What is Cognitive Behavioral Therapy?

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A psychological disorder is a psychological dysfunction in an individual associated with distress or impairment, and a reaction that is not culturally expected (Broadway). Broadway quotes the DSM-IV from the National Institute of Mental Health (NIMH) by stating that:

“The concept of mental disorder (like many other concepts in medicine and science) lacks a consistent operational definition that covers all situations." 

What is cognitive behavioral therapy?

Psychological disorders are often referred to as mental disorders, and are brain abnormalities which can seriously affect life quality through behavior patterns that are:

• Unwanted
• Obsessive
• Destructive
• Persistent (Healthgrades).

Psychological disorders range in intensity from minor to major, and may be diagnosed in conjunction with one another at different times during the patient’s life. The intensity may increase and decrease during the disorder’s existence, and the patient may also cease to experience symptoms at times (Davis 4). This essay written by an expert academic writer from Ultius will look at some of the methods that therapists use in attempt to treat these disorders.

Prevalent psychological disorders

Psychological disorders are numerous include:

• Anxiety disorders (such as generalized anxiety disorder, panic disorder, or social phobia)
• Schizophrenia (“Health and Education”).
• Attention Deficit Hyperactivity Disorder (also known as ADHD or ADD)
• Autism Spectrum Disorder (ASD)
• Bipolar Disorder
• Manic-Depressive Illness
• Borderline Personality Disorder
• Depression
• Eating Disorders such as Anorexia Nervosa and Bulimia
• Obsessive-Compulsive Disorder (OCD)
• Post-Traumatic Stress Disorder (PTSD)

Children, preteens, teenagers, adults, and older adults may all experience or be diagnosed with psychological disorders, according to the National Institute of Mental Health.

Specific causes of psychological disorders

The causes of psychological disorders are often unknown, but studies have shown that:

• Chemical imbalances in the brain
• Childhood trauma or experiences
• Warfare trauma
• Physical and mental violence or abuse
• Heredity
• Previous diseases or illnesses
• Prenatal exposures or stress may increase their likelihood (Healthgrades)

Women more frequently suffer from depression and borderline personality disorders while Intermittent Explosive Disorder and substance abuse and addiction disorders are diagnosed more frequently in men.

Benefits of psychological evaluation and therapy

Psychopathology is the scientific study of mental disorders, and includes attempts to understand and interpret genetic, biological, psychological, and social causes. Nosology is the classification scheme associated with psychopathology, and patients with psychological or mental disorders are generally cared for by psychiatrists and psychologists. Treatment of patients is accomplished through psychotherapy and medication in most cases, although often are used a combination with more traditional solutions along with different methods of treatment such as:

• Meditation
• Yoga practice
• Acupuncture
• Massage
• Homeopathies (Boston University Center for Psychiatric Rehabilitation)

Medication

Medications are often used to treat the symptoms of psychological disorders, according to the NIMH (“Mental Health Medications”). The amount and type of medication, dosage, and medication plan is based around the individual patient’s needs while under the care of a doctor. Medication can aid sufferers, lead to normal, healthy lives and even result in the elimination of some disorders of sufferers of:

• Depression
• Anxiety
• Bipolar disorder
• Schizophrenia
• Addiction (“Mental Health Medications”)

The duration and strength of the dosage varies from person to person, and may be prescribed over the long term or just for a designated time period. The type of disorder, age, sex, weight and height, other physical illnesses, addictive habits, liver and kidney functioning, other medications taken including vitamin or herbal supplements, diet, genetics, and whether medication is taken as prescribed may affect how medications work for psychological disorders (“Mental Health Medications”). Common drugs used for schizophrenia, or “typical antipsychotics" are:

• Chlorpromazine
• Haloperidol
• Perphenazine
• Fluphenazine

"Atypical” antipsychotics used for schizophrenia treatments include:

• Clozapine
• Risperidone
• Olanzapine
• Quetiapine
• Ziprasidone
• Aripiprazole
• Paliperidone
• Lurasidone

Side effects of medication

Side effects from psychological disorder medicines are many are varied, and differ for each medication and each individual. For instance, the side effects of many antipsychotics include but are not limited to:

• Drowsiness
• Dizziness when changing bodily position
• Blurred vision
• Rapid heartbeat
• Sunlight sensitivity
• Rash
• Menstrual problems among women (“Mental Health Medications”)

Atypical antipsychotic medications often cause:

• Major weight gain
• Metabolism changes
• Diabetes
• High cholesterol risk
• Rigidity
• Persistent muscle spasms
• Tremors
• Restlessness

Medications are generally taken in pill form.

