TOPIC 11: APPLICATION OF COGNITIVE BEHAVIOUR THERAPY (CBT) IN COUNSELLING SESSION

Introduction Cognitive behavior therapy (CBT) is a type of psychotherapeutic treatment that helps patients to understand the thoughts and feelings that influence behaviors. CBT is commonly used to treat a wide range of disorders, including phobias, addiction, depression and anxiety. Cognitive behavioural therapy (CBT) is aimed to help you manage your problems by changing how you think and act. CBT encourages you to talk about:

how you think about yourself, the world and other people how what you do affects your thoughts and feelings. CBT can help you to change how you think (cognitive) and what you do (behaviour), which can help you feel better about life. CBT can help you see how your thoughts and behaviour relate to the way you feel, and how this might contribute to problems in your life. Your therapist will help you find ways to change your thought patterns and behaviour so you can cope with your problems and anxieties better . CBT cannot remove your problems, but can help you to manage them in a more positive way. CBT is thought to be one of the most effective treatments for anxiety and depression.

Cognitive Behavior Therapy Basics The underlying concept behind CBT is that our thoughts and feelings play a fundamental role in our behavior. For example, a person who spends a lot of time thinking about plane crashes, runway accidents and other air disasters may find themselves avoiding air travel. The goal of cognitive behavior therapy is to teach patients that while they cannot control every aspect of the world around them, they can take control of how they interpret and deal with things in their environment. Cognitive behavior therapy has become increasingly popular in recent years with both mental health consumers and treatment professionals. Because CBT is usually a short-term treatment option, it is often more affordable than some other therapeutic options. CBT is also empirically supported and has been shown to effectively help patients overcome a wide variety of maladaptive behaviors.

Types of Cognitive Behavior Therapy

According to the British Association of Behavioural and Cognitive Psychotherapies, "Cognitive and behavioural psychotherapies are a range of therapies based on concepts and principles derived from psychological models of human emotion and behaviour. They include a wide range of treatment approaches for emotional disorders, along a continuum from structured individual psychotherapy to self help material." There are a number of different approaches to CBT that are regularly used by mental health professionals. These types include:

Rational Emotive Therapy Cognitive Therapy Multimodal Therapy

The Components of Cognitive Behavior Therapy People often experience thoughts or feelings that reinforce or compound faulty beliefs. Such beliefs can result in problematic behaviors that can affect numerous life areas, including family, romantic relationships, work and academics. For example, a person suffering from low self-esteem might experience negative thoughts about his or her own abilities or appearance. As a result of these negative thinking patterns, the individual might start avoiding social situations or pass up on opportunities for advancement at work or at school. In order to combat these destructive thoughts and behaviors, a cognitive behavior therapist begins by helping the client to identify the problematic beliefs. This stage, known as functional analysis, is important for learning how thoughts, feelings and situations can contribute to maladaptive behaviors. The process can be difficult, especially for patients who struggle with introspection, but it can ultimately lead to self-discovery and insight that are an essential part of the treatment process. The second part of cognitive behavior therapy focuses on the actual behaviors that are contributing to the problem. The client begins to learn and practice new skills that can then be put into use in real-world situations. For example, a person suffering from drug addiction might start practicing new coping skills and rehearse ways to avoid or deal with social situations that might trigger a relapse. In most cases, CBT is a gradual process that helps a person make incremental steps towards a behavior change. Someone suffering from social anxiety might start by simply imagining himself in an anxiety-provoking social situation. Next, the client might start practicing conversations with friends, family and acquaintances. By progressively working toward a larger goal, the process seems less daunting and the goal seems easier to achieve.

Who can use it CBT is particularly helpful in tacking problems such as anxiety, depression, post-traumatic stress disorder, eating disorders and drug misuse. Unlike other talking treatments, such as psychotherapy, CBT focuses on the problems and difficulties you have now, rather than issues from your past. It looks for practical ways you can improve your state of mind on a daily basis. Number of Sessions Cognitive behavior therapy is generally short-term and focused on helping clients deal with a very specific problem. During the course of treatment, people learn how to identify and change destructive or disturbing thought patterns that have a negative influence on behavior.CBT usually involves weekly or fortnightly sessions with a therapist. The number of sessions required varies greatly depending on your problems and objectives, with treatment usually lasting from six weeks to six months.

CBT Techniques

Cognitive Rehearsal: In this technique, the patient is asked to recall a problematic situation of the past. The therapist and patient work together to find out the solution to the problem or a way in which the difficult situation if occurs in the future may be sorted out. Validity Testing: It is one of the CBT techniques in which the therapist tests the validity of beliefs or thoughts of the patient. Initially, the patient is allowed to defend his viewpoint by means of an objective evidence. The faulty nature or invalidity of the beliefs of the patient is exposed if he is unable to produce any kind of objective evidence. Writing in a Journal: It is the practice of maintaining a diary to keep an account of the situations that arise in day-to-day life. The thoughts which are associated with these situations and the behavior exhibited in response to them are also mentioned in the diary. The therapist along with the patient reviews the diary/journal and finds out the maladaptive thought pattern and how do they actually affect the behavior of an individual. Guided Discovery: The objective/purpose behind using this technique is to help the patient and enable him understand his cognitive distortions. Modeling: It is one of the cognitive behavioral therapy techniques in which the therapists performs role-playing exercises which are aimed at responding in an appropriate way to overcome difficult situations. The patient makes use of this behavior of the therapist as a 3

