Psycholegal Experts

Cognitive Behavioural Therapy (CBT)

CBT is a form of psychotherapy that has been demonstrated to be effective in helping to people to overcome a wide variety of problems, including those involving depression and anxiety. It is based upon scientifically-informed principles of human psychology and its effectiveness for many problems has been supported by hundreds of scientific studies. CBT focuses on the patterns of thought and behaviour that maintain both adaptive and maladaptive behaviour. It assumes that these patterns are learned, and that new patterns can be learned when old ones are no longer useful.

CBT tends to be a present-centered, active, collaborative, and short-term form of therapy. Although therapists do not disregard how problems may have developed (e.g., as a result of childhood experiences), their primary focus is on helping the client identify and change what is maintaining the problem in the present. The relationship between the therapist and the client is marked by collaboration, and clients are encouraged to take an active role in applying the techniques both within and between therapy sessions. Therapy tends to be short-term (often between 5-30 sessions over a period of one to 18 months), and emphasizes the client learning principles and techniques that will serve them long after their work with the therapist has ended.

Cognitive aspects of CBT

Cognition can be defined as "the mental processes of perceiving, remembering, reasoning, evaluating, and imagining". CBT holds that most of our emotions and behaviours are the result of our cognitions regarding what we think or believe about ourselves, other people, and the world. These cognitions shape how we interpret and evaluate what happens to us, influence how we feel about it, and provide a guide to how we should respond. Unfortunately, sometimes our interpretations, evaluations, and underlying beliefs and thoughts contain distortions, errors, or biases, or are not very useful or helpful. This results in unnecessary suffering and often causes us to react in ways that are maladaptive. CBT provides many methods for becoming more aware of our cognitions and for modifying them when they are distorted or are not useful. Collectively, these methods are called "cognitive restructuring".

Behavioural aspects of CBT

The behavioural aspects of CBT emphasize the role of what we do (i.e., our behaviour) in shaping how we feel, what we believe, and how we behave in the future. In CBT, the therapist helps the client to identify which behaviours are likely maintaining the problem, and which behaviours are likely to help produce positive changes. Often, problems are the maintained by avoidance, either of actual situations or of internal experiences (such as emotions and memories). This prevents new learning that potentially could disprove distorted negative beliefs about oneself, others, and the world, and keeps people stuck in old maladaptive patterns. It also prevents people from experiencing positive reinforcement that provides satisfaction and motivation. In CBT, the therapist and client collaborate in choosing new behaviours for the client to engage in that help the client to gradually overcome this avoidance.

The behavioural aspects of CBT are guided by scientifically-based principles of learning derived from over a century of research on animal and human behaviour (such as classical and operant conditioning).

Techniques of CBT

The following are some of the primary techniques used in CBT.

  1. Promoting more accurate and useful thinking (cognitive restructuring): A key component of CBT is called "cognitive restructuring", which is a set of procedures that promote more accurate and useful thinking. It is very helpful in treating depression, anxiety, and other problems.
  2. Increasing rewarding activity (behavioural activation): Depression often leads to withdrawal, avoidance, and inactivity. This prevents people from having positive experiences that are satisfying and motivating. Through a set of techniques called "behavioural activation", CBT helps people to identify and engage in activities that increase the chance they will have rewarding experiences.
  3. Overcoming anxiety by facing fears (exposure therapy): Anxiety disorders are maintained by avoidance. CBT helps people overcome anxiety by facing their fears in a systematic way called "exposure therapy".
  4. Learning new skills (skills training): Sometimes people avoid certain situations because they perceive they lack the skills to manage them. Accordingly, CBT also often includes learning new behavioural skills, such as assertive communication skills to deal with social situations and relaxation skills to deal with anxiety.

Eye Movement Desensitization and Reprocessing (EMDR)

EMDR procedures facilitate the effective reprocessing of traumatic events

EMDR is a psychotherapy developed by Francine Shapiro that emphasizes disturbing memories as the cause of psychopathology and alleviates the symptoms of post-traumatic stress disorder (PTSD). EMDR is used for individuals who have experienced severe trauma that remains unresolved. According to Shapiro, when a traumatic or distressing experience occurs, it may overwhelm normal cognitive and neurological coping mechanisms.

The memory and associated stimuli are inadequately processed and stored in an isolated memory network. The goal of EMDR therapy is to process these distressing memories, reducing their lingering effects and allowing clients to develop more adaptive coping mechanisms. This is done in an eight-step protocol that includes having clients recall distressing images while receiving one of several types of bilateral sensory input, including side to side eye movements. The use of EMDR was originally developed to treat adults suffering from PTSD; however, it is also used to treat other conditions and is also used with children.

Pain Management

Complex interactions between cognitive, behavioural, emotional and physiological factors will determine an individual’s experience of pain. Pain experience is therefore different from person to person as a result of varying combinations of these factors. Assessing the bio-psycho-social aspects of a patient’s pain can be vital to identifying the most successful treatment options before any intervention begins.

The assessment of the psychosocial aspects of an individual’s persistent pain involves and requires the accurate evaluation of:

  • Behavioural changes affecting work and domestic responsibilities, leisure and social activities, marital and family relationships, sleep patterns and medication use.
  • Cognitive factors, including beliefs and attitudes, expectations, coping skills.
  • Emotional state (such as the presence and severity of anxiety and depression).
  • Whether any post traumatic stress disorder linked to an incident which has caused the pain could be affecting the patients experience of the pain.

After an evaluation a Clinical Psychologist/ therapist might recommend several types of treatment including:

  1. Individual psychotherapy aimed at providing a better understanding of the behavioural and emotional responses to the pain and to help modify such responses to increase ones comfort, ability to cope, and sense of well being.
  2. Pain management to help you learn sufficient self-management strategies for your pain.
  3. Biofeedback to help you learn to reduce activity of the part of your nervous system that responds to stress. Activity from this part of the nervous system increases management of pain.