Cognitive therapy principles and applications

Aaron Beck & Cognitive Therapies

Cognitive therapies are therapies that relate to how a person thinks, and attempt to solve problems based on changing how people think. The founder of cognitive therapies was Aaron Beck.

Beck believed that problems resulted from cognitive distortions, that is, were based in a person's thinking. Beck believed that a person's thought, beliefs, attitudes and perceptions were the basis for what emotions they would experience and how intense those emotions would be and that by changing the thinking a person could change their experience.

Beck explains this concept saying "cognitive therapy is based on the premise that emotions come out of unexamined, habituated thought reactions. These thoughts and the emotions they foster can be deconstructed and, hence, defused of their power to poison all human interactions" (Beck, A.T. (1989). Love Is Never Enough. New York: Harper Collins).

Beck's therapies are made accessible to medical practitioners via the Beck Institute for Cognitive Therapy and Research which provides training and information to mental health and medical professionals ("The Beck Institute for Cognitive Therapy and Research." Beck Institute, 2001. http://www.beckinstitute.org/).

Applications of Cognitive Therapy

Listening to Internal Dialogue

Beck's therapy involves the client focusing on tuning into their internal dialogue. As they react to circumstances they become aware of their thought processes. For example, guilt is one aspect of depression. Where a rational personal would make a mistake and not overreact to it, a depressed person would overreact, feeling guilt that in turn causes them to dislike themselves more and become more depressed. As an example, they may think, without realizing it, "I have made a mistake, I have let everyone down, I feel terrible about it, I am a terrible person." Beck's therapy would have the person become aware of this internal dialogue. In doing this the person would see that all that has happened is that they have made a mistake and that 'them being terrible' is something they have created for themselves. By recognizing this, clients are then able to change their thinking. Beck also makes use of what he calls schemata, where schemata are rules that govern how people process incoming information. By listening to the internal dialogue, clients become aware of what these schemata are. By becoming aware of them they are eventually able to change their internal dialogue and thus avoid the irrational reactions to events. The guilt or self-hatred that they once reacted with are replaced by more rational reactions.

Dream Therapy

Dreams are becoming an increasingly recognized tool for use in cognitive therapy with dreams able to represent underlying beliefs that a patient is not able to recognize or verbalize. Deirdre Barrett describes how this method can be used in dealing with depression, trauma and bereavement by being used as a tool to access underlying latent beliefs (Barrett, D. (2002). "The "Royal Road" becomes a Shrewd Shortcut: The Use of Dreams in Focused Treatment." Journal of Cognitive Psychotherapy, 16:1.)

Conditions Treated by Cognitive Therapy

Conditions treated by cognitive therapy are extensive and extend from psychological problems to improving relationships. In his book Love is Never Enough, Beck describes how husbands and wives can improve their relationships through cognitive therapy (Beck, A.T. (1989). Love Is Never Enough. New York: Harper Collins). Experts also describe how cognitive therapy can be used to treat eating disorders, social phobia, substance abuse, sexual problems, obsessive-compulsive disorder and panic attacks (Salkovskis, P. (1996). Frontiers of Cognitive Therapy. New York: Guilford Press).

Clearly, cognitive therapy can be used to treat a wide range of disorders, illnesses and psychological problems.

Depression

Depression is one condition cognitive therapy is often used to treat. A recent study based on Beck's model of cognitive therapy showed that Beck's therapy was at least as effective as other psychotherapies, with the study concluding that cognitive therapy should be considered as a first-line treatment for depression (Strunk, D.R., & DeRubeis, R.J. (2001). "Cognitive Therapy for Depression: A Review of Its Efficacy." Journal of Cognitive Psychotherapy, 15:4.)

Another studied compared cognitive therapy to conventional drug therapies in treating depression.

The study compared large numbers of controlled studies that compared cognitive and drug therapies and found that "despite conventional wisdom, the data suggest that there is no stronger medicine than psychotherapy in the treatment of depression, even if severe" (Antonuccio, D.O., Danton, W.G., & DeNelsky, G.Y. (1995). "Psychotherapy vs. Medication for Depression: Challenging the Conventional Wisdom With Data." Professional Psychology: Research and Practice, 26:6, p582.)

The study concludes that cognitive therapy should be used as a first-line treatment for depression as it has fewer side-effects than drug therapies, less risk to the patient and has a better long-term outcome.

Suicide Prevention

Another current trend in cognitive therapy is using it as a tool for predicting behavior. One application is using it as a tool to determine the risk of suicide in teenagers. One recent study looked at cognitive risk by identifying maladaptive schemas in adolescent psychiatric patients.

The study concluded that cognitive factors contributed to the risk of suicide along with other factors, with further studies to investigate this recommended (Reinecke, M., & DuBois, D. (2001). "Socio-Environmental and Cognitive Risk and Resources: Relations to Mood and Suicidality among Inpatient Adolescents." Journal of Cognitive Psychotherapy, 15:3.)

Strengths and Weaknesses

Before looking at the strengths and weaknesses of Beck's cognitive therapy it is useful to briefly introduce another common therapy that can be seen as an alternative therapy. The therapy is RET, rational-emotive therapy, a therapy similar in many ways to Beck's therapy. By looking at RET, the benefits of Beck's cognitive therapy can be seen much more clearly.

Ellis's Rational-Emotive Therapy (RET)

Ellis created what is known as RET, rational-emotive therapy. This therapy is based on the assumption that people learn to react to irrational beliefs that they have gained some time in the past. He believed that the basis for a person's problems was in the irrational thoughts they had learned and if these could be confronted, the behavior would be accordingly altered.

The therapy is based on changing the beliefs that the person has and recognizing that it is this belief that causes problems, not anything in society. This is done by making the person confront their thoughts and making them see the irrationality of their actions.

Disputing is the major process in this, it is the stage where people must confront and eventually reject their irrational thoughts so that they can create new rational ones.

Strengths and Weaknesses

Comparing Ellis's theory to Beck's, we can see one of the major benefits of Beck's cognitive therapy in that it is a comforting process rather than a confronting one. In Eliss's theory the patient must confront their irrational theory which can be a stressful process. Considering that the patient may already be distressed, especially in treating conditions like depression, this type of approach may not be beneficial. Beck's non-confronting approach is more comfortable for the patient and less likely to have negative side-effects.