Cognitive therapy: Basic principles and methods
Cognitions – thoughts, beliefs and attitudes
Cognitive therapy is based on the idea that cognitions (what we think or believe) play a major role in what we feel and how we behave. The philosopher Immanuel Kant (1724-1804) believed that mental disorders resulted from people substituting private meanings for public ones. He argued that public meanings are continually checked out against reality. Private meanings are not, so they stay untested and may keep a person in a state of emotional distress.
Problematic cognitions may be conscious (i. e. we are aware of them and aware that we believe them to be true) or unconscious (i.e. we are either only marginally aware of them or even completely unaware of them). Symptoms of emotional distress or disturbed behaviour often arise because what we think or believe (whether consciously or unconsciously) is inaccurate, exaggerated, or results in self-defeating behaviours. According to the cognitive model, we can be relieved of distressing symptoms if we can modify the dysfunctional thoughts and beliefs that contribute to them.
These exaggerated or distorted beliefs can be seen in many disorders. For example, anxious people may underestimate their ability to cope with difficult situations or believe that everyone will reject them if they speak up; depressed people may believe that they have failed at everything or that everyone thinks they are worthless; individuals with eating disorders may believe that it is worth sacrificing just about anything in order to be thin.
Learn how thoughts and beliefs are associated with emotions evoked by everyday events
Cognitive therapists help you to identify and understand the cognitions related to your distress and to help you take steps to change them. This process can involve a wide range of different activities:
- Learning to be more aware of everyday patterns of thinking, feeling and behaving. Cognitive therapists often ask their clients to record what they think and feel and to bring these records to the sessions so that they can be discussed.
- Learning more about your emotions. Sometimes anxiety and depression develop because individuals have not paid enough attention to what they really feel about the important things or people in their lives or the things that have happened to them. It can take time to allow yourself to experience and identify what you truly feel. Your therapist is trained to help you do this, and to help you tell the difference between the basic emotions such as anxiety, anger, sadness, guilt and shame. Once you recognize what you feel, you may need to respect those feelings by changing the way you deal with everyday relationships and situations. Or you may discover that your emotions are based on attitudes or beliefs (sometimes mostly out of awareness) that are inaccurate or exaggerated.
- Facing painful emotions. Sometimes people develop symptoms because they have not been able to face emotions which seemed too overwhelming or painful to deal with. For example, people who have been mugged, assaulted, raped, physically or sexually abused, or suffered a sudden tragedy may have feelings of fear, guilt, shame, grief and anger which are so intense that you seem overwhelming. At the time it seems that the best way to cope is to push the feelings aside and get on with life. Unfortunately this does not always (or usually) solve the problem and distressing symptoms remain. In cognitive therapy you will be supported in facing painful emotions one step at a time in a way that you will plan together with your therapist.
- Monitoring thoughts and beliefs and identifying ones that are negative, exaggerated or self-defeating.
- Discussion or investigation of whether a belief is logical or accurately related to the facts.
- Obtaining information to help you clarify the real nature of a problem or correct misinformation or biased thinking.
- Learning to actively challenge dysfunctional thoughts when you automatically think them in everyday situations.
- Learning and practising positive and adaptive thoughts or self-instructions to guide you through difficult everyday personal situations.
- Learning new ways to handle everyday problems: this could involve learning and experimenting with new skills in areas such as relaxation, time-management, solving everyday problems, conversation, assertiveness, communication with others, parenting, and developing intimacy.
- Experimenting with new behaviours: for example, doing things you previously avoided, changing self-defeating behaviours.
Working with cognitions, emotions and behaviour
This means the approach of cognitive therapists is not limited to a discussion of your thoughts and beliefs. Identifying and understanding cognitions usually involves investigating our emotional lives and the personal stories in which they are embedded. Changing beliefs often calls for experiments with new ways of expressing ourselves and of behaving in different contexts: at work, at leisure, in the family and in our intimate relationships.
In all aspects of this process the cognitive therapist acts as a collaborator, a guide and a sounding board, as you increasingly learn to take charge of areas of your life which have previously been problematic because unrecognized emotions and distorted cognitions have given rise to self-defeating patterns of behaviour.
Cognitive therapy is structured. The therapist will help you set a focus for each session and work towards specific targets. It is valuable to plan what you will work on in each session and your therapist will help you to set an “agenda” for the session. This can prevent you spending a lot of the session on less important matters or coming to the end of the session without having spoken about something that was important to deal with.
The therapist will help you identify and work with personal situations that are problematic. For example, you may work on new ways of coping with everyday upsetting incidents, or ways of taking new initiatives in social situations. In between sessions you will be encouraged to experiment with new ways of thinking and behaving and to report back on how this worked for you.
Sometimes this brings into focus the way in which longstanding emotional patterns rooted in childhood schemas are hindering your progress and in such cases schema therapy may be recommended. Since schema therapy evolved out of cognitive therapy it is easy to move to the schema level if you have started with the basics of cognitive therapy.