COGNITIVE-BEHAVIOURAL THERAPY

Cognitive-Behavioural Therapy (CBT) now has quite a long history. It should be noted that the approach did not begin as a new theoretical orientation in its own right but gradually absorbed a variety of heterogeneous concepts from other approaches that had developed in various historical periods. The second part of the name (‘behavioural’) relates to Behaviourism, a theoretical perspective which developed in the early twentieth century following the work of the researchers John B. Watson and I.P. Pavlov. Psychologists who adhered to behaviourist concepts and ideals restricted their attention to behaviour that was observable. They studied human responses to certain environmental stimuli and tried to ascertain how these responses could be modified by introducing conditioning factors (see glossary). Albert EllisResearch carried out in this field was later found to be particularly fruitful for the treatment of phobias, and eventually led to the introduction of effective techniques used to desensitize individuals with respect to feared objects or situations.

Cognitivism on the other hand, the term from which the first part of the name derives, developed in the 1960s. This field of study focuses on the mental processes which allow us to structure and make sense of our experiences, comparing and relating them one to the other. Within the clinical sphere, the cognitivist perspective proposes that underlying a great number of psychological disorders there are systematic distortions of thought, which generate erroneous assumptions and irrational convictions. In time, these distortions become transformed into relatively stable thought patterns or mental schemes that draw an individual into a self-perpetuating vicious circle. For example, a person who believes he/she simply has to be perfect in every enterprise he/she undertakes will tend to experience extremely negative feelings every time he/she happens to make a mistake.

Underlying such negative emotions there is an error in reasoning and in the interpretations of reality of the subject affected. In the 1960s, the psychotherapist Albert Ellis developed what he referred to as Rational-Emotional Therapy (RET), which addresses these distorted thoughts in particular, helping patients to challenge their convictions and replace them with other more useful ideas, such as: <<Even though it would be just great not to make any mistakes, that still doesn’t mean I have to be perfect>>. In this way, a person who up until that time had only seen things from one point of view - and a maladaptive one at that – may gradually learn to adopt different types of reasoning based on different interpretations of his/her experiences and reality.

 

A further fundamental aspect of this therapeutic approach is the work on the emotions carried out by the patient with the aid of the therapist, through which the subject learns to recognise and control his/her feelings. The emotions are in fact considered as the direct product of an individual’s cognitions and interpretation of reality. At the same time, CBT intervenes directly on the patient’s behaviour; new thoughts, now re-elaborated and rendered more functional, are accompanied by coherent behaviour. It thus becomes possible for the person to construct new paradigms of

interpretation and behaviour, which will be maintained over time as, with practice, the new way of thinking and reasoning and, consequently, of behaving becomes consolidated. Another effective form of therapy is that developed by the psychiatrist A.T. Beck.

The chief characteristics of CBT can be summarised as follows:
  • The therapy focuses on established goals. At the beginning of therapy, by means of an in-depth diagnostic process, the aims of therapy are agreed on, a treatment plan is established to suit the client’s particular needs and a schedule is drawn up containing an indication of when the achievement of goals will be checked and the manner in which this will be verified on the road towards realising the changes that have been proposed;
  • An active and collaborative approach. The therapist and patient work together to recognise and modify the patterns of thought the patient’s emotional and behavioural problems originate from. The therapist will propose cognitive and behavioural strategies aimed at solving these problems, while the patient has the task of putting into practice, between sessions, the strategies learned during each encounter;
  • Focus on the present. Therapeutic work, especially when aimed at solving specific symptoms, is based on an elaboration of what is happening right now in the patient’s life. Consideration of past events and the client’s personal history is very definitely important during the diagnostic phase and in certain types of intervention, but normally therapy tries above all to draw the patient out of the mental paradoxes and contradictions in which he/she has become trapped;
  • Short-term therapy. In general terms, depending on the kind of presenting problem, psychotherapy may last from three to twelve months. In any case, changes are monitored at pre-established times and it is thus possible to evaluate the effectiveness of the work;
  • Integration and flexibility. In particularly severe cases, CBT can be optimally employed together with psychopharmacological treatment. The approach is in any case considered a fundamental theoretical and strategic point of reference in complex social rehabilitation programs for psychiatric patients;
  • Effective in the long term. As already stated, the techniques of the Cognitive-Behavioural approach are relatively easily subjected to an examination and the evaluation of their results. Outcome studies and replicable research conducted so far have shown that, for a vast range of disorders, including anxiety, the modifications obtained with these techniques are long-lasting.
   
>>> (Systemic Family Therapy)


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PSYCHOTHERAPIES --> INDEX:
8 - Bioenergetic therapy