Cognitive therapies in children

Origin of cognitive therapy

Cognitive therapy (CT) is a type of psychotherapy that was developed by American psychiatrist Aaron T. Beck in the 1960’s. Cognitive therapy seeks to help the child overcome emotional difficulties by identifying and changing dysfunctional thinking, negative emotional responses and the subsequent unfavorable behavior stemming from them. This process involves helping children and adolescents develop skills for modifying their beliefs, identifying distorted thinking and relating to their parents, teachers and friends in newer and different ways, owing to the change in their thought patterns.

Role of thoughts

Cognitive counsellors regard faulty thinking to be the source of emotional dismay and unproductive behavior. Different events occur in each person’s life; some are positive and accomplishing while many may be negative and traumatizing too. The positive ones do not damage long term thinking in any way however negative ones like loss, disappointment and failure to accomplish valued goals can have lasting impressions on the human mind. Cognitive therapists believe that people who are able to think effectively about their experiences are able to put negative events in perspective and get on with life, and those who do not think appropriately about them tend to perseverate on negative happenings and allow them to disrupt their happiness and effectiveness for the future.

Cognitive therapy constructs

Cognitive therapy is highly structured and demands a certain level of intelligence in the child to accept, introspect and mitigate personal change. Therapy consists of testing the assumptions which a child typically makes; and identifying how their usually unquestioned thoughts may be distorted, unrealistic and unhelpful. These need to be challenged and opposed. Once those thoughts have been confronted, the child’s feelings about the subject matter of those thoughts are more easily subject to change. Beck identified several patterns of erroneous thinking some of which can be described below:

  • Selective Abstraction: focusing only on certain details while ignoring others
  • Dichotomous thinking: believing that everything is either good or bad, black or white
  • Overgeneralization: Arriving at far reaching conclusions on the basis of little data
  • Magnification: Overestimating the importance of an event when it is unreasonable
  • Arbitrary inference: Drawing conclusions that things are very bad with no evidence
  • Personalization: Viewing events as related to oneself when they are realistically not

Mood repairing strategy of CT

CT typically works in cases where we see that the mood has been wrongly wired and we need techniques to ‘repair’ this faulty wiring. If a child has performed poorly in school, he or she may believe: ‘I am a shame to my parents, I cannot do well in academics ever!’ This triggers a faulty reorganization of thinking. This alters the child’s emotions and subsequent behavior in all situations. It reinforces the belief in the child that he or she is ‘useless’ as a person and can do nothing right in life (although it was triggered by a one-time poor exam performance). Further on adaptive responses become unlikely. This reinforces the original belief of being ‘useless’. Thus a ‘self fulfilling prophecy’ or negative cascade begins. This needs to change. The mood needs to be ‘repaired’ by cognitive restructuring.

Cognitive Counseling Process

Cognitive restructuring is a mechanism for facilitating change. The first step is to have the child describe the stressful situation in his or her life and to identify the faulty thinking that underlies the undesirable feelings. The counsellor identifies the automatic negative thoughts and silent assumptions that the child uses to interpret his or her experience. These cognitive errors and distortions may be explained to the child so that he or she can identify fallacies in perception, inaccuracies in information and redundancy of the self-defeating behavior. The individual’s goal of becoming more effective in managing troublesome aspects of his or her life becomes clearer. The last stage involves the children going back into their world and behaving differently, either by implementing newly discovered thinking or by experimenting with finding new information about their beliefs relating to themselves or others. Scientific problem solving, led by the counsellor but with the child as an active participant, leads to changes in a relatively short time and assures long term wellness.

Cognitive distortions

These are ways in which thinking gets twisted and negativity ensues.

  • Magnification-Minimization
  • Labeling and Mislabeling
  • Personalizing and blaming
  • The ‘should’ absolutism
  • Mind reading/ Fortune telling
  • Filtering and Disqualifying

Where CT works

Cognitive restructuring can offer help in these conditions:

  • Temper tantrums and anger
  • Specific fears and phobias
  • Social anxiety and phobia
  • Food refusal in children
  • Depression and Dysthymia
  • Adjustment problems
  • Relationship problems
  • Interpersonal conflict
  • Impulse control disorders
  • Academic difficulties
  • Shyness and low self esteem

Frequently Asked Questions

What is CBT?
CBT or Cognitive-Behavior-Therapy is a form of cognitive restructuring exercise in which the therapist aims to correct faulty cognitions and at the same time target the behaviors that lead to negative outcomes. Usually combination therapy is used by most therapists to attain long lasting and rapid outcomes.

Frequently Asked Questions

What is this latest perfectionist-pessimist debate?
According to cognitive theories, thoughts are the source of emotion and action. Thus a desire for perfection stems from the thought of wanting things in a specific manner. When the perfectionist encounters a small setback, he or she perceives it as a much bigger failure owing to the cognitive distortion and hence develops pessimism (unrealistic). CT offers opportunity for the patient to learn of current distortions and successfully eliminate them in order to build appropriate thinking.