Abstract
Cognitive Behavior Therapy (CBT) can be regarded as psychotherapy used in treating depression and mental disorders. The treatment targets all therapy forms that are founded on behavior and cognition. Therefore, cognitive behavior therapy applies both behavioral and cognitive principles in treatment. CBT therapists believe that specific human disorders result from particular stimuli in the environment of the patient.
This form of therapy is most useful in addressing problems such as mood, addiction, psychotic disorders, anxiety, addiction disarray, eating disorder, and personality confusion. Since CBT is based on both mental and behavioral approaches, it yields better results compared to other approaches such as psychodynamics. This paper focuses on the history of CBT, its strengths and shortcomings, the issues it is best suited to address, as well as its role from a Christian perspective.
Introduction
CBT is a form of treatment that applies techniques such as counseling, computerized/internet-delivered health services, reading self-help materials, and group educational courses. Despite its application in correcting various behavior-based issues, CBT has been criticized for its weaknesses, such as its inability to prove its superiority over other treatments, the high dropout rates of patients during the treatment, and the fact that it denies patients of their free will.
This therapy can be very useful from a Christian point of view since it makes less use of medicine, it is therapeutic, and that results in both behavioral and mental wellness. Based on the above foundations, this paper explores the subject of cognitive behavior therapy.
History of Therapy
The history of CBT can be traced to philosophical, behavioral, and clinical therapy foundations (Freeman et al. 7). According to the philosophical root, CBT can be traced back to the ancient Stoics’ traditions that were widely applied in the treatment of depression by philosophers such as John Stuart Mill and Epictus Albert Ellis.
On the other hand, Tolin asserts that the behavioral therapy foundation is traced back to the 20th century’s growth of behavioral therapy, the 1960s growth of cognitive therapy, and the coming together of cognitive and behavioral therapy (710). Studies on behavioral conditioning by Watson and Rayner marked the beginning of behavioral therapy during the 1920s (Van’t Veer-Tazelaar et al. 297).
In addition, Mary Jones’ 1924 study on how children can unlearn fears formed the basis for further examination of Joseph Wolpe’s behavioral therapy concept of the 1950s and Ivan Pavlov’s idea of conditioning and learning (Freeman et al. 9).
Hans Eysenck and Arnold Lazarus relied on these foundations to develop the classical conditioning theory. Skinner and associates later developed the operant conditioning in the same period (McKay et al. 236). However, her work did not include cognitive aspects. According to Zhu et al., Julian Rotter and Albert Bandura made their contribution to behavioral therapy in 1954 and 1969, respectively, through the inclusion of cognitive aspects in their social learning theory (319).
This development marked the foundation of cognitive behavior theory. CBT can also be traced to the works of Alfred Adler on the basic mistakes and their effects on unhealthy emotions (McKay et al. 237). Albert Ellis relied on this work to come up with rational emotive behavior therapy that is considered the earliest cognitive therapy.
In the same period, Aaron Beck conducted free association programs that proved that thoughts are conscious and that thinking results from emotional distress (Van’t Veer-Tazelaar et al. 299). Beck developed cognitive therapy that became the second phase of the development of cognitive behavior therapy (Tolin 711). The fourth foundation is the merging of behavior and cognitive therapy since most of the earlier approaches succeeded in treating neurotic disorders but not depression (Tolin 712).
Theorists from both behavioral and cognitive schools began accepting ideologies from each other. Therefore, the cognitive behavior was developed with the inclusion of cognitive, dialectical conduct, rational emotive actions, and cognitive processing, among others (Johnsen and Friborg 747). This stage became the third and modern phase of CBT.
Types of Problems the Therapy is Most Useful in Addressing
Cognitive behavior therapy is most useful in addressing various types of problems. To begin with, McKay et al. reveal how CBT is effective in treating various medical conditions (238). CBT has been successful in the treatment of anxiety disorders, severe low back pain, depression, psychosis, post-spinal cord injuries, personality disorders, and schizophrenia, among others. CBT is also effective in treating suicide disorders, obesity, bulimia, and obsessive-compulsive, and anxiety disorder in both adults and adolescents (Freeman et al. 9).
