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Essay: Cognitive Behavior Therapy

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  • Published: 26 December 2019*
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Introduction
Following the study of the major counseling theories, choosing one that matched my initial worldview was quite difficult. After further consideration, the theory that resonates with me the most is Cognitive Behavior Therapy (CBT). CBT has been shown to be successful in treatment of a variety of psychological problems. (Chambless & Ollendick, 2001) I like that the theory incorporates both a behavioral and cognitive approach and picks elements from multiple theories to improve the overall wellness of a client through thoughts and behaviors.
Aaron Beck developed cognitive therapy in the 1960s and his work has since emerged to be known as cognitive behavior therapy (Beck, 2014). CBT is based on the cognitive model: our thoughts (cognitions) determine our behavior and emotions. Schemas, automatic thoughts, and beliefs are key components of CBT. We are mostly unaware of schemas and they influence the way we process new information and experiences. (Murdock, 2013) Beliefs are another component of schemas and can be split into core beliefs (most basic and hardest to modify) and assumptions (intermediate beliefs). (Murdock, 2013) The cognitive behavior therapist works to identify automatic thoughts, which are short statements that are associated with core beliefs or schemas. (Murdock, 2013) Automatic thoughts occur quickly and are, also, not usually recognized. They can be functional, distressing, and often occur alongside our conscious thoughts – which makes them valuable. (Murdock, 2013)
The cognitive behavior therapist aims to help clients identify distorted cognitions and develop alternative thoughts and beliefs. Beck (2011) commented, “when people learn to evaluate their thinking in a more realistic and adaptive way, they experience improvement in their emotional state and behavior.” (Beck, 2011) In CBT, the therapeutic relationship is built on empathetic understanding, genuineness, and respect. Together, the client and counselor strive to uncover the client’s difficulties through a scientific approach. (Murdock, 2013)
Personal Worldview
Similarly, my personal worldview paper discussed human nature being a way to decision-make, rationalize, and experience emotion. CBT is neutral on human nature and focuses on the cognitions, behaviors, and emotions of an individual. Additionally, I focused on how our environment and genetics play an important role in how we respond to external and internal stimuli. According to Murdock (2013), “CT theorists conceptualize human functioning as the product of learning and genetics” (p. 325). I, also, suggested that our childhood lays the foundation of our personality development. This is believed to be true with CBT because the theory explains how schemas, produced in our childhood, help us to create meaning for past experiences and organize new events. (Murdock, 2013) Our cognitive structures are a result of our interactions with the environment and develop early in life. (Murdock, 2012) These cognitive thoughts continue throughout the duration of our lives, and if they clash with our core beliefs, distort thinking. Distorted thinking leads to negative responses to events. As mentioned in my worldview paper, healthy individuals are able to apply effective coping mechanisms, control behavior, and understand emotions. Distorted thinking does not allow an individual to do any of the aforementioned cognitive or emotional tasks; CBT works with a client to overcome negative thoughts. In my opinion, a positive self-image is important for a client’s successful transition to a healthy functioning life.
