COGNITIVE BEHAVIOURAL THERAPY

Cognitive Behavioural Therapy

Cognitive Behavioural Therapy

ARTICLE 01

Carmin, C.N. Albano, A.M. (2003) Clinical Management of Anxiety Disorder in Psychiatric Settings: Psychology's Impact on Evidence-Based Treatment of Children and Adults, Professional Psychology: Research and Practice, Vol. 34, No. 2 pp 170-176.

Carmin developed schema therapy (ST) as an expansion, extension, and revision of classic CBT. Carmin stated that, "in comparison with standard cognitive therapy, ST probes more deeply into the childhood origins of distorted thinking, relies more on imagery and emotion-focused techniques." Individuals are guided by belief systems, or schema, generated by every experience, action, reaction, and interaction and based on our own personal, religious, familial, cultural, gender, and age-related contacts that we have had over the years. (Hassiotis 2000:583)

Fundamental core beliefs or assumptions are a unique component of the perceptual filter people use to view their world. Cognitive behavioural therapists seek to change schemas that are no longer useful or are maladaptive. Schemas may be selected by an individual for recall, suppressed in memory, or they may be used for interpretation of information, generation of affect, motivation, or action and/or control. ST is, and has been, a critical component of classical CBT since its inception. Understanding an individual's schemas, belief systems, and underlying attitudes is essential in understanding the individual.

Schemas are in a constant state of adaptation and become increasingly complex as an individual ages. Thus, the process of adaptation may serve to help or hinder the individual as they apply their schema to new situations. Carmin proposed that early schemas are more resistant to change than schemas that develop later in life. He identified these schemas as early maladaptive schema. (Gates 2001) Carmin identified 5 domains that correspond with the basic needs in children. The domains are: disconnection and rejection, impaired autonomy and performance, impaired limits, other-directedness, and overvigilance and inhibition. When one's needs are not met, early maladaptive schema develops, which is explored and modified in ST treatment.

Carmin further postulated that there are 3 processes regulating the functioning of activated schema. These processes are schema maintenance, schema avoidance, and schema compensation.

Another approach to CBT is dialectical behaviour therapy (DBT) , which was developed by Dr. Marsha Linehan in her work with parasuicidal patients. Significant empirical support has been shown for the efficacy of treatment with DBT in parasuicidal individuals with cluster B personality disorders. This treatment is a combination of behaviour therapy and acceptance approaches blended together by a set biosocial theory and multiple modes of treatment (eg, individual therapy, group skills training, pharmacotherapy). (Hatton 2002:357)

Mindfulness skills target improvements in awareness of internal experiences without judgment. Mindfulness is the cognitive therapy technique that is otherwise known as, "OK, tell me what you are thinking/feeling right here, right now." Emotion regulation skills are designed to reduce vulnerability to emotions, increase positive emotions, accept emotions, and change specific emotional states using behavioural and cognitive skills. Distress tolerance skills assist patients in tolerating ordinary life pain without engaging in behaviour that is self ...