Fundamental Elements of CBT


Cognitive Behavior Therapy

Donna O’Hara

Argosy University

Rough Draft

Fundamental Elements of CBT

According to Juarascio, Forman, and Herbert (2010), the broad nature of CBT (Cognitive Behavior Therapy) defies the use of any single/clear definition. The author’s idea concurs with the ABCT’ (Association for Behavioral and Cognitive Therapies, the international organization committed to the advancement of CBT), which escapes the use of any precise definition. Instead, the organization identifies its mission as advancing the scientific methods that target the clarification of many issues in the human condition (ABCT, n.d.). However, CBT therapies have special characteristics which make them unique in the presence of other psychotherapies. For instance, therapists form a collaborative working relationship with clients to identify the root causes of problems and challenge them. They believe that the problems/disorders originate from maladaptive cognitions which result from faulty perceptions about the world and its components (Cully & Teten, 2008). Comment by Donna O’Hara: Not sure it captures the clinical purpose of this assignment

Hofmann, Asmundson, and Beck (2013) contend that maladaptive cognitions comprise of general perceptions, attitudes or schemas concerning the humankind, self, the environment or the future which spark routine thoughts in a defined set of situations. Additionally, the therapy focuses on the present rather than the past and emphasizes on principles regarding how the clients interpret the world (Cully & Teten, 2008). Personality development is a result of internal thoughts and cognitions that define an individual’s worldview. Lastly, Hofmann (2011) argues that CBT is an umbrella term for many interventions that use an effective combination of cognitive, behavioral, and emotion-focused methods in psychotherapy. In this case, rational behavior represents facts and helps individuals feel as they would like and to achieve goals.

The concepts behind modern CBT were founded by Aaron Beck. Hayes and Hofmann (2017) argues that CBT’s history has three different generations that tend to overlap. The first generation comprises of the research by Skinner, Wolpe, and Eysenck who were concerned with the prevalent limitations of psychoanalytic therapy. The scholars used operant conditioning principle to study behavior modification primarily by using experiments with animals. In the second generation, Ellis’ (1962) and Beck, Rush Shaw, and Emery (1979) developed the rational emotive behavior therapy and the cognitive therapy respectively to illustrate the significance of language and cognition in psychopathology. They focused on the effects emotional interpretations in shaping the experiences of people. At this stage, clinical trials were used to test the efficacy of treatment programs. Comment by Donna O’Hara: year Comment by Donna O’Hara: year Comment by Donna O’Hara: such as????

On the other hand, the 3rd generation occurred in the 1990s- a period where significant concepts of psychological acceptance and mindfulness were introduced to CBT (Hayes & Hofmann, 2017). It also studied the roles of language and cognition in psychotherapy. However, unlike, the second generation, it focused on developing non-judgmental acceptance attitudes and a total experience to counter troubling situations. It also integrates the use of both clinical trials, theoretical principles and applied technologies.

Personal Worldview

I believe that all human beings are equally important and that the challenges of life can be confronted cooperatively rather than individually. I also believe that interpersonal relationships can only be maintained by showing positive regard towards other people. At this point, we should strive to make the other person whom we are interacting with feel connected and appreciated. Additionally, the interpersonal relationships should be characterized by the right of choice, a non-judgmental approach, collaboration, and independent decision making. I rarely judge people based on culture, race or religion and I can therefore interact with individuals from diverse origins. Comment by Donna O’Hara: Not clear how this is relevant to CBT, consider revising

Ideally, CBT entails the active participation of both the client and the patient to identify problems and think up positive solutions (Hoffman, 2011). Therefore, CBT aligns with my personal worldview which values positive regard, choice, and collaboration in interpersonal relationships. For this reason, interpersonal skills would be in a better position to establish strong therapist-client working relationships promptly. The relationships will help in connecting with the client and presenting relevant information clearly using culturally sensitive examples that align with the client’s worldview. Additionally, the structuring of sessions and homework will be completed through collaboration with the patient to ensure that the client’s preferences regarding time and finances are integrated to the resultant decisions (Kathryn McHugh, 2010).

