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Giordano Granelli
Introduction to Cognitive Behaviour Therapy
Birkbeck University of London
20 Feb. 21
Word count: 1453
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CRITICALLY EVALUATE THE EFFECTIVENESS OF COGNITIVE
BEHAVIOUR THERAPY. DISCUSS THIS WITH REFERENCE TO CBT THEORY
AND RESEARCH.
Introduction
Cognitive Behaviour Therapy (CBT) is a form of talking therapy used to treat mental
health disorders such as anxiety and depression. CBT addresses the importance of core
beliefs and the connection between cognition, emotions and physical reactions. One of the
focuses of the therapy is to challenge unhelpful thoughts in clients by understanding the
causes and triggers that could lead to these negative states. More specifically, CBT therapists
will focus on trying to understand the current emotional and cognitive state of a client,
focusing on how to move forward and establish practical approaches to challenge any
ongoing issues (APA, 2017). CBT was pioneered by Dr Aaron Beck in the 1960s, a
psychiatrist who first argued the dissonance of psychoanalysis theories in some of his clients
affected by depressive states. Specifically, Beck (1960) realised that psychoanalysis theories
weren’t congruent with the spontaneous negative thoughts his patients had. He realised that
some of his patients’ depressive states were linked to their cognition rather than their
subconscious. The psychiatrist developed a way to assess some of his client’s negative
thoughts and beliefs, subsequently naming them negative automatic thoughts. Beck (1960)
established a way to work alongside his clients to identify and confront their negative core
beliefs about themselves and the world. Ultimately, Beck (1960) realised that this process
would help the client changing their cognitive perception, hence improving their moods
(Beck Institute, 2021). This essay will underpin the main procedures of case
conceptualization in CBT, besides the importance of collaborative empiricism in the therapy.
Furthermore, this paper will evaluate the effectiveness of Cognitive Behaviour Therapy
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(CBT), specifically in the treatment of depression. Besides, the paper will provide evidence to
support the theory of CBT being the most effective therapy to help to overcome these
disorders. The ultimate purpose of this paper will be to create an evidence-based argument
that sees CBT as one of the most effective therapies to address depressive disorders.
Assessment and case conceptualisation
Beck (1960), argued the importance of maintaining the empirical collaboration with a
client, thus helping the process of uncovering and challenging their core beliefs and negative
automatic thoughts (Beck, 2005). This is known as rapport, which refers to the ability of the
therapist to create, promote and maintain therapeutic collaboration with a client (Dattilio &
Hanna, 2012). Typically, in the first session, the therapist will try to gather some information
from the client to help the formulation of the hypothesis. Besides, the first approach to a CBT
therapy session will begin with the therapist trying to get to know their client. In other words,
the therapist will try to ask open questions and use different techniques to understand the
current cognitive functioning of the client and therefore create a hypothesis, also known as
case conceptualization. As part of the assessment, the therapist might choose to rely on the
5Ps framework (Carr, 2006). The 5Ps framework uses the systematic review of predisposing,
precipitating, presenting, perpetuating and protective factors which will allow the therapist to
paint a general picture of the client current cognitive functioning. Moreover, the therapist will
aim to delve into the different levels of cognition. A technique that is frequently used to
identify the core belief in the client is called Downward Arrow. The Downward Arrow
technique uses open questioning from the therapist to better understand the origin of negative
thoughts in the client (Neenan & Dryden, 1999). However, this technique arguably carries a
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certain level of risk and it should be used only after the consolidation of the rapport. As stated
thus far, it is important for a therapist to follow the correct steps of building a therapeutic
alliance and gathering the necessary information to move forward in the therapy.
The effectiveness of CBT on mood disorders.
CBT is arguably considered one of the most effective therapies to tackle mood
disorders such as depression. Beck (1967) proposed his theory on cognitive depression
arguing the importance of the so-called cognitive triad. The cognitive triad model underlines
the relation between “the self” “the future” and “the world”. This theory argues that the
vicious cycle between the perception of these three factors will eventually contribute to the
formation of negative automatic thoughts. Often the therapist, after the assessment part, will
work with the client to gradually interrupting the vicious cycle of negative rumination.
