Hello , dear listeners , and welcome back to our podcast here at Licensure Exams . I'm Dr Linton Hutchinson .
And I'm Stacey Frost . We've got another episode of our Theory to Therapy series to share with you . Today We'll discuss one of the most widely recognized therapeutic approaches . That's right , cognitive behavioral therapy , or , as it's commonly known , cbt , and the techniques that are used with this theory .
Ha , cbt . That seems like the therapy most people have heard of and they don't know about the inner workings of CBT . So , stacey , why don't you kick things off by explaining the main idea behind CBT ?
Sure thing , linton . So , first of all , when most therapists hear the term CBT out in the wild , they think of a particular therapy model , but it's really a collection of therapeutic approaches and includes rational emotive behavior therapy , rebt , cognitive therapy , cognitive behavior modification and mindfulness based cognitive therapy , just to name a few .
And all of these fall under the broad umbrella of cognitive behavioral therapies because they're united by a common principle , and that is that psychological distress meaning things like depression , anxiety , etc arises from disruptions in cognitive or mental processes , and each of these approaches focuses on changing the client's thoughts and perceptions in order to bring about
changes in feelings and behaviors .
So what I hear you saying , Stacey , is that if you change your perspective , your actions and feelings will follow suit .
Yep . That is the core idea behind the CBT approaches .
So hey , stacey , I've got a question . Why does CBT get front page news all the time ? Any idea ?
Yeah , well , yeah , it's the treatment choice of everything , including the kitchen sink . It kind of reminds me of that story you were telling me about Publix recently , Linton .
Oh , yeah , publix Basically .
You got to get our Publix plug in .
No , it reminds me of the one size fits all or the castor oil from Publix that we just recently got , because your mom made us take it every winter to prevent all kinds of illnesses .
My mom made you take it .
You too .
Yes , exactly . Well , one of the reasons that you see it so much is that it's been so heavily researched . It's easier to scientifically quantify the effects of cognitive behavioral therapies , more so than , say , the psychodynamic approaches , because with CBT , treatment focuses on very specific , observable , measurable goals .
Okay , I get that , but for the exam you've got to know more than just CBT , right ?
Oh yeah , that's a given , but for our purposes , today we're going to be looking at Aaron Beck's approach , and if you come across the term cognitive behavioral therapy as you're studying for your exam , chances are that Beck's approach is the one that it's referring to . So first , a little bit of background to set the stage , let's travel back to the 60s .
I know how much you love the 60s , linton .
The 60s . Yes , you would have loved it too back then , but instead you ended up being born in the Scooby-Doo and Teenage Mutant Ninja Turtles generation .
I sure was . Well , you know , mcfly , it's one of those areas I'd like to visit in my delirium . Now , back to the future , I mean back to Beck . Like a lot of other psychiatrists , back in the 60s he started out practicing psychoanalytic therapy .
Yeah , as I remember , he studied under Freud , right .
No , linton , you've got your timeline mixed up again . Guess it's a delayed reaction of too much of the 60s . I know you did some we'll call it practical research with Timothy Leary back in the day , but let's save that for another podcast .
OK .
Well anyway , beck was involved in researching the dream content of clients who were depressed while he was working at the University of Pennsylvania School of Medicine when he discovered a curious pattern .
Huh , I did my dissertation on adaptive functioning of dreams of medical students .
Yeah , sounds like you and Beck have some things in common .
Oh , maybe , but what pattern did he find ?
So Beck noticed that these clients all had negative automatic thoughts that often reflected their anxious thought and attitude from their waking lives , and they had a negative conscious bias which was not , as most psychiatrists at the time thought , a result of unconscious drives .
So , extending his research , he wanted to find out more about these thoughts and how they related to depression , and he continued to fine tune his hypothesis that psychological problems stem from negative automatic thoughts , faulty logic , which he called cognitive distortions , and underlying beliefs or schemas .
And all of this research was really the genesis of the cognitive behavioral therapy model that we know and love , didn't Aaron ?
Beck also have something to do with the Beck depression inventory .
Mm-hmm , yeah , yeah .
So he collaborated with medical students , psychiatry residents and psychology doctoral candidates to try to get his cognitive model accepted into the scientific community , and they developed the Beck depression inventory and the dysfunctional attitude scale to assessment instruments you might want to take note of to measure depression and showed how the use of the cognitive model
was just as effective as things like electroconvulsive therapy and antidepressant drugs that were the really , you know , the only go to solution for depression back then .
Mm-hmm , antidepressant , sort of like antenomines . I vaguely remember something like that . Let me see , I heard they used to be called speed uppers , benes , dexies , pep pills , hearts , beans , black beauties . Yes , it's coming back to me , stacy .
Quite the memory you have there looking for someone who'd just heard about antidepressants .
Well , you never know how your past experience will come in handy in the future . So Stacy , anyway , we've got the basic idea behind CBT . What kind of techniques would a CBT therapist use ?
All right , Well , there's a lot of techniques used in CBT , but we've chosen the top five . So first there's cognitive restructuring , which is really more of a category of techniques than a specific one , and it involves identifying and challenging distorted thoughts or beliefs . For instance , let's say you have a client who says I always fail at everything .
The first step is identifying the logical error they're making . Now , reality is certainly subjective , but that statement is objectively untrue . No one always fails at everything . It's just not possible .
