This report will discuss in detail how Cognitive
Behavioural Therapies (CBT) can be used to successfully treat disorders such as
anxiety and depression. The report will discuss the case of a 28-year-old male
who suffers from social anxiety called Jack. Cognitive behavioural therapy
focuses on present issues and looks towards the future. This therapy is an
active, directive, time limited structured approach which treats numerous
psychiatric disorders such as anxiety, depression, phobias, eating disorders and
PTSD (Beck, 1979).
The main premise for this theory is that our thoughts are what influence our
feelings, not the external events in our life. Due to the vast research
undertaken of CBT, it can be tailored to individuals with certain disorders, to
ensure an intense therapy which is also short term (Rothbaum, 2000). Studies suggest that CBT can be more
effective than medication alone for issues such as anxiety and depression.
Cognitive behavioural therapy combines two different approaches for a practical
solution-focused therapy, it encourages patients to take a proactive role
within their own treatment. This report will discuss various forms of CBT, will
look at the strengths and weaknesses of using CBT and finally will discuss the
various ethical guidelines that a therapist must adhere to when conducting CBT
on a patient.
Emotive Behavioural Therapy
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When looking at Jacks case, has suffered a
long time with his anxiety and has had treatment for various issues throughout
his life. However, Jack suffers with automatic negative thoughts about his
ability and his appearance. Moreover, he not only suffers with anxiety, he has
also developed depression.
Cognitive behavioural therapies are being
used increasingly and have been shown to be a very effective technique.
However, CBT is not just one single therapy, it is simply an umbrella term for
various therapies (Neenan, 2000). One of the main therapies that needs
to be considered is the Rational Emotive Behavioural Therapy which was founded
by Ellis, and was one of the first cognitive behaviour approaches (Dryden, 2005). Rational Emotive
Behaviour Therapy (REBT) helps individuals to distinguish their rational and
irrational beliefs and their consequent emotions and behaviours (Ellis, 1987). REBT advocated for
the ABC model. The ABC Model can be used to explain why Jack is suffering from
this recent bout of social anxiety and depression. This model is comprised of 3
stages, stage A, B and C. The first stage of this model is A, the activating
event. The activating event is the thing that triggers the emotional response
or the dysfunctional thinking. In Jacks latest case the activating event is the
public speaking aspect of the promotion and all the responsibility that is now
placed on Jack. The second stage of this model is B, for beliefs. This stage is
the negative thought that occurs from the previous stage. In Jacks case, it
would be him not feeling worthy or good enough to represent the company.
Finally, the last stage is C, the consequences and implications for the
irrational belief. In Jacks case, the consequence is Jack suffering panic
attacks at work. Furthermore, to the panic attacks, upon arrival of his first
therapy session, Jacks appearance seems to be unkempt and he seems to smell of
alcohol. These factors strongly suggest that Jack suffers with depression.
You can also use this ABC Model when
considering Jacks past issues with his anxiety and other disorders. It is
important to note that jack has previously suffered panic attacks when he was a
young boy due to the stress he experienced when participating in his local
football team. Jack explained how his new coach shouts more that his pervious
coach, this could have resulted in Jack believing he is not good enough to be
on the team, this eventually resulted in Jack not wanting to attend the
football club, thus resulting in Jack suffering panic attacks upon arrival of
football club. Jacks parents immediately gathered help in the form of a
therapist who successfully talked Jack through all his fears which eventually
reduced his anxiety levels. Jack took acted on the therapist’s advice to ensure
the anxiety didn’t return by changing the football team he played for. By
removing the stressor in his life (the football coach) it allowed him to conquer
Another example of how this method can
explain Jacks past behaviour is when looking at his teenage years. Throughout
school, Jack was very successful in various subjects, however, he felt that all
his friends were more muscular than him, his resulted in Jack developing a
compulsive need to attend the gym and to watch his calorific intake. Using
Ellis’ ABC model, it is clear why the following behaviour occurred. Firstly,
starting with Jacks insecurities about his muscles, this insecurity lead to
Jack feeling unattractive and worthless. The insecurities and negative inner
thoughts ultimately resulted in Jack compulsively attending the gym, thus
developing a muscle dysmorphia. However, as Jack had a very close and loving
relationship with his family, his parents noticed something was wrong and was
taken to his GP and was diagnosed. He was referred to specialists to deal with
his disorder, successfully participated in treatment and over time he
eventually could overcome his disorder.
