CBT incorporates the central theoretical principles of cognitive and behavioural therapy. CBT thus encompasses a variety of theoretical notions and accompanying intervention strategies from two initially separate frameworks:
Cognitive therapy seeks to identify, evaluate and restructure dysfunctional beliefs that are considered central to emotional disturbance and self-defeating behaviour.
Behavioural techniques are used as a means of reducing emotional distress, altering dysfunctional behaviour and restructuring cognition.
The theoretical position taken by the cognitive model proposes that if we are able to identify the most relevant thoughts or beliefs underlying our unwanted emotional and behavioural reactions, re-evaluate them and replace them with more appropriate alternatives, then we will most likely feel and react in a healthier, more appropriate way. The key in cognitive therapy lies with being able to identify the most appropriate beliefs that need to be targeted.
Novice and inexperienced CBT therapists and clients will often struggle to identify the most clinically-relevant beliefs. Just because a belief co-occurs with an emotion or behaviour, does not necessarily mean that it is the most relevant belief perpetuating that emotion. Identifying the correct cognitive content or process is thus important.
In addition, what Beck has referred to as intermediate or core beliefs, and what Ellis has referred to as core evaluative beliefs that are often more entrenched and more difficult to change, are often present but not verbally articulated and thus need first, to be uncovered. Cognitive therapy thus often initially involves the uncovering of such attitudes, assumptions, rules and core beliefs prior to any sort of intervention. Once identified, the most clinically-relevant beliefs are typically evaluated as either helpful or unhelpful and then replaced with healthier alternatives. This is referred to as “cognitive restructuring” or “cognitive disputation”.
Clients are then often required to work at implementing these new ways of thinking within their natural environment so as to strengthen the influence of these healthier ways of thinking. The mechanisms of change are, however, not quite as linear or simplistic as many seem to think, and behavioural changes may often also lead to cognitive changes. For example, once we have done something that we were previously afraid of doing, we often tend to no longer think of it as dangerous or threatening. The process of changing one’s beliefs or behaviours often requires a great deal of time, dedication, practice and perseverance, but it is certainly possible and tremendously empowering.
Written by Bradley Drake and Jaco Rossouw, Centre for Cognitive-Behaviour Therapy, Cape Town, South-Africa. For further details visit: www.cognitive-behaviour-therapy.co.za. (September 2011)