Cognitive Therapy: Principles, Methods, and Applications

Introduction to Cognitive Therapy

Cognitive therapy is a form of psychological therapy based on the premise that cognitive (thinking) processes both affect and are affected by our emotions. Emotions such as depression and anxiety are particularly influential on cognition, and the therapist in a cognitive therapy application attempts to help the client by linking cognitive processes to emotions that are more productive — and that in turn affect thoughts in a more positive manner, and vice versa (Sanders & Wills, 2005, p. 3). The commonly recognized progenitor of cognitive therapy in its original form is Aaron T. Beck, working in the 1970s, who developed the idea that our thoughts (cognitions), emotions, and behaviors are integrally linked. He proposed that if any aspect of that linked chain were altered in a positive direction within a therapeutic setting, the others would follow suit and allow the individual a better quality of life. Through this process, the therapist conducts experiments on the thinking process to determine whether such changes will shift mood and, therefore, behavior toward a more positive state (Sanders & Wills, 2005, p. x).

Cognitive therapy has evolved a great deal over the years, becoming a popular form of therapy in part because it offers a logical model of thought, emotion, and behavior that is, for many clients, easily discernible and can therefore guide resolution. The forms and models of application, as well as its strategies, have borrowed from and contributed to other psychological models; in many ways, CT has become an extremely popular therapeutic approach. Cognitive therapy is a broad term that includes treatment modes such as cognitive behavioral therapy (CBT), rational emotive behavior therapy (REBT), behavior therapy, and constructivist therapy. All of these are forms of CT in general, and each adds to and aids the growth of the therapy's development and ability to help individuals in their therapeutic processes (Sanders & Wills, 2005, p. x).

This work demonstrates the process of cognitive therapy through a discussion of its modes of application: collaborative empiricism, guided discovery, reality testing, and core beliefs. To treat dysfunctional modes, three approaches are applied: (1) deactivation through distraction or reassurance, (2) modification of content or structure, and (3) the construction of more adaptive modes that "neutralize" the maladaptive ones.

Collaborative Empiricism

Collaborative empiricism describes the way in which cognitive therapy begins the process of formulating goals and ideas for potential change. The importance of this process lies in the fact that the therapist works with the client to determine the needed changes and form a treatment plan through a collaborative discovery process. It is only with the guidance of the client that the therapist can formulate theory associated with the links the client has made among cognition, emotion, and behavior — links that are troubling to the individual and to his or her life processes. The therapist then takes the information provided by the client and develops a coherent plan of therapy that prioritizes the client's specific needs above all other motives or theory. These theories are subsequently tested through the treatment plan to see whether they elicit desired changes in the cognition/emotion/behavior cycle (Hewstone, Fincham & Foster, 2005, p. 510).

Guided Discovery and Reality Testing

Guided discovery is the process by which the therapist asks questions and develops insight into the meanings behind the client's thoughts. Through this process, collaborative empiricism is employed to allow the client — through guidance — to communicate to the therapist what meanings his or her thoughts carry, or what underlies these feelings and ideations about self and the environment. It is important to note that the "guided" aspect of guided discovery does not involve the therapist making any attempt to change or alter the client's thinking. It is simply a guided process of discovering thoughts and their possible meanings (Beck, 1995, p. 8).

Reality testing is the applied construct of taking the information found through collaborative empiricism and guided discovery to develop an idea of the functioning that might be applied by the client, then testing that instinctive ideation — possibly a core belief — by allowing the therapist to offer possible real events and occurrences that could arise in any given problematic situation. In other words, the individual is asked to think aloud through the process of checking and rechecking, with the therapist, the fears or anxieties they hold about a given situation. Reality testing occurs frequently and independently for some individuals when time allows; they check and double-check (through thoughts prior to a behavior) what the consequences of that behavior might be. In reality testing, the therapist interjects the potential real outcomes for a hypothetical situation or through a reenactment of past similar experiences with the client (Beck, 1995, p. 76).

To better illustrate this, consider the following example: a client has expressed unrealistic fear and anxiety surrounding leaving her child at school in the morning — so much so that she often avoids doing so and allows the child to remain home when the child should be at school, which has begun to affect the child's learning and development. The therapist uses guided discovery and collaborative empiricism to uncover that the client's fear is that her child will be abducted. Reality testing then allows the therapist to offer the client questions about the actual likelihood of abduction: Has it ever happened before? Do you know a child who has been abducted at or from school? Have you taught your child coping skills for defense and avoidance of strangers? In this manner, the therapist puts the unrealistic fear in the context of reality — specifically, that it is very unlikely that the child will be abducted, and that there are steps the parent can take to address the fear, such as teaching the child safety skills, speaking with teachers if there is a rational basis for concern (for example, a known person of concern), and, most importantly, changing the core beliefs surrounding this possible event that are fueling unrealistic anxiety.

Conclusion

Cognitive therapy has been cited as one of the most popular and functional types of therapy in use today, in part because the theories and systems it employs are regarded as easily understood and easily applied by both the clinician and the individual in later stages of therapy, or even after formal therapy has ended. Cognitive therapy can be applied to nearly every age group — used as an intervention model for children and adults alike — and is an adaptive mode of therapy that has benefited greatly from research, application, and study. From CT have emerged many other applied forms of therapeutic schema that have aided thousands of people over the years in living happier and more productive lives.