It is important to note that Jack has
continued support from his parents and family throughout his whole life and
throughout the various struggles he has had through his life. Jacks parents
often shower his with gifts to show how proud they are of him. These prior
therapeutic treatments suggest that Jack will be successful at conquering his
anxiety once again. When considering the salient points listed above
surrounding Jacks previous and current issues, it suggests that has the ability
and support to overcome his anxiety as he has previously done so.
It is evident that Jack has numerous
negative automatic thoughts and core beliefs which has caused the disturbance
in Jacks behavioural response both at work and outside of the workplace.
Alongside Ellis’ ABC Model, another cognitive behavioural therapist work is
also important to consider when finding the root cause of Jacks behaviour. Becks cognitive approach aids patients in
recognising their negative thoughts and errors in logic. He identified three
mechanisms that were responsible for depression. The first being the cognitive
triad, the second being errors in logic and the third being negative
self-schemas (Beck, 1979).
Moving on to Jacks teenage years, Becks
cognitive triad theory can also explain why Jack experienced these feelings and
why the behaviour occurred. The cognitive triad theory is comprised of 3 party.
The first being the patient’s negative belief of oneself, such as feeling
worthless or ugly. Secondly, the patients negative view of one’s future, such
as in Jacks case feeling ugly and that he will always be ugly. Finally, the
patient will have a negative view of the world, such as the patient believing
that no one will like or love them. Jacks muscle and weight insecurities
resulted in a negative belief about his self and his body. This negative belief
resulted in Jack developing an Adonis Complex. Furthermore, Jacks feeling of
worthlessness and inadequacy affected his ability at work. This cognitive bias
influenced Jacks opinion that he is not capable of representing the organisation
he works for at events. All the components added together has resulted in Jack
suffering with panic attacks and depression.
Errors in Logic
Beck detailed several irrational
assumptions and errors in logic which can be used to understand Jacks thinking
errors and can be used to explain how they have impacted him throughout his
life. One such example of this is personalisation, this occurs when an
individual takes all the negative feelings of others and blames oneself. Jacks
football coach was probably shouting at the whole team, however, due to his
irrational assumptions, Jack believe that the coach was only angry at him.
Furthermore, arbitrary interface is another example of Jacks thinking errors.
Arbitrary interface is where individual’s drawer conclusions based on
irrelevant information. For example, Jacks thinking errors as a child could
have made him believe he was the reason his team was failing, thus reinforcing
the belief that the coach was only shouting at him.
Individuals such as Jack are more likely to
misinterpret everyday information, Beck found that depressed people are more
likely to focus on negative experiences in their life, rather than the
positive. Jacks experience in the work place has ultimately lead to him developing
depression. Despite Jacks workplace knowing that he has strong leadership
skills, a natural flair for talking to people and the ability to represent the
organisation at various public events. Jack doesn’t believe in his own ability,
he chooses to see the negative, that he isn’t good enough, catastrophizing and
expecting the worse during any event. Thus, proving Jack suffers with these
cognitive biases from his childhood.
Moreover, Becks theory of negative
self-schemas can also be used when discussing Jacks automatic negative
thoughts. A schema is a package of knowledge, which stores information about
oneself and about the world around us and these schemas develop during childhood.
According to Beck, depresses people possess negative-schemas which have
developed from negative events which they experienced during their childhood (Beck, 2002). If what Beck is
saying if true, Jack may have acquired his negative self-schemas from his
childhood as a direct result of a traumatic experience in his childhood,
perhaps the negative beliefs were a result of his football coach ‘bulling’ him
when he was 7 years old, thus developing a belief that he wasn’t good enough.
There are various disorders that may arise from individuals not feeling good
enough. Examples of these include anxiety, depression and obsessive compulsive
disorders. All three of which Jack has suffered at one stage in his life.
Individuals with negative self-schemas are
likely to interpret information about themselves in a negative way, leading to
cognitive biases. Jack interpreted his less muscly physique as a teenager as
something catastrophic, he needed to do something to change his appearance,
which ultimately lead to the development of muscle dysmorphia. Furthermore,
upon accepting his promotion at work, Jack realised he was required to attend
events on behalf of the company. The negative self-schema he developed during
his earlier life had a direct impact on his own opinion of his ability. The
lack of self-worth resulted in Jacks progression into depression.
