Cognitive-behavioural therapy

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cognitive-behavioural therapy

cognitive-behavioural therapy (CBT) is a type of talking therapy that can help people cope with various mental and physical health problems. CBT focuses on how our thoughts, beliefs and attitudes affect our feelings and actions, and how we can change them to improve our well-being. CBT also teaches us coping skills for dealing with different problems in a more positive way.

One of the goals of CBT is to help us achieve self-transcendence, which is the ability to go beyond our personal concerns and connect with something greater than ourselves. self-transcendence can enhance our sense of meaning, purpose and happiness in life. It can also help us overcome negative emotions and cope with stress.

There are different ways to cultivate self-transcendence through CBT, such as:

• Challenging negative thoughts that prevent us from accepting ourselves and others
• Engaging in activities that we value and enjoy, and that align with our goals
• Developing a positive self-image and self-compassion
• Practising gratitude and kindness towards ourselves and others
• Exploring our spirituality and finding a sense of connection with a higher power or a larger community

CBT can help us achieve self-transcendence by changing our perspective on ourselves and our situation, and by encouraging us to live authentically and meaningfully.

Influence of Alfred Adler

Alfred Adler was an Austrian psychiatrist who developed the individual psychology approach and was a significant influence on some of the core principles of CBT.

“Meanings are not determined by situations. We determine ourselves by the meanings we give to situations.” – Alfred Adler

One of his influences on CBT is the recognition of the connection between thoughts and feelings, and how different interpretations of the same event can affect one’s emotions and behaviours. Adler proposed that people create their own subjective meanings based on their personal experiences, beliefs, and goals, and that these meanings shape their world-view and lifestyle (Adlerian Therapy: Key Concepts & Techniques, n.d.). CBT also assumes that people’s cognitive processes influence their emotional and behavioural responses, and that by identifying and challenging irrational or dysfunctional thoughts, people can change their feelings and actions (Adlerian Therapy | Psychology Today United Kingdom, n.d.).

Another influence of Adler’s individual psychology on CBT is the emphasis on courage and overcoming feelings of inferiority. Adler believed that people are motivated by a desire to overcome their perceived inferiority and achieve a sense of superiority or competence. He also argued that courage is the ability to face difficulties and act in accordance with one’s values and social interest, which is a feeling of connectedness and contribution to humanity (Lessons from Alfred Adler | MHT, n.d.).

CBT also encourages people to confront their fears and negative beliefs, and to develop coping skills and self-efficacy. CBT also fosters social interest by helping people strengthen their interpersonal relationships and social skills (Individual Psychology (Adler) | SpringerLink, 2020).

Concept of the mind

However, Adler’s individual psychology and CBT do not share the same concept of ego. For Adler, the ego was not a separate entity or structure, but rather a synonym for the self or the person as a whole. He did not divide the personality into id, ego, and superego as Freud did, but rather focused on the unity and integration of the person (Adlerian Therapy: Key Concepts & Techniques, n.d.).

For CBT, ego is not a central concept either, but it is sometimes used to refer to the rational or realistic part of the mind that mediates between the impulses of the id and the demands of the superego (Ego | Psychology Today United Kingdom, n.d.).

However, It is not entirely fair to say that the model of the ego used by CBT is similar to that proposed by Freud. While both approaches acknowledge the existence of unconscious processes that influence behaviour, they differ significantly in their conceptualisation and treatment of these processes. Freud’s model of the id, ego and super-ego is based on the idea that the personality is divided into three parts that are in constant conflict with each other.

The id is the source of instinctual drives and impulses, the ego is the rational and realistic mediator, and the superego is the internalised moral and social standards. Freud believed that psychological problems arise when the ego fails to balance the demands of the id and the super-ego, resulting in repression, anxiety and defence mechanisms. Freud’s therapy aimed to uncover and resolve these unconscious conflicts through free association, dream analysis and transference (Wikipedia, n.d.).

