Cognitive behavioral therapy

from Wikipedia, the free encyclopedia

The cognitive behavioral therapy is a form of behavioral therapy . Since the 1960s it developed out of cognitivism , which is a countermovement to behaviorist psychology . Albert Ellis , Aaron T. Beck and Donald Meichenbaum are among the founders and well-known representatives of cognitive behavioral therapy .

In short, there is cognitive behavioral therapy is to systematically introspection train (introspection) that the patient needs to pathogenic (z. B. depressogener ) cognitive distortion that countermeasures can be on their own.

Basic principles

Cognitions are at the center of cognitive therapy methods . Cognitions encompass attitudes, thoughts, evaluations, and beliefs. The cognitive therapies , which include cognitive therapy (KT) and rational-emotional behavioral therapy (REVT), assume that the way we think determines how we feel and behave and how we react physically . The main focuses of therapy are

  • the awareness of cognitions,
  • checking cognitions and conclusions for their appropriateness,
  • the correction of irrational attitudes and
  • the transfer of the corrected attitudes into concrete behavior.

The cognitive therapy thus places the active shaping of the perception process in the foreground, because in the last instance it is not the objective reality, but the subjective view of the observer that decides on the behavior. If cognition is inadequate (e.g. through perception selection and evaluation), the possibility of correcting affect and behavior is impaired. Above all, spontaneous and emotionally driven behavior is very much influenced by the way a person has mentally structured his model of the environment.

history

The idea that it is not events that disturb a person, but rather the point of view that he takes on these events, can already be found in ancient philosophy ( Zenon , Chrysippos , Cicero , Seneca , Epictetus ). In the early 20th century, Alfred Adler was the psychologist who came closest to the ideas of later cognitive behavioral therapy. In 1930 he wrote: "We do not suffer from the shock of our experiences (the so-called trauma), but make out of it exactly what serves our purposes best." Other psychoanalytically trained authors who have provided suggestions are Franz Alexander , Karen Horney , Leon J. Saul and Harry Stack Sullivan . On the part of philosophy, Immanuel Kant , Martin Heidegger and Edmund Husserl had a stimulating effect; Karl Jaspers , Ludwig Binswanger and Erwin W. Straus applied their insights to psychiatric issues early on. Another pioneer was Jean Piaget , in whose work cognition also played a central role.

George A. Kelly's 1955 work The psychology of personal constructs was fundamental to the development of today's cognitive behavioral therapy . Kelly had not only formulated a theory of the personal constructs that control a person's expectations and cause painful emotional consequences; he also already provided a therapeutic approach. The role of the therapist is to help the patient to become aware of dysfunctional, irrational thought patterns and to replace them with more realistic ones. In 1957, Albert Ellis began to make the theory more precise. He described a triad of a. triggering environmental event ( activating event ), b. personal construct ( intervening belief ) and c. painful emotional consequences ( emotional consequence ). Eric Berne and Jerome D. Frank contributed further therapy concepts and methods from 1961 onwards.

In 1972 Arnold Lazarus joined in and argued: "It can be said that the bulk of psychotherapeutic efforts revolve around correcting misconceptions" . Lazarus was convinced that this correction could lead directly to changes in behavior. Kenneth S. Bowers contributed to the differentiation by expressing himself critical of the "situationism" of classical behaviorism and emphasizing that there is no simple stimulus-response scheme here. In the mid-1970s, Michael J. Mahoney, Maxie C. Maultsby, Marvin L. Goldfried, Gerald C. Davison, Donald Meichenbaum , Alan E. Kazdin, and G. Terence Wilson continued to develop theory and therapy.

Aaron Beck first got involved in the discourse in 1963. With works such as Cognitive therapy and the emotional disorders (1976) and Cognitive therapy of depression (1979) he became the most important representative of teaching.

Theoretical background

The following important information is missing from this article or section:
The cognitive behavior therapy is u. a. also used for phobias and eating disorders; Beck even thinks it can have a beneficial effect on schizophrenia. What is the theoretical background of cognitive behavioral therapy in these cases?
Help Wikipedia by researching and pasting it .