Right and Stacy , have you ever been to a county fair where they have those little fun houses with mirrors that make everything look distorted ? Well , when I have a client who is stuck in a cognitive distortion , that's the first thing that comes to mind when I'm working with them .
Well , similarly , imagine that your client is standing in front of this metaphorical mirror of distorted thinking and you want to help them step outside the fun house so that they can get a more accurate view of reality . So you teach your client to challenge that belief by looking for evidence that supports their thought .
Right , and you can also use tools like thought records , which are worksheets that the client fills out whenever they have a strong feeling like anger , anxiety or sadness .
The client identifies those intense emotions , the situation that occurred when they felt that way and what were the possible triggers , how they reacted , what their behaviors were and any negative automatic thoughts , what went through their mind when they were feeling angry , sad or anxious .
And as the client goes through the process , they will hopefully learn something about their negative thoughts and how it directly affects their feelings and their behaviors .
Mm-hmm . Well said . So there's another technique that I think is right up your alley , Linton .
Can you guess which one I'm ?
thinking about .
I think I know you must be talking about behavioral experiments .
That's the one .
Yeah , some people call it homework , mm-hmm . You can have a lot of fun with these . This is when you help the client test their beliefs by practicing a new behavior outside of the therapy session . I've got a good example . I use my daughter's sterling . Being an only child , ring a bell , stacey .
Mm-hmm .
She was shy and a bit introverted and really didn't enjoy crowds of people Sound familiar .
It does sound familiar , yep , we could be twins .
Really so I had her sign up for the oration contest at school all of them and we practice anywhere and at any time McDonald's , Wendy's , Pizza Hut . Whenever we went out , Sterling would give her speech . People loved it , and the more she did it , the more relaxed and the more confident she became .
Mm-hmm . Still sort of suspicious about this , linton . I'm not sure how I would have done with giving random speeches like that , but what about those oration contests ?
Well , she won first place multiple times and now with a PhD in cognitive neuroscience . I have a sneaking suspicion that I've been a subject of many of her experiments over the years without my knowledge or consent .
That's a great example , and while me personally knowing Sterling , that is definitely a yes . You have been the subject of some experiments over the years , so there are some similarities between you and Carl Whitaker there . Linton , he really loved those unconventional strategies when he worked with families .
Yeah , he did . But hey , if it works , it works . So here's another example . Let's take James , who fears that he's just average and boring , so he avoids talking to new people In therapy . You might challenge him to introduce himself to someone new on a daily basis and observe their reactions .
Mm-hmm , you know , this reminds me Albert Ellis . The guy who founded REBT , did that very thing , and as a young man believe it or not , if you've ever attended one of his seminars he was shy and anxious around women . So what did he decide to do ?
Oh boy , this is going to be a good one .
It really is . So he confronted his fear of talking to women by striking up conversations with over 100 ladies at a botanical garden , Mm-hmm . And remarkably , after overcoming the challenge of 99 refusals , he succeeded in getting someone to agree to go on a date through his bold persistence . And guess what happened ? Linton .
They got married .
No , she didn't even show up for their date . But at least he was freed from his social anxiety . So we'll loop back to your client , James , who was scared that he would be boring if you challenged him to introduce himself to a new person .
Maybe not like you know 100 people at first , like Ellis did , Right , but James might find that people enjoy talking to him , challenging his initial belief .
Exactly Now . Here's another technique that's often used in CBT Socratic Questioning . This technique allows you to explore the client's thought process , examine their assumptions and identify what their cognitive distortions are . So you can ask clarifying questions , like can you give me an example of what you mean ?
Or questions where you gather evidence , like what evidence supports your thought . Or questions that promote multiple perspectives , like what are the pros and cons ? Or questions that analyze possible outcomes , like what would happen if you did that ?
Good one . Well , how about reframing ?
Yes , we talk about reframing all the time . Why don't you tell us about that , Stacey ?
Sure Well , reframing is where you invite your client to consider other perspectives , like OK , when you're preparing for your exam . Instead of thinking it as a scary , intimidating challenge , try reframing it as an opportunity to show off how much knowledge that you've required .
And another one I like is role playing , where you help the client prepare for potentially challenging interactions by practicing them in a safe and secure environment of a therapy session .
Mm-hmm , that's great . Well , I think we've covered the basics of CBT pretty well . Can you give us a recap of the techniques that we've talked about , Linton ?
Sure . Number one cognitive restructuring . This involves identifying and challenging distorted thoughts and beliefs . Thought records are a great way of doing this . Number two behavioral experiments or homework . You instruct the client to practice new behaviors outside of the therapy session to test the reality of their beliefs . Number three Socratic questioning .
You explore a client's thought processes , examine their assumptions and identifying cognitive distortions . We'll have to do another podcast episode all about cognitive distortions . What do you think , stacey ?
Mm-hmm , definitely , yep , that's a good one .
Next , there's number four reframing . Inviting clients to consider other perspective . I do that a lot with people that are going in to take the exam , where they're really nervous and upset . What I do is I have them reframe that and saying I'm excited , I'm excited , I'm excited , I'm excited . And if they repeat that then their brain gets that idea .
As opposed to that , I'm anxious and fearful that they're just overly excited . And number five role-playing practicing potentially challenging interactions in the safety of a therapy session .
Nice , that's cool . Thank you , wynton , and thank you those of you who are on the road to licensure for being here with us today . Until next time , remember , it's in there .
It's in there .