Academic journal article Canadian Psychology

Enhancing Positivity in Cognitive Behavioural Therapy

Academic journal article Canadian Psychology

Enhancing Positivity in Cognitive Behavioural Therapy

Article excerpt

The predominant focus of psychological interventions is the reduction of symptoms and the resolution of life problems. Most therapies, including cognitive behavioural therapy (CBT), are primarily focused on aversive emotional states, dysfunctional past and current relationships, maladaptive cognitions and appraisals, and problematic behavioural patterns. Although clients typically seek therapy in order to reduce emotional and symptomatic suffering, perhaps a prevailing engagement with negative functioning and life problems narrows the client's focus and comparatively ignores a fulsome engagement of healthy human processes.

Traditional CBT consists of a wide range of methods to reduce symptoms, including cognitive restructuring techniques that emphasise the reduction of maladaptive and distorted thinking. Cognitive restructuring has been defined by Clark (2014, p. 24) as "structured, goal directed, and collaborative intervention strategies that focus on the exploration, evaluation, and substitution of the maladaptive thoughts, appraisals, and beliefs that maintain psychological disturbance." An emphasis is placed on developing "realistic thinking" or "rational responses" through an examination and modification of maladaptive thoughts. However, the approach does not explicitly involve the acquisition of adaptive or positive thought patterns. It is assumed that modification of dysfunctional cognitive processes alone will lead to the adoption of adaptive thought processes and schemas.

CBT is a highly effective evidence-based therapy for a wide range of psychological problems (Hofmann, Asnaani, Vonk, Sawyer, & Fang, 2012) and is deemed to be an empirically supported first line treatment for many disorders (Hunsley, Elliott, & Therrien, 2014). However, even with this highly validated treatment, many clients do not receive significant benefit or the effectiveness is not sustained. It is estimated that 70% of clients who enter CBT treatment improve (Westen & Morrison, 2001; Westen, Novotny, & Thompson-Brenner, 2004). However, on average, across a number of disorders, approximately 18% to 19% of clients who commence cognitive therapy or full CBT drop out of treatment (Swift & Greenberg, 2014). For CBT treatment of depression, the dropout rate averages 16.6% (Cooper & Conklin, 2015). Across a range of treatments types for various disorders, the dropout rate is 19.7% (Swift & Greenberg, 2012). In addition, a percentage of clients who complete a course of CBT do not sustain the benefit accrued and subsequently relapse. Further refinements to the treatment may add to its efficacy and impact clients that might not otherwise be responsive to the intervention.

Given that a substantial percentage of clients who commence evidence-based CBT (or other interventions) do not have a material and sustained reduction of symptoms, might patients gain greater benefit from an approach that emphasizes both the reduction of negative tendencies as well as an increase in positive functioning (Fava & Ruini, 2013)? If therapy could be both problem-focused and wellness-focused, might it tap a broader range of a client's resources?

Contemporary CBT gives very little, if any, attention to positive thought processes and provides no systematic method for acquiring healthy strategies (Beck, 2005; Clark, 2014; Dobson & Dobson, 2009). McMullin (2000) has recommended the use of positive affirmations in order to practice positive thinking. However, a systematic way of learning more adaptive thinking patterns remains to be incorporated into cognitive restructuring. A recent text by Bannink (2012) combines CBT methods with solution-focused strategies, which emphasizes client strengths and successes. However, the development of a CBT-oriented intervention that includes a focus on underlying healthy transdiagnostic processes and an explicit enhancement of healthy behavioural and cognitive patterns may benefit a greater number of clients. …

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