“CBT is based on an ever-evolving formulation of patients’ problems and an individual conceptualisation of each patient in cognitive terms.” (Beck et al., 1979: 4)

CBT, on the other hand, is based on the premise that psychological problems are caused by distorted or dysfunctional cognitions (thoughts, beliefs, attitudes) that affect emotions and behaviours. CBT does not assume a fixed or innate structure of the personality, but rather views it as a dynamic and adaptive system that can be modified by learning and experience. It focuses on identifying and challenging negative or irrational cognitions and replacing them with more realistic and positive ones. CBT also uses behavioural techniques such as exposure, relaxation and reinforcement to help clients change their maladaptive habits and cope with stressful situations (SAGE Publications Ltd, n.d.).

Therefore, while both Freud and CBT recognise the role of unconscious factors in human behaviour, they have very different assumptions, methods and goals. Freud’s model of the ego is more complex, deterministic and pessimistic than CBT’s model, which is more simple, flexible and optimistic. A quote that illustrates this contrast is:

“Freud’s concept of the id (the biological component), the ego (the psychological component) and the superego (the social component) is simply a sort of map designed to clarify the nature of the personality.” (Seligman, 2006: 50)

How cognitive-behavioural therapy works

CBT is based on the idea that our thoughts, emotions, and actions are interconnected, and that by identifying and modifying negative or irrational thoughts, we can improve our mood and cope better with life’s challenges. It typically involves working with a therapist to set goals, learn skills, and practice strategies to overcome difficulties. In addition, it can help with various mental health problems, such as anxiety, depression, phobias, ocd, PTSD, and more. CBT is supported by scientific evidence and has been shown to be effective for many people.

A typical CBT session

A typical cognitive-behavioural therapy (CBT) session would progress through several stages.

The first stage is to establish rapport and set goals with the client. The therapist would ask the client about their current situation, their expectations and their motivation for seeking therapy. The therapist would also explain the principles and methods of CBT, and how it can help the client overcome their difficulties.

The second stage is to identify and challenge negative thoughts and beliefs that contribute to the client’s problems. The therapist would help the client recognize the patterns of thinking that are distorted, unrealistic or unhelpful, and how they affect their emotions and behaviours. The therapist would also teach the client techniques to test and modify their thoughts, such as using evidence, alternative perspectives and positive affirmations.

The third stage is to develop and practice new skills and strategies to cope with stressful situations and achieve their goals. The therapist would work with the client to create a plan of action that involves gradual exposure to feared or avoided situations, problem-solving skills, relaxation techniques and self-care activities. The therapist would also encourage the client to apply these skills in their daily life and monitor their progress.

The fourth stage is to review and consolidate the learning and achievements from the therapy sessions. The therapist would help the client evaluate their outcomes, identify their strengths and areas for improvement, and plan for future challenges. The therapist would also provide feedback and support to the client, and celebrate their successes.

cognitive-behavioural therapy and self-transcendence

One of the goals of cognitive-behavioural therapy is to help people achieve self-transcendence, which is a state of being beyond the ordinary limitations of the self and the world. Transcendence can be seen as a positive outcome of CBT, as it can enhance wellbeing, meaning, and purpose in life.

There is evidence that CBT works with transcendence in different ways. For example, some studies have proven that CBT can increase mindfulness, which is a form of awareness and attention to the present moment that can foster transcendence. Other studies have proven that CBT can reduce negative emotions and increase positive emotions, which can also facilitate transcendence. Moreover, some studies have indicated that CBT can help people develop a more coherent and integrated sense of self, which can also lead to transcendence.

Challenges of CBT and self-transcendence

There are also some challenges and limitations in using cognitive-behavioural therapy with self-transcendence. For instance, some people may have difficulties in accessing or experiencing transcendence due to their beliefs, values, or personality traits. Also, some people may have different definitions or expectations of transcendence, which may not match with the goals or methods of CBT. Furthermore, some people may encounter ethical or moral dilemmas in pursuing transcendence, such as whether it is appropriate or desirable to transcend one’s social or cultural norms.

