Cognitive Behavior Therapy
Cognitive behavior therapy (CBT) is a talking therapy that attempts cognitive and behavioral change based on an individualized formulation of a client's personal history, problems, and world views. CBT emphasizes clear relationships amongst thinking, behavior, and emotion. By helping the patient look at her thought processes and evaluating their accuracy, the therapist may try to reduce or extinguish negative emotional reactions which might result from inaccurate or distorted thinking. In addition to looking at the content of thoughts, the therapist may also focus on the relationship between thoughts and emotions. For instance, where a negative thought may be accurate, the focus may be on putting the thought in context to reduce obsessing on the thought.
After collaboratively developing a problem list, and deciding on a clear goal for the therapy, CBT techniques such as guided discovery and Socratic questioning are used to identify distortions in thinking or relations between thoughts and emotions. This would be followed by an agreed upon homework for the patient to complete by herself before the following appointment (eg, attempting to identify distortions over the next week and trying to correct them). Regular feedback and having the patient give a capsule summary of the session are also important elements.
A narrative formulation of the person's personal history is jointly generated to provide a sense of the emergence, maintenance and links amongst different problems at hand. The patient is at the heart of the recovery process. There is evidence that developing such a narrative formation is a therapeutic process in itself and an essential aspect of recovery. Thoughts and beliefs can be examined for their truth by questioning. “Socratic questioning” can be used to encourage the probing of evidence, reason, and rationale. For example, a patient who believed that he was under surveillance was asked to give a rationale for his belief. The CBT therapist used questions to explore the individual's reasoning (eg, “How do you know that is happening?,” “Can you give me an example of that?,” “What do you think causes this to happen?,” “When you think it through now, are these reasons good enough?”).
Another technique commonly employed in CBT is “reality testing” where a patient will be encouraged to actively find evidence to test the reality base of a belief or assumption; a process which is done in collaboration with the therapist. For example, a person who believes in the existence of giant moths that will eat people might be encouraged to find some evidence-based information about moths and discover that these insects tend only to live for approximately 1–2 weeks and would be unable to bite a human as they have no teeth!
Behavioral experiments” are another method frequently utilized in CBT whereby a “scientific experiment” can be set up to test a specific prediction. For example, a person who believes that his next door neighbor is communicating threats to him by coughing might set up an experiment in which he watches a television program to test alternative predictions that there are other reasons why people cough. The CBT therapist will facilitate the patient in developing awareness of how people might cough due to smoking, allergy, or a chest infection. Once the patient can see that the people on the TV are possibly coughing for other reasons, the patient can then begin to be explore the local environment, and the reality of the patient's ideas specifically about his or her neighbor's coughing can be explored. (Tai & Turkington, 2009; Kingdon, Turkington & Welden, 2008.
Cognitive therapy has dynamically improved the most neurologically impaired, poorly functioning schizophrenic patients. Researchers from the Perelman School of Medicine at the University of Pennsylvania have shown that a psychosocial treatment can significantly improve daily functioning and quality of life in the lowest-functioning cases of schizophrenia. Aaron Beck, Paul Grant, Oct. 3, 2011.