All behavioral therapies attempt to improve the mental health of patients. Various theories have served as the underpinning for these therapeutic treatments for mental health disorders. Cognitive-behavioral therapy is one of the efficacious treatments for some of the psychological problems affecting humans. This paper discusses the history of the cognitive-behavior theory, which is applied in the CBT model. The major propositions of this theory are identified and the manner in which it works documented. The effectiveness of this theory in treating anxiety disorder, eating disorders, depression, and obsessive-compulsive disorder are then discussed. The various strengths of the theory are highlighted, and its weaknesses revealed. The paper concludes by noting that CBT is an important model for treating a number of mental disorders and restoring the mental health of individuals.
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History of the Theory
Cognitive Behavioral Therapy (CBT) can trace its beginning to the work of the US psychiatrist, Aaron T. Beck in the 1960s. This psychiatrist was engaged in studies on the treatment of depression at the University of Pennsylvania. Dr. Beck discovered that depressed patients were experiencing negative thoughts that had a direct impact on their mental state (Dobson, 2009). These thoughts occurred automatically, and they influenced how the patients viewed themselves and the world. Based on this discovery, Dr. Beck was able to develop a new approach to treating depression, which he called cognitive therapy. The CB theory has three propositions at its core. The first proposition is that cognitive activities affect behavior, which means that a person’s appraisal of events can affect how he responds to the events. The second proposition is that the tasks a person engages in can be carefully examined and changes to the activities made. Finally, CB theory proposes that by cognitive change, it is possible to produce desired behavior in the individual.
Cognitive-Behavioral Therapy is a generic term for a number of therapies that include both behavioral and cognitive interventions. These therapies rely on the two forms of interventions with the aim of creating broad changes in the patient’s emotional, cognitive, behavioral, and interpersonal spheres of functioning. In the behavioral interventions, attempts are made to change functioning by intervening at the level of behavior. In the cognitive interventions, attempts are made to effect changes by altering the perceptions and thinking patterns of the patient (Schibbye et al., 2014). The key principle of the cognitive-behavioral theory is that our emotional states are caused by our beliefs related to certain events rather than the events themselves. CBT interventions try to change unhealthy behavior in an individual by cognitive restructuring. Through this therapy, modification of troublesome thoughts and maladaptive behavior is undertaken with the aim of reducing the symptoms.
In the early years of the development of CBT, supporters of the theory had to engage in numerous researches to demonstrate the empirical legitimacy of this theory. Through the 1960s and 1970s, researches and clinicians engaged in the intensive development of the cognitive-behavioral models of psychopathology and psychotherapy. The models were subjected to empirical scrutiny leading to increased understanding of this approach. Due to these efforts, there is significant empirical evidence in support of the premise made by the cognitive-behavioral theory that a person’s view of events can affect the response to those events. Cristea, Montgomery, Szamoskozi, and David (2013) assert that CBT is one of the fastest developing fields in psychotherapy, and many therapists are utilizing this technique to treat a wide array of psychological disorders. The efficacy of CBT is well established, and the current debate is on the degree and exact nature of the appraisals an individual makes in different circumstances.
Types of Problems the Theory is most useful for
CBT is one of the most important methods for treating phobias. By definition, phobias are exaggerated or irrational fears of some objects or situations. The most common social phobia is an anxiety disorder, and it affects about 3.2% of the population (Moldovan & David, 2014). If left unmanaged, the social phobia has a negative impact on the work performance, social life, and personal relationship of the individual suffering from it. CBT intervention helps participants to learn to identify the irrational beliefs that lead to anxiety and to dispute these irrational beliefs and develop rational ones. This treatment protocol is based on the understanding that Phobias are largely caused by classical conditioning, and fear is maintained by the avoidance behavior. By combining both cognitive and behavioral components, CBT is able to treat phobias effectively. Cognitive-behavioral therapists identify the maladaptive reactions present in a patient. Using a series of techniques designed to target each cognitive and psychological response system, CBT tries to substitute the maladaptive reactions developed by the patient with healthy coping habits. Schibbye et al. (2014) declare that there is a large empirical base supporting the efficacy of CBT in the treatment of social anxiety disorder.
