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.