Multicultural Issues

CBT is founded upon the belief that therapy should be tailored to address the problems of an individual client (Cully & Teten, 2008). This implies that therapists can focus on the uniqueness of the client in terms of ethnicity, religion or culture. It therefore provides tools for tailoring therapy towards multicultural effectiveness. Secondly, the therapy also focuses on client empowerment by encouraging patients to make changes by themselves in an environment where they control their own thoughts. Indeed, the therapist helps the client to acquire new skills but provides avenues to ensure that the client applies them independently. The approach to therapy fosters a collaborative relationship that appreciates cultural differences between the client and the therapist.

Thirdly, CBT is concerned with conscious processes and specific behaviors rather than the unconscious processes (Cully & Teten, 2008). As a result, therapists can choose to use an interpreter when dealing with diverse clients. The therapy sessions could also use the client’s second language. In this case Bhardwaj (2016) argues that emotional distress decreases at a faster rate when the second language is used. Comment by Donna O’Hara: More informative here

From a different perspective, the use of a series of assessments throughout the course of therapy allows the client to prescribe certain measures such as his/her family views on progress (Bhardwaj, 2016). In addition, the therapist shows respect towards the opinions of the client to promote multicultural counseling. Lastly, the use of collaborative relationship with the client to advance therapy enhances creativity and flexibility in counseling. Consequently, counselors can change their approaches depending on the parameters of cultural sensitivity (Kathryn McHugh, 2010).

CBT’s Effectiveness

Hofmann, Asnaani, Vonk, Sawyer, and Fang (2012) assessed 106 meta-analyses that scrutinized the use of CBT in children and elderly adults. CBT was identified as the most preferred technique in the handling of anxiety in children and adolescents where the effect sizes were of a large range. In addition, better outcomes were found for the treatment of obsessive compulsive disorder when compared to alternative therapies and medications. In cases of depression, the data for children was not very convincing as it ranged in medium effect size. CBT for suicidal behaviors had scarce results which warranted more research. On the other hand, CBT exhibited limited efficacy relative to pharmacological approaches in treatment of disruptive class behavior, aggressive and antisocial behaviors (Hofmann, Asnaani, Vonk, Sawyer, and Fang, 2012). In this context, it efficacy was like other psychotherapies or no treatment at all. Moreover, the results were like hyperactivity disorders which exhibited less efficacy than medications. On the other hand, the efficacy in treatment of adolescent smoking behavior was not more than other psychotherapies. The results for motivational enhancement therapies were similar.

In elderly adults, CBT proved to be more efficacious than waiting list control conditions in treating depression. However, efficacy matched other active treatment methods such as reminiscence, psychodynamic therapy and interpersonal therapy (Hofmann, Asnaani, Vonk, Sawyer, and Fang, 2012). In most cases, the instances where CBT was efficacious for depression were characterized by an 11-months follow-up. On the other hand, CBT failed to increase the effectiveness of anti-depressants when used as an adjunct. Lastly, CBT was more efficacious for anxiety disorders when compared to other treatment methods as it successfully alleviated accompanying symptoms of depression and worry. Comment by Donna O’Hara: Need citation to support information

Limitations of CBT

First of all, CBT may not be applicable for patients with learning difficulties or complex mental health difficulties (Cully & Teten, 2008). The techniques of CBT are aimed at making the client an active participant in the counseling relationship. At the same time, the therapist has the obligation of teaching the client certain skills that would help them probe their problems and understand the root causes. For this reason, learning difficulties inherent in the client would impede the progress of therapy. Complex mental health problems also discourage the active participation of the patient since they may not connect with the therapist’s guidelines. Comment by Donna O’Hara: The author

Secondly. Cully and Teten (2008) argue that though CBT has been tested for efficacy in adolescents/teens, its application may not be suitable for young children. In this case, it would be inappropriate for the therapist to trust a child in the independent application of cognitive restructuring techniques. Thirdly, this type of therapy disregards the use of personal history and family issues which could be the underlying causes of the psychological problems. Instead, it traces cognitive distortions which may not be the ideal source of problems. The focus of the present and disregard of the past is also a major limitation of CBT. Sometimes the problems that people face are more relevant when they revisit their past (Kathryn McHugh, 2010).

