Behavioural Therapy (CBT) and
Rational Emotive Behavioural Therapy (REBT) are talking therapies which are
founded by Ellis and Beck; they ‘assume that maladaptive behaviours and
disturbed mood or emotions are the result of inappropriate or irrational
thinking patterns, called automatic thoughts’ (Bannink, 2012). The thoughts are
related to pondering negative emotions and need to be acknowledged in order to
determine how they are incorrect and dysfunctional. The aim of CBT is to
support clients to achieve desired changes in their lives by eliminating the inaccurate
circumstances and substituting them for more accurate, self-helping
alternatives. This form of therapy is suitable for the client because she has negative
thoughts which have caused her to have anxiety and low self-esteem. The client
has also been prescribed anti-depressants however she reports her anxious
symptoms are not getting any better. According to Williams and Garland (2002)
indicators for CBT eligibility are
unhelpful thinking styles, avoidant or unhelpful behaviours, difficulties at
work, no improvement from medication and relationships problems; these are all
factors that relate to the client. It is evident CBT and anti-depressants used
together are more likely to be effective than either treatment alone (Blackburn
et al., 1981).
Williams (2001) states individuals with unhelpful thinking
styles tend to overlook their strengths and become very critical of themselves
and second guess what others think – these relate to the client as she has
self-doubt and thinks she is a terrible actor, she has also become mistrustful.
Beck’s cognitive model of emotional disorders suggests three levels of
cognition that are responsible for the perseverance of anxiety and depression.
This model looks at schemas which are theoretical builds that are induced from tenacious,
repetitive themes in contemplations and imageries in addition to recurring
forms of subjective information processing. States of mind and convictions
assume an essential part in the cognitive model, with negative convictions
about the self, world, and future (e.g. I am a terrible actor, and I do not
deserve opportunities that are being offered to me’) portraying dejection and
convictions about risk, threat and weakness characteristics of anxiety states.
These schemas are promptly initiated by a variety of incentives and once
retrieved they control the information processing system. This in turn outcomes
biased information processing, which affects both negative and positive processing
as it causes a selective processing in the recovery of negative information
regarding the self for depression, threat, danger and helplessness for anxiety.
This causes negative ‘automatic’ thoughts, images and memories which cause an
emotional state that varies from person to person and their life experiences.
The cognitive model also hypothesises a developmental level that suggests a
causal role for reasoning in the etiology of emotional disorders. The
development of negative thoughts about the self, derive from early childhood
events such as parental loss, rejection or neglect and later on in life become
activated by negative events occurring, activation of these negative
self-schemas that occur repetitively are more easily retrieved by extensive trivial
stressful life events (Clark & Beck, 2010). Beck’s cognitive model of
emotional disorders relates to the client as her thoughts are negative; she
believes she doesn’t deserve the current opportunities being offered to her and
that if she wasn’t considered beautiful she wouldn’t get offered work she also
believes that she is a terrible actor. She feels as though she’s being
marginalised and judged as a dumb blond and worries about being judged or rejected.
There is a sense of threat, risk and weakness portrayed from these thoughts and
beliefs. The model also suggests anxiety and depression are triggered by
negative early life events, in her early life the client did not know her
father and when her mother became ill she had to live with a foster family to
which she suffered physical abuse, which caused her to become withdrawn and
develop a stutter; she said “it seemed at the time, like no one wanted me”. The client is experiencing anxiety and low self-esteem;
she has also been taking anti-depressants which reportedly are not improving
her anxious symptoms. A study conducted by Sowislow and Orth (2012) found that
self-esteem shows diverging structural relations with depression and anxiety as
supported by the tripartite model (Clark, Watson, & Mineka, 1994) which
indicates that both depression and anxiety are associated to great negative
affect, the temperament to experience distress and bad mood. The study also
supported the notion that low self-esteem contributes to depression (i.e.
vulnerability model of low self-esteem and depression).
REBT (Ellis, 1957) is effective for the client’s needs as it
stays in the present and believes that the past does not determine the future
and is not crucial in a person’s life, action is necessary in shaping an
individual as talking is not enough to change their thoughts and behaviours.
REBT is based on the ABC model; it uses 3 classes of techniques (Walen,
DiGiuseppe, Dryden, 1992) the effect of several triggering life events (e.g.
bereavement of a family member; A) on a individuals mental state (e.g.
emotional state, thinking, interaction; C) is arbitrated by information
processing (thoughts/views; B) (David, 2014). It is also essential that the
client has homework as Broder (2000) suggests it is as or more important than
the therapy session itself (e.g.
audiotherapy, mood diary, meditation, thought stopping techniques) in order to
test ideas learnt in therapy to challenge their thoughts and to see the
progress they have made.