Cognitive Therapy In Psychiatry.

Introduction:
Cognitive therapy is a psychological treatment method that helps patients correct false self-beliefs that contribute to certain moods and behaviors.
The basic principle behind cognitive therapy is that a thought precedes a mood and that both are interrelated with a person’s environment, physical reaction, and subsequent behavior. Therefore, changing a thought that arises in a given situation changes mood, behavior, and physical reaction. Although it is unclear who benefits most from cognitive therapy, motivated patients who have an internal center of control and the capacity for introspection likely would benefit most.

Background: Cognitive therapy was developed by American scientist Aron T Beck. in the 1960' s. It is based on a cognitive model which states that thoughts, feelings and behavior are all connected. Difficulties can be overcomed and goals achieved if inaccurate and negative  thinking can be controlled. This form of psychotherapy has been found to be effective for a large number of psychiatric disorders including but not limited to depression, anxiety, eating disorders,  substance abuse and personality disorders.

Essential Components of CBT:
CBT is based on the idea that our thoughts causes our feeling and behavior so if we can change the way we feel we can change the situation even though the situation has not really changed.

The basic steps or components of this therapy are briefly describes here:

1. Building trust and rapport with the patient is very important as in any other case and helps in getting close to the patient and understand him more accurately.

2. The basic question to ask a patient is is reporting a distressing situation or dysfunctional behavior is " what is going On in your mind right now?" This helps in identify the negative thinking and an approach to think differently.

3. In the first step the therapist helps the patient identify the problematic belief. This is known as functional analysis. The process may sometimes be difficult initially but ultimately leads to self discovery and insights.

4. The second part of CBT focuses on the actual behaviors that are contributing to the problem. The patient begins to learn new skills and tries to put them in real world situations.

5. CBT is a gradual process that helps in changing the behavior in a slow step wise process.


6. CBT is considered to be a rapid therapy in terms of when the results are obtained. The average number of sessions is only 16 compared to other therapies which might even take years to give a positive result.

7. CBT also involves homework assignments and in short the role of the therapist is to listen, teach and encourage while the patient expresses the concerns, learns and implements that learning.

Goals Of Cognitive Therapy: The goals of cognitive therapy are to help individuals achieve a remission of their disorder and to prevent relapse. Much of the work in sessions involves aiding individuals in solving their real-life problems and teaching them to modify their distorted thinking, dysfunctional behavior, and distressing affect. Therapists plan treatment on the basis of a cognitive formulation of patients’ disorders and an ongoing individualized cognitive conceptualization of patients and their difficulties. A developmental framework is used to understand how life events and experiences led to the development of core beliefs, underlying assumptions, and coping strategies, particularly in patients with personality disorders.

A strong therapeutic alliance is a key feature of cognitive therapy. Therapists are collaborative and function as a team with patients. They provide rationales and seek patients’ agreement when undertaking interventions. They make mutual decisions about how time will be spent in a session, which problems will be discussed, and which homework assignments patients believe will be helpful. They engage patients in a process of collaborative empiricism to investigate the validity of the patient’s thoughts and beliefs.

Cognitive therapy is educative, and patients are taught cognitive, behavioral, and emotional-regulation skills so they can, in essence, become their own therapists. This allows cognitive therapy to be time-limited for many patients; those with straightforward cases of anxiety or unipolar depression often need only 6 to 12 sessions. Patients with personality disorders, comorbidity, or chronic or severe mental illness usually need longer courses of treatment (6 months to 1 year or more) with additional periodic booster sessions.

Techniques Of Cognitive Therapy:
Therapists use a wide variety of techniques to help patients change their cognitions, behavior, mood, and physiology. Techniques may be cognitive, behavioral, environmental, biological, supportive, interpersonal, or experiential. Therapists select techniques based on their ongoing conceptualization of the patient and his or her problems and their specific goals for the session. They continually ask themselves, “How can I help this patient feel better by the end of the session and how can I help the patient have a better week?” These questions also guide clinicians in planning strategy.

There is no one typical client for this approach, as cognitive therapy has been demonstrated in numerous research studies to be effective for depression, anxiety disorders, substance abuse, eating disorders; for bipolar disorder and schizophrenia (as an adjunct to medication); and for a variety of medical problems with psychological components. Of course, treatment has to be varied for each disorder and therapists must not only understand the cognitive formulation of a specific disorder but also be able to conceptualize individual clients accurately and devise a treatment plan based on this formulation and conceptualization. Cognitive therapy interventions must also be adapted for older adults, children, and adolescents and for group, couples, and family treatment.