Clinical Psychology: Cognitive Behavioural Therapy
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· by miyukiphd
· (Originally posted) October 17, 2017
Psychology is a relatively new discipline and psychology has various sub-disciplines – e.g., cognitive psychology, organisational psychology, clinical psychology and so on. Clinical Psychology is my specialised area of psychology and it researches and treats different mental health conditions and maladaptive behaviours that interfere with everyday life. One of the reasons I chose clinical psychology over all other kinds was because clinical psychology applies to many people (i.e., many applications). Clinical psychologists who work in clinical settings are mainly treating clients with mental health conditions and/or maladaptive behaviour using psychotherapy.
Firstly, based on clients’ self-reported symptoms and assessment, clinical psychologists achieve a diagnosis (e.g., depression) and/or a case formulation (identify origin, triggers, reactions/coping, and maintaining factors). Then, with their clients’ agreement, clinical psychologists attempt to achieve clients’ treatment goals using psychotherapy, and its effects are derived from research findings. It is our role to inform and treat our clients with the most effective psychotherapy based on guidelines of psychotherapy (or updated research findings) and ethics – unless there is a good reason not to use (e.g., the client tried the first line of therapy previously yet did not find it useful, requesting a different approach). To become a clinical psychologist in Australia, we need to study at university for at least 6 years (a Bachelor’s degree with honours then a Master’s degree) followed by 1.5 to 2 year supervised practice. And this is not the end of our learning, and we are required to take at least 30 hour continuing personal development every year. Regular peer supervision, self-reflection and self-care are musts for us!
There are various kinds of psychotherapy, and of all, Cognitive Behavioural Therapy (CBT) has found its effectiveness in research for over 50 years. CBT has been used for depression, anxiety (Panic Disorder, OCD, etc.), and eating disorders etc. In general, I guess people try to change how they ‘feel’ when they are feeling sad, angry, and/or scared. The attempt may be done by harmful ways, such as suppression and/or avoidance by drugs/alcohol etc.
On the other hand, CBT is based on an assumption that ‘a situation is not a cause of our emotions, but our thoughts (also see as our belief, perception, or cognition, how we interpret the situation) are the cause’. In addition, ‘our psychological conditions are led by our cognition, leading to our emotions and behaviour. These three factors are believed to interact and maintain our psychological conditions’. Thus, CBT proposes that we may not be able to change the situation (trigger), but we can change our interpretation of the situation and how we react (behaviour), which would ultimately change how we feel.
Does the same situation result in different emotions, depending on our interpretation? For example, if you imagine that you are invited to a theme park with a lot of rides for free, what would you feel? Would you be feeling excited? Or scared? The first emotion (excitement) may be derived from your interpretation, “I love rides and it is going to be a great day!”, while the second emotion (scared) may be from “I hate rides. I would feel sick and embarrass myself.” Behaviour would be different – the first person may prepare for the day, researching the theme park, while the second person may be thinking about a good excuse not to go. As in this example, it is easily seen how CBT’s assumption is so omnipresent. In short, CBT supports the view that a situation (trigger) leads to our automatic thoughts, leading to our emotions and behaviour (as well as physical sensations).
We develop our belief system, depending on our experience (environment), genetics and temperament. We sometimes develop distorted beliefs and these beliefs become our habitual thinking pattern. They are called automatic thoughts, which our brains create instantly, like a knee-jerk reaction. The first step in CBT is to identify clients’ automatic thoughts and unhelpful behaviour. Then, my clients and I work on creating more helpful thoughts and behaviour to create change.
I hope that you could identify your unhelpful, distorted automatic thoughts and unhelpful behaviour to improve your wellbeing!