What is Cognitive Therapy?

by Dr. Bruce Mercogliano, Ph.D.

In cognitive therapy, the therapist explains to the patient that her anxiety is based on an unrealistic view of the situation: because the patient incorrectly interprets what she is experiencing – her pounding heart, for example – she becomes quite alarmed. Her exaggerated, distorted, automatic thinking might lead her to fear that she is having a heart attacked. Cognitive therapy helps to correct the patient’s distorted thinking and calm her down.

Cognitive therapy generally requires 5 to 20 sessions over a period of several months. When patients hear that treatment is time-limited, they get the message their their problem is curable. This enhances their motivation and their feeling of hope. Brief therapy also encourages patient’s self-sufficiency; when the sessions are over, they have the tooks to solve some problems on their own.

For cognitive therapy to work it’s important for the patient to choose a therapist with whom she feels comfortable, someone with whom she can be open and someone she can trust and rely on. She should find the therapist empathetic and supportive.

Cognitive therapy entails collaboration. The therapist and patient work as a team to problem solve. The patient brings the information and the therapist provides the expertise. The patient is encouraged to be an active participant.

Cognitive therapy uses the Socratic method: through questioning, the therapist gains an understanding of the patient’s thoughts and distortions so he or she can help correct them.

The cognitive therapist provides structure and direction. When a patient is anxious, she feels out of control. A sense of structure helps her feel more in control; as she regains control, she feels calmer. The therapist, with the patient, sets an agenda for each session and provides a treatment plan that focuses on specific targets: symptom relief, teaching the patient to recognize distorted automatic thoughts, training her to respond logically to these thoughts, and helping her to identify and change long-held incorrect assumptions.

Cognitive therapy helps treat a patient’s current problems by identifying and correcting distorted thinking that is causing problematic behavior. (When thinking is distorted, behavior is distorted, too.) The cognitive therapist uses a variety of strategies and tactics; the choices depend on the patient’s specific problem. Therapist and patient will assist the treatment’s effectiveness.

The cognitive therapist is like a teacher. He or she explains the problem suggests alternative ways of thinking, assigns homework, and may suggest additional resources such as tapes and lectures. The therapist also helps patients “learn how to learn,” that is, how to profit from their experiences and not repeat their mistakes.

The therapist uses a scientific way of thinking about the problem. Therapist and patient look at actual facts and evidence that will negate incorrect thinking. One of the central features of cognitive therapy is homework. The patient corrects her distorted thinking in the office with the therapist and then practices what she has learned in the real world. Back in the therapist’s office, she discusses her recent successes and failures.

Different from psychoanalysis, which sees human behavior in strong, unconscious forces, cognitive theory grasps that each individual develops a variety of beliefs based on his or her experiences in life.  These beliefs make a picture of the individual’s cognition or perception of future situations, affecting what he thinks about himself, others, and the world.  In essence, the way he behaves in everyday life.

According to cognitive theory, if a parent places a high level of importance on good academic performance, the child may believe that anything less than an “A” is a statement that he is a worthless person.  With this idea, the student may feel worthless when faced with life’s challenges and failures to always be number one.  Thus, individuals who have feelings of failure to many events may be come depressed.  Cognitive therapy is a treatment option for such people.

The cognitive therapist tries to relieve the client’s pain by helping him identify his beliefs and replaces these patterns with more realistic ones, which can lead to a more enjoyable life.  A way the therapist may approach this is through teaching sessions.  The therapist might explain to the client that children are cognitively immature and self-centered and tend to believe that whatever happens is based on their behavior.  When applied to adulthood, such a belief affects the patient with feelings of responsibility and worthlessness whenever things go wrong, and the therapist and client work together to prove that these past assumptions are distorted beliefs.

A good homework assignment would help the client sort out distorted beliefs from reality.  If the client is afraid to go out shopping because of fear that someone may steal her pocketbook, the therapist may suggest keeping a log of what happens each time the client leaves the house.  In the next session, they can explore how realistic or unrealistic these thoughts are.

Cognitive therapy has been shown to be an effective means of treating many disorders such as depression, anxiety and substance abuse.