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HYPERLINK "" Cognitive behavioral?therapy?(CBT) is a short-term, goal-oriented?psychotherapy?treatment that takes a hands-on, practical approach to problem-solving. Its goal is to change patterns of thinking or behavior that are behind people’s difficulties, and so change the way they feel. It is used to help treat a wide range of issues in a person’s life, from sleeping difficulties or relationship problems, to drug and alcohol abuse or?anxiety?and?depression. CBT works by changing people’s attitudes and their behavior by focusing on the thoughts, images, beliefs and attitudes that are held (a person’s?cognitive processes) and how these processes relate to the way a person behaves, as a way of dealing with emotional problems.An important advantage of cognitive behavioral therapy is that it tends to be short, taking five to ten months for most emotional problems. Clients attend one session per week, each session lasting approximately 50 minutes. During this time, the client and therapist are work together to understand what the problems are and develop new strategies for tackling them. CBT introduces patients to a set of principles that they can apply whenever they need to, and that’ll last them a lifetime.Cognitive behavioral therapy can be thought of as a combination of psychotherapy and behavioral therapy. Psychotherapy emphasizes the importance of the personal meaning we place on things and how thinking patterns begin in childhood. Behavioral therapy pays close attention to the relationship between our problems, our behavior and our thoughts. Most psychotherapists who practice CBT personalize and customize the therapy to the specific needs and personality of each patient.The History of Cognitive Behavioral TherapyCognitive behavioral therapy was invented by a psychiatrist, Aaron Beck, in the 1960s. He was doing psychoanalysis at the time and observed that during his analytical sessions, his patients tended to have an?internal dialogue?going on in their minds — almost as if they were talking to themselves. But they would only report a fraction of this kind of thinking to him.For example, in a therapy session the client might be thinking to herself: “He (the therapist) hasn’t said much today. I wonder if he’s annoyed with me?” These thoughts might make the client feel slightly anxious or perhaps annoyed. He or she could then respond to this thought with a further thought: “He’s probably tired, or perhaps I haven’t been talking about the most important things.” The second thought might change how the client was feeling.Beck realized that the link between?thoughts?and?feelings?was very important. He invented the term?automatic thoughts?to describe emotion-filled thoughts that might pop up in the mind. Beck found that people weren’t always fully aware of such thoughts, but could learn to identify and report them. If a person was feeling upset in some way, the thoughts were usually negative and neither realistic nor helpful. Beck found that identifying these thoughts was the key to the client understanding and overcoming his or her difficulties.Beck called it cognitive therapy because of the importance it places on thinking. It’s now known as cognitive-behavioral therapy (CBT) because the therapy employs behavioral techniques as well. The balance between the cognitive and the behavioral elements varies among the different therapies of this type, but all come under the umbrella term cognitive behavior therapy. CBT has since undergone successful scientific trials in many places by different teams, and has been applied to a wide variety of problems.The Importance of Negative ThoughtsCBT is based on a model or theory that it’s not events themselves that upset us, but the meanings we give them. If our thoughts are too negative, it can block us seeing things or doing things that don’t fit – that disconfirm – what we believe is true. In other words, we continue to hold on to the same old thoughts and fail to learn anything new.For example, a depressed woman may think, “I can’t face going into work today: I can’t do it. Nothing will go right. I’ll feel awful.” As a result of having these thoughts – and of believing them – she may well ring in sick. By behaving like this, she won’t have the chance to find out that her prediction was wrong. She might have found some things she could do, and at least some things that were okay. But, instead, she stays at home, brooding about her failure to go in and ends up thinking: “I’ve let everyone down. They will be angry with me. Why can’t I do what everyone else does? I’m so weak and useless.” That woman probably ends up feeling worse, and has even more difficulty going in to work the next day. Thinking, behaving and feeling like this may start a downward spiral. This vicious circle can apply to many different kinds of problems.Where Do These Negative Thoughts Come From?Beck suggested that these thinking patterns are set up in childhood, and become automatic and relatively fixed. So, a child who didn’t get much open affection from their parents but was praised for school work, might come to think, “I have to do well all the time. If I don’t, people will reject me.” Such a rule for living (known as a?dysfunctional assumption) may do well for the person a lot of the time and help them to work hard.But if something happens that’s beyond their control and they experience failure, then the dysfunctional thought pattern may be triggered. The person may then begin to have?automatic thoughtslike, “I’ve completely failed. No one will like me. I can’t face them.”Cognitive-behavioral therapy acts to help the person understand that this is what’s going on. It helps him or her to step outside their automatic thoughts and test them out. CBT would encourage the depressed woman mentioned earlier to examine real-life experiences to see what happens to her, or to others, in similar situations. Then, in the light of a more realistic perspective, she may be able to take the chance of testing out what other people think, by revealing something of her difficulties to friends.Clearly, negative things can and do happen. But when we are in a disturbed state of mind, we may be basing our predictions and interpretations on a biased view of the situation, making the difficulty that we face seem much worse. CBT helps people to correct these misinterpretations.Interpersonal?therapy?focuses on the interpersonal relationships of the depressed person. The idea of interpersonal therapy is that?depression?can be treated by improving the communication patterns and how people relate to others.Techniques of interpersonal therapy include:Identification of Emotion?