Rumination of negative thoughts is in some cases found in depressed clients, and it involves
the excessive focus on a specific situation or event which often turns out to be
counterproductive for the client’s mental health (Scott, 2020). Arguably, the therapist will try
and challenge the client’ core beliefs and negative repetitive thinking, to introduce a positive
association with new activities. One of the commonly used techniques to address that issue is
called behavioural activation. Behavioural activation tackles the connection between
inactiveness and depressive mood, and its predominately used to identify and monitor
activities that might trigger positive moods in the client (Kanter et al., 2010). As the word
suggests, the activating part of this procedure helps the client to break the vicious cycle of
inactiveness often found in depression. At times, the therapist will recommend engaging in
exercises and will suggest scheduling specific times to their clients for ruminating on
negative thoughts. A tool that therapists often use to monitor the signs of progress of
behavioural activations is weekly schedules, a document sheet where the client is asked to
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report any activity they have engaged with during a period and the emotional response that
the activity triggered. However, in some severe cases of depression, the therapist might
choose to focus on engaging the client with basic behavioural tasks at first, moving to more
complex cognitive interventions later on in the therapy. To summarise, providing an
understanding of mood disorder dynamics and behavioural activation, could help the process
of recovery and provide the client with tools to tackle future relapses.
Empirical support on CBT effectiveness
The cognitive behaviour therapy model works in creating a goal-based and active
strategy to tackle various disorders such as mood disorders and anxiety. The creation of a
therapeutic alliance with the client (Norcross & Hill, 2004), alongside its focus to tackle the
client’ current cognitive functioning, makes CBT one of the most effective and evidencebased therapy (Hofmann et al., 2012). Research shows that after carrying out a meta-analysis
on efficiency factors in various demographics, CBT has shown positive results in the
treatment of substance addiction, schizophrenia, depression and dysthymia, bipolar disorder,
anxiety disorders, eating disorders, insomnia, personality disorders, anger and aggression,
criminal behaviours, general stress, chronic pain and fatigue, pregnancy complications and
female hormonal conditions (Hofmann et al., 2012). Besides, due to the relatively rapid
approach of the therapy and the broad scope of effectiveness, CBT is often advised as the first
help for public mental health. The National Health Service (NHS) offers access to talking
therapies like CBT through a service called IAPT (Improving Access to Psychological
Therapies). This service provides help to anyone who is going through mental health hardship
with the scope of addressing this ever-growing social issue (NHS, 2019). However, the nature
of CBT being fairly short-timed and the purpose of IAPT to deliver therapeutic help to as
many people as possible could lead to issues regarding its effectiveness. Jason Roscoe (2019)
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discusses these potential issues in his article called “Has IAPT become a bit like
Frankenstein’s Monster?”. Roscoe (2019) explains how some therapy sessions are rushed,
and CBT trainers are pushed to apply disorder-specific protocols without having enough
empirical evidence on the client’s problems. The author continues explaining how this
standardised CBT protocols might only serve as a temporary fix to the client’s issues, yet
without addressing the predisposing factors that might have led to the client’s current
dysfunction (Roscoe. 2019). Therefore, the risk for IAPT could be delivering quantity-based
CBT therapy rather than quality-based. This could arguably translate into a higher relapse rate
for patients accessing CBT trough public health institutions.
Conclusion
As stated thus far, CBT remains the most effective form of therapy to tackle mood
disorders. The nature of the therapy and the possibility for public health to make it accessible
on large scale makes CBT an essential first help tool to address mental health deriders in
modern society. Although the issue of quantity-based therapy is tangible, CBT can provide
clients with an understanding of the general picture that led to their current mental issues.
Furthermore, the cognitive engagement required by CBT can arguably provide the knowledge
necessary for the clients to be independent of the therapist. This could make a former CBT
patient more likely to know how to tackle future relapse issues, by practising self-help.
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