I rushed into writing my first blog to mainly introduce my own brand of CBT without perhaps giving sufficient credit to the ‘parent company’, the big daddy: Cognitive-Behavioural Therapy ! But better late than never, so here we go…
CBT, what’s all the fuss about?
Well.. most rumours are actually true. At least according to Frontiers of Psychiatry (the January 2018 edition) CBT is the gold standard in the field of psychotherapy, because of its clear research support and continuous development and improvement based on research findings. It presently dominates the international guidelines for psychosocial treatments, making it a first-line treatment for most disorders, as noted by the National Institute for Health and Care Excellence’s guidelines 2 and American Psychological Association.3
This is no longer the new kid on the block, even though it was the latest to join in at the big boys table in the mid-60’s. Back then, CBT was merely a treatment protocol for depression written by the brilliant Aaron Tim Beck an analytically trained psychiatrist. The clinical world soon realised that this new kid (CBT) is here to stay and might even attempt to take over. So much so that today, we are talking about ‘CBT’ being an umbrella term for a number of therapies or approaches with many strange names but a clear task to treat a variety of different psychiatric disorders (i.e. Schema Therapy, MCT, MBCT, DBT, ACT, CFT and a lot of other acronyms).
CBT is a pretty fast paced, short-term, modern therapy with flexible therapeutic boundaries. Yes that’s correct fellow therapists, behaviourists have always steered away from traditional psychotherapeutic boundaries – in my humble opinion, these dated boundaries are probably still rooted in an unworkable Freudian-psychoanalytical approach. I am sure this is a gross exaggeration, but nonetheless it does not change the fact that CBT does not necessarily adhere to the traditional therapeutic boundaries. Whilst some therapists still wonder over the usefulness of shaking hands with their patients or comforting someone crying, we stick our hands down the toilet to demonstrate to our OCD patients that germs don’t instantly kill.. and then we shake their hands! Sessions can take place in the comfort of a clinic (if we are lucky enough) or in patient’s residence or outdoors or at patient’s work place. It all depends on the type pf exposure exercises or social experiments that we would have agreed on, in advance, with the patient.
The formal term used in CBT is ‘collaboration’. Indeed we collaboratively agree on most (or all) experiments but in reality, this model is directive, problem-solving and goal oriented, relying on a lot of teaching and a clearly prescribed evidence-based process usually led by an expert therapist (oh yes.. I’ve done it again). The treatment methods (exposure or relaxation training) are steeply rooted in behaviourism, learning theories and even physiology. The works of BF Skinner, J Watson, I Pavlov, E Jacobson, A Salters and a few other creative but not always popular (or even ethical by today’s standards) behavioural psychologists from the beginning and middle of the 20th century, form a solid foundation for all CBT approaches.
Nowadays cognitive-behavioural practitioners describe three distinct waves of CBT. The first wave is characterised by the above mentioned behaviourists, the second-wave was kicked off by Aaron T Beck and Albert Ellis – this is ‘the CBT’ that most people are familiar with! Third-wave CBT is marked by a slight departure from earlier methods with the arrival of imagery-based philosophically informed approaches such as mindfulness (MBCT). Even though though mindfulness and compassion based therapies are associated with the Buddhist philosophy it is important to acknowledge that the main drivers that underpin these methods (as developed by John-Kabat Zinn, J Mark Williams JD Teasdale or Paul Gilbert) are not just philosophical aspects of our daily living as much as the focus on training the attention and affect regulation (or stress regulation).
So what do all these methods in common ? Well… this is a subject worthy of a whole new article…