— Helping the person identify what their emotion is and where it is coming from.Example?— Roger is upset and fighting with his wife. Careful analysis in therapy reveals that he has begun to feel neglected and unimportant since his wife started working outside the home. Knowing that the relevant emotion is hurt and not anger, Roger can begin to address the problem.Expression of Emotion?— This involves helping the person express their emotions in a healthy way.Example?— When Roger feels neglected by his wife he responds with anger and sarcasm. This in turn leads his wife to react negatively. By expressing his hurt and his?anxiety?at no longer being important in her life in a calm manner, Roger can now make it easier for his wife to react with nurturance and reassurance.Dealing With Emotional Baggage?— Often, people bring unresolved issues from past relationships to their present relationships. By looking at how these past relationships affect their present mood and behavior, they are in a better position to be objective in their present relationships.Example?— Growing up, Roger’s mother was not a nurturing woman. She was very involved in community affairs and often put Roger’s needs on the back burner. When choosing a wife, Roger subconsciously chose a woman who was very attentive and nurturing. While he agreed that the family needed the increased income, he did not anticipate how his relationship with his own mother would affect his reaction to his wife working outside the home.Cognitive therapy is often added during EX/RP so that the patient can process these behavioral experiences and “make sense” of them as treatment progresses. EX/RP typically lasts 12 to 16 sessions; although it is probably often provided on a once-weekly basis, it can be delivered more frequently (e.g., daily or twice-weekly).Other forms of behavior therapy have been shown to be successful in treating OCD, though these are becoming increasingly replaced by EX/RP in the field. Two common and popular techniques are?systematic desensitization?and?flooding,?which are types of exposure accompanied with relaxation techniques. Systematic desensitization techniques involve gradually exposing the client to ever-increasing anxiety-provoking stimuli. It is important to note here, though, that such a technique should?not be attempted until?the client has successfully learned relaxation skills and can demonstrate these to the therapist. Exposing a patient to either of these techniques without increased coping skills can result in relapse and possible harm to the client.Relaxation techniques may include imagery, breathing skills, and muscle relaxation. The aim is for patients to learn to habituate to their anxiety. It is important for the client to find a relaxation technique that works best for them, before attempting something like systematic desensitization or flooding. Systematic desensitization is the preferred technique of the two; flooding is not recommended except in rare uses. Flooding’s potential harm usually outweighs its potential benefits if not done correctly by a highly skilled professional (e.g., traumatizing the individual further). Flooding allows the patient to face the most anxiety-provoking situation, while using the relaxation skills learned.Additional cognitive-behavioral techniques, which may have some effectiveness for people who suffer from OCD, include?saturation?and?thought-stopping. Through saturation, the client is directed to do nothing but think of one obsessive thought which they have complained about. After a period of time of concentration on this one thought (e.g., 10-15 minutes at a time) over a number of days (3-5 days), the obsession can lose some of its strength.Through thought-stopping, the individual learns how to halt obsessive thoughts through proper identification of the obsessional thoughts, and then averting it by doing an opposite, incompatible response. A common incompatible response to an obsessive thought is simply by yelling the word “Stop!” loudly. The client can be encouraged to practice this in therapy (with the clinician’s help and modeling, if necessary), then they are encouraged to continue this behavior at home. They can often use other incompatible stimuli, such as snapping a rubber band which is around their wrist whenever they have a thought. The latter technique would be more effective in public.Recent research supports mindfulness-based treatments for OCD, and specifically Acceptance and Commitment Therapy (ACT). ACT is a behavioral therapy that aims to change the?relationship?individuals have with their own thoughts and physical sensations that are feared or avoided. Similar to EX/RP, patients are led by paying-attention-to and enduring their states of obsession-related anxiety while resisting the urge to react (i.e., perform compulsive action/ritual).Different from EX/RP, ACT focuses on values and acceptance whereby promoting acceptance of distressing states, people are taught to more-effectively focus on the present moment and act in line with their goals and life values — instead of being pushed around by their obsessions. Once the patient can acknowledge that rituals are only effective at reducing short-term distress, while preserving their long-term struggle, they can begin to act out of awareness towards values (e.g., family, job, health)?regardless?of distress. More research supporting this treatment is needed, and this therapy may be most effective in OCD-patients with greater insight.Albert Ellis, an important contributor to the ideas behind?cognitive-behavioral? HYPERLINK "" therapyand the founder of Rational Emotive Behavior Therapy (REBT), discovered that people’s beliefs strongly affected their emotional functioning. In