Cognitive Therapy (CT)

What is cognitive therapy (CT)?

American psychiatrist, Aaron T. Beck formed the Cognitive Therapy (CT) approach to psychotherapy in the 1960’s. At that time psychodynamic approaches were the standard form of therapy.

Beck was disillusioned with the theory that the subconscious mind and childhood events drive behaviour. Instead he concluded that our conscious thoughts, feelings and behaviour are all connected and that by identifying negative thought patterns, we can actively re-direct them and move towards more positive outcomes.

Beck noticed many of his patients suffering from depression often spontaneously developed a flood of negative ‘automatic’ thoughts about themselves, the world and the future. The more time they spent reflecting on these thoughts (or ‘cognitions’), the more likely the patients were to accept them as real and valid. They were in so much distress they had trouble recognising those thoughts as inaccurate.

For example, if a person noticed they hadn’t been contacted by a friend for some time, it may have triggered a thought cycle that included phrases like “They don’t like me” or “I must have done something to offend them”. This might have led to the patient excluding that friend from other social events. The reality could simply have been that the friend had been busy with family or work.

During Cognitive Therapy sessions, therapists work with their clients to identify any inaccurate or unhelpful thought patterns and beliefs. They then look for alternative ways of thinking with the aim of overcoming personal difficulties and changing associated behaviour patterns. This approach is mainly focused on patterns that influence present behaviour and finding solutions to current problems. These skills can be employed by the client in the future, giving them more confidence in their ability to handle similar situations.

Many people (including professionals in the field) use the terms Cognitive Therapy and Cognitive Behavioural Therapy (CBT) interchangeably, however CBT incorporates many forms of Behavioural Therapy as well. CT is not often used on its own any more but it is still appropriate in some circumstances.

What is rational emotive behaviour therapy (REBT)?

In the 1950’s, another therapist called Albert Ellis had also been working on similar theories regarding the relationship between conscious thought and behaviour. His approach was first called Rational Therapy (RT) which later became Rational Emotive Behaviour Therapy (REBT).

Ellis’ created an ‘ABC’ framework that follows the connection between events, beliefs and consequences.

A)     Activating event

This includes both the initial event and our perception of it. For instance, if a man misses out on a promotion he may see that as a reflection of his ability to do the job.

B)     Beliefs

The rational or irrational belief we associate with the initial event. In this case the man could generate thoughts like:

• I wasn’t good enough
• I must have done badly at the interview
• They didn’t like me

Consequences

The emotions, behaviours and thoughts generated as a result of the event. For example, we could experience emotions such as anger, rejection or loneliness. Subsequent behaviours could include avoiding certain situations (such as job opportunities) or retaliating inappropriately.

Therapists use this framework with their clients to ‘reformulate’ their chain of thoughts and actively challenge their negative beliefs. Past experiences are acknowledged but generally only when they relate to current behaviours. The focus is more on what can be changed now to create a better future.

What is the difference between CT and REBT?

While the two therapies have many similarities, there are notable differences. A common explanation of these difference is when helping a client with a specific negative thought pattern, a therapist using Rational Emotive Behaviour Therapy would suggest an ‘elegant’ solution whereas one using Cognitive Therapy would suggest an ‘inelegant’ solution.

For example, if a woman avoids dating because she is afraid that men won’t find her attractive in a CT session she may be asked questions like:

• What makes you think that men find you unattractive? Has anything specific happened to lead you to that conclusion?
• What are some of the things you like about your appearance?
• Have you experienced situations when you were comfortable in male company?

The aim here would be for the girl to see that if she did go on a date she could have fun and chemistry is possible. By contrast, in REBT, the questions would revolve more around improving the girl’s sense of self-worth.

• Suppose a few guys didn’t like you? What is so awful about that? They don’t represent the whole male population.
• Does your opinion of yourself need to be based on what others think of you?

How the therapist voices their questions and suggestions can be more direct and forceful in REBT. They challenge unhelpful thoughts and beliefs and encourage their clients to do the same. For example, phrases like “While I like to go out on dates, I don’t NEED any man’s approval in order to feel good about myself” are said aloud and with passion.

What kinds of issues can CT and REBT help?

Cognitive Therapy and Rational Emotional Behaviour Therapy can both be used with a variety of mental health issues including:

• Neurotic disorders
• Phobias and other forms of anxiety
• Depression
• Personality disorders
• Major self-esteem issues

Therapy sessions are normally run over a fixed short to medium time period in order to deal with the current concerns as quickly and effectively as possible. This allows the client to develop a sense of control and empowerment and gives them positive strategies to take with them into the future.

Related therapies

• Acceptance and commitment therapy (ACT)
• Behavioural therapy
• Cognitive analytic therapy (CAT)
• Cognitive behavioural therapy (CBT)