Cognitive Behavioral Intervention

 

Cognitive behavioral therapy (CBT) is an essential type of therapy that involves the individuals affected talking to a therapist. CBT is can at times be more efficient than medication when it comes to the treatment of depression, a factor that cannot be underestimated especially considering that the latter is often quite difficult to treat through the use of medication (Demner, 2016). However, it should be used mainly in cases where the depression is mild or moderate because it ensures that there is the advancement of a situation where the individual involved is allowed to discuss the various aspects of their depression with their therapist, who undertakes to ensure that there is the development of a situation where there is the advancement of means through which to promote the patient’s interests. In more severe cases, the therapist has to be especially skilled because it can be used to ensure that the patient is provided with therapy that is in conjunction with medication (Johnsen & Friborg, 2015). The use of the latter method, where CBT is made use of in conjunction with medication can be critical for the wellbeing of the client because the latter is better able to handle a diversity of matters affecting them and causing their depression while at the same time being provided with the means through which to overcome their depression. Talking with their therapist is an essential means of promoting the interests of the clients because they can express themselves and have a listening ear for their problems. Therefore, CBT can be extremely effective in situations where it is combined with other forms of treatment, especially in the more severe cases because under such circumstances, it becomes possible to make sure that there is the advancement of client interests since the most severe of their symptoms are handled while therapy is taking place.

CBT is a critical form of therapy because it ensures that the therapist intervenes directly with the client through assessing the various aspects of their problem. Clients are required to divulge as much information as possible concerning the manner through which their specific problem affects them because it ensures that the therapist is better able to understand the source of the problem and guide their client towards coming to terms with it (Beck, 2011). Under such circumstances, the therapist acts as a guide to the client in such a way that he or she provides guiding questions concerning the manner through which a diversity of issues have come to affect the client. The role of the client is one where they are required to answer the questions that they are asked honestly in such a way that allows the therapist to make adequate conclusions concerning the problems that are affecting their client. It is critical that the therapist makes sure that there is the establishment of means through which to develop the trust of their client in such a way that allows the latter to be more open when it comes to the provision of relevant information concerning their case. This process allows the client to detect the negative or false thoughts that are a major cause of the problem, for example, depression, and undertake to help the client replace such thoughts with more realistic ones. The latter thoughts can be extremely useful for the client because they ensure that there is the advancement of a situation where it is possible to bring about healthier thoughts that encourage a positive outlook to life. Thus, if a client has feelings of worthlessness, they often end up obsessing over their flaws and fail to consider that they can make a positive contribution to their own lives and societies. The intervention of a therapist through the use of CBT ensures that these negative thoughts are prevented and that there is the development of a situation where they have healthier lives.

It is critical to note that CBT allows the client to realize that they have negative thoughts and that it is these thoughts that are causing the psychological problems such as depression in their lives. This is an extremely pertinent factor, especially considering that it can lead to the development of a situation where the therapist helps the client come to terms with these thoughts and seek to make changes for the better. The role of the therapist is to ensure that the problem is identified and that it is swapped for more positive thoughts. The latter is critical because it allows the client to realize that their negative thoughts are not helping them much, and that rather than making their lives better, they force them to take a pessimistic view of life. CBT also takes into consideration that at times, individuals tend to prefer talking about their problems and they need someone that they can trust in order to share their darkest fears with. The fact that the CBT sessions tend to be confidential allows these individuals to ensure that they are better able to handle a diversity of matters with the help of therapists in such a way that makes it possible for them to come to terms with the problem at hand and seek the best way through which to remedy them. The application of CBT allows the therapist to ensure that they help their client seek to change their attitude towards their lives because it is only through this change in attitude that the client can be able to change their behavior. A client suffering from depression can be helped to get over it through CBT where they are allowed to talk about their problems in the form of a discussion with their therapist, with the latter helping the client recognize the negative aspects of their thoughts and seek to change them for the better. The achievement of this goal can help to significantly reduce the symptoms of depression in the client since they will seek to avoid the negativity associated with it.

