Tuesday, 6 October 2020

How the Cognitive Model is Used in CBT to Tackle Long-term Problems

Cognitive Behavioural Therapy (CBT) is a highly structured, time-focused and goal oriented therapeutic approach underpinned by extensive empirical research which clearly demonstrates its efficacy and clinical effectiveness.

CBT brings together a wide range of proven cognitive approaches and behavioural strategies to alleviate suffering and improve psychological resilience. The purpose of CBT is to help change problematic patterns of thinking and behaviour and develop adaptive coping strategies for the problems that life presents. These strategies can be used to target problems relating to our current situation or environment or longer-term problems rooted in our earlier life experiences.

To find out more about CBT or to talk to an accredited Cognitive Behavioural Psychotherapist, visit www.thinkcbt.com 

Whilst behavioural strategies are a key part of the CBT approach, this article will focus on the cognitive aspect of CBT and specifically on how past experiences can influence how we think in the here and now.

The Importance of Cognition in CBT

A key premise in Cognitive Behavioural Therapy is that it’s not the situation or event that maintains suffering, but the way we think about or respond to the situation. CBT therefore works by identifying, testing and altering the content and processes of thinking and by changing our relationship with unhelpful thoughts. 

This broadly involves two processes. Firstly, understanding and working on the current psychological maintenance factors that keep the problem going. Secondly, identifying historical factors that underpin the problem. In this article we will focus on how historical factors influence our beliefs and thinking processes.

Levels of Thinking – a Model of Human Cognition

Thoughts and thinking processes are largely the product of our earlier learning experiences. Where learning experiences are adaptive, we develop and cope more effectively. Where earlier life experiences are maladaptive or traumatic, our cognitions can be negatively influenced and time-frozen.

Aaron Beck (1967) drew on the original ideas of Piaget (1948), when he introduced the term cognitive schema to describe the content and structure of our negative core beliefs and thinking processes. Beck’s work on cognitive schema has been further developed into a model commonly used in modern Cognitive Behavioural Therapy.

The onion diagram can be used to illustrate the different layers or architecture of the cognitive schema.

This shows how cognition can be presented on four levels including negative automatic thoughts, dysfunctional rules and assumptions and negative core beliefs. 

How Negative Schema Develop

The schema is like an internal filing cabinet of the mind. As children we start to understand and organise the world around us by opening and labelling files according to our early experiences. We subsequently spend our adult lives putting new material into these old files. Where our experiences were healthy and adaptive, we update the filing system to organise, classify and interpret new experiences in a helpful and adaptive manner. Where earlier life experiences were challenging or disruptive, we file and interpret our new experiences according to the old filing system. This can reinforce the problem and lead to negative or disorganised thinking.

The idea behind the filing cabinet metaphor is that our underlying beliefs and thinking processes are initially influenced by our early childhood experiences. This can include relationships with parents, the environment we grew up in, the demands or expectations that shaped our attitudes, our school years, social factors and significant early events involving loss or trauma. 

It’s important to emphasise that unhelpful thinking patterns in adulthood are often rooted in ordinary experiences perceived and interpreted through the eyes of a child. It’s not just what happened, it’s about how we interpreted what happened that often determines how we label our files. For example, if we interpreted the behaviour of an anxious parent as distant, insecure or unloving, then this could lead to a file labelled unwanted, unsafe or rejected. 

As a child we do not have the intellectual or emotional insight to objectively understand and interpret our early experiences. This can lead to filing errors and a disorganised filing system when it comes to understanding our future experiences. 

Whilst negative and traumatic life events can profoundly influence our early schema, unhelpful beliefs about ourselves or how other people view us, are often rooted in the misinterpretation of early challenging life experiences. The residue of old thinking patterns continues to affect how we see things in the present and profoundly influences our emotional responses and behavioural repertoire.

So why is this important? If we can understand how our early maladaptive schema were formed, we can find new ways of interpreting old experiences with the power of hindsight and a more objective adult perspective. This process is known as “Cognitive Restructuring” and is best undertaken with the support of a psychologically trained CBT expert. 

Cognitive restructuring of core beliefs, assumptions and rules involves testing, altering and updating these deeply rooted thinking patterns to find a more realistic, healthy and adaptive way of interpreting the schema. This can include structural change in which we challenge and change the content of our Schema, or defusion in which we find a helpful reframe which is consistent with reality.

Where early experiences include traumatic or abusive events, this can lead to deeply rooted and enduring psychological health problems. In these cases, the process of cognitive restructuring is highly specialised and should be supported by a trained Cognitive Behavioural Psychotherapist or Psychologist.

Contrary to the idea that CBT does not deal with historical or long-term problems, schema work or cognitive restructuring of core and intermediate beliefs involves an in-depth assessment of historical factors and the development of healthy and rational beliefs. This helps the individual to unfreeze and re-interpret old belief systems and develop healthy coping strategies.

This concept together with a wide range of CBT tools and strategies is presented in the new Think CBT Workbook and Skills Primer. You can download a free copy of the Think CBT Workbook by visiting our website www.thinkcbt.com and following the links to the workbook.

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