Cognitive Behavioral Therapy

Cognitive behavioral therapy emerged onto the psychotherapy world in the 1970’s adding a simple yet profound component to the behavioral therapies that were existent at the time. This addition was that in order for change to occur, and essential precondition was that a person’s thought patter must change. Needless to say this postulate became part of the many treatment modalities that were to follow which were EMDR, Cognitive Behavioral Sensory Desensitization, etc.

A typical example of how this treatment worked was if someone was agoraphobic or had a fear of open spaces they would be paralyzed by their cognitions such as “I’ll pass out if I got outside” or “People are dangerous.” If these thoughts were replaced with more neutral or realistic thoughts through the utilization of cognitive behavioral therapy then the person afflicted with the unhealthy thought pattern should be able to go outdoors without anxiety. The issue that causes the impairment has nothing to do with the outdoors but rather their thought. (Trauma therapy would say the thoughts emanate from a traumatic event and the treatment must be more intense than just replacing the unhealthy thought as it is impervious to this one dimensional intervention.)

There have been many great therapists of the cognitive behavioral school i.e. Albert Ellis, Aaron T. Beck, Judith Beck, and others but my personal favorite is David Burns, M.D. In his seminal book, Feeling Good, he makes two large contributions to cognitive behavioral therapy and therapy in general. 1. His generating a list of cognitive distortions which I used extensively years ago and had many clients identify theirs and make changes in their thoughts and behaviors accordingly. So many clients do the fourth cognitive distortion- ‘disqualify the positive’ – (meaning someone will give them a complement and they negate by thinking or saying “it was nothing”) they therefore have horrible self-esteem based on a single cognitive distortion. And as Dr. Burns said elsewhere negative emotional events can only inflict their damage as a result of low self-esteem.

And the simple antidote for this cognitive distortion is a simple thank you.

2) The other profound method found in David Burn’s book Feeling Good on cognitive behavioral therapy is the triple-column ledger technique which is a way to move patients from negative automatic thoughts utilizing the cognitive distortions learned before and then thinking through and creating a rational way to handle the situations.

In the late 1990’s – early 2000’s I had great success with most of my patients with this technique except for the clearly traumatized whom I had to success with until I utilized EMDR. Now it is clear to me that most of my clients benefit from CBSD which is trauma based which is consistent from the research-Prolonged Exposure Therapy says 60% of the population has been traumatized and EMDR from 60-90% has been. I can’t explain the difference in then and now other than my clients from then may have returned to treatment as the method of cognitive behavioral therapy did not go deep enough. Yet, I must note, there are cases I have today that the cognitive behavioral therapy approach is the most appropriate.