An Introduction to Cognitive Behavioral Therapy
> 6/16/2008 4:44:00 PM


Several mental health treatment methods fall under the Cognitive-Behavioral Therapy (CBT) heading, and the phrase does not denote a specific technique so much as a general ideology that counters the insightful analysis of psychodynamic therapy with a more direct, short term and goal-oriented form of treatment for conditions like depression, PTSD and chronic anxiety. The average number of sessions in a CBT treatment course is only 16, and many of its practitioners and advocates believe it to be more cost-effective and empirically proven than more traditional techniques. CBT’s name stems from the fact that its application ideally combines cognitive treatments designed to remedy faulty thought processes with concrete action-based approaches aimed at the aggressive resolution of problematic behavioral patterns. Variations in the CBT family include Dialectic Therapy, a method specifically designed for disturbed/borderline clients, Self-Instruction Training, and a Schema-Focused Therapy model that more closely resembles the psychodynamic approach in its intense focus on the early-life traumas that often shape a malformed perspective.

Albert Ellis, an American psychologist whose influence is often considered as great as Freud’s, introduced the preliminary framework of CBT the 1950’s. Ellis intended his approach, called Rational Emotive Behavioral Therapy, to serve as a reactionary alternative to more popular and purely analytical methods, targeting behaviors themselves and making use of exposure therapy in order to force personal revelation rather than focusing more exclusively on a client’s underlying emotional motivations. The theory behind this approach proposes that the practice of directly teaching clients to overcome the symptoms of their neuroses and depressions will eventually create in them a more confident self-impression. Depression, from this perspective, starts with an analytical process overwhelmingly biased toward the negative, particularly as it relates to self-appraisal and interpretations of the actions and motivations of others. Because CBT focuses so specifically on the behavioral manifestations of various disorders, it has also proven effective for eating and drug abuse disorders, as well as problems involving particular phobias or compulsions.

Because the victims of long-term mental illness so often see themselves and their surroundings in a distorted fashion, CBT aims to provide a call back to reality and away from the self-fulfilling prophecy of counter-productive behaviors that feed into an overwhelmingly negative impression of one’s own life. By directly modifying behaviors while also questioning the underlying conflicts that facilitate them, the hope is that this change in perspective will facilitate a cyclical change whereby a stronger self-image will lead to symptomatic reductions. Instead of the progressive expressive goals of psychodynamic therapy wherein a client learns with time to better recognize, express, and counter problematic emotions and behaviors, CBT tends to be more blunt and to-the-point, focussing not on sensitivity but on real-world ways in which to better achieve the results one wants. CBT encourages clients to keep journals recording their own negative thought patterns and engage in behavioral “experiments” to condition themselves. Examples include forced exposure to sensitive situations for chronically anxious clients and the development of more active social lives for those whose conditions compromise their ability to create and maintain interpersonal relationships.

Cognitive Behavioral Therapy is in no way superior to or more valid than psychodynamic therapy or other forms of therapy. It is simply an alternative approach to treatment, based on many of the same basic principles, that will ultimately be better suited to some clients. Medication serves as an essential compliment to regular therapy in most cases, but CBT has, in repeated studies, proven just as effective as antidepressants in treating related symptoms. According to statistics, it is even better at preventing relapse. CBT most often takes place in a one-on-one setting but can, in some cases, be applied on a group basis akin to exposure therapy. Groups of similar patients may gain solace from the realization that their cases are not unique and that others also suffer from the conditions that continue to plague them. The assertive, “proactive” CBT philosophy mirrors that of many self-help programs and has actually held a powerful influence over that movement, serving as a guiding model for motivational courses and products. CBT does not necessarily have to be administered by a licensed psychotherapist, but professional qualifications obviously come into play for many considering therapy. Psychiatrists, psychiatric nurses, and social workers may also find a practitioner’s knowledge of the discipline to be an essential tool in their treatment portfolio.

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