The starting point and theoretical basis of cognitive behavioral therapy is the assumption that, for example, depression, anxiety and obsessive-compulsive disorder are related to negative, unrealistic, illogical and distorted patterns. Using the cognitive theory of depression , Beck and his colleagues assume that depression is something other than dysphoria and grief and that cognitive biases play a key role in it. According to this theory, depressed patients have unrealistic pessimistic expectations that are stubbornly chronic and reinforce themselves. Depressed people orient their thinking to certain theses - theses about themselves (e.g. “I don't deserve love”), about the world (“Others expect too much from me.”) And about the future (“It won't work More good things come. ”) - whose truthfulness is not checked. All perceptions are bent in such a way that they do not invalidate these theses but confirm them. This results in an automated circular thinking with which the patient systematically goes into defeat. During therapy, the patient should first learn to observe himself, to identify problems, to recognize individual blockages, to develop and try out alternatives and then to reevaluate his thinking and behavioral patterns: for example, by consciously distancing himself, reinterpreting something positively or sees a problem as a challenge.

analysis

This article or the following section is not adequately provided with supporting documents ( e.g. individual evidence ). Information without sufficient evidence could be removed soon. Please help Wikipedia by researching the information and including good evidence.
What is the context of these analysis steps? Sources would also be helpful. Tracing symptoms back to childhood plays a subordinate role in cognitive behavioral therapy; this point should be examined particularly carefully.

It begins with a description of the basic cognitive assumptions underlying automatic thoughts, followed by a description of the automatic thoughts that go through a person's mind due to problematic events. Furthermore, research is carried out on the events at which automatic thoughts occur; in this context it is of essential importance what exactly triggered the automatic thoughts in the respective situation.

The analysis then tries to capture which feelings, which behavior and which physical reactions are associated with the automatic thoughts. For example, the physical symptoms can be a first clue as to how, where and when this basic assumption could have arisen. In the last step, the analyst tries to find out which formative experiences the client had in his childhood. At the same time, it is examined to what extent the experiences are responsible for the creation and for maintaining the basic assumptions.

therapy

Cognitive behavior therapy combines methods on the cognitive level and behavioral level. In order to achieve a change in cognitive patterns and related behaviors, cognitive procedures and behavioral procedures are used. The therapy is didactic and directive, i. H. the therapist acts as a teacher; but the client should be enabled to think, feel and act independently.

Basic assumption of the therapeutic procedure

If the content of the cognitions is changed, then the experience, feeling and behavior of a person will also change. Correcting dysfunctional cognitions at least leads to an improvement in the depressed person's condition.

Aim of therapy

The main goal of cognitive therapy according to Beck's theory is to change the distorted, unrealistic cognitions on which the client's depressive disorder is based, in the direction of a more realistic perception and interpretation of reality. The depressive thinking, which is described as global, one-dimensional, absolutist, irreversible and evaluative, should be influenced towards a differentiated thinking with the attributes concrete, multi-dimensional, relativizing, reversible and non-evaluative. In the course of the therapy, the client should learn to independently identify and ultimately change their distorted, not realistic cognitions.

Before cognitive therapy in the narrower sense can take place, behavioral therapy measures are usually initiated in order to gradually increase the client's level of activity, as inactivity occurs very often in depressed patients.

Six steps of cognitive restructuring

1. Presentation of the cognitive model

At the beginning of the therapy the therapist tries to explain the connections between automatic thoughts and the basic cognitive assumptions to the client. Because it is crucial that the client knows how the therapy should work. In this way, one promises greater therapeutic success, as the client knows what the therapist intends with his methodical approach and what this should trigger in him.

2. Detection and awareness of the dysfunctional cognitions

In this phase of therapy, the client is primarily encouraged to observe himself. Introspection is the key to becoming aware of dysfunctional cognitions . Role plays and systematic conversation techniques are also used to support this.

