Cognitive Behavioural Therapy

25 Jul

Our last blog post explained the benefits of Cognitive Behavioural therapy as opposed to just Hypnotherapy.  In this blog post, we would now like to explain a little more about the different types of cognitive behavioural therapy. 

Cognitive Behavioural Therapy (CBT) is a talking therapy. The basis of CBT is that what people think can affect how they feel and how they behave.  Within this broad definition is a number of cognitive behavioural psychotherapies such as Behaviour Therapy (BT), Cognitive Therapy (CT), Rational Emotive Behaviour Therapy (REBT), Mindfulness Based Cognitive Therapy (MBCT),  Acceptance and Commitment Therapy (ACT) to name but a few.

 The two pioneers of CBT, Albert Ellis and Aaron Beck, shared the view that most disturbances arise from faulty thinking and that the remedy is to be found in corrective actions.  Both concentrate on present problems and present thinking in contrast to the earlier forms of psychotherapy.  Also, both recommended the inclusion of behavioural exercises.  Because of the inclusion of behavioural exercises, Cognitive Therapy (CT) is now known as Cognitive Behavioural Therapy (CBT).

This blog will briefly explain the two main schools of Cognitive and Behavioural Therapies.   Both have a scientific theory that can and has been tested, as well as a structured framework and process of therapy.   

Rational Emotive Behaviour Therapy (REBT)

REBT was founded in 1955 by Albert Ellis and has the longest history of any of the cognitive behaviour therapies listed above.   The often quoted phrase of Epictetus (Stoic Philosopher) “People are disturbed not by things but by their view of things” is at the heart of REBT. 

This quote is conceptualised by REBT’s ABC diagram of human disturbance.  It is not the event, but the belief or view you hold about the event, which is at the heart of emotional states and performance.  Emotions, thoughts, behaviours can be healthy and functional or dysfunctional. The event can be something that has happened in the past, something that is happening now or something that could happen in the future.  It can also be real, imaginary or internal or external.  Internal events can be thoughts, images, memories, physical sensations or even emotions.  For example, people can become depressed about their feelings of anxiety.  So anxiety in this example would be the A in the ABC diagram below and Depression would be the C in the ABC.

CBT, Event, Belief, Consequences Diagram

CBT, Event, Belief, Consequences Diagram

 

 

 Beliefs that are unhealthy have at their core explicit or implicit rigid, powerful demands and commands usually expressed  as MUSTs, SHOULDs, HAVE to’s, GOT to’s e.g. I absolutely must not be rejected.  Essentially, unhealthy demands are not based on what is possible in reality.  Therefore, certain unfavourable or undesirable possibilities are not accepted e.g. rejection.

 These demands also have powerful derivatives such as “If I am rejected, which I MUST not,

a) It’s awful (i.e. 100% bad)

b) It’s unbearable (i.e. can’t survive, cope or be happy at all)

c) It proves I am a worthless person.

So REBT is about:

  1. Helping a client understand their emotions, behaviour and goals,
  2. Identify their unhealthy or unhelpful beliefs that are sabotaging their happiness and goals,
  3. Challenge them and replace them with their healthier version in order to become undisturbed and eventually happy. 

REBT essentially helps clients develop resiliency and self acceptance by enabling them to face their worst case scenarios and their ‘what ifs’ rather than ignore them.  This can lead to a powerful philosophical shift which enables clients to focus on their desires, wants and wishes without becoming disturbed or stuck about the ‘what if’.  Clients then view setbacks and failures as purely temporary as opposed to life or soul destroying, while remaining motivated and focused on their desires and goals. 

 

Cognitive Behavioural Therapy (CBT)

Cognitive Behavioural Therapy is based on Aaron T Beck’s theory that our emotions and behaviour are influenced by the way we think and by how make sense of the world.  Our interpretations and assumptions developed from personal experience often conflict with external reality.   Beck encouraged his patients to focus their attention on their ‘automatic thoughts’.  This led him to reformulate concepts of depression, anxiety, phobias, and obsessive compulsive neuroses in terms of ‘thinking errors’.

The cause of the disturbance in Beck’s CBT is attributed to the following:

 1)      Schema.  This is similar to Ellis’ belief system in the ABC model.  Schema refers to ‘belief system’ or ‘network of beliefs’.  That system or network is made up of a host of beliefs about people, events, situations etc.  These schematic beliefs are maintained in a conditional form e.g. if I don’t win, I am a failure. 

2)      Law of Rules.  Our reactions to many situations are consistent, guided by a ‘set of rules’ which help us make sense out of the world. 

3)      Cognitive Errors.  Thinking errors or faulty thinking which are common to many psychiatric disorders.  All patients show distortion to reality to varying degrees.  For example, seeing things only in black and white or focusing on a specific detail whilst ignoring everything else and drawing conclusions from that.

Clients are helped test their assumptions and views of the world in order to check if they fit with reality.  When clients learn that their perceptions and interpretations are distorted or unhelpful they then work at correcting them. 

Difference

Both schools are open to influence from each other and in practice ideas from both can be utilised, as appropriate, to achieve successful outcomes for clients.  However REBT and CBT remain distinct.

 Testing Assumptions

 In REBT the client’s assumptions are assumed to be true and are not immediately put to a reality test.  In Beck’s CBT, the client’s assumptions are tested for validity first.  The reason for this is that REBT theory states that a client’s assumptions are a consequence of holding an unhealthy beliefs, so these assumptions are assumed to be true in order to ‘cut to the chase’ and identify the unhealthy beliefs.  It deals with the questions of ‘what if’ at the outset.

 

Treating symptoms or generalised philosophy?

CBT is based on the treatment of the symptom.  Whilst REBT also treats the symptom, in REBT, the aim is to effect ‘profound philosophic change and a radically new outlook on life’ (Albert Ellis) by transforming deeply held core beliefs about the self, others and the world.   

 However, a drawback to REBT may be that some clients may not like the model or its application.  CBT is more cautious and aims for some kind of improvement and return to normal functioning, symptom relief or symptom management but offers a variety of problem-solving techniques.  On the negative side, this approach misses the chance to offer a client a simple philosophy and the tools to become their own therapists when faced with different problems in the future. 

REBT or CBT, that is the question…

So, when it comes to REBT or CBT there is always a question for therapists. Should they use REBT, CBT or a combination of both?  At CCBH, we prefer REBT to CBT but not always, it will depend on the particular situation.

We know this has been a longer blog post, but hopefully it has been useful to you! Do ask any questions about REBT or CBT below…

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