Cognitive Behavioural Therapy - Essay Example

Psychodynamic and cognitive behavioural therapy theories and their role in clinical hypnosis Introduction Hypnosis can be defined as " a condition that can be artificially induced in people, in which they can respond to questions and are very susceptible to suggestions from the hypnotist” (cited in, James, 2010, 2). The term hypnosis and hypnotism have their origin from the Greek word Hypnos (god of sleep), the father of Morpheus, Greek god of dreams, and the words hypnosis and hypnotism are derived from the term neurypnosis, coined in the mid-1800s, by James Braid, a Scottish surgeon (ibid). Braid based his researches on the same lines as Franz Mesmer (mesmerism), and opined that neurypnosis is a condition where the central nervous system of an individual enters a stage of paralysis during an almost ‘sleep-like’ condition, which is a form of bodily relaxation brought on by abstraction (concentration of the mind) (Braid, 1843). Since its origin, the term has been defined and redefined many times, and various theories at later stages suggest that hypnosis is a state of control over one’s mind, while some suggest that it is a symptomizing hysteria. The current popular and a more realistic form of definition however identifies hypnosis as a systematic measure used for therapeutic purposes (James, 2010). Clinical hypnosis, as a medical subject, even though had existed for quite some years, always remained on the fringes with not much importance associated with its actual application on patients. However, the subject is now gaining a great deal of attention owing to technological innovations in the field of CAT and fMRI scanning. Modern day researchers are considering hypnosis as being a viable, cost-effective and time saving form of therapeutic intervention, without any probable side-effects. Contrary to the older theories that suggest hypnosis as a state where the human mind remains unconsciousness (akin to sleeping), recent researches propose that individual under hypnosis remain completely awake, with concentrated and focussed attention, however with a complementary fall in the level of tangential and exoteric awareness (Spiegel and Spiegel, 1978). The subjects under hypnosis tend to show elevated levels of ripostes to the suggestions as provided by the hypnotiser (Lyda, 2005). Traditionally hypnosis has had always been delineated as changed state of human consciousness, (trance like), where besides heightened responses to suggestions, hidden memories of the subject can also be worked upon, by the hypnotiser (Hilgard, 1986). In clinical hypnotic therapy, the exposition for its application is that when hypnotised, the mind (conscious form) does not present much hurdles for a successful psychotherapeutic study, thus allowing for a clear psychological discernment (Heap, 1988). Various other researchers suggest the trance created during hypnosis to be a form of mental relaxation obtained through controlled meditation and symbolism (McMaster, 1996). The various differences seen associated with definitions of clinical hypnosis, chiefly arise from the point of individual differences in ‘hypnotisability’ (Crawford, Brown, & Moon, 1993) and contentious theoretical models (Kirsch, 2001). Traditional theories, have limited use in terms of modern clinical therapies, as they tend to view hypnosis from angle of the subject, disregarding the hypnotherapist’s role, while also implying passive answers to suggestions owing to the trance like state (Yapko, 1989). Modern researchers however opine that hypnosis is a process through which there is a great deal of communication between the subject and the hypnotist, where the latter makes skilled use of affective and intense words and expressions, for inducing a healthy change in the psychology of the subject. Thus, under modern medical sciences clinical hypnosis is more of a persuasive tool for effective communication with a patient that uses various theories like the cognitive behavioural theory, psychodynamic theory, neodissociation/dissociation theories, social role-taking theory, information theory and systems theory for treating patients. Discussion Cognitive behavioural therapy: Cognitive-behavioural therapy or CBT displays a singular range of psychology oriented clinical interventions theorised on different models related to human cognition, behaviour, and emotions (Dobson, 2000). Modern form of CBT comprises of a large variety of strategies for treating patients that also consider the modern form of diagnoses and treatments applicable for various mental disorder issues (Beck, 2005). Here the patient and the clinician work in coordination to distinguish and comprehend the problematic areas, as regards the link that exists between one’s feelings, thoughts, and behaviour, and customised therapy objectives are established that are generally time bound in nature. CBT aims at targeting the symptoms directly, alleviate distress, review the thought processes, and assist in producing beneficial behavioural ripostes. In this therapy, the clinician provides support to the subject to handle his/her problems by making use of his or