3. Questioning the dysfunctional cognitions

If the dysfunctional cognitions entered consciousness in the previous phase, the next section of the therapy is about checking the appropriateness of those cognitions. The client must now question the cognitions and check from a rational point of view whether they are realistic and justified.

4. Reflection on the cognitions

The client reflects on his own cognitions, learns to recognize their inappropriateness himself and is thereby able to question the automatic thoughts and ultimately to discard them.

5. Development of alternative beliefs

In this phase of therapy, new functional beliefs are developed with which the client can positively influence and experience future situations. So there is a restructuring of the dysfunctional cognitions into functional ones.

6. Training of functional cognitions

The functional cognitions developed in this way must now be actively practiced and trained in everyday life in order to stabilize them. This can be done at an early stage with e.g. B. role-play can be achieved and later in real everyday situations. Before the therapy can be considered complete, a phase must first take place, which is characterized by constant success checks. These controls are necessary in order to identify any stagnation or setbacks in good time and to be able to counteract them.

Methods of cognitive restructuring

The central method of conducting a conversation is the so-called “Socratic Dialogue”, which is intended to guide the client in identifying and changing his dysfunctional thinking content. Cognitive homework (in the form of written training units - e.g. column techniques, daily logs of negative thoughts) are also used.

The core of Beck's technology is what is known as the reality check . The aim is to test the distorted cognitions against reality, i.e. to check the extent to which the formulated perceptions and interpretations of the client can be empirically proven and which cognitive distortions they may be based on. During this reality check, the client is instructed, for example, to collect observations in everyday life that contradict his or her interpretations or conclusions.

Behavioral Procedures

Behavioral procedures should serve to activate the client and to get his affective disorders under control, at least to some extent. The change in behavior leads to positive emotions, which in turn lead to changed cognitions. Behavioral techniques include:

Cognitive procedures

Cognition-oriented procedures should serve to achieve a long-term cognitive restructuring: Negative cognitions should be replaced by more rational ones, which should lead to more active, more competent behavior. The cognition-oriented procedures include:

  • Collecting and recording automatic thoughts
  • Two-column technique: arguing against automatic thoughts
  • Recognizing patterns of cognitive biases
  • Reality testing: testing cognitions
  • Re-attribution: separation of responsibilities (see attribution theories )
  • Decastrophize
  • Building expectations

Segal and others (2002) postulate that a change in the content of depressive thinking is not necessarily necessary, but rather a change in attitudes towards one's own thoughts, images and memories.

Behavior and role of the therapist

Beck's cognitive therapy is based on the principle of collaborative empiricism: client and therapist are equal partners, since the client is considered an expert in his or her thought patterns. Active involvement of the client is therefore urgently required.

Similarity and difference to psychoanalysis

The founder of cognitive therapy, Aaron T. Beck, had initially completed training as a psychoanalyst. Although, in Beck's opinion, psychoanalysis and cognitive therapy are similar in their focus on the patient's core problem, the difference is that psychoanalysis starts from unconscious structures, while Beck assumes that the dysfunctional schemata are conscious. Events long in the past or the actions of other people also do not play a decisive role in cognitive therapy.

effectiveness

Cognitive behavioral therapy has proven to be particularly effective in treating phobias , panic attacks, and depression . It has also been shown to be effective in treating eating disorders .

criticism

Criticism of Beck's approach was mainly voiced by John D. Teasdale - himself a pioneer of mindfulness-based cognitive therapy . A brief overview:

  • Beck postulates that unrealistic schemata and impaired cognitions are the cause of depression. However, it has been shown that these are more the result of depression than its cause: In phases of recovery, the dysfunctional attitudes disappear.
  • Rational arguments often prove ineffective despite the client's understanding.
  • Depressive thinking is state-dependent.
  • "Depressive realism": Depressed people often have better assessments than non-depressed people about the extent to which they can or cannot cope with tasks; they are less prone to self-deception (promoting self-esteem). Because of this greater accuracy of reality, the dysfunctionality of thinking is questionable.
  • Interventions on a purely cognitive level are not enough, according to Teasdale, because the depressogenic schemata consist of visual, auditory, somatic and cognitive information. Interventions must address these other modalities as well.