Preventing the attitudes that are associated with negative thoughts can be considered essential for the advancement of means through which CBT can help clients. The therapist has to find out the negative thoughts that the client has and guide them towards avoiding such thoughts because they are often not helpful. Instead, the therapist has to make sure that there is the advancement of a situation where it is possible to bring about the establishment of means through which to promote the interests of the client by helping the latter achieve a positive attitude towards their life. Thus, such thoughts as “what is the point of trying” can be completely prevented through the use of CBT, which ensures that the client is encouraged to recognize the negativity involved in it and instead seek to undertake a more positive attitude. The client comes to realize that there are a considerable number of positive factors in their lives which allows them to overcome their problems and instead undertake to adopt those options that are in favor of their recovery. Handling clients through the use of CBT can also be considered important for the therapist because it allows the latter to get to the heart of the problems that are affecting their clients and to address them directly. It is also a means through which to bring about the achievement of means to understand the different issues that often affect clients and develop interventions that are designed to help each client in the most effective way possible. Clients often need personalized assistance in order to overcome their problems, meaning that the use of CBT allows for a more personalized style of intervention that helps them achieve the goal of the therapy. In this way, the therapist works with the client in a manner that seeks to help the latter overcome the negative attitudes towards life and instead adopt an attitude that is more helpful for them in the long-term.

The Case

Jax is a 42-year old Iraq war veteran who has been experiencing symptoms that are associated with PTSD for more than eight years. He had several tours to Iraq and was in the country in some of the most intense period, when there was an attempt to fight off the insurgency. He is an individual that was considerably affected by the manner through which some of his colleagues ended up being killed by an improvised explosive device (IED) while they were being transported to a combat zone. Jax has consistently sought to avoid thoughts of the event over the years and this process has ended up forcing him to take measures aimed to preventing such thoughts from surfacing (Holdeman, 2009). One of the most significant actions that he has undertaken has been the excessive use of alcohol to assuage the guilt that he feels towards the incident. Despite taking alcohol, the problem has not gone away and once its effects are over, the thoughts concerning the incident in Iraq have continued to resurface. A result of this situation has been that he has ended up developing problems at his workplace to such an extent that he has missed a considerable number of days of work. Furthermore, he has become distant from his family, wife and two children, having developed feelings of discontentment and inadequacy towards them. Jax has also developed nightmares concerning the incident that led to the deaths of his colleagues. During this event, he was the leader of the convoy that was going for the mission when the truck he was in broke down. He asked the ones behind to move on ahead while it was being repaired when the following truck was hit by an IED. The resulting six deaths that resulted are burned into his mind, and he keeps on seeing their smiling faces in the nightmares prior to their explosion that led to their deaths.

A thorough assessment of Jax’s condition, especially his PTSD, informed the decision to make sure that there was the development of a situation where an effective intervention was made. The intervention included a means through which to promote the use of CBT to help in the achievement of alleviation of the symptoms through creating a rationale for the cause of the trauma that Jax was suffering from. One of the most fundamental aspects of the use of CBT was to provide Jax with worksheets which he could use to self-monitor the events that were taking place in his life. This was to be done on a daily basis and in such a way that promoted the interests of the client. Jax was required to record the events, his thoughts about them, and the consequent feelings after reflection (Monson et al., 2006). These worksheets were important because they helped to provide Jax with the sensitization that he needed to concerning the diverse types of cognitions that he was having concerning the events that he faced daily. It also allowed him to put into perspective the events that had taken place leading to the explosion and the manner through which he had ended up reacting. An example of such a recording was where he recorded thoughts concerning his regret for having not asked the following truck to push on ahead. He regretted this action because it is the one that ended up leading the servicemen in the other truck to end up getting killed. Jax maintained that it was his fault that his fellow servicemen had been killed and this was a major source of the PTSD that he was suffering. He wished that he had not asked them to move ahead because not doing so would have saved the lives of his fellows. This feeling is one of those that had to be tackled using CBT because the latter intervention aims at ensuring that there is a considerable reduction of the negative feelings that end up causing problems such as PTSD and depression (Hembree & Foa, 2010).