Psychotherapy

Psychotherapy is also called “talk therapy,” and engages people with psychological disorders through helping them to interpret and understand their illnesses (“Psychotherapies”). Psychotherapies allow individuals to learn to manage their own symptoms in a way that can make their lives healthier and more socially conforming, and is often combined with some medications as determined by mental health professionals, the patient’s family, and the patient. There are many different types of psychotherapy, and there is no specific treatment plan for all patients; some therapies may be used in conjunction with others to encourage the patient to live his or her life to the fullest and with the least interruption, frustration, and episodes. 

Cognitive behavioral therapy

Cognitive behavioral therapy (or CBT) is a blend of cognitive therapy (CT) and behavioral therapy (BT) developed by Aaron Beck, a 1960s psychotherapist. CT is based on a how a patient’s thoughts and beliefs influence his or her actions and emotion in an attempt to make thinking more adaptive and healthy (“Psychotherapies”). The focus of BT is to change unhealthy behavior patterns and actions; CBT can be adapted in combination with medication to treat many different psychological disorders including:

• Depression
• Anxiety
• Bipolar disorder
• Eating disorders
• Schizophrenia 

Dialectical behavior therapy

Dialectical Behavior Therapy (or DBT) is another form of CBT originally developed by Marsha Linehan in order to treat suicidal thoughts or actions in patients (“Psychotherapies”). Borderline personality disorder or BPD is also treated in this manner today. The therapist allows the patient to arrive at the correct response or belief by engaging him or her with two opposite viewpoints on the subject (thus the term “dialectical” meaning opposite).

Through this process, the patient discovers the answer to his or her destructive behaviors seemingly alone, validating emotions and feeling self-empowerment, according to the NIMH. The patient also begins to understand the he or she is responsible for resolving and preventing the undesired behaviors, resulting in more independence and less treatment in the long term (“Psychotherapies”). This type of therapy is not possible without a strong and equal relationship between patient and therapist and the therapist must remind the patient when boundaries are crossed repeatedly in order to reinforce patient response and response in outside situations (“Psychotherapies”).

Interpersonal therapy

Interpersonal therapy, or IPT, is most commonly used to treat depression and dysthymia (more persistent but less severe depression), and was originally conceived by Gerald Klerman and Myrna Weissman in the 1980s (“Psychotherapies”). The basis of the treatment is that improved communication patterns and interpersonal relations can treat depression as effectively, or more effectively, than medications and other therapies.

Through identification of interactions and behaviors that are problematic, IPT guides patient change. IPT can be used in conjunction with antidepressants in many cases. IPT identifies patient triggers and troubling emotions which may lead to depression, and recommends appropriate emotional expression as well as past or current relationship examination that may be affected by mood and behavior distortions (“Psychotherapies”). Interpersonal and Social Rhythm Therapy, or IPSRT, can treat bipolar disorder by including both IPT and behavioral psychoeducation in therapy.

Family-focused therapy

Family-focused therapy, or FFT, was conceived and developed by David Miklowitz and Michael Goldstein for bipolar disorder treatment assumes that societal views on patient-family relationships hold the key to successful management of mental illness (“Psychotherapies”). Therapists work with patients to identify relationships which are “worsening the patient’s illness” according to the NIMH.

These family members are brought into therapy sessions in order to resolve conflicts and identify solutions, in cases where this is possible. Education of the family is included in this therapy, as well as encouraging the family to report and observe signs of relapse and create an action plan in case of relapse, resulting in more support for the patient (“Psychotherapies”). The stress caused by helping patients cope with psychological disorders is likewise addressed in FFT.

Brain stimulation therapy

Brain stimulation therapies activate or touch the brain directly with electrical currents, magnets, or implants in order to treat psychological disorders. Electroconvulsive therapy or "shock treatment" is the oldest and most researched of these therapies, according to the NIHM (“Psychotherapies”). These types of therapies are generally not used until alternatives such as medication and other psychotherapy methods are exhausted and do not produce results.

Diagnosis of psychological disorders & the “Four D’s”

In order to properly diagnose mental illnesses, mental health practitioners who are new to the profession used the “Four D’s.” The “Four D’s” are used in assessing traits, symptoms, or conditions and are:

1. Deviance
2. Dysfunction
3. Distress
4. Danger (Davis 1)

The “Four D’s” allows practitioners to define, select, and diagnose a psychiatric disorder according to the NIMH’s DSM IV-TR (qtd in Davis). In his 2009 article, Timothy O. Davis noted that there are

“grey lines that define when symptoms [of a psychological disorder] rise to the point of classification as a disorder.”