her own devices, where specific practical and psychological abilities are acquired and the clinician actively advocates modifications with focus on practicing the theories learnt during sessions. In this process, the clinician helps the patient to learn to cite the augmentation as his/her own accomplishments or self-efficacy. Behavioural interventions form to be the medical applications of various learning theories, while cognitive interventions include therapies where the patients find meanings associated with specific situations, symptoms, and incidences in their lives, while interpreting beliefs about their own selves, others around them , and the world in general (Beck, 2005). The clinicians help patients to identify the negative attributes within one’s thinking processes and the negative interpretations of various meanings and beliefs where the therapist encourages the patient to experiment with alternative ideas, perspectives or beliefs. CBT does not work towards proving the patient as wrong and the clinician correct, but makes them work in skilful coordination, where the patients are made to search for themselves the various pragmatic alternatives towards bettering their situations. Some of the well-known researchers in the line of CBT include Aaron Beck, Albert Ellis and Fritz Perls. Their theories are discussed in the next segment to get a more comprehensive view on this form of clinical therapy. Some of the more significant processes and techniques used in CBT are shown in in Table 1. Table 1: Some Methods and Techniques Used In CBT (Leichsenring, F., Wolfgang H., Weissberg, M., and Leibing, E., 2006, 236). Theories of CBT used in clinical applications: Aaron T. Beck, an American psychotherapist, first formulated the “Cognitive therapy” or CT during the 1960s, an approach that forms to be a part of the wider group of cognitive behavioural therapies or CBT. This new approach was outlined in his book in Depression: Causes and Treatment in 1967, and further elaborated with a greater focus on anxiety disorders in his Cognitive Therapy and the Emotional Disorders published in 1976, (Deffenbacher et al., 2000).  Beck was the first to highlight the notions of the underlying "schema," or the methods through which an individual processes information, as regard the future, those around that person, the world, including self. As per Becks theory and concept of the symptoms of depression, such people have a ‘schema’ that is negative in form, as read’s his views towards the world and which is acquired during childhood or his adolescent years (Neale and Davison, 2001, 247-250). He further conceptualised that schema acquired by depressed people occurs due to a death/loss of a parent, peer rejection, bullying at school, parent or teacher disapproval and sharp criticism, parent depression and any other similar negative incidents that may affect a person as a child (ibid). When an individual with such attained schemas face another situation that is similar to the original events, which led to the acquired schema to take shape in some way or the other, the negative schemas are actuated. Becks in his negative triad theorises that individuals undergoing depression think negatively about themselves, the future and their actualities about the world (Beck, et al., 1979, 11).  Beck also distinguished certain specific cognitive deformities that may help the individual to acquire depression, like selective abstraction, magnification, arbitrary inference, minimization and overgeneralization (Neale and Davison, 2001, 247-250). Since in this theory depression occurs from distortions present within the subject’s perspectives, as for example, ‘selective perception,’ or ‘over-generalization,’ the clinician tries to focus on these deformities of the mind, encouraging the subject to modify his or her perspective and behavioural attitude (Beck, 2005). Fritz Perls, a German psychiatrist, formulated the “Gestalt therapy” in the 1940s which is a psychotherapy  that focuses on an individual’s own sense of responsibility, his/her experiences occurring at the present, the subject-clinician relationship, social and environmental frame of reference in the subject’s life, and the adjustments that people make (self-regulatory in nature) to control the total situation. Gestalt therapy can be delineated as "a conceptual and methodological base from which helping professionals can craft their practice"(Nevis, 2000, 3).  Joel Latner in his papers opined that the there are two basic principles that form the foundation of Gestalt therapy. These are, the psychotherapy is based on the all-important empirical ‘present moment;’ while the second principle suggests that all individuals are placed within interpersonal relationships of various kinds; thus, the only possible route to understand oneself is against the backdrop of the various web of relationships that one forms with society, family and others (Latner, 2000). The Gestalt therapy theorises on the present processes and their content. The main emphasis remains on the activities, thought processes, and feelings taking place at the present (phenomenology of the subject and clinician), instead of focusing on what could have been, what was, or what should have been. It is an awareness practice ("mindfulness") where seeing, feeling, and behaving are understood to said to be contributory towards interpretation, analysis, and externalisation (exegetics of experience) (Brownell, 2010).  