Another thought that Jax recorded in the worksheet concerning the traumatic event was that he should have realized that the explosion was going to happen; taking the action necessary to prevent the deaths that occurred. This is a sign that he was feeling guilty and had a lot of self-directed anger; which was not good for his mental health. Under such circumstances, the therapist made the decision to introduce a cognitive intervention aimed at challenging the thoughts that dominated Jax’s mind; causing the PTSD. The therapist made the decision to introduce Jax to the different types of thinking errors as a means of making sure that there was the development of a situation where the client understood that there are instances where an individual ends up taking things out of context. When the latter event takes place, it is usual for the individual involved to not only overestimate probabilities, but also have emotional, rather than rational reasoning. The major aim of this process was to ensure that Jax understood that he was focusing on irrelevant factors and it was these factors, more than anything, that were pushing him towards a situation where he developed PTSD (Schnurr et al., 2007). The associated negativity was the driving force towards his having problems with drinking, which had the inevitable effect of not only destroying his competency as work, as well as creating a negative relationship with his family. The therapist sought to make it clear to Jax that the root cause of the problems that he was having was based on his failure to consider that the traumatic event that he had experienced in Iraq was not his fault and that it could have happened to anyone. Therefore, the therapist ensured that he developed a discussion that sought to evaluate the evidence that was presented by Jax in such a way that showed the latter that the problems that he was experiencing were based more on negative thought than on any serious facts of the events that took place in Iraq.

The therapist’s aim was also to help Jax come up with his own conclusions concerning the events that had taken place in such a way that he considered everything from a more positive light. During the discussions that they had, Jax came to the conclusion that he felt considerable guilt and anger, especially based on his belief that he should have seen the explosive that killed his colleagues. Jax further came to the conclusion that IED are often meant to be concealed; meaning that there was no way that he could have seen it before the explosion took place. He was the source of the information concerning his having failed to see the IED, because no one had blamed him for the event that took place. Instead, this thought was not based on the facts of what had taken place, and was rather a conclusion that came about based on emotional thought and decision-making. With this realization, the therapist pushed Jax towards the realization that the best IEDs are never seen and that the driver of the truck that had exploded had been a highly competent soldier who would have stopped or tried to evade the IED if he had seen it. This intervention can be considered critical because it ensured that the therapist pointed Jax towards a direction where he had positive thoughts (Hien, Levin, Ruglass, & Lopez-Castro, 2015). This move was aimed at shifting the client from his obsession with guilt to a logical conclusion concerning the events that had taken place. Rather than focusing on his guilt and finding reasons for not having happiness because of the feelings of guilt over an event that he had no control over, the therapist made use of CBT to ensure that Jax was able to focus more on the factors leading to the traumatic event and its logical course based on rational instead of emotional deductions.

Evidence for the Intervention

One of the most important aspects of CBT is that it is an extremely goal-oriented and structure therapy method. The context within which the therapy is carried out is one that seeks to support the client and this method is often paired with a collaborative stance (Chu et al., 2015). It is essential to consider that CBT involve the development of a diversity of support factors between the client and therapist. These include the establishment of rapport, trust, collaboration, and the installation of hope. These factors are important because they ensure that there is the development of a situation where the client is able to undertake actions that can be considered essential for their recovery. The therapist in this case is an individual that essentially undertakes a supportive role for the client and this is in such a manner that he guides the client towards the achievement of a more positive outlook in their life. The methods that are used in CBT can be compared to the specific factors that are involved in the technical aspects that are found in psychotherapy, and these are important because they serve as the basis of the improvement of the condition of the client. The intervention techniques that are adopted under such circumstances are necessary when it comes to determining the manner through which the therapist will approach the therapy. The condition of the client is also an important factor in determining the method that will be adopted by the therapist. Therefore, the use of CBT is not fixed and requires an experienced therapist to ensure that he provides the guidance that the client needs to overcome the negativity that is involved in such problems as depression and PTSD. It is therefore essential to consider the abovementioned factors because they are critical for a large percentage of the change that takes place in clients following therapy. The achievement of improving the outcomes is also affected by the manner through which the therapist handles such aspects of CBT as empathy, genuineness, and personal regard.