It may be fair to suggest that CBT’s style of approach has the possibility of hindering self-transcendence. For example, in the case of voice-hearing, it is becoming widely accepted that a significant cause of negative voices are dissociations resulting from previous traumatic events (Pilton et al., 2015).

dissociation is a psychological process that involves a disruption of the normal integration of memory, identity, perception and emotion (American Psychiatric Association, 2013). dissociation can interfere with the way trauma memories are stored and processed, leading to distorted and intrusive recollections that may manifest as auditory hallucinations (Wearne et al., 2018).

“dissociation is a common response to trauma, one hypothesis is that trauma causes hallucinations through the process of dissociation, which either impairs the integration of traumatic experience with components of the self identity or causes a failure of contextual integration of present and past experiences, resulting in involuntary intrusions.” (Wearne et al., 2018, p. 385)

For example, a person who experienced childhood abuse may hear a voice that resembles their abuser and repeats the abusive words or threats. Such voices can cause distress, fear and shame in the voice-hearer, and may impair their functioning and wellbeing.

CBT aims to help people cope better with their voice-hearing experiences by addressing their thoughts and beliefs about them. CBT does not necessarily try to get the individual to prove to themselves that the voices are not “real” or to adopt a coping methodology based on minimising the influence of those voices.

Rather, CBT helps the individual to develop a shared understanding of their voices with the therapist, and to identify and challenge unhelpful or distressing thoughts that may be triggered by the voices. CBT also helps the individual to explore alternative ways of relating to their voices, such as being more assertive, compassionate or curious.

For example, Paulik et al. (2013) presented a case study of a woman who experienced distressing voices that criticised her and told her to harm herself. She received cognitive Behavioural Relating Therapy (CBRT), which is a novel intervention that combines elements of CBT and Relating Therapy. CBRT helped her to recognise and modify her patterns of relating to her voices, which were based on fear and submission. She learned to be more assertive and confident with her voices, and to challenge their authority and power over her. As a result, she reported reduced voice-related distress, improved self-esteem and increased social functioning.

Therefore, CBT could be seen as an approach primarily focussed on helping an individual cope with their voices, and does not always seek to heal the cause of the negativity in the voices – the blocked memories of the trauma that those voices are dealing with, the underlying cause of their negativity.

Contrasting cognitive behavioural analysis with Internal Family Systems

To provide a contrast, Internal Family Systems is another form of talking therapy that encourages people to explore their relationship with their voices, but from a different perspective. It is a therapeutic approach that views the self as composed of multiple subpersonalities or parts, each with its own perspective, feelings and needs (Schwartz, 1995). It is based on the idea that we are all individuals made up of different ‘parts’, and that to heal, we need to build healthy relationships with all of those ‘parts’ of us.

“IFS therapy helps clients access their Self—a core of valuable leadership qualities—and from that Self understand and heal their parts—subpersonalities that are often in conflict with each other and with one’s core values.” (Schwartz & Sweezy, 2019, p. 3)

IFS helps the individual to identify and access their ‘Self’, which is the core of their being that is compassionate, calm and curious. It also helps the individual to understand and empathise with their ‘parts’, which may include voice-hearing ‘parts’ that are trying to protect them from pain or trauma. IFS helps the individual to heal their ‘parts’ by listening to them, acknowledging their needs and emotions, and reassuring them that they are safe and cared for.

For example, ReachOut Australia (n.d.) described how IFS can help someone who hears voices that tell them they are worthless or unlovable. It can help them to realise that these voices are ‘parts’ of them that are trying to protect them from feeling rejected or hurt by others. IFS can help them to connect with their ‘Self’ and to communicate with these ‘parts’ in a compassionate way. IFS can help them to understand why these ‘parts’ are saying these things, what they need, and how they can be helped.

