Utilization of CBT in Grief and/or Depression

Posted on March 27, 2024March 27, 2024 by Mark Moran

Grief and loss strike an imbalance in life. During the adjustment process, numerous complications can occur that can veer a person off course in adjustment. Sometimes Grief Counseling and simple talk can help but other times more powerful forms of counseling are required via licensed counselors with an expertise in grief counseling. In some cases, therapy involves looking solely at the past and the emotional aspect via Psychodynamic Approach, sometimes professionals utilize a more rational approach through Cognitive Behavioral Therapy, and in some cases, professionals utilize a combination.

CBT helps identify distorted thinking of an event and help the person reframe those thoughts and maladaptive behaviors

Cognitive Behavioral Therapy or CBT has a high success rate in helping complicated and dysfunctional grievers find understanding and meaning in life through examination of the loss and recognition of unhealthy feelings, irrational thoughts and imbalanced behaviors. It involves intense reflection, grief work and homework, and application to help the person reframe distorted views due to complicated grief or even cases of depression. Originally utilized by Aaron Beck (1967), it looked to challenge distorted feelings and help the person find healing through rational re-direction. In essence, CBT recognizes the Cognitive Triangle of thought, behavior and emotion. Each aspect of human existence affects the other. Thoughts can positively or negatively affect behavior, behavior can affect emotion and emotion can affect thought. If any of these are imbalanced, it can create a distortion itself.

Albert Ellis, (1957) was a core contributor to Beck’s thought. Ellis was discouraged by the limitations of psychoanalysis and limitations of only becoming aware of an emotion but wanted tools to cognitively help the person move forward. Ellis drafted the ABC Model which identified a triggering or Activating event with a belief that in turn caused a consequence. An activating event could be labeled as any traumatic event or loss that in turn was interpreted by the person. In complications of grieving, the interpretation or belief regarding the event many times caused negative consequences, instead of the event itself. The purpose of the therapy was to revisit the event, understand it and correlate proper consequences from the objective nature of the event instead of subjective beliefs or faulty conclusions. Hence irrational, unhealthy, and counter productive thinking and new distorted behaviors from an event are key elements within complications of grieving. CBT looks to challenge those ways of thinking and behaviors with an indepth cognitive, intellectual and rational discussion to help correct the emotions and behaviors via better thinking or reframing.

Cognitive Distortions

Individuals who suffer from depression or complications in grieving generally have a faulty cognitive view of reality. Due to the event, loss, or trauma, there is a type of worldview that haunts them and adversely affects their emotional and behavioral response to life. For those suffering from depression or complicated loss, many have a variety of distorted views which include:

All-or-nothing thinking: Viewing situations in binary terms, without considering nuance.
Catastrophizing: Anticipating the most adverse outcomes without empirical justification.
Mind Reading: Presuming to understand others’ thoughts without direct evidence.
Emotional reasoning: Basing conclusions on emotions rather than objective data.
Labeling: Characterizing oneself or others based on a singular trait or event.
Personalization: Attributing external events to oneself without a clear causal line

McCleod. S. (2023). Cognitive Behavioral Therapy (CBT): Types, Techniques, Uses. Simple Psychology. Access here

As McCleod points out, many of these distortions are assumptions that usually are tied to lower self image or negative self schemas. These negative self schemas play a key role in the illogical thinking and ideals of a depressed person

Cognitive Triad and Cognitive Distortions

Beck used the example of the Cognitive Triad that illustrated three ideals of self, the world, and the future. In all cases of depressed individuals, the self image of the person was negative, the ideal that the world hated them was present and that the future possessed no future blessings. Beck theorized that this triad stemmed from a negative schema in life that originated from a negative life event that was never processed properly. This in turn led to a complication in grieving or adjusting. From these events, a series of even more cognitive distortions emerged within the depressed person in how they viewed life itself.

Among the many included magnification of bad events or minimization of good events, over personalization of others emotions as if they are correlated with oneself, and improper correlation of negative causal events with oneself (select abstraction). As one can imagine, a depressed person is trapped not only with emotional imbalance but is also haunted daily with these negative cognitive sequences

CBT Process

CBT challenges these thoughts. It looks for one to reframe them and see things in different lights. It looks to gain a better understanding of these thoughts and behaviors and incorporate better problem solving ways to deal with them. This reframing involves first a serious discussion and revisiting of the activating event and understanding it more objectively. Sometimes the therapist will utilize exposure therapy with the patient, asking them to discuss and think about the past incident. For more traumatic or painful memories, this takes time and over sessions, longer exposure occurs. Sometimes, this is through direct memory or pretending to be a bystander watching the past. This challenges the person to face one’s past, fears and trauma and move forward.