The theory is effective in treating eating disorders, including anorexia nervosa and bulimia nervosa. Eating disorders are a serious illness with significant psychiatric and medical comorbidity. Fursland et al. (2012) explain that these disorders have an effect on major organs of the body and can lead to severe medical problems and even death. A key tenet of the Cognitive Behavioral Psychotherapy theory is that our emotional states are caused by our beliefs related to certain events rather than the events themselves. CBT intervention, therefore, attempts to change the patient’s faulty belief system. This technique helps the patient address his/her distorted cognitions about body weight and shape. Fursland et al. (2012) reveal that through this therapy, behavior change is encouraged in the patients. The individuals suffering from eating disorders are helped to establish normal and regular eating patterns.
This theory has also shown significant success in treating depression. Depression is associated with many negative outcomes, including breakdowns in interpersonal relationships and employment, decreased quality of life, cognitive impairment, and heightened suicide risk (Hind, 2014). Establishing effective methods of treating this condition is, therefore necessary in order to avoid the negative consequences of depression. The Cognitive theory proposes that depressed individuals have a cognitive vulnerability to depression. As such, negative cognition is an important part of depression. When CBT is used, the patient is provided with the skills to identify the negative thoughts that influence his/her feelings and behavior. Once the thoughts have been identified, CBT techniques assist the individual in acquiring beneficial coping responses.
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The cognitive-behavioral theory is useful in managing the obsessive-compulsive disorder. OCD is a common mental health problem characterized by the poor quality of life and impaired functioning by the patient. Nakatani et al. (2009) contend that if left untreated, OCD may produce substantial disability for individuals and their families. CBT protocols have been created to treat OCD. These programs involve psycho-education, selection of target symptoms for exposure and response prevention, and relapse prevention and planning (Nakatani et al., 2009). The therapy sessions normally extend for 8 to 12 sessions, depending on the patient’s progress. Studies indicate that CBT delivered by trained professionals can achieve high rates of improvement and remission (Nakatani et al., 2009).
Strengths of the Theory
A major strength of CBT is that its efficacy in dealing with some psychological disorders is proven. From its early years of development, CBT was subjected to rigorous clinical evaluations to demonstrate its effectiveness. Due to this expansive research on the theory, therapists have established the effectiveness of CBT models in treating anxiety and depression (Hind, 2014). Patients and therapists can, therefore, have some level of confidence in the effectiveness of the CBT programs used to treat specific mental health conditions.
In addition to the effectiveness of CBT being established, extensive research has made this theory applicable to a broad range of mental health issues. As such, individuals suffering from various types of conditions, including anxiety disorders or eating disorders. Due to the widespread research on CBT, there are at present varieties of cognitive-behavioral approaches to treating various psychological problems. Dobson (2009) state that mental health professions with specific expertise in different mental health issues can utilize CBT to treat their patients.
CBT is also preferred by many therapists and patients since it does lead to any side effects. Some traditional treatment options for mental health issues involve using medication to manage or eliminate symptoms. These medications are often associated with adverse effects on the patient. The typical CBT implementation involves a number of one-hour sessions with a professional therapist (Fursland et al., 2012). The process is strictly natural, and there is no medication involved. Instead, the therapist helps the patient to identify maladaptive patterns and develop skills and strategies to overcome them.
A key merit of CBT is that it considers the effects of thoughts on both the behavior and feelings of an individual. Dobson (2009) notes that the CBT approach great out of a dissatisfaction with purely behavioral approaches to dealing with psychological problems. The highly structured nature of CBT makes it possible for measurable achievements to be reached through therapy. Through this theory, the therapist and client come up with a number of specific treatment goals. These goals are realistic, and they can be measured after a specified period of time. The ability to quantify goals makes it possible for the success or failure of the treatment efforts to be established.
A major strength of CBT is that is can be effective in a relatively short duration of time. Schibbye et al. (2014) confirm that symptom reductions begin to occur during the initial phase of treatment. For minor disorders, the patient can be completely cured in as little as three sessions, while 12 sessions can be enough for major disorders. Research indicates that early improvements (that is the reduction of symptoms in the initial phase of treatment) are strongly related to positive treatment outcomes for the patient (Schibbye et al., 2014).
Finally, the techniques developed from CB theory are of practical usefulness to an individual. These skills, which are based on theoretical principles, offer helpful strategies for coping with challenges encountered in everyday life. Therapists highlight that an individual can incorporate the strategies obtained from CBT in their normal life (Hind, 2014). This result in better coping with the stresses and difficulties encountered on a daily basis.
