Cognitivebehavioural Therapy

A clinical model that is used in psychotherapy to modify cognitions (the way a person interprets events), was developed by A.T. Beck, the founder of cognitive-behavioural therapy. This model can be helpful in understanding and modifying the beliefs of people with diabetes.

Cognitive therapy, originally developed to treat depression45 and anxiety46, has been successfully applied to a wide array of psychological problems, ranging from personality disorders to eating disorders and substance abuse47. Cognitive therapy is described as:

.. .an active, directive, time-limited, structured approach.. .based on an underlying theoretical rationale that an individual's affect and behaviour are largely determined by the way in which he structures the world. His cognitions (verbal or pictorial 'events' in his stream of consciousness) are based on attitudes or assumptions (schemas), developed from previous experiences.45

In other words, central to cognitive therapy is the assumption that behaviour and emotions are in constant interaction with cognitions. These cognitions or beliefs may be inaccurate, leading to excessive emotional reactions and a failure to cope effectively. The aim of cognitive therapy is to help patients identify their dysfunctional cognitions, test them against reality and alter them, thereby modifying emotional disturbances and improving coping behaviour.

The assignment of meanings, explanations and expectations to internal and external events is thought to be accounted for by 'cognitive schemata', also called 'core beliefs' or 'automatic thoughts'. Core beliefs are highly individual, are formed by past experiences, and are activated by particular events within or outside the person48. When underlying cognitive schemata are mainly negative in content, the processing of incoming information will be distorted, resulting in unpleasant, maladaptive feelings and behaviour. Depressed patients, for example, often show a characteristic cognitive pattern, consisting of a negative view of themselves, the future and the world surrounding them. This can result in feelings of inadequacy, worth-lessness and blame directed at oneself, hopelessness and apathy with regard to the future and a world that is unjust and excessively demanding.

Cognitive techniques used in CBT to help patients alter these negative automatic thoughts involve monitoring negative automatic thoughts and recognizing the interactions between cognition, affect and behaviour. The patient is invited to examine the evidence for his/her automatic thoughts and to substitute distorted cognitions with more realistic ones. In effect, patients learn to identify and alter the underlying beliefs which lead them to think in a distorted way45.

A therapeutic approach that is closely related to the work of Beck and stems from the same period, is rational-emotive therapy (RET), developed by Albert Ellis. Identical to CBT, Ellis states that thinking, feeling and acting are in constant interaction. One of the statements most central to Ellis's work is the phrase by the ancient Greek, Epictetus49: 'People are disturbed not by things, but by the views they take of them'. Dysfunctional beliefs in RET are termed 'irrational beliefs' and can, according to Ellis, be classified in three main categories: (a) demandingness towards the self ('I must, under all circumstances, perform well and have the approval of others; if not, that is awful and makes me an incompetent and unworthy person!'); (b) demand-ingness towards others CYou must treat me nicely, otherwise it is terrible and you are bad, unworthy people!'); and (c) demandingness towards the world ('The conditions under which I live must at all times be easy and enjoyable; if not, I can't stand it and life isn't worth living!'). Obviously, these beliefs can result in a variety of negative emotional states, including anxiety, self-hatred, anger, depression and dysfunctional behaviours such as procrastination, withdrawal, phobias and addictions50. RET has been applied to a wide variety of emotional and behavioural problems, and although there are various theoretical and philosophical differences between the two approaches, RET and CBT are not that different in clinical practice. An element important to note is the 'ABC Model' that is used in RET to identify and challenge irrational beliefs. This model is further explained in the section on content of CBGT.

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