Research base for CBT
The use of CBT is recommended by a robust evidence base derived from randomised controlled trials which demonstrate the effectiveness of cognitive and behavioural psychotherapies in the treatment of common problems, including the anxiety disorders, generalised anxiety, panic, phobias, obsessive compulsive disorder, post-traumatic stress disorder, bulimia and depression as identified by a host of recent reviews by NICE, SIGN and other review bodies.
CBT models have also been developed for use in an increasing range of mental health and health difficulties including severe and enduring mental health problems, such as psychosis, schizophrenia, bi-polar disorder, anger control, pain, adjustment to physical health problems, insomnia and organic syndromes, such as early stage dementia. There is an extensive research base around behavioural approaches in
working with children and people with learning disabilities, severe and enduring mental health problems and “challenging behaviour” generally.
More recently CBT is becoming the treatment of choice for adolescent depression, and for use with children and in intellectual disability (learning disability). Research into the contribution of psychological factors to physical health problems (such as low back pain, chronic fatigue, recovery from surgery for example) is growing and has led to the development of CB approaches in these areas.
Developments in Cognitive-Behavioural Therapy research, theory and practice (particularly in the development, or refinement, of clinical techniques/methods) are occurring rapidly. So are developments in cognitive and behavioural psychological perspectives of normal and abnormal psychological processes such as human development and emotion. The application of cognitive, behavioural and cognitive-behavioural theory and approaches is happening in many fields other than mental health, eg.: education and training, public health,
organisational psychology, forensic psychology, management consultancy, sports psychology.
Key concepts in Cognitive Behaviour Therapy (CBT)
The cognitive component in the “cognitive behavioural psychotherapies” refers to how people think about and create meaning about situations, symptoms and events in their lives and develop beliefs about themselves, others and the world. Cognitive therapy uses techniques to help people become more aware of how they reason, and the kinds of automatic thought that spring to mind and give meaning to things .
Cognitive interventions use a style of questioning to probe for peoples’ meanings and use this to stimulate alternative viewpoints or ideas. This is called ‘guided discovery’, and involves exploring and reflecting on the style of reasoning and
thinking, and possibilities to think differently and more helpfully. On the basis of these alternatives people carry out behavioural experiments to test out the accuracy of these alternatives, and thus adopt new ways of perceiving and acting. Overall the intention is to move away from more extreme and unhelpful ways of seeing things to more helpful and balanced conclusions.
The behavioural component in the “cognitive behavioural psychotherapies” refers to the way in which people respond when distressed. Responses such as avoidance, reduced activity and unhelpful behaviours can act to keep the problems going or worsen how the person feels. CBT practitioners aim to help the person feel safe enough to gradually test out their assumptions and fears and change their behaviours.
For example this might include helping people to gradually face feared or avoided situations as a means to reducing anxiety and learning new behavioural skills to tackle problems.
Importantly the cognitive and behavioural psychotherapies aim to directly target distressing symptoms, reduce distress, re-evaluate thinking and promote helpful behavioural responses by offering problem-focussed skills-based treatment interventions.
Key factors in the delivery/process of CBT
• Therapeutic Relationship – a trusting, safe, therapeutic alliance is an essential but not sufficient ingredient for CBT.
• Collaboration – is a way of being with clients based on an equal partnership, each of us bringing something to the relationship. The therapist brings skills and knowledge of psychological processes, theories of emotion and techniques that have helped others and could help the current client. The client is an expert of their own experience, with their own resources.
The overall aim is for the individual to attribute improvement in their problems to their own efforts, in collaboration with the psychotherapist.
Therapy is not experienced as something that has been “done to” the client. CBT is not about trying to prove a client wrong and the
therapist right, or getting into unhelpful debates – rather by skilfully collaborating, clients come to see for themselves (discover) that there are
alternatives
Homework – the client tries things out in between therapy sessions, putting what has been learned into practice. This is referred to as homework and sometimes includes behavioural experiments.
CBT compared to other modalities and myths about CBT:
• The cognitive and behavioural psychotherapies target problems in the here and now with much less therapeutic time devoted to experiences in early childhood.
• The therapeutic relationship is seen as an essential ingredient, but unlike other psychotherapies is not viewed as the main vehicle of change. Instead the focus is in collaborative working on jointly agreed problems.
• It is both highly structured (although always based on a formulation of the relationship between the client’s presenting problems and underlying cognitive and/or behavioural processes) and flexible due to the constant evaluation of the outcome of the interventions.
• Cognitive therapists do not usually interpret or seek for unconscious motivations but bring cognitions and beliefs into the current focus of attention (consciousness) and through guided discovery encourage clients to gently re-evaluate their thinking
• It is a form of therapy that addresses problems in a direct and targeted way.
• Its focus is on a shared model of understanding, its psycho-educational stance, open sharing of the formulation and teaching of skills of self-evaluation and management.
• Its power as a model is shown by its increasing use and accumulating recommendation by a myriad of evidence-based guidelines.