Cognitive Behavioral Therapy

has its roots in classical and social learning

theories
Kinds of Psychotherapy Focus on changing current behavior and
attitudes rather than insight
cognitions are seen as having been learned
and then maintained through reinforcement
Ethel Maureen B. Pagaddu, MD
rational thinking is viewed as based on fact
Cagayan Valley Medical Center
but that thinking can also be based on
assumptions which need to be challenged
with a view to changing them

the therapist challenges these assumptions How CBT works:

directly rather than via the unconscious and
hence is concerned with changing the it can last between 6
difficult/troublesome behaviour rather than how weeks and 6 months
they originally emerged
since the aim is to change thinking and beliefs a important but the therapist also believes that
wide range of techniques is used, clear goals are changes occur when the patient learns to think
differently rather than via the relationship per se.
by suggestion and support from the therapist The focus is therefore on teaching rational skills.
interpretations may form part of the work but
finding reasons for particular beliefs is not patient is also
considered essential encouraged to question personal behavior and
assumptions.
 Behavioral Techniques
Behavior change based on principles of conditioning.
techniques are taught, and the focus is on
helping the person achieve the goals they 1. Behavioral records and contracts
Identifies the reinforcers that have maintained the unwanted habits.
have set. Set behavioral goals in a contract, with small achievable steps.
2. Systematic Desensitization
The patient is encouraged to do homework Based on the principle of counter conditioning.
using reading, thinking and putting techniques Unwanted response (e.g. fear) is paired with a stimulus that elicits an
incompatible response (e.g. relaxation).
into practice. 3. Aversive conditioning
Substitute punishment for the reinforcement that has maintained the
bad habit.
4. Flooding or exposure to threat
Therapist accompanies client into the feared situation. They both
survive.
5. Skills training
Practice those behaviors that are necessary for achieving the client's
goals.

Relaxation Training Cognitive Techniques

- deep breathing Identifies the beliefs and expectations that
- visualization maintain client's problems and substitute them
- progressive muscle relaxation with more adaptive beliefs.
*Distorted beliefs and perceptions in
depression:
1. Internality belief
Reason for one's misery is internal --- "I'm
incompetent."
2. Stability of beliefs
This bad situation is permanent.
3. Control
I have no control over my emotions or the situations
that cause them.
 Psychoanalytic Psychotherapy He lives simultaneously in his external and
internal worlds: the former he is mostly aware
Explores the unconscious dynamics of of, but the latter is primarily unconscious. The
personality unconscious, internal world is energetic and
substantially determines his feelings and
Each individual is the product and author of actions in the external world.
his own particular history: how he is now is a
All behavior, no matter how apparently
direct consequence of his earlier experiences irrational and senseless, is logical and
with others and his environment. purposeful according to some personal system
Subsequent experience confirms and modifies Emotional growth is beset by anxieties and
that early experience, for better or worse. detoured by defenses and so does not always
keep pace.

How it works:
The therapist works via the unconscious which can provide answers and, is not at all interested in
be accessed through free association and dreams molding the patient to some preconceived idea of

which the patient feels safe and can risk allowing

unwanted and difficult feelings into changing specific behavior as it will, in due course,
consciousness.
systems, hence the need to gain insight into these.
patient, explore and discover with him or her
what is emotionally true for them. central to this task. By exploring emotional and
relational difficulties from the past and in the
present, including feelings and difficulties arising
during the session, increased
understanding allows the patient to gain Techniques
emotional insight and thus helps widen the Free association
choices available in life. In this way the patient Saying whatever comes to mind.
finds new ways of perceiving his or herself and On couch facing away from therapist.
other people, thus enhancing work and Free associate to:
relationships which then become more satisfying Dreams
and creative. Early memories
Work

one to five sessions a week. Promotes insight.

