Cognitive Behavioral Therapy

Abstract

Cognitive behavior therapy has widely been used as a way of dealing with stress, depression, and anxiety among patients. The theory has been proven to work because it focuses on the events in the mind that define one’s behavior. It seeks to influence the mental activities as a way of managing one’s behavior. In this paper, the theory has been put into application to help a patient suffering from posttraumatic disorder and discrimination at workplace.

History and Development of the Theory

Cognitive behavior therapy, commonly known as CBT is a goal-oriented theoretical concept that was developed in the 1960s by a psychiatrist, Aaron Beck. Its primary users are patients suffering from depression and psychiatrists trying to help patients suffering from depression-related problems. It is designed to deal with the thoughts, feelings, and behavior of people. According to Warren (2012) REBT (Rational Emotive Behavior Therapy) that was developed by Albert Ellis is a pioneering form of CBT. CBT was designed to help the affected individuals cope with extremely stressing situations caused by various forces in life.

According to Thase, Kingdon, and Turkington (2014), maladaptive behaviors play a critical role in the development of psychological disorders. The moment one embraces a given thought that is negative or elicits painful memories then one cannot cope with distress and one’s behavior becomes unpredictable. As such, it is important to manage one’s thoughts and feelings, and CBT helps in doing that. This concept is problem-focused, making it different from most of the approaches to psychotherapy that has been historically used to manage mental distress.

Instead of giving emphasis to the possible cause of the problem, it emphasizes on the problem itself and what can be done to address it. After determining the problem, the concept strongly supports the coming up with a series of actions that can be used to address the identified problem in the best way possible. Corey (2016) notes that as the concept continued to develop and gain popularity in the medical field, it became apparent that it can be used in combination with some medications to help in treating various other disorders. Obsessive compulsive disorder, bipolar, posttraumatic stress disorder (PTSD), substance abuse, anxiety, and psychotic disorders are some of the conditions that can be addressed using CBT.

Rationale of the Theory

Cognitive behavior therapy is a present-oriented psychotherapy that primarily focuses on solving a current problem by teaching patients the skills that can help them modify their dysfunctional thinking and behavior. The rationale of this theory is that one’s behavior is shaped by thoughts and feelings. When one constantly thinks of a traumatic event that took place in the past, then one will always feel sad, and the sadness will define how they behave. The following figure 1 shows how the behavior of an individual is influenced by these two factors and what can be done to avoid negative thoughts that may lead to erratic behavior using cognitive behavior therapy.

As shown in the figure above, it all starts with one’s thoughts. The therapy is based on the premise that if one has stressful thoughts, then one’s feelings will be influenced by the stressful thinking. The behavior of such an individual is likely to be in line with the thinking and feelings. In this case of stress, the individual is likely to behave in a way that is either defensive or offensive to the forces believed to cause stress.

When one decides to be defensive, then one may be withdrawn and untrusting as a way of creating a defensive wall to help them avoid similar stressful situations. When one decides to be offensive, then one can make deliberate attempts to attack individuals or objects believed to be the cause of distress. The rationale of this theory is that by targeting the thought, a psychotherapist is able to influence one’s feeling enabling them to behave in a given manner.

Theoretical Assumptions

Cognitive behavior therapy is based on a number of assumptions which are worth discussing in this section. According to Anderson, Cuijpers, Carlbring, Riper, and Hedman (2014), the most fundamental assumption of CBT is that humans have no free will and as such, their thoughts, feelings, and behavior are determined by cognitive processes which are raised by the external stimuli. In this assumption, it is believed that people rarely think independent of the external forces within their environment.

What people experience, observe, or hear defines their pattern of thinking. As such, understanding a patient’s environment enables a psychologist to understand the possible causes of trauma and how it can be managed the best way based on the environmental forces that that the patient is currently exposed to. Although this assumption has been criticized by a number of scholars, Corey (2016) says that there is a consensus among psychiatrists that one’s environment fundamentally affects one’s way of thinking. Another fundamental assumption of CBT is that when maladaptive thinking of an individual is changed, then one’s behavior will be changed.

As shown in the figure 1 above, before one acts in any given way, a series of events take place in the mind. The more one embraces a given thought, the more he or she gets convinced that he or she should act in a given manner.

Associated Techniques Related to the Theory

It is important to look at the associated techniques related to the cognitive behavior therapy. One of the techniques associated with CBT is acceptance and commitment therapy (ACT). In this unique technique, one is encouraged to open up to unpleasant feelings in a meditative process. The technique empowers an individual to learn not to overreact to these unpleasant feelings (Bhattacharya, Chaudari, Saldanha, & Menon, 2013).

It is important to note that there are different approaches that may be embraced when using this theory. The most common approach is the goal-oriented approach where a psychiatrist sets small and easy to attain goals with the patient. Another approach may be problem-focus approach where undivided attention is given to address the source of depression. Instead of avoiding the unpleasant feelings because of the fear of overreaction, the technique gives special skills, which enables one to know how to withstand the feelings. One is able to gain a better understanding of the events that cause unpleasant feelings and what can be done to avoid them or manage their effects.