Weaknesses of the Theory
The emphasis on a person’s current problem is cited as a major weakness of CBT. When using this approach, therapists focus on the current problems being experienced by the patient and take steps to alleviate the problems using the CBT model. However, psychoanalysts agree that mental health issues can be caused by underlying issues that are hidden deep in the individual’s past (Cristea at al., 2013). To effectively restore the individual’s mental health, it would be important to consider these underlying issues and address them. A therapeutic approach that fails to consider past issues is regarded by many psychiatrists as inadequate.
Another weakness of this theory is that it is incapable of dealing with complex mental health issues. By its nature, CBT is a structured technique. The method improves the mental condition of the patient through cognitive change (Cristea et al., 2013). While this theory is efficient in dealing with simple mental health issues caused by maladaptive coping behavior, it does not provide solutions for mental health issues caused by genetic disorders or other complex factors.
A weakness of CBT is that it places too much emphasis on the ability of the individual to independently carry out changes that result in a healthy mental state. At its core, the theoretical propositions that the desired behavior changes can be effected once the therapist teaches the patient skills and strategies for coping (Dobson, 2009). While this might be true for some cases, the mental health of an individual is impacted on by a number of external factors including the work environment and the family setting. To properly address the mental problems experienced by the person, it might be necessary to address the wider problems in families or workplaces.
Another weakness of CBT is that it can lead to confusion since different cognitive-behavioral approaches put varying degrees of emphasis on the cognitive versus the behavioral aspect of treatment. Cristea et al. (2013) confirm that in most cases, the therapy’s own bias dictate whether emphasis will be placed on the behavioral or cognitive aspect of treatment. This creates a situation where the treatment outcomes may not be uniform even among therapists using the same CBT model.
The attainment of mental health is critical to achieving positive outcomes in life. For these reasons, mental health researchers and clinicians have endeavored to develop the best treatment strategy for patients. The most effective therapies are founded on sound theoretical frameworks. This paper set out to discuss Cognitive-behavioral theories, and the CBT approaches psychotherapy. It began by tracing the origins of cognitive-behavioral theory to the work of Aaron Beck. The paper then showed how researchers demonstrated the empirical legitimacy of this theory over the decades. A review of the types of problems that the theory is most useful for has been made. It has been shown that CBT is important in treating anxiety disorder, eating disorders, depression, and obsessive-compulsive disorder. The paper then highlighted some of the strengths and weaknesses attributed to this theory. From the discussions made in this paper, it is evident that CBT, first proposed by Aaron Beck, is a useful tool for mental health professionals.
Cristea, I.A., Montgomery, H.G., Szamoskozi, S., & David, D. (2013). Key Constructs in “Classical” and “New Wave” Cognitive Behavioral Psychotherapies: Relationships Among Each Other and With Emotional Distress. Journal of Clinical Psychology, 69(6), 584–599.
Dobson, K. (2009). Handbook of Cognitive-Behavioral Therapies. NY: Guilford Press.
Fursland, A., Byrne, S., Watson, H., La PUma, M., Allen, K., & Byrme, S. (2012). Enhanced Cognitive Behavior Therapy: A Single Treatment for All Eating Disorders. Journal of Counseling & Development, 90(1), 319-329.
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Hind, D. (2014). Cognitive behavioural therapy for the treatment of depression in people with multiple sclerosis: a systematic review and meta-analysis. BMC Psychiatry, 14(5), 1-31.
Moldovan, R., & David, D. (2014). One session treatment of cognitive and behavioral therapy and virtual reality for social and specific phobias. Preliminary results from a randomized clinical trial. Journal of Cognitive and Behavioral Psychotherapies, 14 (1), 67-83.
Nakatani, E., Mataix-cols, D., Micali, N., Turner, C., & Heyman, I. (2009). Outcomes of Cognitive Behaviour Therapy for Obsessive Compulsive Disorder in a Clinical Setting: A 10-Year Experience from a Specialist OCD Service for Children and Adolescents. Child & Adolescent Mental Health, 14(3), 133-139.
Schibbye, P., Ghaderi, A., Ljotsson, B., Hedman, E., Lindefors, N., Ruck, C., & Kaldo, V. (2014). Using Early Change to Predict Outcome in Cognitive Behaviour Therapy: Exploring Timeframe, Calculation Method, and Differences of Disorder-Specific versus General Measures. Plos One 9(6), 1-10.