Cognitive behavioral therapy (CBT) is one type of psychotherapy which has become a significant part of psychology. In its original form, it was formulated to treat, depression, but in the present setup, it is applied in the management of several other mental conditions. CBT is accorded different meanings by different scholars, though all of them are closely interrelated. CBT is defined as a popular type of talk or psychotherapy where a client talks with a psychotherapist using a structured methodology through participation in a limited number of sessions. This type of therapy helps individuals to realize their harmful or inaccurate thinking processes and thus stand in a better position in viewing difficult situations in a better way and respond to them more effectively. The paper in this stance seeks to provide an introductory literature review on CBT and all the details and the findings about the therapy and what is not known about the same.
According to Stringaris (2015), CBT involves a class of interventions which share the foundational premise that specific cognitive factors sustain mental disorders and psychological challenges. The core understanding of this approach, as espoused by Rathod " Kingdon (2009), states that maladaptive cognitions promote behavioral and emotional distress. Rathod " Kingdon (2009) holds that these maladaptive challenges include general schemas or beliefs about the future, the self, and the world which result in automatic and specific thought processes in certain situations. The basic model holds that therapeutic approaches to shape these maladaptive thoughts result in problematic behaviors and emotional distress.
In line with the medical psychiatry, the overall aim of CBT is the reduction of symptoms, better functioning, and decline in the effects which arise from a mental disorder (Naeem et al., 2010). To achieve this objective, the patient is projected to be an active participant in a cooperative and problem-solving approach to challenge and test the validity of maladaptive thoughts and to modify the behavioral patterns of the patients (Naeem et al., 2010). Thus, in the contemporary setup, CBT refers to a group of interventions which combine diverse emotions, behaviors, and cognitive techniques in modifying the conditions of the client. Even though this approaches significantly stress cognitive elements, behavioral, emotional, and physiological components are appreciated for the role they play in managing the disorder (Naeem et al., 2010).
A recent study by Butler et al. (2006) on CBT’s meta-analysis identified 16 quantitative evaluations which involved 332 clinical trials covering 16 distinctive disorders. This was the first examination of meta-analytic studies evaluating the efficacy of CBT for several psychological conditions. The research has since grown into one of the most compelling assessments of CBT. Nonetheless, the research methodology adopted was restrictive, because only a single meta-analysis was employed for every disorder. Additionally, the scope of the study just captured up to 2004, but several surveys have been carried out and published since then. In fact, most of the researches (contributing 84%) were published after 2004. This study aimed to offer a comprehensive assessment of all the present-day meta-analyses probing the findings for the effectiveness of CBT. According to the results, the meta-analysis incorporated in the studies were all approved to be procedurally sound (Butler et al., 2006).
Research by Naeem (2011), reveals that CBT is an effective strategy for others disorders such as panic disorders and other dysfunctional behaviors in addition to depression. Successful CBT sessions involve a healthy collaboration between the counselor and the person receiving treatment. Moreover, this therapy entails precise identification of the problem, setting sustainable goals, homework assignments, reality checks, various feedbacks, empathic communication, and enlightening individuals to utilize the acquired tools to enhance growth and positive behavioral transformation.
Investigations by Hofmann (2012) postulates that CBT was modeled 40 years ago to manage and control depression, but currently, there are several other CBT models for handling many other disorders. The disorders include eating, dental phobia, borderline personality, bipolar disorder, schizophrenia, substance abuse, marital conflict, anger, childhood depression, social phobia, insomnia, generalized anxiety, post-traumatic stress disorder, panic disorder, and several other physical and mental conditions. Besides, these research espoused that CBT brings forth better results than medications for handling some cases to do with insomnia. Moreover, CBT is virtually applicable in almost all maladaptive behaviors where beliefs and thoughts play a significant role.
A study conducted by Henwood, Chou " Browne (2015), stresses on the need to recognize, challenge, and modify how people look at a situation. CBT holds that the thought patterns of people are like wearing a pair of spectacles which make individuals view the world in a particular manner. As highlighted by the CBT pioneer, Dr, Aaron T. Beck, the interpretations and perceptions of depressed people are distorted. Sad people have a high likelihood of making cognitive mistakes such as having a negative mindset, running their thoughts in black and white, catastrophizing, and jumping to conclusions (Henwood, Chou " Browne, 2015). These errors in thinking arise spontaneously, the victim accepts them as truths not realizing that they are just distortions. Hays (2009), in his research, posits that the role of CBT is to shape an individual’s thoughts by modifying the automatic thoughts and challenging the validity of such views by likening them with the reality. When a person shuns negative thoughts, catastrophic thinking and self-depreciating, their level of difficulty reduce and they gain the capability of functioning in a healthy and desired way.
Further, Hays (2009), postulates that CBT shows people that it is not the actual happenings which cause the problems and disorders which they encounter, but the meaning accorded to those events. Negative and distorted thinking causes problematic behaviors and overall dysfunction of a person. Unearthing faulty reasoning, shaping beliefs and relating to other people more positively can assist people to control or overcome many common disorders, phobias, and illnesses Hays (2009). In the recent past, CBT has been proved helpful for people with back pain. Graham (2005) in his findings hold that specific online interventions utilizing CBT approaches can reduce the symptoms in the affected individuals. In another study carried out by Forsyth (2011) involving adults with severe back pain, the volunteers given access to an interactive online interventions to educate themselves on self-management skills portrayed higher scores on self-managed measures on pain, self-efficacy on pain management, disabling beliefs and attitudes, disability, and regulation of moods compared to the control group which stayed three weeks awaiting treatment. When the control group was exposed to CBT interventions, the scores were identical between the two groups.