Relaxation technique is also associated with CBT. This method is popularly used to help one cope with anxiety, pain, stress, anger, or depression. The technique focuses on helping an individual to attain the state of calmness even in situations of distress. It aims at reducing the mind from concentrating on the pain or stress. Another technique related to CBT is the psychological resilience. As Hayes, Levin, Vilardaga, Villatte, and Pistorello (2013) say this technique enables people to adapt to adverse condition or social disadvantages which are beyond their personal control. It can be a stressful workplace environment, family issue, or a health problem which cause unpleasant feelings. This technique helps one to know how to deal with these negativities in the environment without developing mental stress.

Case Study: Ahmed

Identifying Information

Ahmed is an African American man who happens to be a Muslim. He has been working at Cobra Star Inc, a leading shoe making company in the United States. Mr. Ahmed has been subjected to racial discrimination at work over the past decade in terms of promotion and job assignments. He states that even his fellow African American colleagues at work treat him with mistrust, primarily because of his religion. He is forced to work at the company because of the limited option of employment within this community.

Nature of Referral

Ahmed referred himself to a therapist. On March 22, 2017 when he was preparing to leave, the city of London was attacked and he was one of the casualties. He sustained minor injuries, but was significantly affected when he saw the level of injuries sustained by other victims.

Relevant History

• Psychiatric. Ahmed admits that he has had a problem of low self-esteem as a child when he was in high school.
• Family. He stays with his wife and two children. His father was security guard before being arrested for robbery with violence. The father currently serves a term in prison. He was brought up with an alcoholic mother. His elder brother is a medical doctor but has been avoiding the family for the last several years.
• Academic. Ahmed is a high school graduate. He joined teachers training college but was expelled when he organized a series of demonstrations at the institution. He never made attempt to join college after.
• Social. Ahmed says that he managed to overcome his low-self esteem problem when he joined college. He believes that he is a social person.
• Medical. Ahmed is currently a recovering drug addict. He says that he has not used alcohol or hard drugs over the last six months, but he is fighting withdrawal symptoms for marijuana.

Assessment

The patient shows strong signs of emotional distress. He is deeply troubled and is not very sure what to do. He wants to keep his job, but feels that the current situation he is in will leave him jobless.

Dialogue

Counselor: It is important that you have come for the counseling services because you understand there is a problem.

Ahmed: I need help because I feel I have stretched myself to the limits and my workplace is turning out to be a nightmare.

Counselor: What do you think is your biggest issue in the current workplace that is affecting you?

Ahmed: I believe that most of my colleagues are not comfortable with me in the workplace because of my religion.

Counselor: I want us to find a way of making them appreciate you as you are. Are you committed to this program?

Ahmed: I am willing to work with you to find a solution to my current problems.

Conclusion

The discussion revealed that Ahmed need acceptance from his colleagues but he is not sure how to do that. We agreed that he will engage the colleagues, address their fears and misconceptions to gain their acceptance.

Why and How the Patient Would Use the Theory

The condition of this patient is getting worse and the environmental forces are not in any way making it easy for him to cope with the posttraumatic stress disorder following the terror attack in London. Ahmed needs help to ensure that he is able to lead a normal life. The reason why cognitive behavior therapy is needed when helping this patient is that his current condition is caused by mental stress. CBT is currently one of the most popularly used psychotherapeutic interventions for patients suffering from posttraumatic stress disorder. CBT goes beyond dealing with PTSD by looking at all the factors causing stress at a given moment.

Ahmed is currently battling three major stressors in his life. The first problem is the posttraumatic stress disorder following the terror attack in London. Then there is the racial discrimination that he has been forced to withstand at workplace for the last one decade. The third and major stressor is the fact that his colleagues now associate him with an attack where he was a victim, not a perpetrator. The victimization is most likely going to make him lose his job as the managers may be forced to act in the interest of the other employees.

It is important for the psychiatrist to know how to use this theory when handling this patient. The situation of this patient is very delicate because the constant persecution has bred hatred and mistrust. Using this theory will require the psychiatrist to deal with the three situations differently because they are the current problems. To help Ahmed deal with the posttraumatic stress disorder, acceptance and commitment therapy will be necessary. Instead of avoiding the thoughts of the incident, he will need to meditate upon the events and accept the fact that he had no control over what happened.

He must embrace positive thoughts by believing that although the event was unpleasant, he was lucky enough to have come out alive. He should train his mind in a way that whenever he remembers the events in London attack, what stands out prominently is the fact that he was able to survive. This technique will help him overcome the strain. The psychiatrist should also use psychological resilience technique with this patient. He should be trained to adapt to stressful environmental situations at work.

