In this video I describe cognitive therapy, cognitive-behavioral therapy, and group approaches to treatment. I describe the general principles of these approaches and some of the key terms associated with each, along with examples of how these might be applied in treating specific cases. Disclaimer: This channel is for educational purposes only and is not intended as medical advice for the diagnosis or treatment of psychological disorders.

Video Transcript

Hi, I’m Michael Corayer and this is Psych Exam Review. In this video we’re going to take a look at a few more approaches to psychotherapy. So in the previous video I talked about the psychoanalytic approach to psychotherapy, the humanistic approach, and behavioral therapy and so in this video we’re going to look at cognitive therapy, cognitive behavioral therapy, and some group approaches to the treatment of mental illness.

So we’ll start by looking at cognitive therapy and this has an emphasis on thinking patterns and the role they might play in certain symptoms of mental illness. So certain thinking patterns might be associated with symptoms of disorders and the goal is to try to change those thinking patterns and improve a person’s reasoning, their self-control, and their responses to certain types of events. So we can start by looking at the cognitive therapy of Aaron Beck and Beck believed that many people suffering from mental illnesses had distorted views; and they had distorted views of themselves, of others, or of the future and he referred to this as the cognitive triad. And by trying to correct these views about the self, others, and the future he thought you could reduce the symptoms of certain mental illnesses.

And one way to try to correct these views was to challenge the person’s beliefs and this would help them to avoid certain negative beliefs. So one example of this would be catastrophizing; so this is the idea that a person has a tendency to fall into thought patterns that are the worst possible consequences of something that has happened. Some negative event has occurred and this sort of spirals into the worst possible outcome and that’s what the person keeps thinking about. So for instance we might have a student who has just failed a math test and, in this case, the student’s thought patterns then lead them to think “well, because I’m failing my tests I’m not going to get into college, and if I don’t get into college then my life is ruined”. And so this has now led them to this worst possible consequence. Instead of saying, “well it’s just one test. I can improve or I can do better in the future”, saying “my life is ruined”, right? That’s an example of catastrophizing and so in a therapy session in cognitive therapy the role of the therapist would be first to try to identify where the person might be engaging in these sort of faulty thinking patterns and then by revealing these to the patient they can try to change those thinking patterns, right?

They can first challenge them and try to improve the person’s awareness of when this is happening, and then once they can begin to recognize it on their own, they can gradually start thinking about how they could change those patterns. How could they reinterpret the events so that they’re not, for instance, jumping to the worst possible conclusion whenever something bad happens?

Ok, a similar approach by Albert Ellis was a bit more direct and this is what’s known as Rational Emotive Behavior Therapy. In this case, the therapist would more directly point out the errors in the person’s thinking and then they would work together with the patient to try to resolve those errors or change those thinking patterns. This is what Ellis called “cognitive restructuring“. Where at first the therapist will question the assumptions that the patient is making, and they’ll also question their predictions about how the world works.

So for instance in the case of, you know, failing a test leading to college rejection leading to my life being ruined, they might challenge those predictions about the world. “Really? Well, you know, does everybody who doesn’t go to college, their life is ruined?” “Well, no that’s that’s not really an accurate prediction of how the world works”. Or “everybody who fails a math test doesn’t get into the college that they want to go to? You think that’s necessarily true about the world?” And so this kind of direct challenging of those beliefs or those predictions would be the first step and then the person would try to replace those with more realistic and productive ways of thinking. “Ok, you know, maybe it’s not realistic me for me to think that one failure is going to lead to, you know, my life being ruined. What would be a more productive way of thinking about this? What could I learn from this experience? How could I use this to maybe motivate me to do better in the future?”. And so they’re trying to replace the negative thinking patterns and the faulty habits that the person might have and they’re thinking with more productive ways of viewing the world.

Now, modern approaches to cognitive therapy tend to draw on the work of both Aaron Beck and Albert Ellis and they also can include some other techniques that weren’t included by Beck or Ellis and these include things like the use of mindfulness meditation. And the goal here is to try to get the person to detect certain thought patterns or certain emotional issues before they grow into larger problems. So by engaging in meditation they can become more aware of their thoughts or more aware of some of their emotional reactions to things. And then they can work to resolve those.

Next we’ll look at cognitive behavioral therapy or CBT, and this is a combination of cognitive techniques that I’ve just described and some of the behavioral techniques that I talked about in the previous video on the use of rewards, the use of punishments, the attempts to change certain emotional responses to certain stimuli. And so cognitive behavioral therapy is going to include both of those but it also has some unique aspects that we don’t see in either of those separate approaches.