Effectiveness of Cognitive Behavioural
Cognitive behavioural therapies attempt to
identify and challenge the negative and irrational thoughts an individual may
have. Strategies such as these have been proven t successfully treat
individuals with depression. Lyons and Woods conducted a meta-analysis of 70 studies
which involved rational emotive therapy. The study reported that patients who
received this form of therapy showed significant improvement over the span of
this study, compared to those individuals who did not receive this therapy.
Rational-emotive therapy was found to be an effective form of treatment for
numerous disorders such as anxiety, depression, obesity and so on (Lyons, 1991).
Some therapists when performing CBT on
patients often recreate the conditions needed to suffer a panic attack, this is
done for many reasons. According to Aaron Beck, people who have panic disorders
are often misinterpreting various internal sensations. To conquer this,
psychiatrists must make the patient aware of the sensations they are feeling
throughout the attack. This can be done by creating an attack, when the patient
is aware of the sensations, at that point they can relabel the sensations as a
nonthreatening disaster and as something not catastrophic, they must see it as
something that can be explained and something that is normal. As the patient is
very alert, the patient can take that information in and within a very short
space of time, they are able to change their entire interpretation of these
There have been numerous studies which look
at how CBT can be used to treat disorders such as depression. One study looked
at whether CBT combined with medication was a more effective treatment than
just CBT alone. The study examined 327 teenagers with moderate to severe
depression. The results at week 12 found that there was a 73% positive response
rate with the patients on a combination of CBT and medication compared to a 48%
response rate to those patients on CBT alone. This trend continued throughout
the study. This study establishes that medication and CBT accelerates the
response rates, therefore making it more successful (March, 2007).
On the other hand, as CBT relies heavily on
the individual’s cognitive biases, the role of cognitive processes is unclear.
It is not known whether they cause the disorders or whether they are a
consequence of the disorder. Furthermore, the effectiveness of CBT as a
treatment for such disorders is heavily reliant on the ability and experience
and training of the therapist. Not only is it heavily reliant on the ability of
the therapist, it requires the full cooperation of the patient, so can be argued
that CBT is not suitable for those patients who have more complex learning
difficulties and mental health issues.
Will CBT be helpful
There has been extensive research which
proves CBT can be used as an intense and very versatile method to conquer
anxiety and depression. However, for these treatments to work, the patient must
acknowledge how they largely create their own psychological problems based upon
cognitive bias. On one hand, Jacks experience gives a strong indicator to
suggest CBT will be an effective form of treatment for his anxiety and
depression. On the other hand, as Jack wishes to complete the therapy within a
short time frame, it maybe in his best interest to try a combined therapy which
includes anti-depressant medication and CBT.
Ethical and Legal Considerations
There are many ethical and legal issues
which are likely to be encountered when practicing any therapy. Therapists must
provide a safe space for the client during any interaction. The therapist must
adhere to strict ethical guidelines and procedures to avoid any undue harm to
the patients. The Code of Ethics outlines various issues, one being the clear
boundaries which need to be in place, this protects the client and the
therapist from experiencing any unwanted harm and to ensure no ethical
boundaries are crossed (SHARMA, 2016). Another ethical consideration is
ensuring confidentiality between the therapist and the client (Bhola, 2016). Files on each
patient must be kept securely and disposed of in the correct manner, once
treatment is complete to ensure maximum confidentiality and to protect any
sensitive information (Vinay, 2016).
This follows a legal matter which the therapist must comply with. Individuals
who possess personal data are legally obliged to comply with the Data
Protection Act, breaking this act may result in the prosecution of an
individual or fines.
To conclude, it is not clear as to whether CBT
will be an effective treatment for Jack as each case varies on the willingness
of the client and the ability of the therapist. However, looking at Jacks
history and successful treatments it is highly likely that Jack will succeed in
his treatment. Both CBT and REBT are helpful tools to use when uncovering why
an individual may suffer with disorders such as these. They both have proven to
be useful techniques when treating mental health issues, compared to other