The findings of another study confirmed that CBT is helpful to people under medication for example breast cancer patients who portray menopause symptom as a side effect of cancer treatment. This multicentre, randomized, and controlled study involved 422 women exposed to CBT, physical exercises or both. After a period of six months, the women receiving CBT experienced a significant reduction in urinary and endocrine symptoms, and a better shape in physical functioning. Additionally, the sampled women reported a significant decrease in night sweats, hot flashes and rejuvenated sexual activities.
In a survey carried out by Fernandez (2015), CBT revealed an excellent efficacy in the management of depression bringing forth effect sizes of over .85; moreover, evidence from the study shows that CBT leads to lower chances of relapse compared to pharmacological treatment. Nonetheless, the study confirmed that CBT is not always sufficient; around 30-50% of the individuals treated using the method respond negatively. Further, for the one who respond positively, recurrence and relapse is a common phenomenon. Thus, important insight may accrue from gaining an understanding of the processes which may hinder or facilitate positive therapeutic transformation.
Process and shape of therapeutic change in CBT
The method of executing therapeutic change makes the difference in outcomes obtained from CBT. Understanding the change processes allows the testing of accepted theories of evolution, help in understanding depression and facilitate the advancement of treatment to maximize the outcomes of therapeutic change (Corrie, Townend " Cockx, 2015). One type of process research concentrated on a temporal variation on the pattern of change of symptoms across all sessions of therapy.
The studies investigating the nature of change in CBT in the contemporary setup has often attracted the attention of discontinuous arrangements of non-linear change with the proposition that they mark key transition stages in therapy and thus foster the capacity to study and isolate therapeutic processes and variables which may be causally linked to the desired change. This study identified more than three different patterns of non-linear modification in CBT when handling depression, and they include rapid early responses, depression spikes, and sudden gains (Corrie, Townend " Cockx, 2015).
These patterns of change are of significant concerns to clinical researchers because of their prognostic importance across a wide range of disorders and therapies and for their ability to recognize and concentrate analysis on therapy periods which may assist in unearthing important process which informs therapeutic change (Corrie, Townend " Cockx, 2015).
Butler et al. (2006), hypothesized that instant gains arose from cognitive shifts and observed in pre-gain meetings and thus recommended that they are in line with Beck’s proposition of cognitive mediation as a medium of change modifying behavior in CBT. The author also observed improved collaboration in post-gain sessions, theorizing that the mental shift and sudden gain enhanced triggered an upward movement which further promoted therapeutic benefits. Nonetheless, limitations exist to the interpretation which can be developed from the survey because the researchers only provided correlational data, the reliability of the rating was in doubt, and spontaneous gains did not suggest reduced symptoms after one year and failed to forecast relapse (Butler et al., 2006). Additionally, amongst the clients who respond to CBT, showed that sudden gains did not confer added therapeutic merits. Also, sudden benefits noted by Bui et al. (2018) in group therapy did not correlate with the results of the treatment. Nonetheless, Corrie, Townend " Cockx (2015) countered by providing evidence that sudden gains arising from CBT showed more stability than those arising from non-cognitive treatments. Thus, Corrie, Townend " Cockx (2015), concluded that sudden increases implicate the reflective cognitive transformation and preventive merits of CBT.
Among the many mental therapies, CBT is not regarded as a single therapy, but a combination of several others with the objective of assisting clients achieves desirable behavior, emotions, and cognition. Fernandez et al. (2015) argued that CCBT reflects an integration of both behavioral and cognitive approaches to psychotherapy. The traditional and fundamental CBT perspectives state that psychological disorders comprise three essential elements: behaviors, cognitions, and feelings. All these three elements are interlinked (Fernandez et al., 2015). Thus a change in one aspect can result in a modification of either of the remaining two factors. For instance, Simmons " Griffiths (2014) suggest a model of CBT presuming that conditions alone do not cause psychological disorders, but rather the manner in which people interpret, react and make sense of these situations. The researchers postulated that people would feel stressed when they understand circumstances negatively. Thus, the objective of CBT interventions is to correct the negative bias in behaviors and thought processes. That is to say; cognitive and behavioral treatments work to interrupt the vicious cycle of the client’s challenges by establishing a positive change in one or more elements of mental distress by employing different therapeutic approaches.
Conclusion
The paper sought to advance a literature review about CBT and all the details about this type of therapy. The CBT approach to depression is an effective treatment to depression, but it cannot work out in all cases. Nonetheless, there is room for improvement. There is a need for empirical findings on why and how change takes place in CBT, but yet it is paramount in efforts of ensuring that the efforts of therapeutic change are maximized. Finally, this literature review has offered valuable insight on the available studies pertaining CBT and thus provides a foundation on the type of research which can be done to increase the effectiveness of CBT for the benefit of clients and practitioners.
References
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