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Introduction Over 2000 years ago the Greek Stoic philosopher Epictetus said that people are disturbed not by things but by the views they take of them.
It is the interpretation we place on events, rather than events themselves, that determine our emotions. For example: if you were lying in your bed at night and were woken by a window blowing open in the next room, the way you thought about the event would affect how you felt about the situation. If you thought the window had blown open accidentally, you might feel angry or annoyed. However, if you thought that someone was trying to break in, you would be more likely to feel anxious. Therefore, our feelings are not just automatic reactions to events, they are created by the thoughts that we have.
Just as individuals construct irrational thoughts that maintain their negative emotions and maladaptive behaviour, they can reconstruct their thoughts and view situations differently, which will result in positive feelings and adaptive behaviour.
What Is Cognitive Therapy? Cognitive Therapy is a way of talking about the connections between how we think, how we feel and how we behave. It particularly concentrates on ideas that are unrealistic. These often undermine our self-confidence and make us feel depressed or anxious. Looking at these can help us work out different ways of thinking and behaving, that in turn will help us cope better. The basic premise of cognitive therapy therefore, is that the way we think about events in our lives (cognitions) determines how we feel about them (emotions), which in turn influences how we react (behaviour).
Cognitive Therapy also helps people to look at their "rules for living” called schemas. Schemas are cognitive structures or templates that organise how we think, feel, act, relate, and understand and are typically referred to as our personality style. Schemas are outside of conscious awareness and determine how we interpret the world and respond to situations. Whilst cognitive structures can be adaptive, allowing us to process information rapidly, the same rapid processing can result in entrenched maladaptive structures. This is because they are strong beliefs and assumptions about how we should live our lives, which we develop whilst we are growing up.
How does psychological and emotional distress occur? Psychological and emotional distress occurs when people perceive the world as threatening. When this happens perceptions and interpretations of events become highly selective, egocentric, and rigid, resulting in people making systematic errors in reasoning, called 'cognitive distortions'.
Cognitive Distortions include: All-or-nothing thinking: Seeing things in black-or-white categories that exist on a continuum.
Mental Filter: Dwelling on a single negative detail, instead of seeing the whole picture.
Over-generalisation: Seeing one negative event as a never-ending pattern of 'always', or 'never'.
Jumping to conclusions: Interpreting things negatively when there is no evidence to support it.
Discounting the positive: Positive experiences are dismissed, as 'not counting'.
Magnification: Magnifying ones problems and shortcomings, or minimising one's positive qualities.
Imperative statements: Rigid, absolute demands about oneself, others or the world taking the form of should, must, ought, have to, or awfulising, catastrophising, leading to "' I can't stand it".
Emotional reasoning: Assuming negative emotional thinking reflects reality. i.e. '"I feel it".
Labelling: Attaching a negative label to an action i.e. I'm a failure, instead of, I made a mistake.
Personalisation: Holding oneself responsible for an event outside one's control.
Tunnel vision: Seeing only the negative aspects of a situation.
Research has shown that specific patterns of thinking are associated with a wide range of emotional and psychological problems. These negative or extreme thought patterns have frequently become so habitual that they are experienced as automatic and go unnoticed by the individual.
Cognitive Restructuring Cognitive Therapy treats emotional problems by changing or restructuring maladaptive patterns of thought. Clients are taught how to uncover and re-examine these negative beliefs, and replace them with more adaptive ways of viewing life events. Through this process, clients learn self-help techniques that can produce rapid symptom shifts, solve current life problems, and improve self-esteem. This negative pattern of thought called negative automatic thoughts, can be seen as abbreviations of deeper cognitive structures called schemas.
Cognitive Therapists also teach clients coping skills, which serves two functions: 1. enables clients to deal with the problems for which they have sought therapy 2. clients are more able to apply the coping skills to future problems in their lives.
In essence, Cognitive Therapy is a school of psychotherapy that:
How Cognitive Therapy is different from other therapies. Cognitive Therapy incorporates a variety of features that differ from traditional psychotherapy and shorten the process of change. Five of these elements are briefly described below:
1. formulation of clients' problems guides the treatment plan (see collaborative conceptualisation below).
