It’s amazing how a counseling or psychotherapeutic technique can alleviate the suffering of people with depression, anxiety, eating disorder, and other forms of maladjustment.
These disorders especially depression are not only prevalent in our country, Philippines, causing cases of suicide; they have also become global phenomena. GMA News online reported in 2015 that there are 4.5 million depressed Filipinos – the highest in Southeast Asia — only one out of three who suffer from depression will seek the help of a specialist, according to World Health Organization. One third will not even be aware of their condition. Moreover, statistics reflected in The Huffington Post showed about 350,000,000 people globally are affected by some form of depression.
In the United States, anxiety disorders on the other hand, are the most common mental illness which affect 40 million adult Americans age 18 and older, or 18% of the population. (Source: National Institute of Mental Health)
For anxiety disorders, a study conducted by Makino, Tsuboi, and Denenrstein on the Prevalence of Eating disorders and the Comparison of Western and Non-western Countries demonstrated that the prevalence of eating disorders in Western countries is higher than that of the non- Western countries, but that in non-Western appears to be increasing.
Knowing these statistics made me reflect on some of the related psychotherapy and counseling techniques we studied in the graduate school, one of which is the Cognitive Therapy or Cognitive-Behavioral Therapy (CBT) which was proposed by Aaron Beck.
Aaron Beck is an American Psychiatrist whose theory on the effect of cognition on a person’s behavior is now widely used in the treatment of depression. In an article published by Dr. Robert Leahy in Psychology Today, he emphasized that Cognitive Behavioral Therapy is empirically based and effective for a wide range of disorders as summarized in “meta-analyses” where numerous studies surveyed, combined, and effect sizes extrapolated. He cited three analyses reflected below:
- Butler, A.C., Chapman, J.E., Forman, E.M., & Beck, A.T. (2006). The empirical status of cognitive-behavioral therapy: A review of meta-analyses. Clinical Psychology Review, 26(1), 17-31.
- Chambless, D.L., & Ollendick, T. H. (2001). Empirically Supported Psychological Interventions: Controversies and Evidence. Annu. Rev. Psychol, 52, 685-716.
- Tolin, D.F., Is cognitive-behavioral therapy more effective
than other therapies? meta-analytic review, Clinical Psychology Review (2010),
Dr. Leahy also mentioned that CBT is often viewed as the psychotherapy treatment of choice. He exemplified, “The United Kingdom has advanced the largest dissemination of psychological treatments ever implemented—primarily CBT—in the program called, Improving Access to Psychological Treatments. This program was begun under Prime Minister Tony Blair who, in my view, bears little resemblance to a Mafia Don.”
Now, let us take a look at the cognitive therapy paradigm and determine how it can be applied in the treatment of depression, anxiety, and eating disorders.
Based on cognitive model, one’s thoughts influence one’s emotion and behavior (Beck J., 2011). Thus, identifying and modifying “cognitive distortions”, a person’s inaccurate thoughts (Neukrug, 2010), that are affecting the individual’s social and occupational functioning will help the client cope with the present condition.
Here are common cognitive distortions identified by Aaron Beck’s daughter, Judith Beck (1995), in her book “Cognitive Therapy: Basics and Beyond“.
- All-or-nothing thinking (also called black-and-white, polarized, or
dichotomous thinking): You view a situation in only two categories instead
of on a continuum.
Example: “If I’m not a total success, I’m a failure.”
- Catastrophizing (also called fortune-telling): You predict the future
negatively without considering other, more likely outcomes.
Example: “I’ll be so upset, I won’t
be able to function at all.”
- Disqualifying or discounting the positive: You unreasonably tell
yourself that positive experiences, deeds, or qualities do not count.
Example: “I did that project well, but that doesn’t
mean I’m competent; I
just got lucky.”
- Emotional reasoning: You think something must be true because you
“feel” (actually believe) it so strongly, ignoring or discounting evidence to
Example: “I know I do a lot of things okay at work, but I still feel like I’m a
- Labeling: You put a fixed, global label on yourself or others without
considering that the evidence might more reasonably lead to a less
Example: “I’m a loser. He’s no good.”
- Magnification/minimization: When you evaluate yourself, another
person, or a situation, you unreasonably magnify the negative and/or
minimize the positive.