particular certain irrational beliefs made people feel depressed, anxious or angry and led to self-defeating behaviors.When Ellis presented his theory in the mid-1950’s (Ellis, 1962), the role of cognition in emotional disturbance had not been fully addressed by the field of psychology. Ellis developed REB theory and therapy in reaction to what he saw as the inadequate techniques of psychoanalysis and behaviorism. He attributed the deficiency in the two camps’ techniques to their conceptualization of personality and emotional disturbance. Ellis felt that by ignoring the role thinking played in emotional disturbance both psychoanalytic and behavior theory failed to explain how humans originally became disturbed and how they remained disturbed.The word “belief” means a conviction in the truth, actuality, or validity of something. So a belief is a thought with an emotional component (conviction) and a factual component (truth, actuality or validity). Beliefs can be either positive or negative. Having a negative belief is not necessarily a bad thing; however, when one believes in something that is false, a negative belief tends to become what Ellis called an “irrational” belief. Irrational beliefs are not friendly to happiness and contentment and are definitely unhelpful for getting one’s basic desires for love and approval, comfort and achievement or success met.Core Irrational BeliefsDemandingness or Absolutism?– inflexible, dogmatic, extreme beliefs signaled by words such as should, must, have to, and need to (e.g., “I should not be in pain” or “I should be able to do what I used to do”). This is not the kind of should as in “I should go to the store and get some milk,” but rather a should with a capital “S”, a demand.Demand for Love and Approval?from nearly everyone one finds importantDemand for Success or Achievement?in things one finds importantDemand for Comfort?or nearly no frustration or discomfort.When someone holds one of these irrational beliefs, they also tend to hold one or a combination of the following irrational beliefs.Awfulization?– refers to 100% disasterizing beliefs signaled by such words as disaster, horrible or awful, and catastrophe.Low Frustration Tolerance?– beliefs signaled by words such as intolerable, can’t stand it, and too hard.Global-Rating?– beliefs in which you condemn or blame your entire selfhood or someone else’s basic value in some important way. Global rating is signaled by such words as loser, worthless, useless, idiot, stupid.ABCDE Model of Emotional DisturbanceAlbert Ellis thought people developed irrational beliefs in response to preferential goals being blocked. He set this up in an ABCDE model (Ellis and Dryden, 1987). “A” stands for Activating Event or Adversity. This is any event. It is just a fact. “B” refers to one’s Irrational Belief about the event at “A.” That belief then leads to “C,” the emotional and behavioral Consequences. “D” stands for disputes or arguments against irrational beliefs. E stands for New Effect or the new, more effective emotions and behaviors that result from more reasonable thinking about the original event.Disputing Irrational BeliefsIt is important to use vigor or energy when disputing irrational beliefs. Disputing is not just a rational or cognitive method but also an emotional method of changing irrational beliefs into rational ones.What is Exposure Therapy?By?John M. Grohol, Psy.D.~ 1 min readExposure therapy is a specific type of?cognitive-behavioral?psychotherapy?technique that is often used in the treatment of post-traumatic stress disorder (PTSD) and phobias. Exposure therapy is a safe and proven technique when used by an experienced, licensed therapist who specializes in these kinds of conditions and treatments. When used properly, scientific research has shown that it can be a powerful method to help a person overcome the?anxiety?and fear associated with PTSD or phobias.In PTSD, exposure therapy is intended to help the patient face and gain control of the fear and distress that was overwhelming in the trauma, and must be done very carefully in order not to re-traumatize the patient. In some cases, trauma memories or reminders can be confronted all at once (”flooding”), while for other individuals or traumas it is preferable to work gradually up to the most severe trauma by using relaxation techniques and either starting with less upsetting life stressors or by taking the trauma one piece at a time (”desensitization”).A therapist works with the client to determine which method is best suited for the particular client and their trauma. A patient is never forced to engage in treatment they feel uncertain about, or are afraid of. A good therapist will help explain the kinds of techniques they would like to use and ensure all of the patient’s questions are answered to their satisfaction.In phobias, exposure therapy is used in conjunction with relaxation exercises and/or imagery. In conjunction with learning how to bring about a relaxed state at-will, the therapy technique gradually exposes patients to what frightens them and helps them cope with their fears.Exposing someone to their fears or prior traumas without the client first learning the accompanying coping techniques — such as relaxation, mindfulness, or imagery exercises — can result in a person simply being re-traumatized by the event or fear. Therefore exposure therapy is typically conducted within a psychotherapeutic relationship with a therapist trained and experienced with the technique and the related coping exercises.When looking to engage in exposure therapy to help treat your PTSD or phobia, look for a psychotherapist with experience or a specialty in this kind of psychotherapy. Because of the potential for harm with this specific kind of therapy technique, it is not recommended that a person ask a therapist or other professional who isn’t specifically trained and has a lot of experience in these techniques. It is not something that is as conducive to self-help, or help from a well-intentioned friend to try.When used properly and professionally, exposure therapy is a safe and effective psychotherapeutic technique. ................
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