There is also evidence that CBT is effective in the treatment of hypochondriasis, dysmenorrheal, and Alzheimer’s disease (Johnsen and Friborg, 748). Secondly, McKay et al. assert that CBT is also successful in treating anxiety disorders in both adults and children (236). Therapists apply the in-vivo exposure where patients are involved in a straight confrontation with what they fear most to make them unlearn stimuli such as fear. Therapists also apply glucocorticoids to prevent evasive learning retrieval, which results in a positive reaction concerning fear or anxiety (Tolin 712).
Thirdly, CBT has been effective in the management of schizophrenia, psychosis, and mood disorders. In the American psychiatric association practice guidelines of 2000, cognitive behavior therapy was rated the highest efficacy level in the treatment of depression-related disorders (Van’t Veer-Tazelaar et al. 299). This finding is based on CBT’s approach to both mental and behavioral aspects. In treating psychosis, CBT involves reality tests, hallucinations changing, and management of relapses (Johnsen and Friborg 749).
The American Psychiatric Association also rates CBT as one of the best approaches to treating schizophrenia, bipolar disorders, and acute depression (Freeman et al. 9). Finally, CBT has also been effective in preventing mental illnesses. The application of CBT reduces general anxiety and hopelessness in patients (McKay et al. 238). This situation results in reduced panic and social anxiety. Research by Van’tveer-Tazelaar et al. indicates that CBT stepped-care therapy also has better results in patients of over 75 years (300). Patients who go through CBT also have a 38% lower risk of suffering from depression.
Strengths of the Therapy
Cognitive-behavioral therapy has various strengths. To begin with, CBT applies both mental and behavioral approaches (Van’t Veer-Tazelaar 299). The approach also works with the premise that a change of mind and behavior controls both thinking and acting. According to Johnsen and Friborg, the fact that certain behaviors can be learned and unlearned is the strength of CBT (750). Therefore, disorders such as anxiety, mood, schizophrenia, and psychological disarray can be unlearned in the same way they are learned through confrontation (McKay et al. 239).
Techniques of Cognitive Behavior Therapy
There are various techniques of cognitive therapy. The first technique is therapy. According to Johnsen and Friborg, therapy involves having face-to-face interactions with a psychoanalyst for between 6 and 18 sessions (750). Each of these sessions takes about one hour, separated by a period of one to three weeks. According to Van’t Veer-Tazelaar et al., special sessions can also be organized after the major encounters (297).
A therapist is guided by scientific perspectives, operationalization of problems, and measurability of aspects, goal attainment, and behavioral and cognitive approaches. Patients are also assigned homework. Hence, the end of therapy depends on how patients manage their assignments (Freeman et al. 10). The second technique involved computerized or internet-based CBT. According to Zhu et al., this approach involves the use of internet-enabled computers to deliver interactive voices between the therapist and patients (321).
This approach has the advantage of being cheaper compared to employing the services of a physical therapist (Van’t Veer-Tazelaar et al. 298). Besides, it not only saves time but also reduces absenteeism. Computer-based CBT has been found to be effective in treating children and adolescents who suffer from anxiety and depression.
The third technique involves reading of self-help materials. In this technique, patients are provided with materials, which they are assisted to use in reading self-help cognitive behavior therapy. In self-help therapy, the program is more effective when a medical professional is available to guide the patients in the process of reading and interpreting the materials (Van’t Veer-Tazelaar et al. 298).
It is presumed that the reading of CBT materials will have a therapeutic effect on patients who suffer from either cognitive or behavioral disorders. The fact that the patient administers the materials to him or herself implies a higher tendency to own the program and/or to take it at their will and pace (Freeman et al. 12).
The final technique is the group educational course. Group educational course approach involves having several patients who take part in group courses (Johnsen and Friborg 752). Exchange of ideas, discussion, and group works enhance shared worldview and identity to the patients. Therefore, patients can appreciate that their condition is not unique and that it can be altered through learning and other forms of treatment.
Weaknesses of the Therapy
Although CBT has been approved and seconded by major therapy associations in the world such as the American Association of Psychiatry as better therapy compared to others, it has a few shortcomings that challenge its efficiency and adaptability. To begin with, researchers have criticized the idea that CBT is a superior treatment therapy when compared to others. It is also argued that the positive impact of the application of CBT has been reducing in size and impact from 1977 (Freeman et al. 12).
