Cognitive Therapies | Psychology for UPSC Optional (Notes) PDF Download

Introduction

Cognitive behavioral therapy (CBT) is a type of psychotherapy that is effective in addressing various mental health issues. It revolves around the concept that our thoughts (cognition), emotions (feelings), and behaviors (actions) are interconnected and influence one another. More precisely, our thoughts shape our emotions and behaviors.

When our thoughts become negative and distorted, they can lead to distress and difficulties. Psychological distress alters our perception of situations, causing a skewed interpretation that negatively impacts our actions.

The goal of CBT is to assist individuals in recognizing their negative interpretations and behavioral patterns that reinforce distorted thinking. Cognitive therapy supports individuals in developing alternative ways of thinking and behaving, leading to a reduction in psychological distress.

CBT encompasses various therapeutic approaches that share common elements. Among the early forms of CBT are Rational Emotive Behavior Therapy (REBT), pioneered by Albert Ellis in the 1950s, and Cognitive Therapy, developed by Aaron T. Beck in the 1960s.

General Assumptions

• The cognitive approach in therapy focuses on the role of faulty thinking in the development of mental illness. These faulty cognitions can be attributed to cognitive deficiencies, such as lack of planning, or cognitive distortions, which involve processing information inaccurately.
• These distorted cognitions lead to a skewed perception of the world. Ellis emphasized irrational thinking as the cause, while Beck proposed the cognitive triad concept. Our mental representations of the world influence how we interact with it. If these representations are inaccurate or our reasoning is flawed, it can disrupt our emotions and behaviors.
• Cognitive therapists guide clients in identifying and evaluating distorted cognitions. Clients learn to differentiate between their thoughts and reality, understand the impact of cognition on their emotions, and develop skills to recognize, observe, and monitor their thoughts.
• The behavioral aspect of therapy involves assigning homework tasks to clients, such as keeping a thought diary. The therapist provides tasks that help clients challenge their irrational beliefs.
• The goal is for clients to identify their unhelpful beliefs and prove them wrong, leading to a change in their beliefs. For instance, an individual experiencing social anxiety might be assigned the homework of meeting a friend at a pub for a drink to challenge their anxious beliefs.

REBT

Rational Emotive Behavior Therapy (REBT) is a type of cognitive therapy first used by Albert Ellis, focusing on resolving emotional and behavioral problems.

The goal of this therapy is to change irrational beliefs to more rational ones.

• REBT encourages people to identify their general and irrational beliefs (e.g., ‘I must be perfect’) and subsequently persuades them to challenge these false beliefs through reality testing.
• Albert Ellis (1957, 1962) suggests that each individual possesses a unique set of assumptions that shape their perceptions of themselves and the world. These assumptions serve as guides in navigating life and play a crucial role in determining how they respond to various situations.
• Regrettably, some people harbor predominantly irrational assumptions, leading them to behave and react in inappropriate ways that hinder their prospects of happiness and success. Albert Ellis refers to these as basic irrational assumptions.
• For instance, some individuals irrationally believe that they are failures unless they are universally loved by everyone they know. As a result, they constantly seek approval and experience repeated feelings of rejection. This assumption influences their interactions to such an extent that even a wonderful party can leave them dissatisfied if they don't receive sufficient compliments.
• Ellis outlines several other common irrational assumptions, including the belief that one must excel in everything, that it is catastrophic when things don't go as desired, that happiness is beyond personal control, that dependence on someone stronger is necessary, that past experiences greatly influence present life, and that there must be a perfect solution to all human problems, with failure to find it seen as a disaster.
• Ellis emphasizes that people often cling tightly to these illogical thought patterns, requiring forceful techniques to help them vigorously and assertively change their irrational thinking.
• According to Ellis, these are other common irrational assumptions :
  • The idea that one should be thoroughly competent at everything.
  • The idea that it is catastrophic when things are not the way you want them to be.
  • The idea that people have no control over their happiness.
  • The idea that you need someone stronger than yourself to depend on.
  • The idea that your history greatly influences your present life.
  • The idea that there is a perfect solution to human problems, and it’s a disaster if you don’t find it.

According to Ellis, individuals often tenaciously cling to these illogical patterns of thinking, making it necessary to employ highly emotive techniques to assist them in actively and resolutely transforming these irrational thoughts.