Following analysis, one is asked to discuss thoughts and emotions associated with the event. This is where illogical and damaging thoughts and behaviors can identified and weeded out. The patient is given alternative ways of thinking and reframing thoughts about the event, as well as ways to better cope with daily issues. This is key in helping the individual. The therapist not only unroots the cognitive distortion but also gives the patient the psychological and mental tools necessary to alter negative thoughts and behaviors in association with the event. Sometimes, the therapist and patient can role play a future event to help the patient better prepare for interaction. Other tools include meditation and ways to calm oneself when a potential social trigger presents itself that can challenge the new reframing.

CBT gives the patient the opportunity to also be their own therapist. To work through issues, apply skills and complete homework assignments.

It is essential in CBT to identify and recognize the distorted thought or maladaptive coping in response to the event and give the person the tools necessary to properly understand the issue and reframe it for healing purposes. CBT usually takes 20 sessions or so to finally uproot the issue and help reframe and correct distorted thinking.

Limits of CBT

While CBT is successfully, it can have limitations. It is based primarily upon the cognitive thought process and looks to correct maladaptive coping and distorted thoughts to help the person find balance, but other therapies, such as the Psychodynamic Approach Looks at the emotional response stemming from the past event and how that event negatively affects present day emotions. The Freudian Psychodynamic Approach finds the repressed feelings and how to cope with those feelings. If utilized in combination with cognitive, I feel both approaches integrated can help the person have a more holistic and complete person healing process. The other limitation of CBT is if solely utilized as talk, it does not address the chemical imbalance within the brain and neurotransmitters. Sometimes, serotonin balance is necessary and depression medications are necessary to help a person find new balance and alter thought process.

Hence, a multi faceted approach is sometimes necessary in treating a person, not merely an intellectual approach. This does not mean CBT is not highly effective. It is extremely useful tool in helping individuals reframe negative thoughts and behaviors due to an incident and helping them correct those issues.

Conclusion

Please also review AIHCP’s Grief Counseling Certification and see if it meets your academic and professional goals

CBT and other therapies combined are excellent ways to help correct complications in grieving stemming from distorted thinking and helping the individual from an intellectual standpoint reframe and understand the loss in a logical way void of false images. It is a heavy talk based therapy that asks one to revisit the past, rethink and reframe it, and correct distorted thoughts and behaviors. It sometimes requires additional therapies with it to help others overcome depression or complications in the grieving process but overall is very successful. This type of therapy or any grief therapy is reserved for licensed therapists. Pastoral grief counselors who are not licensed need to refer more serious cases of grief and loss to these types of licensed counselors.

Please also review AIHCP’s Grief Counseling Certification. The program is open to both licensed and unlicensed Human Service professionals and offers an online and independent program that leads to a four year certification.

Additional Resources

“Cognitive Behavioral Therapy (CBT)”. Cleveland Clinic. Access here

“What is Cognitive Behavioral Therapy?”. (2017). Post Traumatic Stress Disorder. APA. Access here

Raypole, C. & Marcin, A. (2023). “Cognitive Behavioral Therapy: What Is It and How Does It Work?”. Healthline. Access here

“Cognitive Behavioral Therapy” Psychology Today. Access here

Psychodynamic Therapy and Emotion

Posted on March 15, 2024March 27, 2024 by Mark Moran

For many experiencing complications with emotion, notably grief or anxiety, individuals turn to therapy. Not all loss is simple and sometimes emotion itself is far from simple or easy to identify its source. Anxiety and depression plague individuals and can have crippling effects on their mental health and social interaction. Therapists and licensed counselors usually turn to some type of medication to help balance the neurotransmitters in the brain or hormones in the body. Others will also look to cognitive behavioral therapy to help articulate the issue from a rational way, introducing adaptive coping strategies, better responses and overall reframing.

Psychodynamic Therapy

Professionals from the Freudian school also can utilize Psychodynamic therapy which can also have equal benefits in helping individuals not only with deeper pathologies but also depression and anxiety. Psychodynamic Therapy looks within the person’s emotions and past to help decipher the reasons for depression, anxiety or emotion. Stemming from Freud, the idea suggests that all emotion or behavior stems from one’s subconscious and also partly early childhood experiences. Through various internal mechanisms both inherited biological and learned through experience, one learns to balance these emotions and feelings but when imbalance occurs, anxiety can result, which can also lead to subconscious repression. Psychodynamic therapy looks to the unconscious to find these events that has caused these unconscious feelings that are now manifesting in one’s life.