Transference Psychodynamic Psychotherapy

Transfers elements of patient's inner emotional life
onto their therapists.
Brief psychodynamic psychotherapy is a time-
That means the patient begins to treat the therapist as limited treatment (10 to 12 sessions) that is
if they were a parent with whom there is a conflict. based on psychoanalysis and psychodynamic
Everyday example: You immediately like a new theory.
acquaintance because they remind you of your favorite It is used to help persons with depression,
uncle. anxiety, and posttraumatic stress disorder, among
Therapy example: An unresolved Oedipal conflict with others.
her father leads patient to fall in love with her
Focuses on the therapeutic alliance or dynamic
therapist. interaction between therapist and patient, the
Therapist helps the patient understand (insight) how use of transference, the active interpretation of a
the transference reflects unconscious conflicts. therapeutic focus or central issue, the repetitive
links between parental and transference issues
 Family Therapy Humanistic-Existential Psychotherapy

Humanistic psychotherapy is an approach which

Since disorders develop in a social context and
sustained by a social context, the context (family) tries to do justice to the whole person including
is treated. mind, body and spirit.
KEY CONCEPTS EXPLAINED It is explicitly concerned with the human context
Therapist observes family to discover roles, tensions, of the development of the individual with an
imbalances in power and communication, and then emphasis on subjective meaning, a rejection of
facilitates changes in those family dynamics determinism, and a concern for positive growth
Genogram rather than pathology.
A family tree of psychological events across generations.
Family Systems approach to treat individuals It recognizes the self-healing capacities of the
Helps understand the family's resistance to patient's positive client. The humanistic psychotherapist works
changes. towards an authentic meeting of equals in the
therapy relationship.

Existential psychotherapy is based on the Existential psychotherapy aims at enabling

existential belief that human beings are alone clients to find constructive ways of coming to
in the world. This isolation leads to feelings of terms with the challenges of everyday living.
meaninglessness, which can be overcome only
by creating one's own values and meanings. experience of anxiety and distress leading to
This therapy focuses on free will, responsibility an exploration of their personal beliefs and
for choices, and search for meaning and value system, in order to clarify and
purpose through suffering, love, and work. understand these in relation to the specific
Searching with and finding one's own answers physical, psychological and socio-cultural
is encouraged. context.
The experience and influences of the past, Brief Psychotherapy
present and future are given equal emphasis.
Four "existential problems" are cited as the It differs from other schools of therapy in that
core of the existential struggle that is the it emphasizes :
primary focus in this therapy and considered (1) a focus on a specific problem
to be at the root of most psychological (2) direct intervention
difficulties: death, freedom vs. responsibility, It is solution-based rather than problem-
isolation, and meaninglessness. oriented.
There are no absolute solutions to the It is less concerned with how a problem
existential problems yet all of us have to come arose than with the current factors
to terms with them. sustaining it and preventing change.

Expressive Therapy Interpersonal Therapy

It is a form of therapy that utilizes artistic Interpersonal psychotherapy (IPT) is a time-

expression as its core means of treating limited psychotherapy that focuses on the
clients. interpersonal context and on building
includes the modalities dance therapy, drama interpersonal skills.
therapy, art therapy, music therapy, writing IPT is based on the belief that interpersonal
therapy, among others. factors may contribute heavily to
Expressive therapists believe that often the psychological problems.
most effective way of treating a client is
IPT aims to change a person's interpersonal
through the expression of imagination in a
creative work and integrating and processing behavior by fostering adaptation to current
what issues are raised in the act. interpersonal roles and situations.
 Hypnotherapy Biofeedback
It is a therapy taken undertaken with a subject Biofeedback involves the use of electronic
in hypnosis systems to monitor internal processes such as
heart rate, brain waves, or perspiration to help an
Hypnotherapy is often applied in order to individual become aware of their physiological
modify a subject's behavior, emotional responses and learn to have more control over
content, and attitudes, as well as a wide range them.
of conditions including dysfunctional habits, Biofeedback involves the recording and display of
anxiety, stress-related illness, pain small changes in the physiological levels of the
management, and personal development. feedback parameter.
This therapy seems particularly effective in
treating anxiety disorders.