One thing that’s unique about it is it’s much more problem-focused and action-oriented. That means it’s very direct. The therapist and the patient work together to have a very narrow focus on specific areas for improvement and then they try to structure a program of behaviors that will help them to make more rapid progress in those specific areas. And this means there’s a greater sense of transparency to the therapy, where the therapist will make it very clear to the patient why they’re doing certain things and what the end goal is that’s in mind for a particular program of behaviors. Ok, so each session will usually have an agenda that says this is what we’re going to work on in this session. And then we’re going to focus on restructuring certain beliefs or certain thoughts that are relevant to this particular outcome that we want. Then the patient is often given homework. And this refers to certain practices that they’re meant to do before the next session, and that way they have something they can discuss. How did it go? What went well? What didn’t work? What do we need to change for the future?

So I’ll give you an example of this if we imagine somebody who is suffering from obsessive-compulsive disorder. Ok, so a specific therapy session in cognitive behavioral therapy might begin by looking at where this person is having these obsessive thoughts. When is this occurring? What stimuli are leading to this triggering of these obsessive thoughts? So firstly, ok, we want to identify when do thoughts occur. Let’s make a list of all those occasions and then we might say “ok, in this particular occasion you’ve said that these obsessive thoughts occur. Let’s create some options for you. Let’s say if it tends to happen when you’re at work at a certain time of day or a certain situation triggers these thoughts, what are some alternative behaviors you can do in that situation, that you could actually do, that would help you to get your mind off of these obsessive thoughts?”

So maybe right now the tendency is to then engage in a compulsive behavior, like in the case of compulsive hand washing. Say “ok, what could you do instead? What would maybe get your mind off of those obsessive thoughts?” And then the homework might be, “alright, you’re going to put this into practice. You’re going to be in that situation a few times this week, and I want you to really try this. You’ll have this list with you and when you feel those obsessive thoughts coming on, I want you to go to that and try some of these behaviors, and then we can assess: did this actually help you to reduce your obsessive thinking?”. Or maybe it wasn’t very effective and we can have a better plan for next time. And so this will be one way and this approach has been successful for patients in treating certain symptoms or in this case for obsessive-compulsive disorder.

And it’s also worth noting that when this is successful we can also see changes in brain activity over time. So we can see that certain areas may be associated with certain emotional responses or certain repetitive thought patterns; that these can actually change over the course of successful therapy. This is an important reminder when it comes to psychotherapy because it can often be dismissed as seeming kind of abstract but we should remember that these types of psychological interventions can actually influence a person’s biology.

Ok, so lastly we will look at some group approaches to therapy and the first few types we have look at relationships. So we have couples therapy and family therapy. And in couples therapy a couple will work with a therapist to try to improve their communication or perhaps to deal with specific problems maybe related to sexual dysfunction, or domestic violence, or specific problems that might be influencing the relationship. So, for instance, if one person in the relationship has been diagnosed with an illness or diagnosed with a mental illness like depression then this is going to affect the relationship, and so both partners need to be involved in this process of trying to determine which issues might arise. What problems might occur and how can they address these and communicate better to prevent these from, perhaps, ruining the relationship?

And another group approach is family therapy. This is a therapy that looks at families as a system of relationships; so these relationships are going to influence all members of the family and this can be relevant for some disorders. So there might be some disorders that the system of relationships in the family are actually increasing stress for the person suffering. Or they can relate to some of the symptoms that are involved in that disorder. So, for instance, in the case of something like an eating disorder with a teenage girl then it might be relevant to look at what kinds of pressures or expectations are parents putting on this child? Or is there, you know, situations of sibling rivalry that is influencing certain symptoms or expression of certain symptoms? And so that would be something that will be addressed in family therapy.

And we also have what’s called group therapy. This is where individuals work on their own individual problems but in a group setting. So, for instance, you might have a group of 10 patients who are all suffering from an eating disorder like bulimia nervosa and each of them, of course, is suffering, they have their own individual problem but they’re working on it in a group. And there’s a number of benefits that can come from working on this type of problem in a group setting and one of these is that it encourages social behaviors and social skills. So particularly if there are some symptoms that are associated with withdrawal or reduced social activity, then this can help the person to be more social. They have to get along with other people and be able to communicate with a range of people and then they also can get feedback from multiple sources. So they can hear other views on their own symptoms, or their own expression of symptoms, or anything that might be relevant to the disorder. And then this means they can improve and how they relate to others and this can reduce some of the feelings of isolation and also some feelings of stigma.