Psychoanalytic critics often tie in with the reduction of psychology to a "laboratory science". Psychoanalysis takes the view that it is impossible to reproduce the complex relationships of the psyche in a laboratory situation. Psychoanalysts criticize that behavior therapy therapies primarily aim to reduce symptoms, as is usual in behavior therapy. By reducing them, in no way should the cause of a mental disorder be combated, but rather an annoying symptom should be improved for a short time. This can cause other types of symptoms. This process is called symptom shift. As a result, they doubt the sustainability of the improvements. The tendency towards efficiency that dominates behavioral therapy has also been criticized. With therapies that are as short as possible, the individual is given little space and only the illness is placed at the center of the contact between therapist and client. This could prevent lasting healing.

However, this point of criticism could not be confirmed in catamnesis studies . After performing or using cognitive behavioral therapy, there are no more frequent shifts in symptoms than with other forms of therapy.

literature

  • Aaron T. Beck: Cognitive Therapy and the Emotional Disorders . Intl Universities Press, 1975. ISBN 0-8236-0990-1
  • Aaron T. Beck: Cognitive Therapy for Depression . Edited by Martin Hautzinger. From the American by Gisela Bronder. 3. Edition. Beltz, Weinheim u. a. 2004 (Beltz-Taschenbuch: Psychologie), ISBN 3-407-33023-5 .
  • Beate Wilken: Methods of Cognitive Restructuring. A guide to psychotherapeutic practice . 5th updated edition. Kohlhammer, Stuttgart 2010, ISBN 978-3-17-021324-1 (Kohlhammer-Urban-Taschenbücher 466).
  • Dieter Schwartz: Reason and emotion: the Ellis method, use reason, feel good and achieve more in life . Practice of rational-emotive behavior therapy. 5th (unchanged) edition. Borgmann (modern learning), Dortmund 2007, ISBN 3-86145-165-4 .
  • Jeffrey E. Young, Janet S. Klosko: Reinventing Your Life. Break the vicious circle of self-harming behavior ... and feel happy again . Junfermann, Paderborn 2006, ISBN 978-3-87387-619-4 (Original title: Reinventing Your Life . Translated by Theo Kierdorf with Hildegard Höhr).

