A. Beck and A. Ellis are recognized as pioneers in developing the cognitive-behavioral therapy (CBT), which took its roots from several psychological approaches including the structural theory, depth psychology, cognitive psychology, Freudian theory, as well as the constructivist perspectives. Cognitive therapies are based on the understanding that the individual’s emotional disturbance is a result of negative thinking that develops when that individual attempts to find meaning of emotionally difficult events. CBT attempts to change these negative thought processes, correct misconceptions and to reframe negative thinking about the stressful events. In bereavement and grief, CBT helps to correct distorted attributions and misperceptions, like self-blame and survivor guilt.
There are four basic assumptions that guide cognitive theory and therapy. The first assumption is that individuals actively construct their reality by attaching personal, idiosyncratic meanings to events. The second assumption is that cognition mediates affect and behavior, and cognition, emotion, and behavior are reciprocally determining and interactive constructs. The third assumption is that cognition is knowable and accessible, individuals can be guided to gain access to their faulty information processing. Finally, the fourth assumption is that cognitive change is central to human change processes. Thus, any affective or behavioral change can only occur together with change in the mediating cognitive products, processes, and structures.
Cognitive model is also based on a tripartite conceptualization, which includes (a) cognitive content or automatic thoughts, (b) cognitive processes or information-processing styles, and (c) cognitive structures or schemas. Automatic thoughts occur rapidly and unintentionally, cognitive processing styles and schemas are the faulty tendencies in the processing of information. Often, the schemas take an absolute, wide-ranging, and self-related focus, which highlight the individual’s self-criticism, self-blame, and guilt. Several factors, including intrapersonal and interpersonal, the nature of death, the previous experience with death, attachment style, and the history of psychiatric problems are known to be associated with the difficulty in grieving.
During a CBT session, the therapist and the client establish a direct, collaborative relationship in the form of discussion, where the therapist asks questions and draws the client’s attention to information that may be outside the client’s focus, while discussing past and present events, as well as client’s anticipation to near future events with options discussed depending on the changes of client’s cognitions. The client can apply the new knowledge to reevaluate a faulty conclusion or to reconstruct the meaning of the event. A so-called process of guided discovery is utilized in CBT for clients to realize something they did not expect. The CBT therapy is a process in which the client discovers and learns skills that the client may use long after the therapy ended.