IFS would tend to target the wound and see resolving that issue as a way of transforming, for example, an inner critic into an inner supporter. For instance, a person who hears a critical voice that tells them they are worthless may discover that this voice is actually a protector part that tries to prevent them from being hurt by others. By addressing the underlying pain and fear of this part, the voice may become less harsh and more supportive. Over time, the part will move into a position of being a supporter, which means, from a self-transcendence point of view, it will have become actualized.

Some quotes and examples to illustrate the points being made are:

Therefore, whilst both CBT and IFS can help voice hearers achieve relief from their voices, IFS is the better option for those seeking self-transcendence and true healing. CBT may help voice hearers transcend their negative or limiting thoughts and beliefs about their voices, and relate to them in more constructive and empowering ways. But IFS can also help voice hearers with their inner conflicts and wounds that cause the voices to be negative, in so doing, for example, actualise an “inner critic” part into an inner supporter.

To illustrate this further, we can compare CBT and IFS approaches for voice hearing and examine their underlying assumptions, goals, and methods. According to Mind (n.d.), CBT for voice hearing aims to:

• Stop the voices or reduce how often you hear them
• Make the voices less frightening and more manageable
• Make you feel less bothered by the voices, even though you can still hear them
• Make the voices quieter and less intrusive so you feel calmer and less distracted by them

CBT for voice hearing focuses on how the voices make you feel or think about yourself, and how they affect your life. It may help you reduce your distress about the voices, identify things that might trigger your voices, and help you gain more power or control over your voices. CBT may also help you think about the beliefs you have about your voices and how these beliefs affect your experience of hearing voices (Mind, n.d.; Getselfhelp.co.uk, n.d.).

CBT, therefore, may not seek to heal the wound that causes the negativity which drives the voice as its main objective, and also its overall approach may stop short of encouraging a truly integrative concept of self for the individual. Therefore, whilst CBT can provide some improvement for an individual, its prime objective is to help individuals cope with their dissociations, rather than heal the original wound, and therefore that particular aspect of self will not self-actualize.

“CBT helped me challenge some of the negative things my voices said about me. It also helped me find ways to cope when the voices got too loud or scary.”

IFS, on the other hand, is based on the idea that we have multiple parts or subpersonalities that interact with each other. Some of these parts may manifest as voices that we hear. IFS assumes that every part has a positive intention and a valuable role to play in our system. However, some parts may become extreme or wounded due to trauma or neglect, and may need healing and integration. IFS aims to:

• Help you access your true Self, which is the compassionate core of your being
• Help you understand and appreciate each part and its role in your system
• Help you heal the wounded parts and transform the protective parts that may interfere with your wellbeing
• Help you achieve harmony and balance among your parts (PositivePsychology.com, 2020).

IFS for voice hearing encourages you to explore your relationship with your voices, and to see them as parts that need your attention and care. It may help you discover the origin and meaning of your voices, and how they relate to your life story. It may also help you communicate with your voices in a respectful and curious way, and negotiate with them to find solutions that work for everyone. IFS may help you stop fearing or fighting your voices, and instead embrace them as valuable sources of information and guidance (Counseling Today, 2020).

“IFS helped me realize that my voices were parts of me that had been hurt in the past. It also helped me listen to what they needed from me, and to heal them with compassion.”

Hopefully, the distinction between the two approaches is reasonable clear: CBT may not always lead to Self-actualization or self-transcendence. IFS, on the other hand, has healing and integrating the affected part as its primary concern, and therefore is a Self-actualization and self-transcendence first approach.

Therefore, it is important for cognitive-behavioural therapy practitioners to be aware of the potential benefits, risks and limitations of using CBT with transcendence. They should also be sensitive and respectful to the individual differences and preferences of their clients regarding transcendence. Additionally, they should be open and flexible to adapt their CBT techniques and strategies to suit the needs and goals of their clients regarding self-transcendence.

Further reading

If you are interested in learning how cognitive behavioural therapy (CBT) works with transcendence, you may find the following weblinks useful. They provide information on what CBT is, how it can help with different mental health problems, and what evidence supports its effectiveness.