How the Theory Could Be Helpful and Harmful in Addressing the Issue

It is important to appreciate that this theory can potentially be helpful and harmful in addressing the diversity issue and the condition the patient is currently facing. When used in the right way, and the patient is positive enough, then CBT will help this patient to overcome most of the problems he is currently facing. The posttraumatic stress disorder may develop into serious behavioral problems if ignored. This treatment is going to deal with this psychological problem and free the client from the stress associated with this event. The client will not stop the memories of the event. However, these memories will not cause as much pain as they currently are.

This theory is also going to change the approach that the client is using to address discrimination in the workplace. It will empower him in a way that will make him view the diversity as strength in the workplace instead of being a dividing factor. The client will know that being accused of a crime unfairly does not in any way make him guilty. However, it is important to note that this theory may also be harmful to this patient in addressing the diversity issue. It is easy to assume that the patient, after the therapy, will develop resilience towards the environmental stressors.

References

Anderson, G., Cuijpers, P., Carlbring, P., Riper, H., & Hedman, E. (2014). Guided Internet-based vs. face-to-face cognitive behavior therapy for psychiatric and somatic disorders: A systematic review and meta-analysis. World Psychiatry, 13(3), 288–295. Web.

Bhattacharya, L., Chaudari, B., Saldanha, D., & Menon, P. (2013). Cognitive behavior therapy. Med J DY Patil Univ, 6(2), 132-138. Web.

Corey, G. (2016). Theory and practice of counseling and psychotherapy (10th ed.). Belmont, CA: Wadsworth.

Hayes, S., Levin, M., Vilardaga, J., Villatte, J., & Pistorello, J. (2013). Acceptance and commitment therapy and contextual behavioral science: Examining the progress of a distinctive model of behavioral and cognitive therapy. Behavior Therapy, 44(2), 180–198. Web.

Nordgrena, L., Hedmanb, E., Etiennea, J., Bodina, J., Kadowakid, A., Erikssone, S.,… Carlbringf, P. (2014). Effectiveness and cost-effectiveness of individually tailored Internet-delivered cognitive behavior therapy for anxiety disorders in a primary care population: A randomized controlled trial. Behavior Research and Therapy, 59(8), 1–11. Web.

Thase, M., Kingdon, D., & Turkington, D. (2014). The promise of cognitive behavior therapy for treatment of severe mental disorders: A review of recent developments. World Psychiatry, 13(3), 244-250. Web.

Warren, J. (2012). Mobile mind mapping: Using mobile technology to enhance rational emotive behavior therapy. Journal of Mental Health Counseling, 34(1), 72-81.

Detailed Outline

1. Abstract: It provides a brief summary of the entire paper. It looks at the major concepts of CBT and how it can be applied to address a psychological problem of in a patient.
2. Cognitive Behavior Therapy: This is the first section of the paper. The section looks at cognitive behavior therapy as a theory that is used in addressing psychological problems of patients as explained by scholars such as Bhattacharya et al. (2013). It is divided into four main sections. The first section looks at the history and development of the theory. The second section looks at the rationale of the theory. The next section critically analyzes the theoretical assumptions that must be taken into consideration when using this theory. The last section looks at the associated techniques related to this theory.
   1. History and Development of the Theory: The subsection looks at how the concept was developed and the extent to which it is currently used in medical settings, especially by psychiatrists when dealing with various psychological problems. The section also discusses the person who developed this theory.
   2. Rationale of the Theory: The subsection focuses on the importance of this theory in the current medical setting. It explains how this theory is used and why medical experts consider it one of the most appropriate ways of dealing with clients suffering from stress or depression-related complications (Nordgrena et al., 2014).
   3. Theoretical Assumptions: Every theory has fundamental assumptions. The subsection looks at the underlying assumptions when using this theory. It also looks at how these assumptions have been perceived by other scholars and whether or not they compromise the validity of the theory.
   4. Associated Techniques Related to the Theory: The subsection focuses on the techniques which are associated with CBT. The researcher also looks at the approaches that the theory has. Acceptance and commitment therapy, relaxation technique, and psychological resilience are some of the associated techniques which are discussed in this section.
3. Case Study: This is the second section of the paper. It focuses on a fictitious client case that relates to diversity in the workplace and stress caused by various external environmental stimuli. It then looks at why and how the theory would be used to help this patient overcome stress and anxiety. The section then looks at how the theory could be helpful and at the same time harmful to the client.
   1. Why and How the Patient Would Use the Theory: The subsection looks at why the current condition of the patient needs CBT. It explains how CBT can be used to address the three main sources of stress that the client is currently facing (Thase et al. 2014). It shows how this theory can be put to practice to address a medical problem.
   2. How the Theory Could Be Helpful and Harmful in Addressing the Issue: In this section, the focus is to determine the pros and cons of the theory. It looks at how the patient will benefit when the strategy is used, and some of the challenges that may be associated with the theory in relevance to the condition of the patient.
4. References: A list of sources used in this paper. In this section, the researcher provides a list of books and articles that informed the study.