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Contrast and compare CBT and Existential therapy Cognitive-behavioural therapy or CBT is representative of the integration of behavioural therapy and cognitive therapy. It encourages the empowerment of an individual to be able to change how they think (cognitive) and how awareness of particular problematic patterns may impact upon our consequent responses (behaviour) (R ch7). Pivotal to our understanding of such mental health problems from a CBT perspective is Beck’s ‘Cognitive theory of emotion’.
It purposes that events and situations are not responsible for emotional responses.
Instead it is the ‘meanings’ we attach which reflect the complex interaction between an individual’s history, mood and the context of experience. These interpretations will influence our actions either positively or negatively respectively due to different emotions being related to particular meanings.
The cognitive theory of emotion suggests that our responses become disorders when an individual becomes ‘stuck’ or ‘trapped’ in both particular patterns of meanings and persistent maladaptive responses to those interpretations The role of therapist is to support an individual in making sense of their perceptions of their internal and external worlds.
This is achieved through a ‘shared understanding’ or collaborative relationship of exploring ‘alternative ways’ of coping with negative situations. Beck et al. 1979) further specify that feelings of sadness or even depression are associated with a perception that something has been lost, actually or conceptually R. In the case of anxiety, the cognitive theory of emotion suggests symptoms are the result of an individual anticipating physical or social threat. In CBT, careful questioning can even identify unconscious meanings or interpretations R.
These thought processes can lead to preoccupation or distress preventing a person from doing as they wish R.
Thus, CBT believes negative interpretations of threats or danger can potentially explain symptomatic behaviours such as safety seeking behaviour, physical reactions (i. e. heart racing, shortness of breath), increased levels of anxiety and fixation of potential sources of threat or danger. These reactions are often perpetuating to the disorder as they can have the effect of further increasing the negative perception of stimuli causing a vicious circle of severe and persistent anxiety The cognitive theory of emotion aids the client to identify where (and how) they have become ‘stuck’ in their ways of thinking.
Psychological treatments for anxiety and depression seek to understand how the world really works to challenge ‘locked’ in beliefs. Through ‘guided discovery’ cognitive therapy empowers an individual to broaden their choices concerning their response to stimuli. Within anxiety disorders, the maintaining factors are ‘transdiagnostic’ as they operate across a range of disorders. The use of diagnostic categories in CBT is to define characteristics of an individual who expresses high levels of specific psychological processes.
The particular focus of concern impacts upon how an individual is helped to understand and change their problems. By using a guiding model and appropriately modifying it, both client and therapist are able to better identify negative interpretations. The fundamental principles of existential counselling and psychotherapy are based on existential philosophy. It was developed in Europe in the 1930’s by disillusioned psychoanalysts Binwanger and Boss. Principally, existential psychotherapy is associated with the work of Heidegger but the ideas of the likes of Satre, de Beauvoir and Nietzsche are also incorporated.
More recently it has been influenced by leading writers such as May, Yalom, Frankl and Laing. The leading contemporaries in this field currently are considered to be Deurzen and Spinelli. The principal method of existential counselling and psychotherapy is to implement a phenomenological approach in an effort to help a client to cope with the inevitable adversity and uncertainty of life. By attempting to perceive the world as it appears to the client, the therapist is able to draw upon existential philosophies to frame their responses and inform the questions and challenges that they may make.
Existentialist ideas are brought into the therapeutic process as hermeneutics; the methods of interpretation of personal meanings which enable the therapist to better understand the client’s issues in living. R By working through a multiple of universal aspects of what it is to be human a client is helped to seek new ways of living. In terms of sadness and depression, comparisons and contrasts can be made between CBT and existential therapy. Heidegger and Boss understood sadness or depression as a mood invoked by feelings of being closed off from an aspect of our freedom.
They suggest that depression is a consequence of this restricted way of thinking and not the result of inner psychological conflict. Contrastingly, through Beck’s pivotal cognitive theory of emotion, CBT considers sadness or depression to be a common negative emotional response or disorder associated with thoughts and mental images from the past brought about by a viscous cycle of negative patterns of interpretation and dysfunctional reactions which further compound a negative mood. It further suggests that feelings of sadness or even depression are associated with a perception that something has been lost, actually or conceptually.