The ABC Model

The ABC Technique of Irrational Beliefs, coined by Albert Ellis (1957), is a valuable tool in cognitive therapy.
The initial three steps involve examining the process through which irrational beliefs are formed and can be documented in a three-column table.

• Activating Event or Objective Situation: The first column is used to document the objective situation or event that triggers a strong emotional response or leads to negative and dysfunctional thinking.
• Beliefs: In the second column, the client records the negative thoughts that arise in response to the activating event.
• Consequence: The third column is dedicated to documenting the negative emotions and dysfunctional behaviors that result from the negative thoughts. The second column serves as a bridge connecting the situation with the distressing feelings. The third column, labeled as "C," is further explained by describing the emotions or negative thoughts that the client believes are caused by the activating event. These could include anger, sadness, anxiety, and so on.

Ellis believes that it is not the activating event (A) that causes negative emotional and behavioral consequences (C) but rather that a person interprets these events unrealistically and therefore has an irrational belief system (B) that helps cause the consequences (C).

REBT Example

• Gina experiences distress because she received a low grade on her math test. The Activating event (A) is her test failure. She holds the Belief (B) that her self-worth is tied to achieving good grades. As a Consequence (C), Gina feels depressed.
• Once irrational beliefs have been identified, the therapist will often assist the client in challenging these negative thoughts by examining evidence from the client's own experiences and reframing them. Reframing involves interpreting the situation in a more realistic and rational manner, leading to the development of healthier coping strategies.
• In Gina's case, the therapist would help her recognize that there is no evidence supporting the belief that she must have good grades to be worthwhile or that receiving bad grades is an awful outcome. While it is understandable that she desires good grades and they can be beneficial, her worth as a person is not determined solely by her academic performance.
• By realizing that receiving bad grades is disappointing rather than awful and that it reflects her current proficiency in math or studying rather than her overall worth, Gina may experience feelings of sadness or frustration instead of depression. These healthier negative emotions can serve as motivators for her to study harder and improve her academic performance in the future.

Critical Evaluation

• Numerous studies have been conducted to support the effectiveness of rational emotive behavior therapy (REBT). Initially, many of these studies focused on individuals with experimentally induced anxieties or non-clinical issues such as a mild fear of snakes (Kendall & Kriss, 1983).
• However, more recent research has expanded to include clinical populations, and these studies have consistently shown the beneficial effects of rational emotive behavior therapy. For instance, studies conducted on actual clinical subjects have demonstrated the effectiveness of REBT in helping individuals with various psychological difficulties (Lyons & Woods, 1991).

Cognitive Therapy

Aaron Beck's therapy approach, introduced in 1967, shares similarities with Ellis's but has gained significant recognition in the treatment of depression. Cognitive therapists assist clients in identifying negative thoughts and errors in their reasoning that contribute to their experience of depression.

The therapist also guides clients to question and challenge their dysfunctional thoughts, try out new interpretations, and ultimately apply alternative ways of thinking in their daily lives.

According to Aaron Beck, an individual's response to distressing thoughts can contribute to psychological difficulties. In our daily encounters, both comforting and distressing thoughts arise in our minds, referred to as automatic thoughts by Beck.

When a person's automatic thoughts predominantly take a negative turn, it is expected that they may experience depression. For instance, thoughts such as "I'll never finish this essay," "My girlfriend is attracted to my best friend," "I'm gaining weight," "I'm broke," or "My parents despise me" can contribute to such feelings.
Interestingly, these negative thoughts often persist despite contradictory evidence.
Beck (1967) identified three mechanisms that he believed played a role in depression:

• The cognitive triad, which consists of automatic negative thinking patterns.
• Negative self-schemas, which shape one's view of oneself.
• Errors in logic or faulty information processing.

The Cognitive Triad

• The cognitive triad refers to a pattern of negative thinking commonly observed in individuals with depression. This triad consists of negative thoughts related to oneself, the world, and the future, often characterized by feelings of helplessness and criticism.
• In individuals with depression, these negative thoughts tend to arise automatically and spontaneously.
• As these three components of the cognitive triad interact, they disrupt normal cognitive functioning, resulting in difficulties with perception, memory, and problem-solving. The person becomes preoccupied with negative thoughts, which can further contribute to the depressive experience.
  