The second weakness of CBT is witnessed through the high dropout rate of patients who enroll in the program. CBT has a higher dropout rate than other treatments. In some instances, the CBT dropout rate can be four times higher than other treatments for similar programs, such as psychodynamic therapy (Tolin 713).
The dropout is even worse when CBT is applied in treating anorexia disorder. Patients suffering from this eating disorder have a higher likelihood of dropping from CBT and turning to their initial behavior (McKay et al. 240).
The other weakness of CBT is that it has not provided a clear framework for correct thinking (Johnsen and Friborg, 755). CBT provides a framework for distorted thinking, but it does not offer a counter framework that shows how clear and correct thinking happens and/or exists. The argument is that if irrational thinking can result in emotional and mental disorders, then rational thinking should result in emotional and mental wellbeing (Zhu et al. 322).
Another weakness of CBT is its absence of free will and determinism. The ability of human beings to think about their will is assumed not to exist and that human beings have their thoughts and emotions influenced by external stimuli. The cause-effect approach to CBT makes it unrealistic.
The Role of CBT from a Christian Point of View
From a Christian point of view, CBT can be helpful. Christianity is based on the moral teachings of values such as love and wellbeing of the mind, body, and spirit. Since CBT aims at treating both mental (cognitive) and behavioral disorders, the wellbeing of Christians is assured (Tolin 715). CBT ensures that human beings are emotionally and mentally healthy.
Christians cannot serve God without physical, psychological, and emotional health. Therefore, this therapy can help Christians who suffer from such conditions to regain their wellbeing to serve God. Moreover, CBT involves techniques such as self and group-administered therapy materials (Freeman et al. 12). Unity and working together are among the Christian values. Therefore, it is helpful for Christians to embrace CBT.
Conclusion
CBT is cognitive and behavior-based therapy. The behavior is most useful in addressing stimuli-based problems such as anorexia, mood, addiction, psychotic disorders, anxiety, addiction disorders, eating disorders, and personality disorders. CBT makes use of techniques such as a therapist, computerized/internet-delivered care services, reading self-help materials, and group educational lessons.
However, CBT has weaknesses, such as its inability to prove its superiority over other treatments. It is associated with a high dropout rate of patients during treatment. Besides, it also denies the patients their free will. On the other hand, CBT can be very useful from a Christian point of view since it is therapeutic and that it results in both behavioral and mental wellness issues, which are the foundations of Christian values.
Works Cited
Freeman, Jennifer, Abbe Garcia, Hannah Frank, Kristen Benito, Christine Conelea, Michael Walther, and Julie Edmunds. “Evidence base update for psychosocial treatments for pediatric obsessive-compulsive disorder.” Journal of clinical child and adolescent psychology 53.1(2014): 7–26. Print.
Johnsen, Tom, and Oddgeir Friborg. “The effects of cognitive behavioral therapy as an anti-depressive treatment is falling: A meta-analysis.” Psychological bulletin 141.4(2015): 747–768. Print.
McKay, Dean, Debbie Sookman, Fugen Neziroglu, Sabine Wilhelm, Dan J. Stein, Michael Kyrios, Keith Matthews, and David Veale. “Efficacy of cognitive-behavioral therapy for obsessive-compulsive disorder.” Psychiatry Research 225.3(2015): 236-246. Print.
Tolin, Franagan. “Is cognitive-behavioral therapy more effective than other therapies? A meta-analytic review.” Clinical Psychology Review 30.6(2010): 710–720. Print.
Van’t Veer-Tazelaar, Petronella, van Marwijk, Patricia van Oppen, Hein van Hout, Henriëtte van der Horst, Pim Cuijpers, Filip Smit, and Aartjan Beekman. “Stepped-Care Prevention of Anxiety and Depression in Late Life: A Randomized Controlled Trial.” Archives of General Psychiatry 66.3(2009): 297–304. Print.
Zhu, Zhipei, ZLi Zhang, Jiangling Jiang, Wei LI, Xinyi Cao, Zhirui Zhou, Tiansong Zhang, and Chunbo Li. “Comparison of psychological placebo and waiting list control conditions in the assessment of cognitive behavioral therapy for the treatment of generalized anxiety disorder: a meta-analysis.” Shanghai archives of psychiatry 26.6(2014): 319–331. Print.