Cognitive Behavioral Therapy

 The word “cognition” is just a fancy name for “thought.”  We all have thoughts.  All the time.  And depressed, anxious, phobic, or obsessive compulsive people have a tendency to have predominantly very negative thoughts, and negative behavior patterns that go along with the negative thoughts.  Cognitive Behavioral Therapy was developed to help people change their negative thinking and behavior patterns.  Numerous studies have concluded that cognitive behavior therapy is at least as good as antidepressant medications for adults with depression (13).  Primary components of cognitive intervention include, “passive relaxation,” the use of “thought stopping,” and “cognitive restructuring.”   

Passive relaxation was described above as the process in which an individual adopts a “passive attitude” toward intruding thoughts, with a return to the focus of the exercise.  The concepts of thought stopping and cognitive restructuring suggest that the individual make a conscious appraisal of negative and distorted thinking styles and beliefs, such as “all-or-nothing thinking,” “emotional reasoning,” or the use of “mental filters.”  Once these negative or distorted cognitions are identified, they can be actively replaced with more positive self statements based on situational evidence, rather than emotional reasoning (14).  Studies have indicated that “approximately 40% to 60% of the cases of fatigue among all patients (cancer patients as well as other patients) are not caused by disease or other physical reasons.  Anxiety and depression are the most common psychological disorders that cause fatigue (15).  Patients who suffer from depression, experience difficulty concentrating, fatigue, feelings of hopelessness, and loss of interest.  These symptoms, as well as anxiety and fear, become contributors to the emotional distress associated with clinical diagnoses such as cancer, insomnia, stroke, and coronary artery disease (16).  In fact, the authors of a review of nonpharmacological interventions in Adults (17), suggested that “emotional distress (especially anxiety, depression, and beliefs about pain) has emerged as predictive of patient pain levels.”  The connection between cognitive behavioral therapy and relaxation, or guided imagery, is in the use of positive affirmations, or positive self-talk, to ease symptoms through focused breathing exercises, progressive muscle relaxation, and a variety of guided imagery or hypnotic suggestions (14).  Guided imagery and hypnosis also rely on the theoretical assumption that cognitive processes shape affective and behavioral experience, and that cognitive processes can be changed with effortful practice.