Here the subject is taught by the clinician to be aware of his/her actions which allows that individual to acquire an ability to change his perspectives and attitudes. Since the primary aim of Gestalt therapy is to make the subject more aware and experimental in nature, and free himself from any barriers that stunt development of the mind, this therapy is often categorised under of humanistic psychotherapies (ibid). However, there is also a cognitive behavioural aspect to the approach as it considers human perception and the interpretative processes through which human experiences takes place and using it attempts to bring about positive changes in one’s perspectives. Albert Ellis, an American psychotherapist, conceptualised the famous Rational emotive behaviour therapy (REBT), also known as the rational emotive therapy or the rational therapy during the 1950s and continued with his work till his death in 2007. REBT is a compendious, action oriented, theory and philosophy based psychotherapy that emphasises on seeking solutions for behavioural and emotional issues, allowing the subjects to lead a quality life (Ellis, 1957). One of the basic theories of REBT states that any individual, in majority of the cases, along with being upset due to adverse conditions, are also affected by the way they view the surrounding reality through their analytical beliefs, language, the interpretations and philosophies as regards themselves, and those around them. In REBT, the subjects learn and apply this technique through the A-B-C-model of mental disturbances and transformations (ibid). In this model (A-B-C) the theory states that A, (or adversity, which is also an inducing/activating agent) is not the sole contributor towards problematic mental and behavioural Cs (Consequences), but the latter is also dependent on the perspectives or beliefs (B) that people have about A, (adversity). Adversity (A) may be an internal occurrence or it may be an external condition, an incident that may have occurred in the past, is taking place in the present, or is believed to take place in the near future (Dryden & Neenan, 2003). According to the theory of REBT, if a subject’s analytical beliefs (B) on A (which is the activating agent) is absolute, non-elastic, and rigid then C, (the mental and behavioural consequences), would tend to be self-destructive for the subject. On the other hand, if the subject’s analytical belief or B were conditional, flexible and practical in nature, then the C, would tend to be self- constructive. Using REBT, the clinicians can assist the subjects to comprehend interpretations and meanings that are impractical, illogical, and self-destructive in nature, and once the subject are able to distinguish these negative attributes, they also learn to dispute (D), and question and differentiate them from the positive attributes. This ability of differentiating between negative and positive attributes, helps the subject to slowly move away towards becoming more self-constructive in nature, thus giving a choice to the subjects where they are made to feel that even though they may have faced unpleasantness in their lives, they have a choice to move out of it and lead a better life (Ellis, 1994). Albert Ellis defined three key insights used in REBT (Ellis, 2003). Insight 1 - A naturally leads to C, and even though highly disturbed Cs (like depression) results from powerful form of a negative A (like rape or assault), the extreme form of emotional disturbances (Cs) stem from the subjects beliefs that are often irrational in nature (absolute and inflexible in nature) Insight 2 - after acquiring self-destructive or irrational beliefs (for whatever the cause maybe), if the subjects are presently in a disturbed frame of mind, they would hang o their illogical beliefs and remain disturbed mentally. Instead of viewing them as past events these individuals are still actively holding on them in the present, albeit unconsciously. Insight 3 – besides accepting insights 1 and 2, the subject must also work towards applying insight 3, which is finding their irrational beliefs’ and perspectives through continual practice and then logically  disputing them; changing one’s rigid stance and becoming more flexible in nature, and strongly rejecting one dysfunctional digressional and fears. Only a combination of cognitive, behavioural, emotive and a strong attack on the debilitating emotional problems, can one completely remove all self-destructing issues. Psychodynamic therapies: Psychodynamic psychotherapy is a branch of clinical psychology that aims to reveal the unconscious subject lying hidden within a patient’s psyche in order to decrease the mental stress and tension, and is quite similar in form to psychoanalysis. This form of clinical therapy depends on the relationship that develops at an interpersonal level, between the patient and his/her