Cognitive Behavior Therapy: A Critical Evaluation.

Cognitive Behavior Therapy: A Critical Evaluation.

During the last half of the twenty century the history of Psychology was greatly transformed by the appearance of the Cognitive Behavioral Therapies. The role of cognition captured the attention of researcher and clinician as a predisposing or causal factor in a number of disorders. The way we see and interpret our life events filter reality.

According with David et al (2005) REBT since its creation, several hundred papers have been published focusing on the theory and practice. Some studies have confirmed the main aspects of the original REBT theory while others have made critical contributions to its evolution (David, 2003). The theoretical constructs of REBT (e.g., IBs and RBs) have influenced many research areas in clinical 176 Journal of Rational-Emotive & Cognitive-Behavior Therapy psychologies and psychotherapy and have also been assimilated by the psychological mainstream.

Rational-Emotive Behavior Therapy

The fundamental assumption for REBT is that the way we interpret the events and situations can contribute to our psychological problems. They stresses thinking, judging, deciding analyzing and doing .Our cognitions, emotions, and behaviors basically interact and is the root of many psychological problems.

Ellis credited the ancient Greeks and Romans which includes, Epictetus, Marco Aurelious especially Epicurus which point that people are disturbed by the interpretation they have of things and events. He went back to ancient philosophers, including Confucius, Gautama Buddha, and Lao-Tzu. Also Adler influenced Ellis ideas. Adler contended that our emotional reactions are associated with the way we perceive the world, and our social interest is a factor determining our psychological health. Adler active teaching and life demonstrations are part of REBT.

Ellis contended in his book “How to make yourself Happy and remarkably less disturbable” (1999, p 10)) that REBT is different with other therapies that make you feel better, because REBT help you to get better and stay better. When you get better, you adjust your cognitions about the events; you allow the events to be as they are (rational/functional) not as your irrational beliefs (irrational/dysfunctional). The main hypothesis is that our emotions are rooted from our beliefs, evaluations and interpretations. Ellis called irrational beliefs, when we turn our healthy preferences into unhealthy, irrational demands and musts.

We are basically born with both tendencies, to think rationally or “straight” and irrationally or “crooked” ( Corey,2005) We have to accept that we are mainly responsible for our emotional problems, as well as the capacity to change these disturbances. Ellis states that probably we were born demanding because we are needy to be care for and protected. Later in life in our culture many shoulds are incorporated in our culture with TV commercials, movies, stories, etc. We naturally make our desires and preferences into a strong commands and demands.

Ellis proposed a theory of personality called the A-B-C theory. The A is an event, a fact, behavior or attitude. C is the emotional and behavioral consequence or reaction of the individual. A does not cause C, instead B which is our belief system about A mainly causes C. We feel the way we think. Unhealthy emotional reactions to our event in life such us depression or anxiety are kept by our irrational ideas

The next step on the process is D, in which we can dispute our irrational beliefs in three ways: realistically or empirically; logically; and practically. When we actively and persistently dispute your self-defeating, Irrational Beliefs (IB) will create new belief more rational ones which lead to a healthy feelings and actions in our life..

The main goals of REBT are to help the client in the process of achieving unconditional self-acceptance (USA) and unconditional others acceptance (Ellis, 1999) According to Ellis we are self-evaluating our actions and behaviors and we include ourselves as a total person. The therapists goals consist on teaching the client evaluate the behavior from the evaluation of themselves, and to accept our imperfections in more realistic ways.

The therapist has to show clients the use of many irrational “shoulds,” ”oughts,” and musts.” The clients turn their healthy preferences into unhealthy, irrational demands and musts. (Ellis,1999) The client keep their emotional patterns active by continuing self-evaluating irrationally, being responsible of their neuroses.

A fundamental step occurs helping clients modify their thinking. Rationally develop a new philosophy of life where preferences are non-dogmatic, high frustration tolerance and self and others rate not global. The therapist is persuasive regarding the use of rational beliefs through education.

The clients participate effectively once accept that their beliefs are the cause of emotional disturbances. Ellis states that in REBT the clients role is a learner in a re-educative process from IB to RB. This process is focus mainly on present-centered experiences, considering the client is presently disturbed because still believe in self-defeating view of themselves.

The clients are a learner in the therapy and at home carrying out behavioral homework assignments. The homework represent the opportunity to challenge themselves the effect of the IB and carefully plan new positive actions that induce new RB.

The therapist unconditionally accept all clients refusing to evaluate them They model to clients how to accept unconditionally others and themselves. The therapy is cognitive confronting the client’s IB and self destructive behaviors.

The REBT therapist shows to his or her clients that they are confident about the client’s ability to change, however they do not foster a sense of dependence for approval from the therapist.( Ellis, 1999)

Rational Emotive Behavior therapist integrates cognitive methods, emotive and behavioral techniques. Among the cognitive methods REBT incorporate a cognitive methodology, that in quick manner demonstrate the client their IB.

1. Disputing irrational beliefs: it consists in dispute the client’s IB and instruct them how to challenge and adopt new philosophies.

2. Doing cognitive homework: clients have to make lists of their problems, actively search for IB, and dispute them.

3. Changing one’s language. The use of overgeneralized, or imprecise language.

4. Using humor: Ellis use humor to help client not to take so seriously, including songs and encourage people to sing when they feel depressed (Ellis 1999)

According with David et. al, (2005) “ REBT works most effectively in relations with other therapies. They arrived to the next general conclusion:

· REBT seems to be useful for a large range of clinical diagnoses ans clinical outcomes

· REBT is equally efficient for clinical and non clinical populations for a large age range (9-70) and both for males and females.

