Hard-nosed scientists don’t have a great deal of time for Freud’s approach to the mind. There are two main reasons. First, it is a turn-off for theorists because there is no way to test the basic theory that psychological problems are rooted in unconscious memories. Almost by definition, there is no way to verify unconscious memories. Second, those who take a practical view are also frustrated because the therapy takes so long and is so intricately tailored to each individual that it’s impossible to make any sort of standard comparison with other therapies.
These deficiencies of the Freudian approach led Aaron Beck – himself trained in Freudian therapy – to develop cognitive behaviour therapy in the early 1970s. CBT traces its heritage to Ivan Pavlov and James Watson rather than to Freud. It bases its approach on their theories – tested in numerous experiments. Pavlov showed that stimuli that occur together become associated with one another, as when the dog comes to salivate in response to the bell that rings at feeding time. Watson and other behaviourists showed that behaviour that brings about good consequences is reinforced, as when the rat comes to press on a lever that delivers food, while behaviour that brings about bad consequences is weakened.
The basic idea of CBT is that problems like depression are caused by the way we interpret the things that happen to us rather than by the things themselves. In this, CBT is similar to rational emotive behaviour therapy, the brainchild of another disenchanted Freudian, Albert Ellis. The difference is that, whereas REBT focuses on the way our negative thoughts are dictated by our demanding assumptions about life, CBT concentrates on the content of the thoughts themselves and on the physiological responses – such as the racing heart, palpitations and sweating of a panic attack – that accompany them.
There are three patterns of problem thoughts, according to Frank Bond, a psychologist at the City University in London who practises and does research on psychotherapy. They are about ourselves: “I’m useless”, about other people: “She’ll despise me for this” or about the world: “The plane is going to crash”.
When thoughts like this occur frequently, they are clearly distorted. The difficulty is that we have to recognise this before we can begin to do anything about it. The CBT therapist works collaboratively with the client to help them identify their habitual negative thoughts and to recognise that they are unreasonable. For example, careful analysis of the events that provoke bouts of depression or anxiety will usually reveal errors like assuming that a trivial mistake is a career-threatening disaster, or that a racing pulse signals an imminent heart attack.
Starting to think about and monitor your own thoughts is the first step to developing ways of challenging habitual negative thought patterns. Often this goes on between consultations. “Although therapy sessions are very important, homework is usually much more effective than work done in the consulting room” says Bond.
Homework often provides material for the consultations. For example, early in therapy a client may be asked to keep a diary of incidents that provoke attacks of depression or anxiety so that their thoughts surrounding those incidents can be examined with the therapist. Later in therapy the homework may consist of exercises to cope with particular problem situations.
As we might expect from its origins, CBT has been tested repeatedly. An extensive trial in the 1970s showed that it is as effective against depression as drugs. Bond himself has just completed an experiment in a media organisation that shows that CBT alleviates stress at work. A group of workers given three group sessions of three hours each over three months improved significantly in comparison to a control group given no treatment.
Although his experiment lacks the sophistication of a placebo treatment for the control group to assess non-specific effects, his experiment did control for some possible effects. Bond is confident that he has shown not just that[italics] CBT works, but why[italics] it works. “The CBT group do better because they are more willing to accept negative thoughts and emotions. It’s a matter of knowing how you think and feel ” he says. “Then you can try to do something about it.”
Use an accredited therapist, and check that they are trained to treat your problem. In the UK the main accrediting body is the British Association of Behavioural and Cognitive Psychotherapies which is affiliated to the UK Council for Psychotherapy. For a copy of the BABCP register send pounds 2 and a 39p stamped 16cmx23cm SAE to BABCP, P.O. Box 9, Accrington, BB5 2GD.
UKCP http://www.psychotherapy.org.uk/ Tel: 0207 436 3002
In the USA
APA http://helping.apa.org/ Tel: 1 800 964 2000