Cognitive Therapy-Think Positive!

Cognitive Therapy-Think Positive!

Cognitive Therapy-Think Positive!

Gateway Question 15.5: How does cognitive therapy change thoughts and emotions? Whereas humanistic therapies usually seek to foster insight, cognitive therapies usually try to directly change what people think, believe, and feel, and, as a consequence, how they act. In general, cognitive therapy helps clients change thinking patterns that lead to troublesome emotions or behaviors (Davey, 2008; Power, 2010).

In practice, how does cognitive therapy differ from humanistic therapy? Janice is a hoarder whose home is crammed full with things she has acquired over two decades. If she seeks help from a therapist concerned with insight, she will try to better understand why she began collecting stuff. In contrast, if she seeks help from a cognitive therapist, she may spend little time examining her past. Instead, she will work to actively change her thoughts and beliefs about hoarding. With either approach, the goal is to give up hoarding. Further, in practice, humanistic therapies often also result in active change and cognitive therapies often also yield deeper insight.

Cognitive Therapy-Think Positive!

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Cognitive therapy has been successfully used as a remedy for many problems, ranging from generalized anxiety disorder and post- traumatic stress disorder to marital distress and anger (Butler et al., 2006). For example, compulsive hand washing can be greatly reduced by changing a client’s thoughts and beliefs about dirt and contamination (Jones & Menzies, 1998). Cognitive therapy has been especially successful in treating depression (Hollon, Stewart, & Strunk, 2006). Joe’s clinical psychologist relied on cognitive therapy to help lift Joe (who could forget Joe?) out of his depression.

Cognitive Therapy for Depression As you may recall from Chapter 13, cognitive psychologists believe that negative, self-defeating thoughts underlie depression. According to Aaron Beck (1991), depressed persons see them- selves, the world, and the future in negative terms because of major distortions in thinking. The first is selective perception, which refers to perceiving only certain stimuli in a larger array. If five good things and three bad things happen during the day, depressed people focus only on the bad. A second thinking error in depression is overgeneralization, the tendency to think that an upsetting event applies to other, unrelated situations. An example would be Joe’s considering himself a total failure, or completely worthless, if he were to lose a part-time job or fail a test. To complete the picture, depressed persons tend to magnify the importance of undesirable events by engaging in all-or-nothing thinking: they see events as completely good or bad, right or wrong, and themselves as either successful or failing miserably (Lam & Mok, 2008).

Cognitive Therapy-Think Positive!

How do cognitive therapists alter such patterns? Cognitive therapists make a step-by-step effort to correct negative thoughts that lead to depression or similar problems. At first, clients are taught to recognize and keep track of their own thoughts. The client and therapist then look for ideas and beliefs that cause depression, anger, and avoidance. For example, here’s how Joe’s therapist began to challenge his all-or-nothing thinking:

Joe: I’m feeling really depressed today. No one wants to hire me, and I can’t even get a date. I feel completely incompetent!

Therapist: I see. The fact that you are currently unemployed and don’t have a girlfriend proves that you are completely and utterly incompetent?

Joe: Well…I can see that doesn’t add up.

Next, clients are asked to gather information to test their beliefs. For instance, a depressed person might list his or her activities for a week. The list is then used to challenge all-or-nothing thoughts, such as “I had a terrible week” or “I’m a complete failure.” With more coaching, clients learn to alter their thoughts in ways that improve their moods, actions, and relationships.

Cognitive therapy is at least as effective as drugs for treating many cases of depression (Butler et al., 2006; Eisendrath, Chartier, & McLane, 2011). More importantly, people who have adopted new thinking patterns are less likely to become depressed again—a benefit that drugs can’t impart (Dozois & Dobson, 2004; Hollon, Stewart, & Strunk, 2006).

In an alternate approach, cognitive therapists look for an absence of effective coping skills and thinking patterns, not for the presence of self-defeating thoughts (Dobson, Backs-Dermott, & Dozois, 2000). The aim is to teach clients how to cope with anger, depression, shyness, stress, and similar problems. Stress inoculation, which was described in Chapter 13, is a good example of this approach. Joe used it to weaken his social phobia.

Cognitive therapy is a rapidly expanding specialty. Before we leave the topic, let’s explore another widely used cognitive therapy.

Rational-Emotive Behavior Therapy

Rational-emotive behavior therapy (REBT) attempts to change irrational beliefs that cause emotional problems. According to Albert Ellis (1913–2007), the basic idea of REBT is as easy as A-B-C (Ellis, 1995, Ellis & Ellis, 2011). Ellis assumes that people become unhappy and develop self-defeating habits because they have unrealistic or faulty beliefs.

How are beliefs important? Ellis analyzes problems in this way: The letter A stands for an activating experience, which the person assumes to be the cause of C, an emotional consequence. For instance, a person who is rejected (the activating experience) feels depressed, threatened, or hurt (the consequence). Rational-emotive behavior therapy shows the client that the real problem is what comes between A and C: In between is B, the client’s irrational and unrealistic beliefs. In this example, an unrealistic belief leading to unnecessary suffering is, “I must be loved and approved by every- one at all times.” REBT holds that events do not cause us to have feelings. We feel as we do because of our beliefs (Dryden, 2011; Kottler & Shepard, 2011). (For some examples, see “Ten Irrational Beliefs—Which Do You Hold?”)