On the other hand, wider emotional problems can be caused by other factors rather than distorted thinking patterns. The use of CBT can therefore result to relapses in emotional and mood disorders after successful treatment. Lastly, the extra work such as journaling that is allotted to the client can be time consuming and a hindrance to effective counseling (Cully & Teten, 2008).

The ACA Ethical Standards

The ethical standards C.7.c (Harmful Practices), C.7.a (Scientific Basis for Treatment) and C.7.b (Development and Innovation) require counselors to apply techniques that are fit for the presenting problems (ACA, 2014). First, counselors must stick to the use of therapies that have a scientific foundation. They are also prohibited from adopting techniques that have been determined to cause harm irrespective related client’s requests. Lastly, the development and innovation in psychotherapy is allowed only when it causes no harm to the client. The standards imply that therapists should only practice within the boundaries of recognized theoretical perspectives that have been tested for consistency. Otherwise, they can cause harm to the client. Comment by Donna O’Hara: Nee to address competency assessment as related to the theory

The possible harm that can result from the use of unsuitable approaches includes the risk of suicide or the deterioration of the mental health and medical health problems. For instance, a therapist who misdiagnose the client can lead to the wrong therapy approach as well as the psychiatrist prescribing the wrong medication. It works hand in hand and the medication can cause depression, seizures, mental breakdown and death of the patient in the worst-case scenarios. Additionally, the use of wrong therapies can increase the client’s suffering due to sustained symptoms. Also, causing unnecessary expense and time wasted with possibly no progress made after multiple sessions of therapy.

Application of Theoretical Techniques

The first theoretical technique that I would use is behavioral activation. It functions as a catalyst to improve access to reinforcement for the improvement in mood and functioning (Cully & Teten, 2008). In this way, the therapist can observe the characteristics that function to maintain the patient’s problem> For instance, if the fictitious need is depression, I would be interested in specific symptoms such as hopelessness and fatigue. However, for a fictitious problem, these symptoms would be less pronounced. In my case, I would use pleasant activities such as increasing the client’s physical confidence and active coping to decrease stress. Thereafter, the working relationship where the patient is an active participant would be used for cognitive restructuring. Comment by Donna O’Hara: Need to create a client then address the techniques relating to clients issues.

The second theoretical technique that applies to my case is problem solving. The aim would be to identify coping strategies through evaluating several options. Thereafter, a plan is chosen that promises to increase the control over troubling issues. However, since the client’s problem is fabricated, the problem-solving technique would focus on the specifics of the ideal problem and operationalize it. Comment by Donna O’Hara: I suggest looking at a specific technique & CBT

Development of Knowledge and Skills

To develop my skills and knowledge, I intend to conduct more research on the theoretical techniques that relate to CBT. Additionally, I feel that at this stage of professional development, practical skills are valuable for career growth and experience. Therefore, I intend to participate in a series of supervised counseling in high ranking counseling and wellness organizations. In addition, I plan to establish a closer relationship with my role model in CBT to learn more about the challenges in the implementation of theoretical concepts to the client. Lastly, I plan to engage more with online discussion forums touching on cognitive behavioral therapy in order to gain more insight on the changing nature and emerging issues in the field. Comment by Donna O’Hara: What does this mean???

Conclusion Comment by Donna O’Hara: Need to tie or summarize the connection of your paper

Considering the few limitations of CBT, it will be important to consider the magnitude of the life stressors inherent in the client. In addition, the client’s motivations for change, his cognitive functioning and education level are important considerations. Lastly, it is recommended that the therapists examine the severity of psychopathology before admitting clients into CBT

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