Dialectical Behavior Therapy

for those suffering from borderline personality

disorder Those involved in this type of therapy
DBT teaches the individual behavioral skills for generally meet with a therapist once a week
interpersonal relationships and ways to effectively cope
with sudden surges of emotion. It focuses on distress
and participate in a group session once a
tolerance and emotional regulation, and usually targets week.
behaviors in a descending heirarchy:
* decreasing high-risk suicidal behavior
* decreasing responses that interfere with therapy
* decreasing behavior that interferes with quality of life
* dealing with PTSD responses
* enhancing respect for self
* acquisition of behavioral skills taught in the group
Eye Movement Desensitization and Reprocessing
(EMDR) Family/Marital Therapy

EMDR focuses on restructuring thought The therapist applies therapeutic principles

patterns and associations related to traumatic while engaging the participation of family
events and memories. members.
the patient focuses on the lateral movement Constructive aspects of the family's
of the clinician's finger while maintaining a relationships are reinforced, while destructive
mental image of the trauma experience elements are identified and altered.
the general belief is that symptoms can be Family members are taught better
relieved as patients work through the communication skills, and ways of coping
traumatic event while in a state of deep outside of the therapist's office.
relaxation.

Play Therapy Supportive Psychotherapy

This is a therapeutic technique most often Supportive psychotherapy aims at the creation of a
used when working with children. therapeutic relationship as a temporary buttress or
bridge for the deficient patient.
Through play therapy a child can create a It has roots in virtually every therapy that recognizes
world they can master, practice social skills, the ameliorative effects of emotional support and a
overcome frightening feelings and/or stable, caring atmosphere in the management of
experiences, and symbolically triumph over patients.
traumas. The global perspective of supportive psychotherapy
(often part of a combined treatment approach) places
This therapy works well for children that may major etiological emphasis on external rather than
not have the verbal skills needed for other intrapsychic events, particularly on stressful
types of therapy, and lets them express environmental and interpersonal influences on a
themselves in a safe and fun way. severely damaged self.
generally indicated for those patients for whom Because support forms a tacit part of every
classic psychoanalysis or insight-oriented therapeutic modality, it is rarely contraindicated
psychoanalytic psychotherapy is typically as such. The typical attitude regards better-
contraindicated; those who have poor ego functioning patients as unsuitable not because
strength and whose potential for
decompensation is high. they will be harmed by a supportive approach,
but because they will not be sufficiently
Amenable patients fall into the following major
areas: benefited by it. In aiming to maximize the
(1) individuals in acute crisis or a temporary state of patient's potential for further growth and change,
disorganization and inability to cope (including those supportive therapy tends to be regarded as
who might otherwise be well functioning) whose relatively restricted and superficial and, thus, is
intolerable life circumstances have produced extreme not recommended as the treatment of choice if
anxiety or sudden turmoil (e.g., individuals going
through grief reactions, illness, divorce, job loss, or the patient is available for, and capable of, a more
who were victims of crime, abuse, natural disaster, or in-depth approach.
accident);

(2) patients with chronic severe pathology with fragile or Supportive therapy uses several methods, either
deficient ego functioning (e.g., those with latent
psychosis, impulse disorder, or severe character singly or in combination, including warm, friendly,
disturbance); strong leadership; partial gratification of
(3) patients whose cognitive deficits and physical dependency needs; support in the ultimate
symptoms make them particularly vulnerable and, development of legitimate independence; help in
thus, unsuitable for an insight-oriented approach
(e.g., certain psychosomatic or medically ill persons); developing pleasurable activities (e.g., hobbies);
(4) individuals who are psychologically unmotivated, adequate rest and diversion; removal of excessive
although not necessarily characterologically resistant strain, when possible; hospitalization, when
to a depth approach (e.g., patients who come to indicated; medication to alleviate symptoms; and
treatment in response to family or agency pressure
and are interested only in immediate relief or those guidance and advice in dealing with current
who need assistance in very specific problem areas of issues.
social adjustment as a possible prelude to more
exploratory work). This therapy uses techniques to help patients
feel secure, accepted, protected, encouraged,
safe, and not anxious.