Example: “Getting a mediocre evaluation proves how inadequate I am.
Getting high marks doesn’t
mean I’m smart.”
- Mental filter (also called selective abstraction): You pay undue attention
to one negative detail instead of seeing the whole picture.
Example: “Because I got one low rating on my evaluation [which also
contained several high ratings] it means I’m doing a lousy job.”
- Mind reading: You believe you know what others are thinking, failing to
consider other, more likely possibilities.
Example: “He thinks that I don’t
know the first thing about this project.”
- Overgeneralization: You make a sweeping negative conclusion that goes
far beyond the current situation.
Example: “[Because I felt uncomfortable at the meeting] I don’t
it takes to make friends.”
- Personalization: You believe others are behaving negatively because of
you, without considering more plausible explanations for their behavior.
Example: “The repairman was curt to me because I did something wrong.”
- “Should” and “must” statements (also called imperatives): You have
a precise, fixed idea of how you or others should behave, and you
overestimate how bad it is that these expectations are not met.
Example: “It’s terrible that I made a mistake. I should always do my best.”
- Tunnel vision: You only see the negative aspects of a situation.
Example: “My son’s teacher can’t
do anything right. He’s critical and
insensitive and lousy at teaching.”
In CBT, the counselor or therapist assists the client to modify those inaccurate thoughts through establishing strong therapeutic alliance with the client, skill in cognitive conceptualization, and use of appropriate cognitive-behavioral technique considering the client’s unique intricacies.
Establishing strong therapeutic alliance means that the counselor or therapist shows sincere care, empathy and optimism to the client while working collaboratively with the latter. These stem out from the deep understanding of the clients’ problems through effective cognitive conceptualization.
Neukrug (2010) enumerated the activities conducted to make accurate cognitive conceptualization:
- Gathering important childhood data (understanding a person’s history can help identify beliefs that have been developed)
- Accurately identifying client’s problems (certain problems led themselves toward certain kinds of beliefs)
- Having the client identify automatic thoughts (specific automatic thoughts are associated with underlying beliefs
- Identifying resulting emotions, physiological responses, and behaviors related to automatic thoughts (responses tend to cluster as a function of specific beliefs)
- Identifying past and current stressors that might have led to the development of specific beliefs
Once these have been done, the counselor or therapist, in collaboration with the client, chooses a CBT technique applicable to the current problem. One of those, which also struck me most when we discussed CBT, is the Rational Emotive Role Play. The counselor or therapist helps the client identify his or her “irrational or thoughts” leading dysfunctional beliefs through a role play. In the role play, counselor may first act as the “rational part” while the client responds as the “emotional, dysfunctional part” of the person. They will then switch roles so that the client will be able to negate his irrational dysfunctional part . During the role-play, the counselor will be able to identify the cognitive distortions affecting the clients’ thinking, beliefs, and behavior.
Rational-Emotive Role Play, together with other forms of CBT, targets dysfunctional thinking (as listed above) that leads to depression, anxiety and eating disorders. Correcting thoughts that are inaccurate (i.e. overlygeneralized, magnified, personified and catastrophized) and building an accurate thinking framework will help the client adopt.
Now, here’s a learning resource – PowerPoint presentation on Cognitive-Behavioral Therapy – which I created and used for our graduate school class in Counseling.
Psychology students taking up Counseling subject may utilize this is a guide in making their own presentations.
Beck, J. (2011). Cognitive Behavior Therapy Basics and Beyond. New York. Guilford Press
Flanagan, J. & Flanagan, R. (2012). Counseling and Psychotherapy Theories: In Context and Practice New Jersey.John Wiley & Sons Inc.
Neukrug E. (2010). Counseling Theory and Practice. Virgina.Cenggage Learning
About Maricon Hernandez
Passion for learning and development while empowering the youth drives Maricon Hernandez.
A dreamer, educator, human resources practitioner, and travel enthusiast, Maricon explores various tourist destinations with her colleagues and friends. She also speaks in seminars and writes articles about topics she’s passionate about. She believes that learning is a life-long process; life is worthwhile when she adds value to other people’s lives through the gifts and resources she has. http://www.mariconhernandez.com