Chapter 69 Cognitive-behavioural therapy
Cognitive-behavioural therapy (CBT) is a set of empirically grounded clinical interventions, applied in a systematic way to help people change their thoughts and behaviours so they can function in a more adaptive and healthy way. The foundational model for CBT was outlined by Aaron Beck (1976; Beck et al., 1979), but as CBT has been applied to new clinical problems there have been significant revisions.
The rationale behind CBT
The cognitive model emphasizes that people’s emotions and behaviours are influenced by their perceptions of events and the meanings they attach to their experience. It is not simply situations that determine how people feel and behave, but the way in which they construe and appraise these situations (see pp. 126–127 and pp. 134–135). Depending on their unique development histories and temperaments, people filter incoming information in ways that reflect their particular concerns and beliefs. Consequently, aspects of thinking may become distorted or maladaptive, leading to emotional and behavioural problems. For example, an individual whose parents were excessively preoccupied with the risks associated with illness may develop an unhealthy preoccupation with illness and maladaptive beliefs about illness, e.g. ‘Illness is always very harmful’, ‘Life with illness is unbearable’ and ‘I should make every possible effort to avoid getting ill’. These beliefs will determine emotional and behavioural responses to possible signs of illness. This individual may be hypervigilant for signs of illness, repeatedly checking his or her body for warning signs so that normal or minor fluctuations in bodily processes may be misinterpreted as evidence of illness. Such people may seek frequent reassurance from doctors and undergo extensive unnecessary medical tests in their search for explanations of symptoms.
The role of the CBT therapist
The role of the CBT therapist is, firstly, to assist individuals in identifying and clarifying their current patterns of thinking and, secondly, to modify this thinking through a range of strategies that encourage individuals to take on a more rational or evidence-based view of their own experience. CBT is based on the principle of collaborative empiricism. Rather than the therapist acting as the expert, the therapist and client work together to resolve problems. Treatment is conducted in a spirit of open-minded enquiry and guided discovery to help clients clarify and evaluate their own thoughts and beliefs. An explicit goal of treatment is to teach clients the model of CBT so that they can develop the capacity to be their own therapist (for a list of core CBT competencies, see http://www.ucl.ac.uk/clinical-health-psychology/CORE/CBT_Framework.htm).