Empathy is an important aspect of CBT because it allows the therapist to understand experiences from the perspective of their client. It is an essential part of making sure that there is the establishment of rapport between the therapist and the client in such a way that there are feelings of mutual respect and trust between them (Moyers, Houck, Rice, Longabaugh, & Miller, 2016). It is also necessary for the therapist to consider that they have to cultivate a high level of multicultural empathy in such a way that they are better able to understand individuals from a diversity of backgrounds other than their own. While it is impossible for the therapist to have knowledge concerning all their clients’ backgrounds, being empathetic allows them to make sure that they are able to undertake to ask questions in a respective yet curious manner so that it can be possible to develop an emotional understanding of their clients. This is the first step when it comes to having an understanding of clients’ unique backgrounds because these individuals are able to appreciate life as seen from the perspective of their clients. Showing empathy for patients allows the therapist to validate their experiences to such an extent that they are better able to handle a diversity of problems that are recognized during the process of CBT. The client, on the other hand, does not feel judged by the therapist because of the belief that he understands what they are going through. Under such circumstances, the client is more likely to be willing to make sure that they disclose additional information to their therapist that might end up being helpful for the entire treatment process. The use of CBT requires that the therapist seeks to make statements of understanding for their client’s viewpoint. This ensures that the therapist is able to effectively describe what their client was heard saying; allowing for the achievement of the goal of gaining the trust and confidence of their client.

The ability to be authentic and free of hypocrisy is an essential aspect of being a therapist because it essentially makes this individual genuine. CBT allows the therapist to not only be professional, but also express who they are at the same time and this is critical when it comes to building rapport with the client while at the same time building a strong therapeutic relationship that will eventually make it possible for the client to achieve recovery (Jung, Wiesjahn, Rief, & Lincoln, 2015). It allows the client to see the therapist as a human being, with similar emotions and problems, meaning that he can be trusted with personal information. The client is better able to make sure that they access the genuine aspects of their therapist in such a way that allows them to have a critical feedback of the events that are taking place in their lives once they begin engaging with their therapist. Genuineness on the part of the therapist is a process that involves the development of instances where there is the implementation of a variety of concepts including nonverbal behaviors as well as the making of overt statements that make it possible for the client to gain confidence in them. Example of nonverbal behaviors that promote genuineness are maintaining eye contact, nodding in agreement, and giving full attention to the client; which is critical when it comes to the latter not only being confidence in the therapist, but also helps in furthering the goal of providing more information than would otherwise be the case. These nonverbal behaviors on the part of the therapist should be made use of in conjunction with what is taking place in the conversation that they are having because it allows the client to realize that the therapist is being genuine. Being genuine on the part of the therapist also involves encouraging the client to be empowered during the therapy through being active in the process in such a way that ensures the client is treated as an equal rather than the inferior. It is essential to consider that those therapists that constantly enforce their authority throughout the sessions end up making their clients feel inferior or intimidated and this is to such an extent that they might end up becoming uncooperative. CBT promotes the development of a therapeutic relationship that is based on the partnership between the client and the therapist. Thus, they should work together towards the alleviation of concerns and problems in the life of the client.

It is necessary to consider that CBT is a process that promotes the idea that clients have to be shown the maximum respect by their therapists. This is an essential process because it ensures that there is the advancement of a situation where the client feels that he is valued and that the contributions that are made in the therapeutic process are important (Burns & Nolen-Hoeksema, 1992). When clients feel that their feelings and thoughts are acknowledged and understood, it becomes possible for them to share more with their therapist because they feel connected to them and to the therapeutic process. The process of communicating positive regard for their client can be an extremely hard one for the therapist because it involves overcoming any form of negative beliefs that are held concerning the client. Under such circumstances, it becomes essential for the therapist to make sure that he or she shares any negative feelings that they might have with their immediate supervisors or consultants in a bid to ensure that they are able to achieve a level of positive regard for their client. The development of the latter is critical to the success of the therapeutic process because the client is better able to adjust to the therapist and undertake to work favorably and positively with them. One way of making sure that there is the achievement of positive regard for the client is commitment, which involves seeking to work with the client on a variety of issues that they are bringing to the therapy. This process is one that should involve avoiding canceling the client’s appointments, being on time, and making sure that all efforts are made to help the client work on the issues that are plaguing them. Not being judgmental is a critical starting point in the therapeutic relationship because it allows the therapist to understand the client’s perspective even though they do not agree with it. Rather, there should be attempts by the therapist to help the client work through the negative aspects of their perspective that are involved in bringing about the psychological problems that they are experiencing.

