While behavioral approaches focus on the actions of the patient, cognitive therapy is a psychological treatment that helps clients identify incorrect or distorted beliefs that are contributing to disorder. In cognitive therapy the therapist helps the patient develop new, healthier ways of thinking about themselves and about the others around them. The idea of cognitive therapy is that changing thoughts will change e motions, and that the new emotions will then influence behavior (see Figure 13.2).
The goal of cognitive therapy is not necessarily to get people to think more positively but rather to think more accurately. For instance, a person who thinks “no one cares about me” is likely to feel rejected, isolated, and lonely. If the therapist can remind the person that she has a mother or daughter who does care about her, more positive feelings will likely follow. Similarly, changing beliefs from “I have to be perfect” to “No one is always perfect—I’m doing pretty good,” fr om “I am a terrible student” to “I am doing well in some of my courses,” or from “She did that on purpose to hurt me” to “Maybe she didn’t realize how important it was to me” may all be helpful.
The psychiatrist Aaron T . Beck and the psychologist Albert Ellis (1913–2007) together provided the basic principles of cognitive therapy. Ellis (2004) 1 called his approach rational emotive behavior therapy(REBT)or rational emotive therapy(RET), and he focused on pointing out the flaws in the patient’s thinking. Ellis noticed that people experiencing strong negative emotions tend to personalize a nd overgeneralize their beliefs, leading to an inability to see situations accurately (Leahy, 2003). 2 In REBT, the therapist’s goal is to challenge these irrational thought patterns, helping the patient replace the irrational thoughts with more rational ones, leading to the development of more appropriate emotional reactions and behaviors.
Beck’s (Beck, 1995; Beck, Freeman, & Davis, 2004) 3 cognitive therapy was based on his observation that people who were depressed generally had a large number of highly accessible negative thoughts that influenced their thinking. His goal was to develop a short-term therapy for depression that would modify these unproductive thoughts. Beck’s approach challenges the client to test his beliefs against concrete evidence. If a client claims that “everybody at work is out to get me,” the therapist might ask him to provide instances to corroborate the claim. At the same time the therapist might point out contrary evidence, such as the fact that a certain coworker is actually a loyal friend or that the patient’s boss had recently praised him.