CBT: Applications and Challenges
Cognitive approaches have been applied as means of treatment across a variety of presenting concerns and psychological conditions. Cognitive approaches emphasise the role of thought in the development and maintenance of unhelpful or distressing patterns of emotion or behaviour.
Beck* originally applied his cognitive approach to the treatment of depression. Cognitive therapy has also been successfully used to treat such conditions as anxiety disorders, obsessive disorders, substance abuse, post-traumatic stress, eating disorders, dissociative identity disorder, chronic pain and many other clinical conditions. In addition, it has been widely utilised to assist clients in enhancing their coping skills and moderating extremes in unhelpful thinking.
Beck, born in 1921, Providence, Rohde Island, was initially attracted to the study of neurology. It wasn’t long, however, before he discovered psychiatry was a more fitting interest for him. Beck struggled with numerous fears throughout his life, including a fear of public speaking and anxiety about his health.
Beck used these fears to help him understand himself and others which ultimately provided the basis on which he developed his cognitive theory (Corey, 2005). Through his research, Beck discovered that people who are suffering from depression often reported thinking that was characterised by errors in logic. These errors, Beck called, ‘cognitive distortions’.
(1) When the client has difficulty identifying emotions and thoughts: It is common for clients to experience emotion prior to any conscious recognition of their preceding thought(s). This can make it difficult to ascertain the actual thought(s) that activated the emotional response.
To assist clients in identifying their thoughts, counsellors may need to use specific questioning techniques to isolate thoughts. Such as, “What were you telling yourself at the time?” or “What was going through your mind?” In addition, role playing the situation and stopping the scene at crucial (emotional) times in the sequence may help clients recall their thinking.
(2) When clients agree with the principles but can’t seem to alter their thinking: Frequently, clients report an understanding of the principles of cognitive therapy on an intellectual level, but cannot seem to apply that understanding in a way that promotes real change (Sanders & Wills, 2005).
Reinforcing that change takes time and even preempting the difficulty of shifting from “the head level to the gut feelings” can be helpful ways of preparing clients to stick with the strategies (p. 167). It may simply be a matter of repetition and practice for clients working through change from the ‘head’ through to the ‘heart’.
(3) Clients have limited motivation for change: For clients that are not attending counselling of their own free will, it is essential that counsellors establish motivating factors for the client in the initial stages of therapy.
Client may, for example, be attending counselling to keep harmony in a significant relationship or to elicit help to get someone ‘off their back’. Whatever the reason for attendance, counsellors should focus on the possible benefits an individual may receive by being involved in the counselling process.