UQx PSYC1030.3x 1-3-3 Cognitive behavioural therapy

UQx PSYC1030.3x 1-3-3 Cognitive behavioural therapy


Now, we’re going to talk about Cognitive
Behavioral Therapy or CBT. Put most simply, cognitive behavioural therapy
differs from behavioural therapy in its emphasis on the importance of an individual’s cognitions
or thoughts. The key strategies involved in cognitive behavioural
therapy are: Explain the rationale for the importance of
thoughts – their relationship with feelings and behaviours;
Identify unhelpful thoughts, Challenge unhelpful thoughts,
Cognitive restructuring – where appropriate, replace unhelpful thoughts with more realistic
thoughts, Of these strategies, the first one – “Explaining
the rationale for the importance of thoughts” – is arguably the most important. The reason this strategy is so important is
that if the rationale is not done well with clients, they are unlikely to engage in any
of the other strategies. The model that underpins the cognitive element
of cognitive behavioural therapy is the A-B-C model. “A” stands for activating event,
“B” stands for your beliefs or thoughts about that event,
and “C” stands for consequences – that is, your emotional, physiological and behavioral
consequences. I’m going to work through an example exactly
the same way that I would with a client. Let’s say that the Activating event, or
the thing that has happened, is that our partner is 1 and a half hours late home from work. They’re not usually late, and there’s
been no phone call. Now, what is one way of making sense of this
event, of explaining it to yourself, or thinking about it in your own head? It doesn’t have to be what you would necessarily
think. It’s just one way of explaining why the
partner is late home. For example, you might think to yourself that
he or she may have had a busy day at work – that they’ve been held up at work. If this is what you genuinely believe, what
is your emotional consequence going to be? It’s unlikely that you will feel worried. You might feel a bit annoyed. But, you probably won’t experience any physiological
consequences. Would there be any behavioral consequences? You might try to ring them to get in contact. But, that’s probably about it. Another, different way of explaining this
event to yourself is that you think to yourself that your partner has had a car accident on
their way home from work. If you genuinely believe that this is the
reason that your partner is late, a likely emotional consequence is that you will be
worried. In terms of physiological consequences, your
heart rate may go up. In terms of behavioral consequences, you might
try calling your partner; you might even try calling the nearest hospital. Let’s look at a third way of making sense
of this event. What about if you think to yourself that your
partner is cheating on you! If you genuinely believe that the reason that
your partner is late home is that they’re cheating on you, you might feel feel angry
and upset. These are some likely emotional consequences. Would there be any physiological consequences? Your heart might start to race; you may feel
short of breath or a bit shaky. What about behavioral consequences – is
there anything that you would do? I’ve had people – clients and students
alike – tell me a whole range of different behaviours they think they might engage in. For example, I’ve had people say that they’d
get on Tinder and hook up with somebody else; and that they’d destroy their partner’s
belongings. One very specific example was when a client
told me that she would cut all the crotches out of her husband’s expensive suit pants. The point that I need to make – whether
I’m explaining this ABC example to you or to clients – is that, for one activating
event “our partner is 1 and a half hours late home from work”, we have easily generated
three different ways of thinking about it. And depending on how we think about, or make
sense of the activating event, we end up with different sets of emotional, physiological
and behavioral consequences. What this tells us is it’s not so much what
happens to us in our lives that is important. From a cognitive perspective, what is critical
is how we make sense of, or think about the things that happen to us in our lives. Providing a good and clear rationale about
the importance of thoughts is the linchpin of cognitive behavioural therapy. Once we’ve done this, we ask clients to
start keeping track of, or ‘catching’ the thoughts that they have when their mood
is low, anxious, angry, or whatever negative emotion they are feeling, so that they can
identify their unhelpful thoughts. Then, we teach them about cognitive restructuring. Cognitive restructuring involves having people
look at the evidence for and against the thoughts that are causing them to feel distressed. It is not about “thinking positively”
per se, but rather about learning to realistically evaluate the likelihood that unhelpful thoughts
are accurate.


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