Mental health diagnosis is not as simple for a person with few psychotherapy and monetary resources as it may be for a person with many of these resources. As such, the emotions, awareness, and behaviors may go undetected for longer in a person without these resources. Additionally, every human beings experiences a range of problematic emotions, cognitions, and behaviors across the life span but these issues may only be classified as disorders when they affect other through the “Four D’s.”

Deviance

Deviance is defined as departure from an established course or norm, especially societal in nature (Merriam-Webster). An example of deviance is the pedophile, who has a sexual interest in children at least five years younger (1). 

Dysfunction

Dysfunction must include obvious places and less likely places and be:

“significant enough to interfere in the individual’s life in some major way,” (Davis 1).

An example of dysfunction is Major Depressive Disorder, recurrent, without psychotic features, which is:

“characterized by two or more episodes of major depressive episode” (Davis 2).

An episode is an incident which interferes with the social or occupational portion of the patient’s life. A decrease in pleasure lasting for most of a day, easily observed by others, is an example of a major depressive episode, as is insomnia, hypersomnia or other sleep disorders, energy loss, low motivation, and an inability to concentrate on tasks. 

Distress

Distress is important in determining the extent to which the patient has developed a psychological disorder – in other words:

"how much is the patient negatively affected by the behaviors?"

Davis cautioned that the relationship between dysfunction and distress is not always linear. For instance, dysfunction can be high while distress is low, or just the opposite. An example of high distress in a psychological disorder is Hypochondria, a preoccupation with the fear of having, or belief that one has a serious or fatal disease. Hypochondria is a somatoform disorder with elements of anxiety disorder, according to Davis. Distress increases in these individuals over time even with reassurances from trained medical professionals, and thought restructuring is the singular solution to Hypochondria disorders. 

Danger

Danger refers to both the self and to others who are in contact with the patient in some way. Davis noted that

“there is some element of danger in every diagnosis and within each diagnosis there is a continuum of severity” (2).

In order to demonstrate danger, Davis examined nicotine dependence. In nicotine dependence disorders, harm is constantly inflicted on the addict, and can be passively inflicted on the people that surround the individual, through the harmful effects that second-hand smoke, and smoking and general, has on the body. The danger surrounding nicotine and other addictive drug abuse range from emotional imbalance to unwarranted physical and mental abuse experienced by the addict and the people surrounding and coming into contact with the addict. A Danish psychological study by Hiroeh, Mortensen, and Dunn found that psychological disorder sufferers were 25% more likely to die from homicide, suicide, and accidents than their mentally healthy brethren (qtd. in Davis 4).

Duration- the fifth "D"

Duration has been indicated recently in psychopathology, as the length of mental distress or illness suffered by patients can increase the seriousness of the diagnosis, as is demonstrated in Schizophrenia Disorders. Symptoms of Brief Psychotic Disorder must last at least the length of 24 hours, but not longer than one month at a time. When a month to six months have passed, the disease is Schizophreniform Disorder, and when six months have passed, the diagnosis becomes Schizophrenia, Undifferentiated Type (4).

Works Cited

 “Health and Education.” National Institute of Mental Health, n.d. Web. 15 August 2015.

“Mental Health Medications.” National Institute of Mental Health, n.d. Web. 15 August 2015.

“Psychotherapies.” National Institute of Mental Health, n.d. Web. 15 August 2015.

“What are psychological disorders?” Healthgrades.com. Healthgrades Operating Company, Inc., 20 September 2013. Web. 15 August 2015.

Boston University Center for Psychiatric Rehabilitation. “Alternative Approaches to Mental Health Care.” CPR.BU. Boston University Center for Psychiatric Rehabilitation, n.d. Web. 15 August 2015.

Broadway, Amy. “What is a Psychological Disorder?” Psychology Today. Sussex Publishers, LLC, 2015. Web. 15 August 2015.

Davis, Timothy O. “Conceptualizing Psychiatric Disorders Using ‘Four D’s’ of Diagnosis.” The Internet Journal of Psychiatry 1.1 (2009): 1-4. Web.

Merriam-Webster. “Deviance.” Merriam-Webster, Incorporated, 2015. Web. 15 August 2015.