Our experience of past, present and future are seen as key factors in mental distress by existential therapists and cognitive behavioural therapists alike. Minkowski saw depression as ‘a person who can see no future, confronts a guilty past and feels the present is meaningless’. As a result, existential therapists believe an individual may become stuck in their ‘existential guilt’ (where one does not fulfil potential or possibility) and ‘sedimenting’ beliefs (Merleau-Ponty,1945/1962).
Similarly, Beck’s (1976) ‘negative cognitive triad’ identifies the relevance of thinking negatively about one’s experiences (past), one’s self (present) and the future. Thus severe and persistent depression can be perceived as a reflective emotional state in each approach. In terms of anxiety, existential therapy suggests such an emotional state is a universal aspect of existence rather than a clinical diagnosis. Soren Kierkeggar understands anxiety to be the consequence of our freedom and our awareness of it.
For Heidegger, anxiety is fundamental to human existence and is not the result of our individual personality or development. He believed that anxious moods occur in the context of an awareness of limited possibilities and the finite quality of life. This is furthered by Cohn (1997) who suggests existential anxiety to be the product of our ‘thrownness’ into a world we did not choose, our necessity to make choices with uncertain outcomes and awareness of death and morality. Within CBT, anxiety is often associated with notions of imminent threat or danger in any given situation or event.
Crucial to anxious experience in CBT is ‘meaning’. Through negative interpretations, symptoms can have the effect of perpetuating the original source of misinterpretation. This causes a viscous circle of severe and persistent anxiety. Unlike existential therapy, CBT suggests that within anxiety disorders there are ‘transdiagnostic’ maintaining factors. Fear is a defensive secondary emotion to anxiety. ‘If we were able to embrace anxiety fully, we would be fearless’ (Dreyfus, 1991) It is purposed that anxiety can ‘attack’ an individual’s sense of self and that fear is specific and therefore potentially manageable.
These ideas further developed by Irving Yalom (1980) who cited two particular ways in which people defend themselves against fear of morality. The first is the belief that ‘I am special’, exempt or immune from inevitability of death. The second is identified as the notion of an ‘ultimate rescuer’. This may involve religious faith or unrealistic belief in a parent, partner or professional. Anxiety can be overwhelming as oppose to invigorating so it is important to recognise what aspects of a person’s life are being revealed.
From this existential psychotherapists can work to better enable a patient to open up their world. Conversely, the use of diagnostic categories in CBT is to define characteristics of an individual who expresses high levels of specific psychological processes. Interestingly, in both approaches the particular focus of concern impacts upon how an individual is helped to understand and change their problems. In CBT, by using a guiding model and appropriately modifying it, both client and therapist are able to better identify negative interpretations.
Idiosyncratic versions of each anxiety disorder are developed as part of this ‘shared understanding’. Both psychological treatments for anxiety and depression seek to understand how the world really works to challenge ‘locked’ in beliefs. Through ‘guided discovery’ cognitive therapy empowers an individual to broaden their choices concerning their response to stimuli. Within anxiety disorders, the maintaining factors are ‘transdiagnostic’ as they operate across a range of disorders. R In both approaches, these beliefs are suggested to be further reinforced by a person’s reluctance to challenge their thoughts and actions.
CBT and existentialist therapy suggest that once habitual behaviours and certain ideas have become established, a person can find themselves in a viscous circle where their actions offer support to their problematic belief systems. So how, therefore, does CBT and existential therapy attempt to disrupt these negative patterns of persistent emotions and subsequent behaviour? Unlike CBT, existential therapy does not seek to impose an external theoretical framework onto recounted material. It differs from many other therapeutic treatments of fear and sadness in that it is critical of psychopathological notions such as those in CBT.
Instead, through engaging in the process of ‘epoche’, the phenomenological method seeks to ‘see the things in their appearing’ to better understand how an individual’s emotions lead to particular behavioural responses. One example of an existential therapeutic technique is Van Deurzen’s ‘emotional compass’. Van Deurzen states that we are constantly moving around an emotional cycle and it is once a person gets emotionally ‘stuck’ that they become paralysed in sadness. Therefore, there are significant parallels to both approaches in terms of ‘stuck’ or ‘trapped’ emotional states.
Furthermore from such understandings, both CBT and existential therapy assume a collaborative process whereby a client and therapist can explore the experiences of the client to better identify the ‘core’ beliefs and inhibiting aspects of their life. In existential therapy, however, it is through philosophical exploration that client can potentially confront these problems and even become able to accept possibilities as ‘a given’ by finding alternative ways of facing life’s challenges. CBT attempts to
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