How it works – cognitive behavioural therapy (CBT) – NHS
cognitive behavioural therapy (CBT): What’s the Evidence?
Overview – cognitive behavioural therapy (CBT) – NHS
What is cognitive behavioural therapy (CBT)? – Mind
cognitive behavioural therapy (CBT) – Mind

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

Beck, A.T., Rush, A.J., Shaw, B.F., & Emery, G. (1979). cognitive therapy of depression. New York: Guilford Press.

Counseling Today. (2020). Hearing voices: A human rights movement and developmental approach to voice hearing. https://ct.counseling.org/2020/03/hearing-voices-a-human-rights-movement-and-developmental-approach-to-voice-hearing/

Getselfhelp.co.uk. (n.d.). psychosis self-help. https://www.getselfhelp.co.uk/psychosis-self-help/

Mental Health Today (n.d.) | Lessons from Alfred Adler. Retrieved December 26, 2023, from https://www.mentalhealthtoday.co.uk/blog/lessons-from-alfred-adler-the-influential-figure-in-cognitive-behavioural-therapy-youve-never-heard-of

Mind. (n.d.). Treatment for hearing voices. https://www.mind.org.uk/information-support/types-of-mental-health-problems/hearing-voices/treatments-for-hearing-voices/

Paulik, G., Hayward, M., & Birchwood, M. (2013). cognitive Behavioural Relating Therapy (CBRT) for Voice Hearers: A Case Study. Behavioural and cognitive Psychotherapy, 41(5), 626-631. https://doi.org/10.1017/S1352465812001014

Pilton, M., Varese, F., Berry, K., & Bucci, S. (2015). The relationship between dissociation and voices: A systematic literature review and meta-analysis. Clinical Psychology Review, 40, 138-155. https://doi.org/10.1016/j.cpr.2015.06.004

PositivePsychology.com. (2020). Internal family systems therapy: 8 worksheets and exercises. https://positivepsychology.com/internal-family-systems-therapy/

Psychology Today, United Kingdom. (n.d.) | Adlerian Therapy. Retrieved December 26, 2023, from https://www.psychologytoday.com/gb/therapy-types/adlerian-therapy

Psychology Today, United Kingdom. (n.d.) | ego. Retrieved December 26, 2023, from https://www.psychologytoday.com/gb/basics/ego

ReachOut Australia (n.d.). Types of therapy: CBT, ACT, DBT and IFS. https://au.reachout.com/articles/types-of-therapy-CBT-act-dbt-and-ifs

SAGE Publications Ltd. (n.d.). Basic Theory, Development and Current Status of CBT. Retrieved from https://uk.sagepub.com/sites/default/files/upm-binaries/39347_978_1_84860_687_6.pdf

Schwartz, R.C. (1995). Internal family systems therapy. Guilford Press.

Schwartz R.C., & Sweezy M. (2019). Internal family systems therapy (2nd ed.). Guilford Press.

Seligman, L. (2006). Theories of counseling and psychotherapy: Systems, strategies, and skills. Upper Saddle River: Pearson Education.

Simply Psychology (2023), Adlerian Therapy: Key Concepts & Techniques. (n.d.). Retrieved December 26, 2023, from https://www.simplypsychology.org/adlerian-therapy.html

SpringerLink. (2020) | Individual Psychology (Adler). In Encyclopedia of Personality and Individual Differences. Springer International Publishing. https://doi.org/10.1007/978-3-319-24612-3_1387

Understanding Voices (n.d.). cognitive approaches. https://understandingvoices.com/working-with-voices/therapies/cognitive-approaches/

Wearne, D., Curtis, G., Choy, W., Magtengaard, R., Samuel, M., & Melvill-Smith, P. (2018). trauma-intrusive hallucinations and the dissociative state. BJPsych Open, 4(5), 385-388. https://doi.org/10.1192/bjo.2018.52

Wikipedia. (n.d.). Id, ego and super-ego. Retrieved from https://en.wikipedia.org/wiki/Id,_ego_and_super-ego