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Unread June 9th, 2011, 01:35 PM
James Pretzer James Pretzer is offline
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Join Date: Jun 2004
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Default Re: Is it important to change the client's dysfunctional cognitions?

The Longmore & Worrell (2007) article is a good one. Thanks for calling it to our attention. I'd encourage anyone interested in this topic to take a look at it. I'd also encourage them to think for themselves when considering the conclusions that Longmore and Worrell draw.

Both the title of the article and the opening line of their Conclusion focus on the question "do we need to challenge thoughts in CBT?" and specifically, do we need to use "logical, rationalist methods" to challenge dysfunctional thoughts and beliefs? This is a legitimate question to ask, but does anyone argue that CBT must must challenge dysfunctional thoughts or that we must use "logico-rational" strategies in doing so?

I can think of quite a few authors who argue that it is useful for therapists to directly challenge dysfunctional thoughts and beliefs and who argue that the strategies that Longmore & Worrell categorize as "logico-rational" can be a useful way of doing so but I can't think of anyone who argues that use of these strategies is necessary for CBT to be effective or that use of these strategies is sufficient for CBT to be effective.

This is an important point. Quite a few studies (many of which are summarized by Longmore and Worrell) show that behavioral interventions, cognitive interventions, and a combination of cognitive and behavioral interventions are equally effective in treating a number of different problems. If anyone was saying that cognitive interventions are more effective that behavioral interventions or if anyone was saying that cognitive interventions are necessary for treatment to be effective, the data would show that they are wrong. However, I'm not aware of anyone who takes that position.

CBT is distinguished by a variety of intervention techniques for altering dysfunctional cognitions. Some of these techniques rely on logical analysis (such as examining the evidence for and against a thought or identifying cognitive distortions) and some of them are behavioral in nature (such as behavioral experiments or in-vivo exposure). CBT also uses many interventions that are shared by other therapeutic approaches. Many who have criticized CBT talk as though we assume that "logico-rational" interventions are necessary and/or sufficient for treatment to be effective. However, that is not our view. We argue that specific "logico-rational" interventions often are useful, but that is quite different from arguing that they are necessary, sufficient, or superior to other interventions.

Cognitive Therapy's stance is that with most problems we need to use both cognitive and behavioral interventions. With moderate to severe depression we advocate using behavioral interventions first (increasing activity and involvement in potentially reinforcing activities), then using a combination of "logico-rational" and behavioral interventions to modify dysfunctional cognitions and dysfunctional interpersonal behavior. With phobias, we advocate addressing fears cognitively, through teaching skills for coping with anxiety, and through in-vivo exposure. The same applies with many other problems. The available research shows that cognitive interventions are no more and no less effective than behavioral interventions. Some of the art in CBT lies in choosing which interventions to use with a given client as well as when and how to use them.

Do we need to challenge thoughts in cognitive behavior therapy? No, we don't need to. However, the empirical evidence shows that, in general, cognitive and behavioral interventions are equally effective with a number of problems and clinical experience shows that cognitive and behavioral interventions work well together.
Longmore, R. J. & Worrell, M. (2007). Do we need to challenge thoughts in cognitive behavior therapy?, Clinical Psychology Review, 27, pp.173-187.
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