Potential Areas of Future Research

The core idea behind CBT is that there is need to make sure that there is an understanding that the reactions and behaviors of individuals tend to be heavily influenced by the meanings that they give to their surroundings (Barth et al., 2016). This is a critical factor because it involves a situation where the therapist leads the client towards providing information concerning the events taking place in their lives and the manner through which they are handling them. The achievement of this goal is one that is pertinent to CBT because it allows for the advancement of ideas concerning the manner that beliefs and interpretations end up influencing the lives of clients. Therefore, future research has to focus on the further development of the way that therapists view the cognitive aspects of CBT in such a way that promotes the advancement of means through which they can achieve therapeutic benefits for their clients. This research should begin on the non-cognitive aspects of the lives of these individuals and then move towards those that are considered cognitive. While individuals have a diversity of experiences and can be considered to be different, which is at the core of CBT, there are several common patterns that take place in the lives of individuals in such a way that promotes the advancement of a situation where there is need to create broad categories of these characteristics. The cognitive aspects of the lives of individuals can be placed into categories so that it is possible to bring about the establishment of a situation where CBT is made more effective. Under such circumstances, the therapist will have the means through which to make sure that there is a general understanding of their client in such a way that they provide the help that this individual needs at the right time.

Future research should also consider that the behavior or individuals plays a crucial role when it comes to the maintenance and changing of psychological states (Gu, Strauss, Bond, & Cavanagh, 2015). This is directly related to cognition because the subsequent behavior of an individual is likely to have an effect on the persistence of a condition such as depression or PTSD. Thus, in a situation where an individual gets into frequent contact with an acquaintance with whom they have not been friendly in the past, they might end up finding that the acquaintance is actually quite a friendly person; resulting in a significant reduction in the negativity that the individual has towards their acquaintance. Therefore, research on CBT should seek to enhance the belief that behavior has a strong impact on the thought and emotional processes of individuals. There is need to advance the idea that it is critical for individuals to find out the negative aspects of their lives and change them into more positive ones. In the use of CBT, it is essential to consider that there has to be the development of critical means to make sure that the client is provided with the means of bringing an end to their negativity because it is the latter which ends up leading to the development of their psychological problems. There should be a focus on the manner through which a change in behavior has an impact on the changes that take place in thoughts and emotions of clients; meaning that therapists have to undertake to better understand the triggers of various behavior in the lives of their clients before seeking to help them.

It is necessary to consider that unlike other therapeutic approaches, CBT is one that seeks to see mental health issues as coming about because of the exaggerated versions of normal events that take place in the minds of individuals (Clark & Wells, 1995). This is different from other approaches, which often consider mental health issues as coming about because of pathological states that are not only different from a qualitative perspective, but also inexplicable through the use of normal processes. Under such circumstances, it is critical to consider that CBT looks at psychological issues as being placed within a continuum in a manner that promotes the advancement of a situation where there is the achievement of practical measures aimed at improving the mental status of those affected. Therefore, more research has to be conducted based on the idea that mental problems can happen to anyone and that they are not an anomaly. Furthermore, there is need to address the idea that CBT applies as much to the therapists involved in the treatment process as the clients.

Conclusion

The processes involved in CBT are critical for the advancement of means through which there is the promotion of the mental health of the client through making them active participants in the process. This is an essential means of helping individuals come to terms with the problems that they are having, as seen in the case of Jax in the case above, where he was helped through the PTSD he had suffered from through being made to realize that all the events he blamed himself for were beyond his control. It was critical for him to ensure that he understood this in order to begin the recovery process from the problems that he had suffered for years. Therefore, CBT is a critical means of making it possible for clients to develop the realization that they have to abandon negative thoughts because these often have a negative consequence on their outlook of life. Thus, CBT can be considered an important part of psychological therapy and recommendations for future research have been made concerning it because it is one of the best ways to make sure that there is the advancement of the interests of client’s mental health through the direct intervention of their therapist.