Cognitive Therapy and the Emotional Disorders, Research Paper Example

During the 1960’s Aaron T. Beck, MD, a psychoanalyst, sought to empirically establish psychotherapy as a useful psychological tool. As such, he began a journey of experiments that, instead of establishing his hypothesis, made him question it. Through his experiments Beck found other impetus for depression that lead the young psychoanalyst to identify “distorted, negative cognition (primary thoughts and beliefs) as a primary feature of depression” (Beck, 2011, p. 1) and also made him develop short term therapy for such occurrences.

Beck’s form of treating depression through cognitive behavioral therapy was “structured, short-term, present-oriented psychotherapy” (Beck, 2011, p. 2). It was a completely new form of therapy. Beck formed the basis of cognitive behavioral therapy on a myriad of sources, not all coming from a medical background: a short list of these influences include Epicetus, Karen Horney, Alfred Adler, Richard Lazarus, and Albert Bandura ((Beck, 2011, p. 2). Although Beck’s cognitive behavioral therapy is based on these men’s ideas and practices, the therapy is also loosely based on other therapies including “rational emotional therapy (Ellis), dialectical behavior therapy (Linehan), problem-soling therapy (Hayes, Follette, & Linehan), exposure therapy (Foa &Rothbaum), cognitive processing therapy (Resick and Schnicke), cognitive behavioral analysis system of psychotherapy (McCullough), behavioral activation” etc. (Beck, 2011, p. 2-3). Cognitive behavioral therapy, as it is today, is used mainly in primary care facilities, schools, and all age ranges. It is used in group as well as individual therapy, with sessions ranging from 45 minutes or less (Beck, 2011, p. 3).

Cognitive therapy is defined as dysfunctional thinking, that in turn may drastically alter a patient’s state of mind so that their personal identifiers (personality traits) are all but wiped out from their mercurial state, is deemed as normal in psychological disturbances. An example of this includes bouncing checks that lead the patient to feel sad (emotion) to become so depressed that they retreat into their bedroom and seek the solace of sleep (reaction/behavior) (Beck, 2011, p. 3). Taking this one instance of behavior (bouncing checks) does not conclude to a state of being wherein the patient is “less” because of one occurrence of behavior. Cognitive behavioral therapy helps the patient to recognize this pattern and further recognize that this one instance does not establish their overall personal identifiers (personality traits) and therefore they’ve had an overreaction to an insular event. In recognizing this, the patient then is able to have better functional behavior. Thus, the cognitive therapist works on changing the structure of the basic beliefs that patients hold about themselves.

Beck ended and reported on his first study in 1977 emphasizing the efficacy of cognitive behavioral therapy. In Beck’s research he states that the common thread, or assumption, between all mental health schools of thought is that they hold the belief that the “emotionally disturbed person is victimized by concealed forces over which he has no control” (Beck, 1976, p. 2). Beck explains that this idea springs from the 19^th century “doctrine of pysicalism, traditional neuropsychiatry: (Beck, 1976, p. 2), and they search for biological causes to these emotional disturbances that occur on a chemical or neurological level (in regards to abnormalities). The treatment for such disturbances has been to placate patients with drugs. The patient’s disturbances, or neurosis, is attributed to the “unconscious psychological factors” (Beck, 1976, p. 2). Beck goes on to state that these unconscious elements are barricaded in the patient’s mind and the only way to effectively placate the patient is through psychoanalytic interpretation (Beck, 1976, p. 3). Thus, the 19^th century’s mode of using drugs or chemicals to relieve the patient’s neurosis is arcane by Beck’s new standards of study. Beck states that other therapies (grown from 18^th century ideas) “regards the emotional disturbance in terms of involuntary reflexes based on accidental conditioning that occurred previously in the patient’s life” (Beck, 1976, p. 3). Through this therapy, the patient is unable to retrain their responses as they have become ingrained or “accidently conditioned” (Beck, 1976, p. 3) from a patient’s earlier experiences. Beck states that such hypothesis or ways of thinking are wrong. Instead, Beck suggests that

“…a person’s consciousness contains elements that are responsible for the emotional upsets and blurred thinking that lead him to seek help. Moreover, let us suppose that the patient has at his disposal various rational techniques he can use, with proper instruction, to deal with these disturbing elements in his consciousness…Man has the key to understanding and solving his psychological disturbances within the scope of his own awareness” (Beck, 1976, p. 4).

