaccurate or unhelpful ideas. The basic question to ask when a patient is reporting a distressing situation, emotion or dysfunctional behavior is, “What is going through your mind right now?” Once we help patients identify their dysfunctional thinking, we help them gain more adaptive and accurate perspectives, especially by helping them examine the validity and usefulness of their thoughts. We also help them design behavioral experiments to test the accuracy of their predictions.
INTEGRATING CBT WITH FAITH
Adapted from Integration of Spirituality and Cognitive-behavioral Therapy for the Treatment of Depression, Jennifer J. Good (downloaded on August 20, 2015)
Spirituality may also play an important part in the identity of an individual. People often make decisions based upon their religion and may even adhere to certain rules of living founded upon their spiritual beliefs. Research has shown that spirituality is associated with values of wholeness, hope, meaning, harmony, and transcending (O’ Reilly, 2004). These values help individuals cope with stressors in the world and strive toward reaching their natural potential. When integrating CBT with spirituality, the therapist utilizes the basic tenets of cognitive-behavioral therapy (CBT) in combination with spiritual values and beliefs to treat the client (Beitel, Genova, Schuman-Olivier, Arnold, Avants, & Margolin, 2007). Research has shown that cognitive-behavioral therapy is an effective form of treatment for individuals who are experiencing depressive symptoms (Beck, 1997). Additional studies suggest that aspects of spirituality assist in decreasing depressive symptoms (Blazer, 2007).
Evidence has shown that religious participation and beliefs may lead to better mental health outcomes, such as enhanced levels of psychological well-being and fewer symptoms of distress and anxiety disorders, such as depression (Ellison, Boardman, Williams, & Jackson, 2001; Grabovac, Clark, & McKenna, 2008). Affirmative religious coping styles are associated with improved positive effects (Powers et al., 2007; Hebert et al., 2007). Furthermore, individuals with strong religious convictions often utilized positive religious coping behaviors to assist with stress reduction and emotion regulation.
The integration of spirituality in cognitive-behavioral therapy may assist in alleviating the depressive symptoms, anxiety, stress and guilt of a religious client. The treatment embraces the physical, emotional, social, and spiritual facets of the client through the application of a holistic approach that addresses each of these domains.
Meditation and Guided Imagery
Adapted from Eugene Gendlin, the founder of Focusing
Focusing shows how to pause the on-going situation and create a space for new possibilities for carrying forward. “Focusing” is to enter into a special kind of awareness, different from our every day awareness. It is open, turned inward, centered on the present and on your body’s inner sensations. When doing Focusing, you silently ask, “How am I now?”
Your body knows more about situations than you are explicitly aware of. By tuning in and sensing through all bodily felt senses, new awareness (that is already there) will emerge. For example, your body picks up more about another person than you consciously know. With a little training, you can get a bodily feel for the ‘more’ that is happening in any situation. From that bodily feel come small steps that lead toward resolution.
Quoted from Murray Bowen (downloaded on August 20, 2015)
Bowen family systems theory is a theory of human behavior that views the family as an emotional unit and uses systems thinking to describe the complex interactions in the unit. It is the nature of a family that its members are intensely connected emotionally. Often people feel distant or disconnected from their families, but this is more feeling than fact. Family members so profoundly affect each other’s thoughts, feelings, and actions that it often seems as if people are living under the same “emotional skin.” People solicit each other’s attention, approval, and support and react to each other’s needs, expectations, and distress. The connectedness and reactivity make the functioning of family members interdependent. A change in one person’s functioning is predictably followed by reciprocal changes in the functioning of others. Families differ somewhat in the degree of interdependence, but it is always present to some degree.
The emotional interdependence presumably evolved to promote the cohesiveness and cooperation families require to protect, shelter and feed their members. Heightened tension, however, can intensify these processes that promote unity and teamwork, and this can lead to problems. When family members get anxious, the anxiety can escalate by spreading infectiously among them. As anxiety goes up, the emotional connectedness of family members becomes more stressful than comforting. Eventually, one or more members feel overwhelmed, isolated, or out of control.
These are the people who accommodate the most to reduce tension in others. It is a reciprocal interaction. For example, a person takes too much responsibility for the distress of others in relationship to their unrealistic expectations of him. The one accommodating the most literally “absorbs” anxiety and thus is the family member most vulnerable to problems such as depression, alcoholism, affairs, or physical illness.
FAMILY OF ORIGIN
Family of origin refers to the family one grew up in, as opposed to the people one currently lives with – is the place that people typically learn to become who they are. From the family of origin a person learns how to communicate, deal with emotions, who we are and get needs met. People also learn many of their values and beliefs from their families. Individuals typically develop a sense of self in the context of their family of origin. Children who are shown love and kept safe may develop a strong sense of self, but if love and safety are frequently unavailable, a child’s sense of self may be weak or damaged. Most families will have some negative aspects as well as positive ones, and any and all family traits may have an effect on a person’s adult life.
Our families shape who we are. If one’s family of origin was dysfunctional; faced issues such as abuse, substance abuse, poor health, or poverty; did not provide children with real-world skills; or did not adequately demonstrate love, that person may experience difficulties in these areas later in life, especially if they start a family of their own. They might also, in many cases, have developed coping strategies or related strengths in the face of a difficult upbringing. Without an awareness of how these issues affected them, however, it is likely that negative patterns may be repeated over time. A therapist can map this out on a genogram.
FAMILY ROLES & RULES
Each family has its own ways of deciding who has the power and authority within the family unit, and which rights, privileges, obligations, and roles are assigned to each family member. These roles are often governed by unspoken but powerful family rules that everyone in the family complies to. When everyone is playing their role, the family maintain some “harmony” and there is no need to change. When someone attempts to change these rules or refuse to play their assumed roles, they are punished for rocking the boat. Some of the family roles are:
- The enabler
- The hero
- The scapegoat
- The joker / clown
- The baby
- The golden child / star
- The saint
- The gatekeeper
- The doer
BOUNDARIES, TRIANGLUATION & DIFFERENTIATION OF THE SELF
A boundary is a limit or space between you and the other person. The purpose of setting a healthy boundary is, of course, to protect and take good care of you.
Healthy boundaries do not always come naturally or easily. We learn to “be” in all kinds of relationships by modeling. In other words, by watching how others handle relationships. In early childhood, it is our parents, grandparents, aunts, uncles, brothers and sisters who shape the way we learn about boundaries. As we grow into adolescents, we rely less on parents and more on our friends to help us define ourselves and our boundaries or limits in relationships. If you grew up in a dysfunctional family, enmeshed or distant relationships, you may develop an enmeshed relationship with your parents. Even though you are an adult, you are still emotionally attached to them like a child. You have not developed your own sense of identity (or differentiation of self). If your parents or significant others cannot deal with the tension in their relationship and triangulate you into their relationship, family roles start to blur.
Learning to set our own healthy boundaries is an exercise in personal freedom. It means getting to know ourselves and increasing our awareness of where we stand and what we stand for. It means letting go of the unhealthy people in our lives so that we can grow into the healthy person that we were meant to be.
Families repeat themselves within and across generations. Members become caught up in predictable, but often unexamined, unconscious, life patterns, which are created in part through their interactions with others. Some of these patterns are communication pattern. Within the family system theory, by tracking and reflecting on the interaction two (2) individuals (transactions) and the patterns emerge in the family over time can indicate the nature of relationships.
Communication pattern is transactional and mutual. It is like a dance, one leads and one follows. When you change your steps, your partner has to follow. By changing your response, your partner has to change the way they communicate and interact with you, and hence, change the relationship as well.