Negative Self-Schemas

Beck believed that depression-prone individuals develop a negative self-schema.

• They hold a collection of negative and pessimistic beliefs and assumptions about themselves.
• According to Beck, negative schemas, or patterns of thought, can develop during childhood as a result of traumatic experiences. Various experiences, such as the death of a parent or sibling, parental rejection or criticism, overprotection, neglect, abuse, or being bullied or excluded from a peer group, can contribute to the formation of these negative schemas.
• Individuals with negative self-schemas are more susceptible to making errors in their logical thinking. They tend to engage in selective focus, paying attention only to specific aspects of a situation while disregarding other equally relevant information.

Cognitive Distortions

Beck (1967) identifies various patterns of illogical thinking, known as distortions, that can be self-defeating and lead to significant anxiety or depression in individuals.

• Arbitrary interference: Drawing conclusions based on insufficient or irrelevant evidence. For example, believing you are worthless because an outdoor concert you planned to attend got canceled due to rain.
• Selective abstraction: Focusing on one aspect of a situation while ignoring others. For instance, feeling responsible for your team's loss in a football match even though you are just one player on the field.
• Magnification: Exaggerating the importance of undesirable events. For instance, scraping a bit of paint on your car and considering yourself a completely terrible driver.
• Minimization: Underplaying the significance of an event. For example, receiving praise from your teachers for excellent work throughout the term, but considering it trivial.
• Overgeneralization: Drawing broad negative conclusions based on a single insignificant event. For instance, receiving a low grade on an exam and assuming you are unintelligent, despite consistently achieving high grades.
• Personalization: Attributing negative feelings experienced by others to oneself. For example, assuming your teacher is angry with you because they appear upset when entering the room.

Critical Evaluation

• In a review conducted by Butler and Beck (2000), they examined 14 meta-analyses that explored the effectiveness of Beck's cognitive therapy. Their findings indicated that approximately 80% of adults derived benefits from this therapy. Moreover, the study revealed that cognitive therapy was more effective than drug therapy and exhibited a lower relapse rate. These findings support the idea that depression has a cognitive foundation.
• These results suggest that understanding the cognitive explanation of depression can enhance individuals' quality of life.

REBT Vs. Cognitive Therapy

• Albert Ellis perceives the role of the therapist as that of a teacher and does not consider a warm personal relationship with the client to be crucial. On the other hand, Beck emphasizes the importance of establishing a high-quality therapeutic relationship.
• REBT tends to be characterized by a highly directive, persuasive, and confrontational approach. In contrast, Beck places greater emphasis on guiding the client towards discovering their own misconceptions.
• In REBT, various methods are employed based on the client's personality, whereas Beck's cognitive therapy tailors the approach to the specific disorder being addressed.

Strengths Of CBT

• The cognitive model is highly appealing as it directs its focus towards human thought processes. Given that our cognitive abilities have played a significant role in our achievements, it is plausible that they may also contribute to our difficulties.
• Cognitive theories offer the advantage of being testable. Through experimental manipulation, research has shown that when individuals adopt negative assumptions or thoughts, they experience increased levels of anxiety and depression (Rimm & Litvak, 1969).
• Extensive evidence suggests that individuals with various psychological disorders, particularly depression, anxiety, and sexual disorders, tend to exhibit maladaptive assumptions and thoughts (Beck et al., 1983).
• Cognitive therapy has demonstrated significant effectiveness in the treatment of depression (Hollon & Beck, 1994), and it has shown moderate efficacy in addressing anxiety-related problems (Beck, 1993).

Limitations of CBT

• The specific role of cognitive processes remains uncertain, as it is not yet clear whether faulty cognitions are a cause or a consequence of psychopathology. In a study by Lewinsohn (1981), participants were examined prior to the onset of depression, and it was found that those who later experienced depression were not more likely to have negative thoughts compared to those who did not develop depression. This suggests that hopeless and negative thinking may arise as a result of depression rather than being the cause of it.
• The cognitive model has a limited focus as it primarily emphasizes thinking as a crucial aspect of human functioning, while broader aspects require attention and consideration.
• Ethical concerns arise in relation to RET, which is a directive therapy aimed at actively changing cognitions, sometimes in a forceful manner. This approach may be viewed as unethical by certain individuals.