Cultural Considerations
Several of the latest studies have identified limitations and provided treatment recommendations for multicultural groups including, elderly Chinese women with anxiety (Mei, Koong, & Haarhoff, 2006), depression in Hispanic patients (Interian & Diaz-Martinez, 2007), and African American children and adolescents (Wilson & Cattone). While, Cognitive Behavior Therapy is based on Western concepts, the theory has been shown effective across cultures with mental illness, if appropriately modified. (Rathod & Kingdon, 2009) Hays (1995) noted four components of CBT that can be beneficial when working with multicultural clients: 1) the theory adapts to meet individual needs and with a wide range of techniques counselors are able to modify therapy to each client and their unique situation; 2) CBT emphasizes client empowerment and allows the counselor to respect and appreciate the client’s cultural differences; 3) the focus on conscious thought, behavior, and emotion can be more easily translated than other therapies with individuals using a second language; 4) continuous assessment throughout the therapeutic process gives client’s and counselor opportunity to evaluate progress from client’s direct feedback. (Hays, 1995)
Theoretical Strengths
Cognitive Behavior Therapy is adaptive. The continuous evaluation and advances made by Beck and colleagues has increased the strength of this theory. (Murdock, 2013) The wide range of techniques allows the counselor to modify treatment to fit each client’s needs. CBT is one of the most studied counseling theories and is well supported by scientific research. Outcome research has supported the practice’s effectiveness among clients suffering with depression, anxiety, PTSD, eating disorders, and other mental illnesses. For example, a meta-analysis study performed showed that, the general evidence of CBT was strong, especially with anxiety. (Hoffman et, al., 2012) Research has also confirmed CBT’s success with children and adolescence. CBT has been effectively used to assist children with ADHD, aggression, and other disruptive behaviors. (Wilson & Cotoone, 2013)
As I mentioned in the above sections, the collaborative therapeutic relationship empowers the client to adjust distorted thoughts while providing them the tools necessary to succeed independently. CBT is instructive; the counselor teaches the client to become his/her own counselor building confidence for long-term success. Furthermore, CBT is short-termed and provides structured counseling sessions and treatment plans. (Murdock, 2013)
Limitations of Therapy
Criticisms about CBT include the difficulty of evaluating the mechanism of change due to the wide range of techniques used between cognitive and behavioral approaches. In a recent review, challenging empirical versus theoretical CBT, found there was no significant difference in treating anxiety and depression using cognitive or behavioral techniques. (Longmore & Worrell, 2007) They concluded that together the techniques work, however, the lack of empirical support showing implementation of the cognitive versus behavioral portion of CBT technique does not significantly alter client outcome. The same meta-analysis study mentioned in the strengths section, also discussed the need for further study on the efficacy of CBT. (Hoffman et. al., 2012)
Though many articles were found during this research, the amount of empirically supported articles involving diverse individuals was scarce. Literature on CBT remains dominated by white European perspectives. (Wilson & Cottoone, 2013) Ultimately, there continues to be a need for cultural inclusion within research-based studies, especially with diverse youth. (Wilson & Cottoone, 2013; Hoffman et. al., 2012)
As in all therapies, there may be times where limitations for the counselor may include developing the optimum collaborative therapeutic relationship, identifying the client’s presenting problem, and setting goals on which both the client and counselor agree. (Beck, 2014) Due to the collaborative nature of CBT, it is important to build a strong alliance with the client, without which the client will likely discontinue treatment.
Theory’s Current Trends
The latest trend found in mental health care is Internet-based Cognitive Behavior Therapy (ICBT). The mental health community has made great efforts to provide therapy to individuals who may not have contact to mental health professionals due to lack of physical access, fear of judgment, or lack of means. “Delivering CBT via the Internet provides a promising new approach to overcome these barriers, and is convenient, private, affordable, and scalable.” (Newby et. al, 2018) Several recent studies have been published in support of ICBT with a focus on perfectionism (Rosenthal, et. al., 2017), anxiety disorder (Newby et. al., 2018), and alcoholism (Sunstrom et. al., 2017). In all three groups, ICBT was shown to be effective and feedback provided by the clients confirmed results. Also, improvements with the alcoholism group remained the same at the 3-month follow up (Sunstrom et. al., 2017). Equally, the studies agree that ICBT is an efficient way to provide therapy, however, more research is needed to determine the true effect of these outcomes.
Continuing with technology, Virtual Reality CBT (VRCBT) is a promising new technology designed to overcome lack of counselor control and loss of confidentiality due to exposure. (Safir, Wallach, & Bar-Zvi, 2012). In a one-year follow up for public speaking anxiety, Safir, Wallach, & Bar-Zvi (2012) found no significant difference between CBT and VRCBT, however, there was a higher drop out rate for CBT than there was for VRCBT. Both styles remained effective after the one-year follow up. Advantages of VRBCT include giving the client an alternative option for exposure; it also gives more control to the counselor, and protects client’s confidentiality. (Safir, Wallach, & Bar-Zvi, 2012).
Conclusion
In conclusion, I chose Cognitive Behavior Therapy because of the ability to shape and modify the experience for each individual client. A collaborative relationship gives the counselor the ability to work with diverse backgrounds and situations. CBT has been proven to be effective in multiple studies including those that embrace technological advancement. Although, limitations do exist within the theory, outcome research provides enough support to conclude the effectiveness of change is more positive than negative.

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