Why Does Cognitive Therapy Work?

by James Krehbiel - Date: 2007-01-19 - Word Count: 967 Share This!

Cognitive therapy, pioneered by Aaron Beck, is a structured, time-limited and pragmatic approach to dealing with a variety of psychological disorders. Most therapists using this approach employ an exploratory, discovery model designed to ferret out maladaptive thinking, cognitive distortions, and faulty underlying beliefs which are based upon prior experience.

Cognitive therapists are interested in working with clients in the here-and-now. Psychoanalyzing one's past is unnecessary and counterproductive. Trying to dissect the "why" of thoughts, feelings and behavior is a worthless pursuit. Prior experience is only explored as it relates to present functioning. There may be "hot buttons" from one's past that perpetuates a cycle of self-defeating behavior. These faulty underlying beliefs are viewed as stumbling blocks to present awareness and adaptive functioning.

This therapy model involves a structured approach by focusing on several aspects of maladaptive thinking. Spontaneous, automatic thoughts represent the free-flowing stream of self-defeating thoughts that are associated with an individual's psychological symptoms. For example, those who suffer from panic attacks believe that their symptoms surface uncontrollably without related triggers. In other words, panic sufferers do not make a connection between their thinking and their symptoms. They do not realize that it is the panicky thinking about the panic that keeps the symptoms alive. An individual may begin to sweat, have heart palpitations, and dizziness during a business meeting. This person may unwittingly say, "Oh my God, here it comes again, those nasty feelings. Everybody here must know that I am panicking - how embarrassing. I better find a way to get out of this meeting before I pass out!" Once the patient is taught to recognize the connection between symptoms and nonsensical thinking, he can be taught to find more rational ways to respond to his dilemma. This person might say, "Here comes those symptoms again, just relax and take some deep breaths. This too shall pass. You know, people are too busy listening to what's going on in their lives to be concerned about my inner thoughts and feelings. Just hang in there and the panic will subside." Panic no longer has power over a client once they realize that the way they think about it determines its impact. Once a patient comes to the understanding that panic is time-limited and the symptoms are benign, progress can be made in minimizing and eventually resolving the syndrome.

Cognitive distortions are the lenses out of which many people view the world. Distorted thinking leads to misperceptions about feelings, thoughts and events. For example, the anorexic client looks out of her distorted lenses to determine that she is too fat. Understanding that her disorder is based upon body misperception, cognitive therapists help the patient to reattribute her thinking to the disorder. An anorexic in treatment might be coached to say, "One of the cardinal features of my disorder is my insistence that I am too fat. This is my clouded thinking about my disorder speaking. I am much more than my body and yet I need to learn rational ways to think about my body." Cognitive distortions include ways of thinking, such as magnifying events, personalizing feelings, using emotional reasoning, and rigid, dichotomous thinking.

Underlying assumptions are the maladaptive beliefs that we carry into the present from the past. These are beliefs and values that create self-defeating behavior. These underlying schemas emerge in counseling as client coping strategies. For example, a patient might say, "I must avoid conflict at all costs. If I don't, I could get hurt or disappointed." Such powerful thinking may shape one's relationships and other patterns of behavior in the present.

Therapists collaborate with patients on goals and provide homework assignments. A proactive approach to counseling makes the patient feel as if he has a vested interest in the outcome. Patients are participants in therapy, not passive spectators. Therapists utilize specific techniques to untwist the client's self-defeating thinking. All techniques are directed toward challenging the patient's faulty thinking and providing more rational ways of approaching problems.

Cognitive therapy utilizes a self-discovery process where patients are taken on an empirical journey to test the validity of their thinking. The therapist makes no value judgments but assists the patient in evaluating the reasonableness of his thinking. Since old patterns die hard, it takes courage on the part of the patient to work toward modifying thinking and behavior so that it is more self-satisfying.

This model of therapy wastes no time on extraneous matters. The goal is to specifically address presenting problems in a pragmatic fashion. Symptoms are to be alleviated and core issues resolved. Because cognitive therapy provides the patient with coping skills and rational self-talk, clients leave therapy feeling confident and self-directed. Former patients are able to maintain and enhance their progress because they have completed the work that was required for recovery.

CT is a user-friendly model of therapy. The concepts are easily understood and put into practice. There is no hidden agenda because the therapist and patient embark on a collaborative fact-finding mission that leads to new ways of viewing problems and changing thinking, feelings and behavior. It is a powerful model because it follows the scientific method by testing hypotheses and the empirical usefulness of various thoughts, feelings, and behaviors. Tests can be constructed to measure the impact and effectiveness of specific thinking and behavior. Patients can qualitatively test the validity of specific cognitions. For example, an anorexic patient may be asked to survey her friends to see how they feel about her current weight. She may then be asked to report her findings to the therapist for exploration.

Cognitive therapy works because it is understandable, structured, pragmatic and present-centered in focus. It seeks to help individuals explore their thinking and ferret out thought processes that are maladaptive. It is applicable to a myriad of disorders which gives it efficacy and comprehensive utility as a model for changing human behavior.

Related Tags: cognitive therapy, rational thinking, maladaptive thinking, underlying assumptions

James P. Krehbiel, Ed.S. LPC is an author, freelance writer, and nationally certified cognitive-behavioral therapist practicing in Scottsdale, Arizona. His personal growth book, Stepping Out of the Bubble is available at amazon.com. James can be reached at www.krehbielcounseling.com.

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