Differences and Similarities between Existential Therapy and CBT
Introduction
In this essay, I will compare and contrast the cognitive-behavioral approach to psychotherapy with the existential approach by addressing theories of Aaron Beck, David Clarks and Adrian Wells, Jeffrey Young and Emmy van Deurzen.
The cognitive-behavioral approach
Aaron Beck established Cognitive therapy (CT) on a clinical basis for the treatment of depressive patients. This gradually led to the development of Cognitive Behaviour Therapy (CBT), integrating methods and concepts from behaviorism and behavior therapy. As a reaction against the psychoanalytic understanding of depression as aggression turned inward, Beck describes depression as an expression of the activation of a cognitive triad, where the patient interprets its world, itself and its future in a negative way (Beck 1970: 255-6). Whereas classical psychoanalysis bases on the ontological principle that drives are fundamental to human psyche, the cognitive approach bases on the ontological principle that cognition is fundamental. This means that cognitive structures are the major determinants of human behavior and feelings. Beck took inspiration from Jean Piaget’s cognitive-constructivist theory of development, assuming that different experiences lead individuals to construct cognitive schemas that contain basic assumptions about themselves, the future and the world (Piaget 1972). Human beings use these schemas to organize perception and behavior. The depressive person has formed a depressive schema, containing dysfunctional assumptions (Fennell 2009: 172; Williams 2009: 263)
His interpretation of his experiences, his explanations for their occurrence, and his outlook for the future, show respectively, themes of personal deficiency, of self-blame and negative expectations. These idiosyncratic themes pervade not only his interpretations of immediate situations but also his free associations, his ruminations, and his reflections (Beck 1970: 285)
Critical incidents activate dysfunctional assumptions that produce negative automatic thoughts, leading in turn to other behavioral, motivational, emotional and physical symptoms of depression. This produces new negative automatic thoughts, forming a vicious circle. According to Beck, systematic logical errors maintain the depressive schemas. Following the integration of behavioral components in the establishment of CBT, different theorists have started to focus on the way in which dysfunctional life strategies maintain dysfunctional schemas and assumptions.
The CBT-approach bases on the conventional diagnostic approach to psychopathology. It covers more psychopathological phenomena than depression. As an example, David Clark and Adrian Wells developed a cognitive model of social phobia following the general cognitive idea that expectations and interpretations produce negative emotions. States of anxiety are due to a systematic overestimation of the danger in a given situation (Clark 2009b: 54). Based on early experiences, patients have developed dysfunctional assumptions about themselves in social situations, leading them to interpret normal social interactions in a negative way viewing them as signs of danger. These interpretations trigger in social situations. The interpretations in turn trigger an anxiety program, consisting of three interlinked components: (1) the somatic and cognitive symptoms of anxiety; (2) the safety behavior in which the patients engage to reduce threat and prevent feared outcomes; (3) and a shift in the patients attention to monitoring and observation of themselves (Clark 2009b; 127-8).
In other words, depression, social phobia and other disorders are specific psychopathological phenomena that are due to deficient learning of cognitive structures and behavioral skills. Therapy is primarily oriented towards faulty cognition and behavior. The strategy of therapy is to target this deficiency through a corrective learning process, including behavioral experiments, verification of expectations and confrontation of beliefs. More accurately, therapists use a variety of emotional, cognitive and behavioral techniques, designed to suit individual patients. This includes debating irrational beliefs, gathering data on assumptions one has made, learning new coping skills, keeping a record of activities, engaging in Socratic dialogue, carrying out homework assignments, forming alternative interpretations, changing one’s language and thinking patterns and confronting faulty beliefs etc. (ibid: 140-3; Beck 1970: 319-30). In recent years, the approach of CBT includes a broad range of strategies that Nicole Rosenberg lists as follows:
(1) A psychoeducational strategy aiming at educating the patient in his mental illness;
(2) An insight contracting strategy, with the aim that the patient obtains a better understanding of his mental processes;
(3) A problemsolving or coping strategy aimed at learning the patient new skills and new ways of thinking and acquiring more effective ways of coping with problems (Rosenberg 2007: 244).
In the 1990’s, the second wave of the cognitive-behavioral tradition was established. This included Jeffrey Young’s schema therapy, integrating elements from attachment theory. Young developed schema therapy for treatment of patients with personality disorders that have proved difficult to treat with traditional short-term CBT. Schema therapy is a clinical educational method, focusing on early maladaptive schemas, defined as:
…self-defeating emotional and cognitive patterns that begin early in our development and repeat throughout life (Young 2003: 7)
The inspiration from attachment theory reflects in the assumption that learning of early maladaptive schemas result from unmet core emotional needs in childhood (ibid:9). If patients develop these schemas, they will either surrender to them by using cognitive filters and self-destructive behavior patterns, or