therapist. Well-known scholars in this line of work include Sigmund Freud, Carl Jung and Alfred Adler. The following are chief characteristics of psychodynamic psychotherapy:  Psychodynamic psychotherapy primarily deals with how human mental processes such as emotions, drives or needs, tend to motivate/affect external behaviour; Emotions lie at the core of all external human behaviours; Conscious and unconscious mental processes act as motivating factors for all human behaviour; Early childhood experiences remain at the core in the shaping of human emotions, and are central to issues related mental problems throughout one’s life; Demands that may be external or internal in form, often exerts a great of pressure on an individual making him feel overwhelmed; Ego defence mechanism is the measure that an individual may adopt, to avoid feeling overwhelmed by these various demands. Even though CBT has scientifically shown to have successful results on patients with depression or anxiety disorder, psychodynamic psychotherapy is also known amongst the scientific fraternity to “be just as effective as CBT” in the treatment of various mental problems (Grohol, Psychodynamic Therapy vs CBT Smackdown for Anxiety, 2009). Given below are some of the concepts used in psychodynamic psychotherapy (table 2). Table 2: Concepts of Psychodynamic Psychotherapy (Leichsenring, F., Wolfgang H., Weissberg, M., and Leibing, E., 2006, 239). Theories of psychodynamics used in clinical applications: Sigmund Freud, an Austrian neurologist, first developed the concept of psychoanalysis. He formulated theories on the unconscious mind (descriptive and dynamic; and the later concepts of id, ego and superego), repression of painful memories, while developing the subject of verbal psychotherapy through psychoanalysis, which is the clinical application for the treatment of psychopathology through interactive dialogue session between the patient and his/her psychoanalyst. In modern clinical therapies though psychoanalysis does not exist anymore, however other forms of psychotherapies are in use, which are mere deviations of the Freud’s concept of psychoanalysis. In this context, Donald H. Ford and Hugh B. Urban states that "Later systems have differed about therapy and technique in certain respects, but all of them have been constructed around Freuds basic discovery that if one can arrange a special set of conditions and have the patient talk about his difficulties in certain ways, behavior changes of many kinds can be accomplished” (1965, 109).  Joel Kovel similarly said, "Freud with his methods and central insight remains the progenitor of modern therapy… [even while psychoanalysis has]…sunk to a relatively minor role so far as actual therapeutic practice goes” (1976, 63). In his theories, Freud held that an individual’s sex drives form to be the chief motivational force in his life. He further established therapeutic techniques like free association (where patients reveal their thoughts without any fear and without any act of concentration while revealing the thoughts); established that transference had a central role in the process of psychoanalysis (where the patients transfer their feelings from their past experiences on to their psychoanalysts); and suggested that dreams assist an individual to continue sleeping, by reflecting his fulfilled desires that otherwise would have disturbed the sleeping person and awoken him/her. Alfred Adler conceptualised that psychology of any human being is psychodynamic in form, however in contrast to metapsychology of Freudian notions that focused primarily on instinct, Adler opined that human psychology is directed by objectives and motivated by an unknown force that is creative in nature (Sundberg, 2001). However, similar to Freuds notions of instincts, Adlers imaginary objectives are also of the unconscious mind, while these objectives have specific "teleological" functions. According to Adler, there is also a fictional form of final objective along with many ‘sub-goals’ (ibid). The dynamism of the superiority /inferiority complex is at play constantly, through different types of ‘over-compensation’ and ‘compensation’ (ibid). Teleology has another objective for Adler, which through its visions of the end goal provides for psychodynamics (both healthy and problematic ones). Adler also emphasised on subject’s own responsibilities as regards positive subjects (mental), and on the fact that he/she must search for goals that work for social development and self-good (Slavik & King, 2007). Carl Gustav Jung, a Swiss psychologist, developed the theory of analytical psychology, is the first psychiatrist to consider the human subconscious as "by nature religious" and he made it the core of all his studies focus of exploration (Dunne, 2002, 3). Jung is famous for his works on dream symbolisation and analysis. In his theories, Jung opines that  ‘individuation,’ is a psychological process where there occurs integrating of opposites that includes subconscious and conscious mind, while holding on to their respective autonomy, which is essential for an individual to become complete, and in Jung’s analytical psychology ‘individuation’ forms to be the core concept (Jung, 1989, 209). Carl Jung first suggested clinical concepts in psychodynamics, like the complex, synchronicity, collective unconscious and the archetype, amongst many others, and a well-known tool used for psychometric purposes, Myers-Briggs Type Indicator or MBTI, was created based on Jungs notional theories. Clinical hypnosis, CBT, and psychodynamics Presently there is a lack of clarity on the exact nature of the functioning of clinical hypnosis. However, physicians expect that with technology advancements in the field of brain mapping and fMRI scanning will finally help to place clinical hypnosis within the realms of neurology, bring it within the scope of mainstream clinical application. The process of clinical hypnosis considers the following conditions: “the patient’s personality the patient’s personal history the history of the presenting condition the specific objective for the session” (James, 2010, 10). As regards the nature of the exact functioning of how clinical hypnosis works on a patient, there has been not much research work on subject, and it is possible to discuss the topic in details only with an increased comprehension of neurological processing during hypnosis. To summarise: “Clinical hypnosis is an extension of natural states of awareness. It cannot make anyone do or be something that they are not already capable of, although it can help to focus on developing skills and resources that are already present. Suggestions that are made in hypnosis will only be taken on board by the patient if they feel safe and comfortable” (James, 2010, 10). Cognitive-behavioural therapy (CBT) and psychodynamic therapy are two of the three core models used widely in present hypnotic psychotherapy (fig 1). In this process, hypnotherapy amalgamates its techniques along with concepts from psychodynamic therapy or cognitive-behavioural therapy (CBT) to treat patients. Fig 1: Showing the three important component parts of hypnotherapy (Robertson, 2007, 1) Cognitive therapies are those, which “emphasise the role of ‘cognitive mediation’ in learning theory. Cognitive mediation is the theory that the client’s current patterns of thinking, especially beliefs and conceptualisations, determine how they will respond to specific stimuli or cues” (Robertson, 2007, 1). The two cognitive theories most popular in this regards are the Cognitive Therapy or CT of Aaron Beck and the Rational-Emotive Behaviour Therapy or REBT of Albert Ellis. The core area of debate in the theoretical history of hypnotism was “over the extent to which hypnosis should be characterised as a ‘special state’, sometimes loosely designated hypnotic trance. This topic is traditionally known as the ‘state versus non-state’ debate” (ibid). The supporters of the non-state stand describe their concepts as the “cognitive-behavioural” or the “socio-cognitive” hypnotic theory. Similarly, the supporters of the state theory contended, “effects of hypnotic procedures are best explained on the underlying basis of a unique or “special” neuro-psychological state” (ibid). The most famous ‘state theory’ of hypnosis was that of Hilgard’s “neodissociation” model, where hypnotic trance was considered to be an artificially created condition of ‘psychological dissociation’ (ibid). Non-state theorists on the other hand claimed, “hypnosis is a special application of a number of relatively ordinary psychological states, like heightened concentration, expectation, and imagination” (ibid). Recently clinicians have stated that hypnotherapy seems to create a collegial effect when combined with psychodynamic therapy or cognitive-behavioural therapy, even though the actual effects of hypnotherapy still remain unclear. Conclusion Hypnotism in treating patients with mental disorders is still in its nascent stages (though tried earlier by Freud and rejected as being ineffective) and a great deal of research work needs to be done, to get a better view on the subject. The process of achieving hypnotic trance, which forms to be the main core of debate amongst the state and non-state theorists, remains hazy and further researches into the field of neurology is essential. Further technological advancements in the field of brain mapping and fMRI scanning are necessary to have a better view of clinical hypnosis, and the possible roles that psychodynamic and cognitive behavioural therapy theories may have within the scope of clinical hypnosis. References Beck, A., Rush, J., Shaw, B., and Emery, G., 1979. Cognitive Therapy of Depression. New York: The Guilford Press. Beck, A., 2005. The current state of cognitive therapy. Archives of General Psychiatry, 62, 953-959. Braid, J., 1843. Neurypnology or The rationale of nervous sleep considered in relation with animal magnetism. NY: John Churchill. Brownell, P., 2010. Gestalt Therapy: A Guide to Contemporary Practice. New York, NY: Springer Publishing. Crawford, H., Brown, A., & Moon, C., 1993. 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Englewood Cliffs: Prentice Hall Yapko, M., 1989. Trancework: An introduction to the practice of clinical hypnosis. N.Y. Brunner/Mazel. Read More