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Homework: The homework is actually a set of assignments given by therapists to patients. The patient may have to take notes while a session is being conducted, review the audiotapes of a particular session or he may have to read article/books that are related to the therapy. Aversive Conditioning: Among the different CBT techniques used by therapists, the aversive conditioning technique makes use of dissuasion for lessening the appeal of a maladaptive behavior. The patient while being engaged in a particular behavior or thought for which he has to be treated, is exposed to an unpleasant stimulus. Thus, the unpleasant stimulus gets associated with such thoughts/behaviors and then the patient exhibits an aversive behavior towards them. Systematic Positive Reinforcement: The systematic positive reinforcement is one of the cognitive behavioral therapy techniques in which certain (positive) behaviors of a person are rewarded with a positive reinforcement. A reward system is established for the reinforcement of certain positive behaviors. Just like positive reinforcement helps in encouraging a particular behavior, withholding the reinforcement deliberately is useful in eradicating a maladaptive behavior.

What conditions can be helped by cognitive behavioural therapy? CBT has been shown to help people with various conditions - both mental health conditions and physical conditions. For example: Certain anxiety disorders, including phobias, panic attacks and panic disorder. Depression. Eating disorders. OCD. Body dysmorphic disorder. Anger. Post-traumatic stress disorder. Sexual and relationship problems. Habits such as facial tics. Drug or alcohol abuse. Some sleep problems. Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME). Chronic (persistent) pain. As a rule, the more specific the problem, the more likely CBT may help. This is because it is a practical therapy which focuses on particular problems and aims to overcome them. CBT is sometimes used alone, and sometimes used in addition to medication, depending on the type and severity of the condition being treated.

What is likely to happen during a course of cognitive behavioural therapy? The first session of therapy will usually include time for the therapist and you to develop a shared understanding of the problem. This is usually to identify how your thoughts, ideas, feelings, attitudes, and behaviours affect your day-to-day life. You should then agree a treatment plan and goals to achieve, and the number of sessions likely to be needed. Each session lasts about 50-60 minutes. Typically, a session of therapy is done once a week. Most courses of CBT last for several weeks. It is common to have 1015 sessions, but a course of CBT can be longer or shorter, depending on the nature and severity of the condition. In some situations CBT sessions can be done by telephone. You have to take an active part, and are given homework between sessions. For example, if you have social phobia, early in the course of therapy you may be asked to keep a diary of your thoughts which occur when you become anxious before a social event. Later on you may be given homework of trying out ways of coping which you have learned during therapy. How well does cognitive behavioural therapy work? CBT has been shown in clinical trials to help ease symptoms of various health problems. For example, research studies have shown that a course of CBT is just as likely to be effective as medication in treating depression and certain anxiety disorders. There may be long-term benefits of CBT, as the techniques to combat these problems can be used for the rest of your life to help to keep symptoms away. So, for example, depression or anxiety are less likely to recur in the future. There is good research evidence too to show that CBT can help to improve symptoms of some physical conditions such as rheumatoid arthritis. What is the difference between cognitive behavioural therapy and other talking treatments? CBT is one type of psychotherapy (talking treatment). Unlike other types of psychotherapy it does not involve talking freely, or dwell on events in your past to gain insight into your emotional state of mind. It is not a "lie on the couch and tell all" type of therapy. CBT tends to deal with the here and now - how your current thoughts and behaviours are affecting you now. It recognises that events in your past have shaped the way that you currently think and behave. In particular, thought patterns and behaviours learned in childhood, However, CBT does not dwell on the past, but aims to find solutions to how to change your current thoughts and behaviours so that you can function better now and in the future. CBT is also different to counselling, which is meant to be non-directive, empathetic and

supportive. Although the CBT therapist will offer support and empathy, the therapy has a structure, is problem-focused and practical. What are the limitations of cognitive behavioural therapy? CBT does not suit everyone and it is not helpful for all conditions. You need to be committed and persistent in tackling and improving your health problem with the help of the therapist. It can be hard work. The homework may be difficult and challenging. You may be taken 'out of your comfort zone' when tackling situations which cause anxiety or distress. However, many people have greatly benefited from a course of CBT. Do-it-yourself cognitive behavioural therapy Although CBT with the help of a trained therapist is best, some people prefer to tackle their problems themselves. There are a range of books and leaflets on self-help for the problems which CBT is useful for (anxiety, phobias, depression, etc). More recently, interactive CDs and websites are being developed and evaluated for self-directed CBT for a variety of conditions. See the resources below for further details. Living Life to The Full Web: www.llttf.com The Living Life to the Full course is a web-based life skills course that aims to provide access to high-quality, practical and user-friendly training in life skills. The course has been written by a psychiatrist who has many years of experience using a CBT approach and also in helping people use these skills in everyday life.

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