Cognitive Therapy

On average, 95 percent of our thoughts are recycled, meaning most of them have already crossed our minds at least once before. Without noticing it, we can form harmful thought patterns that can lead to emotional distress.

If our friends told us they were weak because they couldn't lift 300 lbs, we would consider this thought irrational. Yet, it's easy for us to tell ourselves we're not smart enough when we get our first B+ on an exam.

• We will begin by defining cognitive therapy and the contributions of Albert Ellis and Aaron Beck.
• Then, we will discuss the primary goals of cognitive therapy followed by common techniques used in therapy.
• We will explore examples of cognitive therapy.
• We will conclude by outlining an effective form of cognitive therapy, called cognitive processing therapy (CPT).

Cognitive Therapy Definition

Cognitive therapy is a type of psychotherapy that focuses on changing a person's thinking. This is based on the assumption that our thoughts influence our feelings. Unlike other forms of psychotherapy such as psychoanalysis, cognitive therapy focuses on the present rather than events of the past. Cognitive therapies suggest that dwelling on self-blaming or self-deprecating thoughts feeds depression and prolongs negative thinking. Since we think with words, changing how a person talks to themselves can help reshape their thinking and thereby their functioning.

Albert Ellis's Rational-Emotive Behavior Therapy (REBT)

Albert Ellis's rational-emotive behavior therapy (REBT) set the framework for cognitive therapies. Ellis found that problems often arise due to irrational thinking. He used a confrontational approach to therapy that challenged people's illogical assumptions and self-defeating attitudes. He found that people often assume that their emotions are caused by an event rather than their thinking. Therefore, in REBT, therapists regularly use a technique called "disputing" in which they work to help the client realize that their thoughts are the cause of their depression, not the event itself.

Even the most successful people have failed many times. This does not make them failures. Pixabay.com

Aaron Beck's Cognitive Therapy for Depression

While some credit Ellis as the first to develop cognitive therapy, others cite Aaron Beck for initially using the technique to treat individuals with depression. While doing so, he realized that there is a therapeutic benefit to challenging a person's harmful automatic thought patterns. He sought to help clients reverse their negativity towards themselves, their situations, and their futures.

Today, cognitive therapies are used to treat several mental health conditions other than depression including anxiety, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), bipolar disorder, eating disorders, panic attacks, addiction, and anger. They are not only helpful in treating mental health conditions but also in supporting people through life challenges such as a breakup, chronic illness, low self-esteem, grief or loss, stress, or guilt.

The Goal of Cognitive Therapy

Cognitive therapy has several goals geared towards helping people discontinue destructive thought patterns. They include:

• Identify core schemas and beliefs as well as negative and automatic thought patterns.

• Understand the role of schemas and confirmation bias in affecting attention to problematic beliefs.

• Reverse the client's negative thoughts about themselves, their situation, or their future.

• Teach people new and adaptive ways of thinking.

• Offer more constructive ways in which the client can perceive and interpret events.

What Are Some Cognitive Therapy Techniques?

One of the best ways for a therapist to challenge the thinking of a client is to utilize gentle questioning to reveal irrational thinking. Cognitive therapy uses techniques geared towards revealing, testing, and changing the client's beliefs.

Reveal Beliefs

First, a therapist may begin by questioning the client's interpretations. These questions are meant to guide the client in discovering their cognitive distortions, exploring their beliefs, and revealing faulty assumptions. They may ask the client to rank their thoughts and emotions from mild to extreme to gain a clear perspective on the client's distress. Journaling is a common way in which cognitive therapists try to facilitate the revealing of the client's beliefs.

Journaling is a common technique used in cognitive therapy. Freepik.com

Test Beliefs

Once the client's beliefs are revealed, the cognitive therapist will start to pick them apart. They may have the client engage in validity testing in which they are required to defend their thoughts and beliefs. When they are unable to present acceptable evidence supporting their assumptions, it exposes them as invalid and faulty.

Another way in which a cognitive therapist may test a client's beliefs is through decatastrophizing.

When using decatastrophizing as a technique, the therapist will guide the client in an exercise in which they are asked to imagine a difficult situation from the past. Then, they work together to practice successful ways to cope with that problem. The goal is for the client to be able to better handle dealing with a similar situation.

Change Beliefs

Finally, once the client has identified their beliefs and found ways in which they may be responsible for how they feel, they are ready to apply this knowledge and change their beliefs. The therapist may begin this process by helping the client resist extremes, and instead find replacements for their self-destructive thought patterns. For example, thoughts like "I will never be successful" will shift to "Even though I didn't get promoted this time, I can make changes so my hard work will pay off one day." The therapist may even assign homework to help the client work through these changes.

Examples of Cognitive Therapy

Cognitive therapy can be applied in several ways to promote better functioning and emotional regulation. According to Turner (2016), REBT is proven to be effective in helping athletes reduce irrational thinking. Athletes are at risk of forming these beliefs due to their socialization within a competitive environment. For this reason, engaging the athlete's coaches and parents in their therapy can be an effective way to counteract the irrational thinking they are exposed to regularly.

Cognitive therapy is commonly integrated with other forms of therapy such as behavioral therapy. Cognitive behavior therapy, for example, seeks to treat both the client's destructive thinking as well as their destructive behaviors or actions in connection to their thinking. Ellis (2011) thought that the positive work in therapy should be backed by action.

What is Cognitive Processing Therapy?

Cognitive processing therapy (CPT) is an extension of cognitive-behavioral therapy that is specifically geared toward people who have endured some form of trauma including child abuse, natural disasters, combat, or rape. The goal is to help the client discover the conclusions they have drawn about themselves and the world as a reaction to their trauma. For example, many survivors of trauma might have the false belief that what happened to them was their fault. To process and organize these thoughts, a cognitive processing therapist will often suggest that client engage in several forms of writing.

Cognitive processing therapy is an effective way to treat PTSD experienced by soldiers. Freepik.com

This evidence-based treatment only lasts for 12 sessions and can be in the form of either individual or structured group sessions. Here is an example of how the sessions in cognitive processing therapy may progress.

1. Client becomes aware of the relationship between thoughts and emotions. The therapist will have them write an impact statement outlining why they believe the traumatic event occurred, as well as ways in which the traumatic event impacted their view of themselves, others, and the world.

2. Processing of the trauma. The therapist and the client work together to uncover areas in which the client is stuck in their thinking. The therapist will ask the client to write a detailed account, including thoughts, feelings, and sensory details, of the most difficult part of the traumatic event. The goal is to have a dialogue with the client to help them get unstuck and to a more balanced perspective of past, present, and future events.

3. Evaluate and modify beliefs. Towards the end of the treatment, the focus will shift toward helping the client find tools that will facilitate continued healing.

   It is important to note here that CPT is not meant to miraculously cure someone of their trauma, but rather reframe their thinking so they are better able to cope with the lingering effects of their trauma.