COGNITIVE PSYCHOTHERAPYÂ BACKGROUND AND DEVELOPMENT
“A science comes of age when students stop studying its history”.
Most textbooks on cognitive psychotherapy, or as it is often termed, cognitive-behavioural therapy, start with a history of its development which suggests how young it is. Until fairly recently, psychotherapy in Britain has had two main streams.Â The older followed from the work of Freud, Jung etc., and is the psychodynamic school with analysis as the main strategy.Â The newer thrust has been behavioural therapy with its emphasis on scientific measures, experimentation and reputation, based on the theories of learning and conditioning.Â One might consider humanistic approaches to be a third stream, but it could be argued that they have some similar features to the dynamic schools.
Most of the therapy available in the National Health Service has been behavioural, with analysis and other less proven practices being the prerogative of the private sector.Â The concept of “mind” was ignored in behaviour therapy as one could not measure what went on in the “black box”, what was of interest were the stimuli and responses.Â However, this non-mediational approach was found to be insufficient to account for all human behaviour, particularly the more complex.Â Consequently the concept of mind or cognitions became acceptable and the idea of working with cognitions in therapy became possible in the late 60âs and early 70âs.
The theory and procedures of cognitive therapy have evolved over the last 25 years or so, but their initial impetus came from Beckâs early interviews with depressed subjects (Beck, 1963).Â While operating initially from a classically Freudian perspective, he found, following several systematic studies, that Freudâs formulations of the depressive syndrome (melancholia) missed the mark in several respects.Â The anger-turned-inward model did not fit and Beck found a clinically more satisfactory model focusing on the content of the depressiveâs negative thinking.Â His early descriptions emphasised the negative biases and distortions that he found common among depressed subjects.Â These descriptions led to hypotheses about the content and processes of cognition that are relatively distinctive to depression.Â More importantly, he argued that these cognitive aspects are more central to depression and more verifiable than the dynamic (motivational) processes that were proposed in work to that time.
Beck believes that the depressive exhibits distorted information processing, which results in a consistently negative view of himself, the future and the world.Â These views are presumed to underlie the behavioural, affective and motivational symptoms of depression.Â The experimental work which has followed from these propositions has been encouraging, and evidence of the value of the therapy based on Beckâs theories is growing.
Although Beckâs early emphasis was on dysfunctional thinking in depression, the cognitive model ha put forward represents a comprehensive understanding of mental illness in general.Â He sees emotional disorders as being the results of distorted thinking or unrealistic cognitive appraisalsÂ of life events.Â So it is thought that a personâs emotional or affective state is due to the way in which they structure or perceive reality.Â Furthermore, the cognitive model proposes that a reciprocal relationship exists between affect and the cognition such that one tends to reinforce the other, resulting in an escalation of emotional and cognitive impairment (Beck, 1976).
The cognitive structures that organise and process incoming information he called schemata.Â These schemata he uses to represent the thought patterns that are laid down early in an individualâs development.Â In that development, if logical errors in thinking are included in those schemata, then these will predispose the person to experience emotional problems.Â A well-adjusted person would Â have a realistic appraisal of life events due to his well-formed schemata, but the schemata of maladjusted individuals result in a distortion of reality, leading to psychological disorder. Most of the research work to date has concentrated on the schemata of depressives but it is being broadened to other emotional disorders as more and more cognitive therapy is being used and the outcome studies are encouraging.
Beckâs approach to cognitive therapy involves working on the cognitive, behavioural and emotional responses of the subject.Â The goal of therapy is to replace the subjectâs distorted appraisals of life events with more realistic ones.Â Treatment involves teaching subjects to monitor their automatic thoughts, to recognise the relations between cognition, affect and behaviour, to test the validity of those automatic thoughts, to substitute more realistic cognitions for those distorted thoughts and to learn to identify and alter the underlying assumptions or beliefs that predispose individuals to engage in faulty thinking patterns.
For example, a subject may have the automatic thought that people will ignore him.Â This thought may make him feel unhappy and even depressed.Â He may ignore others rather than risk them ignoring him, so he would then feel bad.Â He must then test the validity of his automatic thought by speaking to those he would expect to ignore him to see if they respond.Â If his test proves that his previous thinking was faulty, then he must learn the new thought that people will not ignore him.Â This new realistic thought changes the emotion of depression and allows him to feel good and to continue reinforcing the new belief by more practice.Â The subject can be taught to identify his own dysfunctional automatic thoughts and to change them, so he becomes his own therapist.
Although Beck developed the concept of cognitive therapy, others were working on somewhat parallel lines.Â Ellis developed Rational-Emotive Therapy, which is a prime example of cognitive-behavioural approach.Â It is a more directive form than Beck,s collaborative approach which uses the Socratic method to elicit the counters to irrational thoughts from the subject.Â This is teaching the subject to become his own therapist rather than letting him remain independent.
Just as strictly behavioural therapies are not cognitive-behavioural, so cognitive therapies are also not really cognitive-behavioural though they are closely allied.Â The cognitive-behavioural therapist would not accept the concept of long past traumas causing or contributing to current disturbance.Â He would work only with current behaviour, emotions, and what he could elicit as the underlying assumptions leading to those actions and feelings.Â The cognitive therapist may consider such past traumas and target their memory for change.Â However, the names given to the different varieties of cognitive therapy are often interchanged.Â What a therapist actually does in his work may not always match the type of therapy he claims to use.Â Dryden (1987) points out that the behaviour therapist may use more of a cognitive approach that he would readily admit, and the reverse can also be true.
Beck, A. T. (1963).Â Â Â Â Thinking and Depression.
Archives of General Psychiatry, 9, 324-333.
Beck, A. T. (1976)Â Â Â Â Â Cognitive Therapy and the Emotional Disorders.
New York:Â International Universities Press.
Dryden, W. (1987).Â Â Â Â Counselling Individuals:Â The Rational-Emotive Approach.
London:Â Taylor and Francis.