Cognitive behavior therapy (CBT) in the Philippines is a type of psychological therapy—others might call it mental therapy, behavior therapy, or even rehab therapy. The variation in terminology could show that our common understanding of CBT is still evolving.
Cognitive behavior therapy argues that our beliefs influence our feelings, behavior, and the development and maintenance of mental disorders such as depression and anxiety. It also uses the principle of formulation, which is a hypothesis about the origin and maintenance of problems. CBT believes that past experiences produced core beliefs about ourselves, others, and the world—these core beliefs influence present-day beliefs & thoughts (“They think I suck.”) and assumptions (“If I’m not perfect, then I’m a worthless person.”) A collaborative formulation—created via teamwork between the client and therapist—helps both the client and therapist to understand how a problem and its thoughts developed and how it is maintained in the present. This shared understanding serves as the foundation for all the succeeding work that will be done in therapy.
Cognitive behavior therapy is thus much more than just “challenging negative thoughts” or “thinking positively,” but those are nonetheless important skills of the modality. CBT uses a formulation as a springboard into techniques such as thought challenging, journalling, and behavioral experiments to track and challenge thoughts that cause distress. For example, a patient who is easy to assume that others are antagonizing them may be invited to scrutinize the belief, “People are out to get me,” based on real life experiences and behavior. If the patient tends to lash out at others to protect themselves from the possibility of being antagonized (assumption: “If I don’t lash out first, then they will certainly lash out at me”), then the therapist may co-design a behavioral experiment about refraining from lashing out at others integrated into the patient’s routine or situations wherein the patient has been likely to lash out previously.
This example utilizes a behavioral experiment (refraining from lashing out next time) as an opportunity for the assumption to be tested based on evidence and experiential learning. If the patient attempts the experiment and finds that others are not necessarily going to lash out at them, then they can reflect on the rigidity of their belief that lashing out is always necessary. If the patient attempts the experiment and indeed experiences someone lashing out at them—an unfortunate outcome that might perpetuate the initial assumption—she and the therapist can review the events, behaviors, and thoughts that led to the lashing out; for instance, were they having a bad day, had they not eaten for a long time, was there something in particular the other person said that was triggering, and so on, to again reflect on the rigidity or absoluteness of their belief(s). Moreover, this example shows how a belief “People are out to get me” and an assumption, “If I don’t lash out first…” lead to the behavior of lashing out at others. It shows that the behavior of lashing out is likely maintained by the belief of others being out to get the patient, and the behavior of other people towards the patient after the altercation may even sustain the patient’s beliefs that people are out to get them! For the patient and the therapist to have reached this point of conducting a behavioral experiment, it would have been necessary for them to collaboratively agree in the formulation that lashing out and the belief of being antagonized were important goals for the patient to change in therapy. Otherwise, the therapy would focus on something else.
Niccolo Tiangco, RPsy, MSc 