Thus, the patient is able to help themselves through already instilled problem-solving capabilities. Beck states that this train of thought goes back thousands of years to the philosophical age of the Stoics “who considered man’s conceptions (or misconceptions) of events rather than the events themselves as the key to his emotional upsets” (Beck, 1976, p. 4). This is the basis for cognitive behavioral therapy, wherein a patient’s emotional distortions of reality are based on “erroneous premises” (Beck, 1976, p. 4). These premises lead to the patient’s aberrant image of themselves that in turn inhibit their cognitive learning capabilities and/or development.

This problem-solving capability has two major processes: problem orientation and problem solving skills (Dobson, 2010, p. 200). Problem-solving orientation is a “metacognitive process that primarily serves a motivational function in social problem solving” (Dobson, 2010, p. 200). The abilities adapted for patients for problem-solving involves “threat vs. challenge appraisals, self-efficacy beliefs, outcome expectancies” (Dobson, 2010, p. 200). These also involve a patient’s understanding of their world (mores, traditions, etc.) and finding ways to cope with problems through positive solutions. Cognitive behavioral therapy has four tenants by which patients do this: “problem solving definition and formulation, generation of alternative solutions, decision making, and solution implementation and verification” (Dobson, 2010, p. 200). The main tools for patients, by the above definition, are self-monitoring, and solution evaluation (Dobson, 2010, p. 200).

Due to cognitive behavioral therapy being a science involving human involvement, there may be problems that arise during the course of treatment either through the patient, the therapist, or the therapy. Therapist must first establish a “therapeutic alliance” (Beck, 2010, p. 346) with the patient in order to garner trust with them: without this alliance very little progress may be made within the 45 minute or less therapy session. The therapist may also “incorrectly conceptualize a patient’s difficulties” (Beck, 2010, p. 346), or the therapist and the patient may be at odds as to proper and productive course of action the patient should take. Cogntitive behavioral therapy is only as good as the therapist working in the session with the patient. Beck (2010) states that in order to curtail such problem, the therapist should listen to unsolicited feedback from the patient in order to better understanding other levels of problems, or by directly asking for a patient’s feedback about the sessions, by rating the sessions on the Cognitive Therapy Rating Scale, or even by “tracking progress according to objective tests and the patient’s subjective report of symptom relief” (Beck, 2010, p. 346). Most importantly, the therapist must not seek out blaming the patient for problems during the therapy session. This could negatively affect the patient’s progress and have a detrimental affect on the patient-therapist relationship (that is built strongly on trust).

Cognitive behavioral therapy’s efficacy is still under question. Right after Beck revealed his new therapy, Rush et al (1977) and well into the present century there have been tests done to determine the efficacy of Beck’s therapy. These tests revealed that under optimal conditions cognitive behavioral therapy may work quite well (Dobson, 2010, p. 307). The question remains whether or not these efficacy studies (both for and against cognitive behavioral therapy) overestimate or underestimate the therapy’s efficacy in settings such as mental hospitals, prisons, or one-on-one sessions, and the difference between each. The field calls for a more extensive study done on this therapy’s efficacy. Dobson (2010) points out that if such efficacy tests are to be done, that the first backing should come from the National Institute of Mental Health, and until they make such tests a priority, it is difficult to tell exactly how beneficial Beck’s cognitive behavioral therapy is for patients, and to the general practice of psychoanalysis. No proper critique of the problem can be accomplished until such tests are made necessary and prevalent in the field.

References

Beck, A. T. (1976). Cognitive therapy and the emotional disorders. New York: The Penguin Group.

Beck, J. S. (2010). Cognitive Therapy. New York: John Wiley & Son, Inc.

Beck, J. S. (2011). Cognitive behavioral therapy. New York: The Guilford Press.

Dobson, K. S. (2010). Handbook for cognitive-behavioral therapies. New York: The Guilford Press.