Cognitive Therapy

Cognitive Therapy (CT) is a form of psychological treatment used by psychologists to treat a range of mental health problems. Cognitive therapy involves identifying negative thoughts and thinking patterns and attempts to change these, replacing the negative thoughts with more healthy positive thoughts. It is more than just "positive thinking" though.

Cognitive therapy was originally developed by Albert Ellis and Aaron Beck. Albert Ellis in 1957 formally set forth the first cognitive behaviour therapy (CBT) by proposing that therapists help people adjust their thinking and behaviour as the treatment for emotional and behavioural problems. Aaron Beck developed cognitive therapy in the early 1960s, as a psychiatrist at the University of Pennsylvania .

Aaron Beck and his co-authors (Beck, Rush, Shaw and Emery) published their book on the cognitive therapy of depression in 1979. They then developed a cognitive treatment plan for anxiety. They identified different patterns of thinking in anxiety and depression. They hypothesised that depression was mainly concerned with loss, whereas anxiety arose because of a perception of physical or psychosocial threat. Other psychologists further developed the models of anxiety and panic. In particular, Clark, in 1986 developed a cognitive model of panic. Since then psychologists have worked at the models of thought problems in anxiety and there has been a vast improvement in the detail and precision of the models and the techniques used. Especially in the links between the different anxiety disorders and the nature of the vicious cycles of thinking that maintain them. Treatment has become more effective, and treatment objectives have become clearer. The central cognitive mechanisms have become better developed and clearer. Psychologists have published further papers refining the knowledge of treatment to a better level.

Cognitive therapy (CT) and cognitive behavioural therapy (CBT) have become two of the most used and effective treatments for anxiety and depression.

From a psychologists point of view, anxiety disorders arise because of shared common underlying thought processes. The treatment by psychologists involves various interventions to tackle these negative patterns such as: reducing avoidance behaviour, dropping safety-seeking behaviours, challenging negative cognitions, cutting out rumination and worry, carrying out behavioural experiments, redirecting attention, distraction techniques, and reflecting on input from memory in the form of memories and images.

So what does this mean in practice?

In simple terms, cognitive therapy is based on three principles.

  1. Firstly, teaching the anxiety sufferer that the view of the world that you "choose" is essential to your mood. The word "choose" is very important, because, if you believe in free will, our viewpoint is, to a large extent, a matter of choice.
  2. Secondly, there is the principle that mood and thought are connected. If you change your thoughts, you alter your mood, for better or worse.
  3. The third principle involves "working" on your thoughts and beliefs.

Cognitive therapy is effective in improving mood and easing anxiety, not by working directly on your mood, but on the thoughts that affect your mood. By improving your thinking, you can lift and calm your mood.

Lesson 1 – Your viewpoint is vital to your mood.

We all have our own views of the world, people and events happening around us. If you move to a new area, you quickly form an opinion about the place. "the area is beautiful", the people are friendly", "I don't like it here", "life here is much less/more stressful than where we were before" etc.

If we go away on holiday or travel, we quickly form opinions about the place or country we are visiting. We all develop our own particular view of a place based on our unique (and limited) experiences. These experiences are filtered and interpreted in our own unique way. Our filtering and interpretation lead to our opinions and conclusions about the world around us.

Travel can be exciting and refreshing because of the new sights and experiences. When we return home to daily routine, it is easy to lose sight of this point. We return to our old and habitual ways of thinking and seeing the world, and forget that our view is only one way of looking at things.

Imagine two scenarios:

You come back from holiday rested and refreshed. You throw yourself back into daily life, work and family life with renewed vigour and enthusiasm. Everything goes well. You are more productive at work, your family are happy with your new cheerful mood, you get a promotion and pay rise. You are happy and pleased with your success and your good mood continues and pervades your life and affects those around you. You feel successful and happy.

Now imagine a different set of circumstances and events. You return from holiday full of energy and enthusiasm. But, events outside of your control mean that things go badly wrong. Maybe, due to the economy, people are made redundant, you lose your job, a family member becomes seriously ill. You are in a bad car accident. There was nothing that you could have done to prevent these things from taking place. They were not your fault and outside of your control. However, you blame yourself, feel helpless and consider yourself a failure. You are filled with mixed emotions: frustration, anger, sadness, resentment amongst others. These feelings pervade your life.

Now, in the first scenario, you see yourself as a success. In the second as a failure. In both situations this point of view seems to be the one and only truth. But, this does not have to be the case. It is not so. When you move or travel there are many perspectives. Some of these views may fit the facts better than others, or be more or less helpful to us, but each individual's viewpoint has its distortions and limitations.

Someone who is very financially successful at work, may achieve their success at the expense of personal relationships. Someone made redundant may be a successful parent, local community member or friend. There are many ways at looking at people and their lives. The essential message is that there is always more than one way of looking at life. Not just at times, but always!

It often feels like we have no choice, but this is an illusion. So, when you are feeling low or worried, ask yourself: "Is there another way I could look at this?" "How would so and so look at this?" "Are there any other points of view?" "What are the other viewpoints?" etc. Reflecting on and answering these questions is a useful mental exercise. It challenges you to expand your perspectives, to think flexibly and to search for an alternative point of view that lifts and calms your mood. To be completed soon...

References:

Clark, D.M. (1986). A cognitive approach to panic. Behaviour Research and Therapy, 24, 461-470.

Clark, D.M. (1999). Anxiety disorders: Why they persist and how to treat them. Behaviour Research an Therapy, 37, S5-S27.

Clark, D.M. (2004). Developing new treatments: On the interplay between theories, experimental science and clinical innovation.

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