Through this process, the therapist hopes to discover the root of the issue, identify it and help the person learn from it. The person then is guided to the root cause of his/her issue and learns how this unconscious feeling is causing havoc in one’s life and how to better regulate it. This involves a type of talk therapy where the patient discusses their feelings and the therapist attempts to discover the source of the emotional imbalance. Erick Erickson, a disciple of Freud, introduced how emotional issues can arise when individuals do no meet certain eight stages. His psychosocial approach identified 8 stages of development within human life from infancy to old age and how two opposite outcomes can occur when needs and goals are not met. Individuals who do not successfully meet certain needs or goals experience regression or incompleteness manifesting in depression or anxiety. Therapists with psychodynamic therapy can help guide individuals discover unconscious feelings about certain events that can lead to deeper reasons why someone feels depressed, angry or anxious. Sometimes, individuals may not be able to form relationship bonds, or have trust issues. These issues usually are a result of some earlier childhood experience that once identified and discussed can find ways to better resolve it.

These types of talk therapies usually last anywhere from 40 to 45 minutes once a week and can continue for a few months or up to a year. The key within the process is to uncover the root cause for the emotional balance within the subconscious mind and help identify it. This allows the person to recognize the issues and its root and better move forward without repeating the same mistakes. With understanding of the source, better ways to respond to it, and coping mechanisms, one can better find balance and move forward. In essence, one can understand the emotion, recognize patterns caused by it and form better relationships from this enlightenment. The therapy looks to unblock one from the past and allow one to move forward.

Comparisons and Differences Between CBT and Psychodynamic Therapies

While looking more at emotion, this therapy differs from CBT which obviously looks at unhealthy ways of thinking and how one can reframe and better oneself. Both CBT and Psychodynamic therapy can look at better ways to manage how we react to things, but they have different starting points. Both are considered effective methods, but it ultimately it depends upon the person. It also can depend upon the type of trauma. Proponents against Psychodynamic theory may contend it takes away free will due to the unconscious drive, but one can modify the strict Freudian values and say emotional trauma at early age can greatly affect a person decision making but not necessarily strip one of conscious decisions.

CBT offers reframing solutions to perceptions and ideas one faces. It looks to remove distortions of reality and how to better reframe it and respond. Psychodynamic may be better at explaining the deeper cause of it but both methods look to understand the emotion and find better ways of dealing with it. In essence, Psychodynamic looks to find what is blocking a person from proceeding forward and ends, while CBT looks at how to cope with the issue through a variety of adaptive coping methodologies. Some therapists may only use one pure form, or combine the two, with one helping the person cope and then later delving into the source of the issue.

A good example of someone facing deeper pathological issues with depression and self image would to be utilize CBT and Psychodynamic therapies. With CBT, the therapist would set out to dismiss from an intellectual standpoint the false image of self that is destructive. Therapy would look to help the individual realize the distorted self view and then offer ways to think differently when low self esteem emerges. It would point out that low ideals of self are not true and how to better deal with these thoughts through meditation, journaling or other self affirmative practices. It would teach one to better reframe these distortions. The Psychodynamic portion would investigate the source of the low self esteem in earlier life, the emotion itself, how to manage the emotion, and proceed in relationships. Once the unconscious source is identified, the individual could better understand why one feels a certain way, recognize patterns and triggers for the emotion and form healthier bonds. In this example, while not purely one therapy, one can see the benefit of both schools of thought being utilized.

Conclusion

Human beings are complex emotional beings. We have a intellect and will. We are rational and emotional. According to Freud, we are torn between internal impulses and external systems. Subconscious and conscious events can occur which create a variety of imbalances. How we find balance depends on what therapy is best for us. Talking therapies, like CBT and Psychodynamic are useful therapies to help from emotional or rational standpoints. Sometimes, talk therapies are also supplemented with medications to help any neural or hormonal imbalances as well. Ultimately, Psychodynamic therapy is a an excellent option for some.

Psychodynamic therapy has Freudian roots. Please also review AIHCP’s Grief Counseling Certification

Please also review AIHCP’s behavioral certifications, especially its Grief Counseling Certification. While grief counseling is clearly not a pathological type of counseling because it deals with a direct loss, it can sometimes turn pathological and require a licensed professional. AIHCP certifies both licensed and unlicensed human service professionals who offer different level of services within grief.

Additional Resources

“CBT vs. Psychodynamic Therapy: What’s the Difference?” Zencare. Access here

Mcleod, S. (2024). “Psychodynamic Approach In Psychology”. Simply Psychology. Access here

Davis, K. (2023). “How does cognitive behavioral therapy work?”. MedicalNewsToday. Access here

Dresden, D. (2020). “What is psychodynamic therapy?”. MedicalNewsToday. Access here

Cherry, K. (2023). “What Is Psychodynamic Therapy?”. VeryWellMind. Access here