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Introduction to Cognitive-
Behavioral Therapy
By: Letícia Gouveia, psychology undergraduate.
WHAT IS COGNITIVEBEHAVIORAL THERAPY?
Aaron Beck developed a form of psychotherapy in the early 1960s, which he originally called "cognitive therapy." For the treatment of depression, Beck designed a structured, short-term psychotherapy, focused on the present, aimed at solving current problems and modifying dysfunctional (inadequate/useless) thoughts and behaviors.
In brief, the cognitive model proposes that dysfunctional thinking (which influences the patient's mood and behavior) is common to all psychological disorders. When people learn to evaluate their thoughts in a more realistic and adaptive way, they improve their emotional and behavioral state. Modifying the underlying dysfunctional beliefs results in a more lasting change.
WHAT DOES RESEARCH SAY?
Cognitive-behavioral therapy has been extensively tested since the first scientific studies were published in 1977. To date, more than 500 studies have demonstrated the effectiveness of cognitive-behavioral therapy for a wide range of psychiatric disorders, psychological problems, and medical issues with psychological components.
WHAT ARE THE BASIC PRINCIPLES OF TREATMENT?
Although therapy should be tailored to each individual, there are certain principles that are present in cognitive-behavioral therapy for all patients. Throughout this book, I use a depressed patient, Sally, to illustrate these core principles.
The basic principles of cognitive-behavioral therapy are as follows:
Principle #1 Cognitive-behavioral therapy is based on a continuously developing formulation of the patient's problems and an individualized conceptualization of each patient in cognitive terms.
From the start, I identify Sally's central thought, which contributes to her feelings of sadness ("I am a failure, I can't do anything right, I will never be happy") and her problematic behaviors (isolating herself, spending a lot of unproductive time in her room, avoiding asking for help). Secondly, I identify the precipitating factors that influence Sallyʼs perceptions at the beginning of her depression (e.g., being away from home for the first time and her difficulty with studies contributed to the belief that she was incompetent). Thirdly, I raise hypotheses regarding key developmental events and recurring patterns of interpretation of these events that may have predisposed her to depression (e.g., Sally has a long-standing tendency to attribute her strengths and achievements to luck, but views her weaknesses as a reflection of her true self).
Principle #2 Cognitive-behavioral therapy requires a strong therapeutic alliance.
I strive to demonstrate all the basic ingredients necessary in a counseling situation: affection, empathy, attention, genuine interest, and competence. I show my interest in Sally by making empathetic comments, listening attentively and carefully, and appropriately summarizing her thoughts and feelings.
Principle #3 Cognitive-behavioral therapy emphasizes collaboration and active participation.
I encourage Sally to view therapy as a team effort; together, we decide what to work on in each session, how often we should meet, and what she should do between sessions as part of the therapy exercises.
Principle #4 Cognitive-behavioral therapy is goal-oriented and focused on problems.
Principle #8 Cognitive-behavioral therapy sessions are structured.
Regardless of the diagnosis or treatment stage, following a certain structure in each session maximizes efficiency and effectiveness. This structure includes an introductory part (checking the mood, quickly reviewing the week, collaboratively setting the agenda for the session), an intermediate part (reviewing the homework, discussing the agenda items, setting new homework, summarizing), and a final part (eliciting feedback).
Principle #9 Cognitive-behavioral therapy teaches patients to identify, evaluate, and respond to their dysfunctional thoughts and beliefs.
Patients may have dozens or even hundreds of automatic thoughts per day that affect their mood, behavior, and/or physiology (the latter is especially relevant for anxiety). The therapist helps the patient identify the main cognitions and adopt realistic and adaptive perspectives, which leads the patient to feel better emotionally, behave more functionally, and/or reduce their psychological arousal.
Principle #10 Cognitive-behavioral therapy uses a variety of techniques to change thoughts, mood, and behavior.
WHAT IS A SESSION LIKE?
The structure of the sessions is quite similar for various disorders, but interventions may vary considerably from patient to patient. At the beginning of the sessions, you will establish a therapeutic alliance, check the mood, symptoms, and experiences of the patient during the past week, and ask them to name the problems they most want help solving. You will also review the self-help activities ("homework" or "action plan") the patient engaged in since the last session. Next, when discussing a problem, you will cognitively conceptualize the patient's difficulties (asking about their specific thoughts, emotions, and behaviors associated with the problem) and collaboratively plan a strategy. Most of the time, the strategy will include the direct, practical solution to the problem, an evaluation of negative thinking associated with the problem, and/or behavioral changes.
THE DEVELOPMENT OF A COGNITIVEBEHAVIORAL THERAPIST
To an untrained observer, cognitive-behavioral therapy may sometimes give the false impression of being very simple. However, experienced therapists perform many tasks simultaneously: conceptualizing the case, developing rapport, familiarizing and educating the patient, identifying problems, collecting data, testing hypotheses, and making periodic summaries. The development of expertise as a cognitive-behavioral therapist can be seen in three stages:
Stage 1 You learn the basic skills of case conceptualization in cognitive terms based on the initial assessment and data collected during the session, as well as how to structure the session and use the patientʼs conceptualization and common sense to plan treatment.
Stage 2 You become more proficient in integrating your conceptualization with your knowledge of techniques. You strengthen your ability to understand the flow of therapy and more easily identify the main treatment goals.
Stage 3 You more automatically integrate new data into the conceptualization and refine your ability to formulate hypotheses to confirm or correct your understanding of the patient.
HOW TO USE THIS BOOK
Your growth as a cognitive-behavioral therapist will be enhanced if you begin to apply the tools described in this book to yourself. In this way, you will teach yourself to identify your automatic thoughts. By focusing on your own thoughts, you will not only have the opportunity to modify dysfunctional thoughts but also influence your mood and behavior positively, becoming more receptive to learning.
Reference:
BECK, Judith S. Cognitive-behavioral therapy: Theory and practice. Translated by Maria José G. Marcondes. 1st ed. São Paulo: Pioneira Thomson Learning, 2004.
