Cognitive therapy

From a carefully considered decision to end a relationship through to making a choice between jam or peanut butter on your morning toast - behind every action we take, big or small, life changing or seemingly trivial - is a complex cognitive process.

This process involves ideas, mental images, values and attitudes that come together to form subconscious and conscious thoughts that define our path.

While for many these processes will tick over naturally without causing any issues, for others negative patterns of thinking will develop - which if left to manifest can trigger or fuel certain health problems.

Cognitive therapy is based on the principle that thoughts and perceptions can impact our feelings and behaviour, and looks at ways to reassess negative thoughts so individuals can learn more flexible, positive ways of thinking that will subsequently influence behaviours.

This fact-sheet will cover traditional cognitive therapy (CT), rational emotive behaviour therapy (REBT) and mindfulness-based cognitive therapy (MBCT).

What is cognitive therapy?

Cognitive therapy (CT) is a therapeutic approach that sits within a larger group of cognitive and behavioural therapies. Origins of the approach lie in the restructuring therapy, rational emotive behaviour therapy (REBT), which was developed by Albert Ellis in 1955. The core principles behind cognitive therapy however tend to be most synonymous with the works of 20th century American psychiatrist, Aaron Beck. Beck identified that what usually held his clients back most were negative thoughts and beliefs. 

According to Beck, thoughts, feelings and behaviours are interconnected and by identifying and changing inaccurate thinking, problematic behaviour and distressing emotional responses, individuals can work towards overcoming their difficulties and meeting their goals.

Cognitive therapy involves therapists working collaboratively with clients to develop skills for identifying and replacing distorted thoughts and beliefs, ultimately changing the associated habitual behaviour towards them. It is usually focused on the present and is a problem-solving orientated treatment.

When individuals are in distress they often can't recognise that their thoughts are inaccurate, so cognitive therapy helps them to identify these thoughts and re-evaluate them.

For example, if an individual makes a minor mistake they may think “I'm useless, I can't do anything right”. This negative thought pattern may then trigger a cycle, whereby the activity where a mistake was made is avoided and this act in itself works to further cement the negative behaviour.

Addressing and reassessing this negative thought pattern however, paves the way for more flexible ways of thinking, increased positivity and a willingness to take on activities that will challenge negative beliefs.

Cognitive therapy also takes on a skill-building approach, meaning that the therapist will help the client to learn and practice these skills independently so that they can continue to reap the benefits long after their one-to-one sessions have ended.

Cognitive theory

Aaron Beck is considered the founding father of cognitive therapy and his theory and model continue to form the foundations of many cognitive and behavioural therapy approaches used today.

When working with patients suffering from depression, Beck found that they commonly experienced a deluge of negative thoughts that presented themselves spontaneously. He dubbed these cognitions "automatic thoughts", and discovered that their content fell into three categories:

  1. Negative ideas about themselves.
  2. Negative thoughts about the world.
  3. Negative thoughts about the future.

From his studies Beck concluded that time spent reflecting on these cognitions would generally lead to patients treating them as valid. In response, he began to help clients to re-evaluate these thoughts and think more realistically, leading to improvements in emotional and behavioural functionality.

According to Beck, successful interventions educate a person to recognise and be aware of their distorted thinking and will challenge its effects.

Today, cognitive therapy is more commonly known as cognitive behavioural therapy (CBT), due to it being almost exclusively practiced in tandem with behavioural principles - though some therapists do still offer cognitive therapy as a standalone.

This type of therapy is most commonly used for the treatment of anxiety disorders and depression, though it may be suitable in some other situations where negative patterns of thinking have developed. 

Rational emotive behaviour therapy (REBT)

Albert Ellis is another therapist who reached similar conclusions to Beck regarding negative beliefs and their tendency to lead to self-defeating/self-sabotaging behaviours. In response to his research, Ellis developed a form of cognitive therapy known as rational emotive behaviour therapy (REBT) - an action-oriented approach to managing irrational beliefs and behaviours.

REBT employs a simple ABC framework that outlines the relationship between events, beliefs and consequences:

A) Activating event

The event and our perception of the event, for example: An individual is passed on the street by a friend who does not acknowledge him - this is perceived by the individual as being ignored and/or disliked.

B) Beliefs

Our evaluation of the event and our rational or irrational belief relating to the event, for example:

  • I could end up with no friends
  • to feel happy, people must like me
  • I'm a terrible friend so I must be worthless as a person.

C) Consequences 

The emotions, behaviours and thoughts stirred by the event, for example:

  • Emotions - Depressed and lonely.
  • Behaviours - Avoiding/ignoring people.

REBT uses the framework above to help individuals address unhealthy emotions and behaviours such as those outlined, working to identify personal beliefs that frequently lead to emotional distress so that they can be reformulated.

REBT can be effective for the treatment of a range of psychological disorders, including anxiety disorders and phobias as well as specific behaviours such as shyness or a constant need for approval.

While approach will differ from therapist to therapist, REBT often involves the counsellor adopting a directive role, challenging a client's irrational beliefs and often issuing assignments which could help individuals overcome negative thoughts. 

Mindfulness-based cognitive therapy

Mindfulness-based cognitive therapy (MBCT) was developed with the aim of reducing relapse and recurrence of depression in those who are vulnerable to episodes. The technique employs traditional cognitive therapy methods and uses them in tandem with newer psychological strategies such as mindfulness and meditation.

The former will help to educate individuals about depression, while mindfulness and meditation will focus on raising awareness of feelings and thoughts and accepting them, but not reacting or attaching to them.

The therapy was originally developed by John Teasdale, Zindel Segal and Mark Williams and is based on Jon Kabat-Zinn’s Mindfulness-based Stress Reduction programme. Generally speaking, MBCT commonly takes the form of eight weekly classes and a one day-long class after the fifth week.

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