· No significant difference between individual and group REBT.

· The higher the training of the therapist the grater-better the results of REBT intervention.

· Higher number of REBT sessions correlate with better outcomes.

REBT and control groups and REBT and placebos (i.e. attention control) has show that REBT has medium to high effect size compared to control conditions. REBT and placebos (David et al, 2005) these data show that REBT systematically has a high effect size when compared with other therapies. Meta-analyses conclude that REBT seems successful in improving subjects’ well-being.

The same studies have found that REBT has about the same efficacy as most behavioral treatments for obsessive-compulsive disorders, social phobia and social anxiety. REBT in conjunction with medication has been found more effective than medication alone for major depression. Also, REBT seems to be an effective adjunct in the therapy of inpatients with schizophrenia conclusions.

Aaron Beck’s Cognitive Therapy.

REBT and CT are therapies that focus on cognitions, emphasize, recognize and change negative thoughts and maladaptive beliefs. They are present-centered, collaborative and structured approaches. Require the active participation of the client, are directive with the client and time limited.

The theoretical assumptions of CT are that self-talking is accessible to introspection and the client’s has to discover his or her beliefs that are meaningful to them. It is fundamental to understand the individual reaction to the event or stream of thoughts focusing on the cognitive content.

Beck get interested in automatic thoughts that lead to emotional responses that persist even with objective evidence especially in depressed individuals. Psychological problems are stem from faulty thinking, incorrect inferences and not distinguishing between fantasy and reality. Some of these cognitive distortions are:

1. Arbitrary inferences: making conclusion without evidence, catastrophizing or thinking the worst scenario.

2. Selective abstraction: forming conclusion based on partial detail of an event ignorant relevant information.

3. Overgeneralizations: radicalize beliefs base on a single incident and inappropriately use to a different event.

4. Personalization: a tendency to relate external circumstances to ourselves when is not basis for the assumptions.

5. Labeling and mislabeling consist in portray own identity on the basis of mistakes made in the past and allowing them to defines one identity.

6. Polarized thinking: all-or-nothing interpretations of the facts, extremes ways of thinking.

For Beck, inaccurate and dysfunctional thinking is the root of psychological distress (Beck 1976) The therapist teaches clients how to identify these cognitions through a collaborative and evaluative process. The therapist encourage the clients to recognize, observe and monitor the automatic thoughts, checking for evidence against them. The therapist uses Socratic dialog, homework assignments to empirically test the client’s beliefs. Beck’s uses Socratic dialogues with the purpose to aim clients to reflect and arrive to their own conclusions on misconceptions. This process is call collaborative empiricism when client’s change confronting his faulty beliefs with new evidence.

Beck’s CT emphasize on the quality of the therapeutic relationship, nonjudgmental acceptance and accurate empathy are among the most important characteristics. The therapist is a catalyst understanding how their beliefs and attitudes define their psychological problems.

The clients participate actively in CT bringing topics to explore, self-identifying distorted ways of thinking and doing homework assignments.

By applying cognitive techniques the therapist assist clients find alternatives interpretations of events in their daily living. The therapist becomes aware of the distortions by examining your automatic thoughts.

According to Kuyken et al,(2001) when well-trained cognitive therapists deliver cognitive therapy, depressed clients are treatable through adapted cognitive therapy for depression. Additionally, an assessment of patients' cognitive and behavioral avoidance may be useful in informing therapists about the likely response to cognitive therapy and in adapting interventions to specifically target these beliefs and behaviors. In summary, this study suggests the appropriateness of cognitive therapy for patients with a personality disorder.

According to Kazantzis006) “CBT is comparable in effectiveness to antidepressants and interpersonal or psychodynamic therapy for depression” CBT and antidepressant are very effective against severe depression. A published data to support the utility of the approach for a variety of anxiety disorders, substance abuse, eating disorders, and, as an adjunct to medication, bipolar disorder and schizophrenia.

The Cognitive Behavioral therapies are very promising therapies. Our cognitions are the main component of our personality and determine many of our psychological disorders.

References:

David, D., Szentagotai, A., Eva, K., & Macavei, B (2005). A Synopsis of Rational-Emotive Behavior Therapy (REBT) Fundamental and applied Research. Journal of RAtional-Emotive Behavior Therapy, 23,

Nikolaos Kazantzis Theory, Research, and Practice of Cognitive Behaviour Therapy in Aotearoa/ New Zealand: Introduction to the Special Feature. New Zealand Journal of Psychology. Christchurch:Nov 2006. Vol. 35, Iss. 3, p. 114-116 (3 pp.)

Paul L Merrick, Frank M Dattilio. (2006). The Contemporary Appeal of Cognitive Behaviour Therapy. New Zealand Journal of Psychology, 35(3), 117-119. Retrieved April 24, 2007, from ProQuest Psychology Journals database. (Document ID: 1204682791).

Kuyken, W., Kurzer, N., DeRubeis, R., Beck, A., & Brown, G. (2001). Response to cognitive therapy in depression: The role of maladaptive beliefs and personality disorders. Journal of Consulting and Clinical Psychology, 69(3), 560-566. Retrieved Tuesday, April 24, 2007 from the PsycARTICLES database.

Monica Ramirez Basco, Gretchen Ladd, Diane S Myers, David Tyler. (2007). Combining Medication Treatment and Cognitive-Behavior Therapy for Bipolar Disorder. Journal of Cognitive Psychotherapy, 21(1), 7-15. Retrieved April 24, 2007, from ProQuest Psychology Journals database. (Document ID: 1255570571).