Often people with a mental illness might feel that they’re the only one suffering with it. Nobody else could understand what they’re going through, and so by meeting in a group they can see, you know, there are other people going through the same things. Or other people who have improved and they can share their advice with me, and this can reduce the stigma and help them feel more like they’re part of a community.

And lastly it’s important to note that this is often cost effective and sometimes cost can be prohibitive for people and prevent them from seeking treatment. So if we can have a situation where maybe a single therapist is meeting with ten patients at once, then this can be a lot cheaper for each patient and that might mean people who otherwise might not get treatment would now be able to afford the treatment.

But there are some drawbacks to group therapy and these are also important to be aware of. So one drawback is the assumption that people with the same disorder will have similar needs and that might not necessarily be the case. And as a result of meeting in a group, of course, the attention of the therapist is necessarily going to be less focused for each patient. That means they might not be aware of particular aspects of somebody’s disorder or somebody’s symptoms because it just doesn’t come up in the group conversation. There’s not enough time to get that level of detail from each patient. And it’s also possible that groups can have group dynamics that are causing discomfort for some of the patients. So maybe some people kind of dominate the discussion, or maybe people feel that they aren’t comfortable sharing certain things in a group setting that they would be able to share with a single therapist one-on-one. And as a result they don’t express those and so now nobody really knows those aspects of the person’s symptoms.

And it’s also possible that being in a group can cause the normalization of symptoms or it can cause comparison between members that can actually be counterproductive for what they want to achieve. So, for instance, let’s say somebody is suffering from bulimia nervosa and they go to a group therapy session which is fairly common for eating disorders, and now they might hear that, well there’s a bunch of other people who are purging, you know, before I felt kind of isolated and then I thought “I was the only one suffering from this” and maybe that’s not a very good thing. But now I say, “well it’s kind of normal, like, I know a bunch of people who are engaging in these behaviors” and so maybe I have less motivation to change. I feel like, “well, you know this isn’t so bad” or I compare myself to other people who are worse. “Well, yeah, sure my symptoms seem bad but I’m not nearly as bad as this other person, so I don’t need to work so hard to improve. I mean they need to get, you know, their act together but I’m doing okay. I’m not nearly as bad as this other person.” And that can be counterproductive to the goals of the therapy session.

And lastly people can also learn negative techniques from other members of the group. So for instance, in the case of bulimia nervosa, they might learn how others engaged in certain purging techniques. Or in the case of anorexia nervosa they might learn how other people hid some of their weight loss from family members and this means that they’re learning negative things. They’re not actually learning how to cope with their symptoms or to improve.

And lastly we can look at self–help and support groups and this is a type of group therapy that offers cost-effective support for specific problems. So you’re probably familiar with a number of these types of self-help groups. There are groups like Alcoholics Anonymous for dealing with alcoholism, or groups for gambling addiction, or other drug problems, groups for social phobias, and these can have the benefits that I just described for other group therapy; reducing isolation, making people feel like they’re part of a community, and it can also provide a sense of commitment. In the case of something like Alcoholics Anonymous people are expected to continue attending meetings even when they’re doing well. And this commitment is seen within their community. So other people can say you know “why weren’t you at this meeting? You know, is something going on? What’s happening? Did you have some issue that maybe you you felt you couldn’t come to the meeting anymore?”. And so the sense of public commitment to improvement and change can be beneficial for many people.

But it’s important remember that these self-help groups and support groups are often not run by trained therapists or by trained counselors and that means that not all of the advice that’s given is necessarily going to be accurate or productive for all the members there. It’s possible that there will be some counterproductive advice; some things that aren’t necessarily supported as being the best practices for certain symptoms or certain behavioral issues. And so it’s important to keep that in mind and it’s also possible that these groups can become insular. So in the unit on social psychology I talked about some aspects of group behavior. We talked about things like group polarization which is the tendency for groups to become more extreme. We also have the possibility of things like conformity and groupthink occurring. And groups may, in extreme cases, become insular, adopt radical views, and in real extremes they could potentially even form cults around certain practices because the group is so isolated from others. Ok, so those are some other types of psychotherapy. I hope you found this helpful, if so, please like the video and subscribe to the channel for more. Thanks for watching!