Back To CoursePsychotherapy Approaches: Help & Review
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Karin has taught middle and high school Health and has a master's degree in social work.
Ellie grew up with a mother who was overly cautious and distrustful of the world around her. Ellie, now age 20, also thinks that she is never safe from others. This causes her immense anxiety on a daily basis in many areas of her life. Ellie has begun to avoid going out, afraid that she will be robbed or raped. Ellie finally decides to visit a therapist who is trained in cognitive behavioral therapy to help cure her negative thinking patterns and anxiety.
Cognitive behavioral therapy, also called CBT, is a form of goal-oriented psychosocial therapy that attempts to reverse a person's negative thinking patterns in the interest of curing the negative emotions and maladaptive behaviors that result from those very thinking patterns. Maladaptive behaviors are behaviors that are counterproductive to a healthy, well-adjusted life. CBT can take an average of 4 months of weekly therapy to make any significant changes, but this completely depends on the severity of the client's or patient's mental disorder.
Let's break down this relatively complicated definition of CBT using the example of Ellie from before.
Ellie's negative thoughts = ''The world is a scary place. I cannot trust anyone. I am in danger. I will get robbed or raped if I go out.''
Ellie's resulting negative emotions = ''Intense anxiety''
Ellie's maladaptive behaviors = ''Avoidance (in this case it's avoidance of social interaction or going outside her home).'' This is maladaptive because it causes Ellie to be socially isolated, which is a risk factor for major depression.
So we've broken down Ellie's maladaptive behavior. How can she manage it with CBT and the help of her therapist? That's the most important question: there are numerous CBT techniques that could help clients and patients like Ellie with a number of disorders, including addiction, anxiety, depression, and obsessive-compulsive disorders.
The following are several common CBT techniques used by psychologists and therapists:
Juan suffers from agoraphobia, which is an anxiety disorder that involves being fearful of situations or places that will make that person vulnerable to being trapped, judged, or embarrassed. Juan doesn't have a car and needs to take a public bus to work, but gets highly anxious being around so many people in an enclosed space.
Juan works with a therapist doing cognitive rehearsal, which is when the patient works through the details and specifics of their negative thought patterns and typical behaviors when they're in a stressful situation, like Juan on the bus. Juan and his therapist are able to think of some things Juan can do next time he uses a bus in order to lessen his anxiety. Some of these things could include opening the window to expose himself to the outside air (thus alleviating the feeling of being trapped), or doing a breathing exercise to slow his heart rate when he starts to feel anxious.
Victoria is a stay-at-home mother of 5-month-old Christopher, and is suffering from postpartum depression, which is a form of depression that afflicts some mothers shortly after giving birth. Victoria thinks that she is a horrible mother because she's always exhausted and doesn't have energy to be active and attentive to her baby at all times.
Victoria's psychologist refers her to a medical professional for medications, but also works with her on CBT's technique of validity testing. This is when a therapist asks a patient to list examples that prove that their negative thoughts are true. In this case, the therapist asks Victoria to test the validity of her ''bad mother'' claim. As she does, Victoria's psychologist slowly normalizes much of Victoria's struggles, including exhaustion, self-doubt, isolation, and low self-esteem. Victoria starts to believe that she isn't a bad mother, but is maybe just experiencing normal feelings and difficulties, just like any other new mother of an infant.
Sean believes that he has very poor communication skills, and this is causing a significant lack of self-confidence and self-esteem at work. He overanalyzes his grammar and ability to speak while conversing with colleagues. His anxiety with this issue causes him to stutter when he's required to give oral presentations at work.
Sean's therapist asks Sean to write a daily journal for the next two weeks, which is a method called journaling, which involves, well, journaling entries that allow clients to see a pattern in their negative thinking patterns and behavior. Over that time period, Sean notes in the journal all the times that he felt he wasn't able to speak well, as well as times that he felt he was totally up on his communication game. Through journaling, Sean realized that his thinking that he had poor communication skills was causing the negative emotion of anxiety, which was in turn making his communication worse. He learned that his communication was best when he was feeling confident.
Tim is feeling overwhelmed at work. He wakes up dreading the work day. When he walks into the office, he's automatically thinking that he will not be able to tackle the challenges of the work day. This causes him to feel tense and angry. He's often yelling at the employees who work under him.
Tim's therapist employs the guided discovery technique. This is a technique where the therapist asks specific questions about a patient's thoughts, feelings, and behaviors during a typical day, which is what Tim's therapist is asking him to do. She then helps Tim connect his thoughts and feelings at the beginning of the work day (feelings of dread, thoughts of incompetence) to his angry yelling behaviors. What this does is that it helps Tim see that he first needs to work on his feelings of incompetence and dread in order to cure his anger and hostility. This can be looked at as ''getting at the root of the problem,'' something you've probably heard people say before.
Myra has difficulty with binge eating. Her therapist asks Myra to complete homework in behavior monitoring. The therapist asks Myra to keep a chart of the time and day that she binge eats, as well as the feeling or behaviors that preceded binge eating. This will help Myra and the therapist discover the cause of binge eating so that they can properly treat it (again: ''getting at the root of the problem''). Myra is also asked to read about her binge eating disorder. This is an example of the homework technique of CBT being put to use, which is what it sounds like: a technique that asks the patient to complete various tasks outside of the therapist office to stem maladaptive behavior.
A hospital in Seattle used aversive conditioning, which is a technique that creates an aversive stimulus paired with a maladaptive behavior, with alcoholic-dependent individuals in 1987. The client was given a warm saline solution that was intended to induce nausea and vomiting. Promptly after the solution was given, the client was exposed to an alcoholic beverage and asked to smell it and take a sip. The smell and taste of the alcohol combined with the aversive stimulus (saline solution causing nausea) was enough to rid the client of their addiction to alcohol after 10 days of this treatment.
Another common type of aversive conditioning that's done in a different way is systematic desensitization. This is when a stimulus--usually a phobia of something stressful, like flying or snakes--is presented to a patient who, over time, is taught to confront the stimulus with increased relaxation. It's essentially teaching the patient's brain to see a stressful thing as no longer stressful, even though nothing about the stressful thing has actually changed.
Ava is a new college student experiencing immense academic stress and pressure. She visits a therapist because she's having difficulty with perfection and procrastination. She often puts off assignments because she wants them to be perfect, and therefore won't do them at all because the pressure of perfection is intimidating.
Ava's therapist employs the use of systematic positive reinforcement, a technique that uses reward intervals to further motivate Ava to get assignments done two days before their due date. She establishes a plan where Ava is allowed to treat herself to something she enjoys every time she completes an assignment two days before the due date.
The goal of cognitive behavioral therapy (CBT) is to reverse a person's negative thinking patterns in order to cure the negative emotions and maladaptive behaviors that result. Maladaptive behaviors are behaviors considered counterproductive to a healthy, well-adjusted life. CBT has been used to treat a variety of mental disorders, such as addiction; anxiety disorders like agoraphobia, which is an anxiety disorder that involves being fearful of situations or places that will make that person vulnerable to being trapped, judged, or embarrassed; stress; depression, like postpartum depression, which is a form of depression that afflicts some mothers shortly after giving birth; and obsessive-compulsive disorders.
There are a variety of techniques that psychotherapists use in CBT, including:
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Back To CoursePsychotherapy Approaches: Help & Review
6 chapters | 91 lessons
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