Web links

Individual evidence

  1. ^ A b c Aaron T. Beck, A. John Rush, Brian F. Shaw, Gary Emery: Cognitive Therapy of Depression . The Guilford Press, New York 1979, ISBN 0-89862-919-5 , pp. 8th ff .
  2. ↑ Gerald Mackenthun (Ed.): Alfred Adler - as we knew him . Vandenhoeck & Ruprecht, Göttingen 2015, ISBN 978-3-525-46058-0 , p. 273 ( limited preview in Google Book search).
  3. ^ Franz Alexander: Psychosomatic Medicine: Its principles and applications . Norton, New York 1950. Karen Horney: Neurosis and human growth: The struggle towad self-realization . Norton & Co, New York 1950. Leon J. Saul: Emotional maturity . Lippincott, Philadelphia 1947. Harry S. Sullivan: Interpersonal theory of psychiatry . Norton & Co, New York 1953.
  4. ↑ Karl Jaspers: General Psychopathology . J. Springer, Berlin 1913. Ludwig Binswanger: The case of Ellen West: an anthropological-clinical study . Orell Füssli, Zurich 1945. Erwin Straus: Phenomenological Psychology: Selected Papers . Basic Books, New York 1966.
  5. ^ Albert Ellis: Outcome of employing three techniques of psychotherapy . In: Journal of Clinical Psychology . tape 13 , 1957, pp. 344-350 . Albert Ellis: Reason and emotion in psychotherapy . Lyle Stuart, New York 1962. Albert Ellis: Growth through reason: Verbatim cases in rational-emotive psychotherapy . Science & Behavior Books, Palo Alto 1971. Albert Ellis: Humanistic psychotherapy: The rational-emotive approach . McGraw-Harper, New York 1973.
  6. ↑ Eric Berne: Transactional analysis in psychotherapy: A systematic individual and social psychiatry . Grove Press, New York 1961. Eric Berne: Games people play . Grove Press, New York 1964. Jerome Frank: Persuation and healing . Johns Hopkins Press, Baltimore 1961.
  7. ^ Arnold Lazarus: Behavior therapy and beyond . McGraw-Hill, New York 1972, p. 165 .
  8. ↑ Kenneth S. Bowers, Situationism: An analysis and critique . In: Psychological Review . tape 80 , 1973, pp. 307-336 .
  9. ↑ Michael J. Mahoney: Cognition and behavior modification . Ballinger, Cambridge 1974. Maxie C. Maultsby: Help yourself to happiness through rational self-counseling . Esplanade Books, Boston 1975. Marvin L. Goldfried, Gerald C. Davison: Clinical behavior therapy . Holt, Rinehart, and Winston, New York 1976. Donald B. Meichenbaum: Cognitive-behavior modification: An integrative approach . Plenum, New York 1977. Alan E. Kazdin, G. Terence Wilson: Evaluation of behavior therapy: Issues, evidence, and research strategies . Ballinger, Cambridge MA 1978.
  10. ^ Aaron T. Beck: Thinking and depression: Idiosyncratic content and cognitive distortions . In: Archives of General Psychiatry . 1963, p. 324-333 .
  11. ↑ Hans Morschitzky: Psychotherapie Ratgeber - A guide to mental health . ISBN 978-3-211-33615-1 .
  12. ↑ a b Gerald Corey: Case Approach to Counseling and Psychotherapy . 4th edition. Brooks / Cole, Pacific Grove, CA 1996, ISBN 0-534-26580-4 , pp. 7 .
  13. ↑ limited preview in the Google book search
  14. ↑ Frank Wills: Cognitive Therapy according to Aaron T. Beck . Junfermann Verlag GmbH, 2014, ISBN 978-3-87387-988-1 .
  15. ↑ John F. Clarkin, Frank E. Yeomans, Otto F. Kernberg: Psychotherapy of the borderline personality: Manual for psychodynamic therapy . Schattauer, 2017, ISBN 978-3-7945-2579-9 , pp. 27 ( limited preview in Google Book search).
  16. ^ Tilo Kircher et al .: Effect of cognitive-behavioral therapy on neural correlates of fear conditioning in panic disorder . In: Biological psychiatry 73.1 (2013): 93-101.
  17. ^ Giovanni A. Fava et al .: Six-year outcome of cognitive behavior therapy for prevention of recurrent depression In: American Journal of Psychiatry (2014).
  18. ^ Andrew C. Butler et al .: The empirical status of cognitive-behavioral therapy: a review of meta-analyzes . In: Clinical psychology review 26.1 (2006): 17-31.
  19. ^ Stefan G. Hofmann, et al .: The efficacy of cognitive behavioral therapy: a review of meta-analyzes . In: Cognitive therapy and research 36.5 (2012): 427-440.
  20. ↑ Fairburn, CG, Cooper, Z., Shafran, R: Cognitive Behavior therapy for eating disorders: A “transdiagnostic” theory and treatment. In: Behavior Research and Therapy . tape 41 , 2003, p. 509-528 .
  21. ^ Zindel V. Segal, J. Mark G. Williams, John D. Teasdale: Mindfulness-based cognitive therapy for depression: A new approach to preventing relapse. Guilford Press, 2002.
  22. ↑ Linda J. Koenig, Caroline M. Clements, LAuren B. Alloy: Depression and the illusion of control: The role of esteem maintenance and impression management. In: Canadian Journal of Behavioral Science / Revue canadienne des sciences du comportement , Vol. 24, H. 2, April 1992, pp. 233-252. doi: 10.1037 / h0078706