2. the cognitive therapist actively directs clients to the discovery of central thinking problems
3. cognitive therapists and clients actively work together to resolve negative feelings, behaviours and functioning
4. cognitive therapy focuses on the resolution of current, specific problems, providing a clear structure and focus to treatment
5. the therapist makes joint decisions with the client and regularly asks for feedback to maintain a high degree of collaboration and empathy.
Collaborative Conceptualisation - a compass for successful treatment Collaborative conceptualisation (formulation) is the foundation of cognitive therapy because it ties together all of the presenting issues, so that the problems are not seen as a random collection of difficulties. This formalisation will explain how current problems are being maintained and will guide therapeutic interventions. Therefore, from the very start of therapy an initial formulation of clients' problems will guide the treatment plan and determine which strategies are used.
In cognitive therapy the therapist and the client are thought of as partners, who are working together on the shared goals of greater health and well-being and improved functioning, viewing automatic thoughts or self-talk as hypotheses that are subject to empirical verification, rather than as established facts or ‘the way things are’. This process has been called collaborative empiricism.
Initial assessment / consultation The initial assessment / consultation will focus on your presenting problem(s). Sometime this will be a single difficulty or complex mix of difficulties. This may include a brief exploration of some of the following areas: your family background; early life experience; work history; medical history and relationships.
At the end of the consultation a preliminary psychological formulation or understanding of your difficulties will have been made. Broadly, this psychological understanding will provide a description of the origin of your difficulties, how they are currently maintained and treatment options. We will consider your goals / aims of therapy and priorities them in order. This will enable you to experience a feeling of mastery and control over your emotions early on in therapy.
You may also be given some questionnaires to take away and complete before the next session, which may provide a further understanding of your difficulties.
Treatment sessions The focus of the treatment sessions will vary depending upon the nature of your difficulties. However, because difficulties are conceptualised, within a cognitive framework, treatment tends to be considerably shorter than for traditional approaches to psychotherapy; even for problems that traditional therapies often take years to resolve, or aren't able to resolve at all. Meanwhile, for people with chronic or lifelong problems, an expansion of cognitive therapy called Schema Focused Cognitive therapy is available.
Length of treatment The overall duration of therapy will vary depending upon the complexity of your issues. In some cases an improvement can be achieved after the assessment itself, whilst in others, a longer period of contact is required before problems are resolved. Most courses of cognitive therapy last from 5 to 15 weeks, with once-weekly sessions lasting 50 minutes.
Key Features StructureSessions typically begin with the therapist and client deciding together how the time in that day's visit will be spent. The treatment as a whole is seen as having a beginning, middle, and end, with the total length of treatment depending on the nature of the problems and the needs of the client. Focus
Cost-Effective. The active and focussed psychotherapeutic approach makes the cost of treatment less expensive than other forms of therapy. The focus on skill building and client independence minimises the course of treatment and reduces the risk of relapse after the end of treatment. (For fees see Cognitive Therapy Appointments)
Lasting Results. Cognitive Therapy emphasises many practical strategies that can be used, even when therapy is over, to cope with life more effectively.
Cognitive Behaviour Therapy has three main goals:
1. To relieve symptoms and resolve problems. 2. To help the client to acquire skills and coping strategies. 3. To help the client to modify underlying cognitive structures in order to prevent relapse.
How effective is Cognitive Behaviour Therapy?
Empirically-based. Cognitive Therapy is the most widely researched form of all psychotherapies. It is one of the few forms of psychotherapy that has been scientifically tested and found to be highly effective in hundreds of clinical studies.
In study after study, it has been shown to be as effective as drugs in treating both depression and anxiety states. Results overwhelmingly support the effectiveness of Cognitive Therapy with virtually all emotional problems and is the preferred treatment for:
Cognitive therapy stresses solutions, not just insight, helping clients to get better rather than just feeling better.
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