COGNITIVE BEHAVIOUR
THERAPY (CBT)
COGNITIVE BEHAVIOUR THERAPY (CBT)
• A form of psychotherapy based on behavior modification but
aimed at altering cognitive processes such as attitudes, beliefs,
expectations, and self image.
• Re-educative (relearning) form of therapy.
HISTORICAL BACKGROUND
Behavior Therapy (1950s)
• Desensitization
• Behavior Modification
Cognitive Therapy (1950-60s)
• Beck’s Cognitive Therapy (CT)
• Rational-Emotive Therapy (RT)
Newer Approaches (1990s)
• Mindfulness Meditation
• Dialectical Behavior Therapy (DBT)
VIEW OF HUMAN NATURE/PERSONALITY
• Usually employed with individuals who suffer from:
• Dysfunctional automatic thoughts - involving content specific
to an event.
• Schemata - general rules about themselves or the world
associated with an event.
• These individuals often engage in self-statements that affect
their behavior.
THOUGHTS AND FEELINGS
• Reciprocal link between thoughts and feelings.
• Unhelpful thoughts are associated with adverse moods.
• Adverse moods are likely to generate more extreme and
unhelpful thoughts.
BEHAVIOURS
• Extreme thoughts and feelings can reduce positive
activities.
• Increases activities that worsen the problem.
• Resulting behaviours may cause adverse long-term
consequences perpetuate the problem.
12 COMMON THINKING ERRORS
1. All or Nothing, Black and White, Dichotomous
• “If I’m not a success, I’m a failure”.
2. Catastrophizing/Fortunetelling
• “I’ll be so upset, I won’t be able to function at all”.
3. Disqualifying the Positives
• “Sure I got a good mark, but I was just lucky”.
4. Emotional Reasoning
• “I feel it, therefore it must be true”.
5. Labeling
• “I’m a loser… I’m no good”; “He’s an idiot!”.
6. Minimization/Maximization
• “I only hit her 3 times”.
7. Filtering/Selective Abstraction
• “I received one low mark…I’m doing a horrible
job”.
8. Mind Reading
• “I know he hates my guts”; “she’s judging me”.
9. Overgeneralization
• “I never…”; “I always…”.
10. Personalization
• “He was short with me because I did something wrong”.
11. Should/Must Statements
• “They should be doing this for me!”; “You should change”;
“If she loves me, she will do this”.
12. Tunnel Vision
• “This smoke is going to be so good!”.
ASSESSMENT AND CASE
CONCEPTUALIZATION IN CBT
INITIAL CONTACT AND ASSESSMENT
• Current issue or presenting complaint.
• History of presenting complaint.
• Appraisal of meaning of the given events is central in CBT.
CLIENTS SUITABILITY FOR CBT
Inclusion:
•Can access thoughts and feelings.
•Accepts some responsibilities for change.
•Understands a CBT rationale and basic formulations.
•Able to form a good enough relationship with therapist.
•A degree of optimism about therapy.
Exclusion:
•Impaired cognitive functioning.
•Chronic or severe problems.
•Unwilling to let go of avoidance behaviors.
•Unwilling to do home work.
•A pronounced pessimism about therapy.
DS MS
M E
ASSESSMENT (SANDERS & WILLS, 2005)
1. Current problem.
2. What keeps the problem going now?
3. How did the problem develop?
4. Developmental history.
5. General health issues.
6. Expectations of therapy and goals.
CBT SESSION STRUCTURE (BECK, 1995)
1.Brief update and mood check (including use of measures).
2. Bridge from previous session.
3. Collaborative setting of the agenda.
4. Review of homework.
5. Main agenda items and periodic summaries.
6. Setting new homework.
7. Summary and feedback.
COGNITIVE CONCEPTUALIZATION
Simplest conceptualization focuses on:
Vicious Cycle Linking
Thoughts And Emotions
Appraisal And Emotions
APPRAISAL:
The meaning the client gives to situations, emotions, or biology
often expressed in the client’s negative thoughts.
VICIOUS CYCLE
• Trigger
• Negative Automatic Thoughts (NAT’s)
• Emotions
• Behaviors
CONCEPTUALIZATION
Levels of Cognition: (Pedesky, 1995)
Negative Automatic Thoughts
Dysfunctional Assumptions
Core Beliefs/Schemas
CONCEPTUALIZATION
I don’t know what to say, I am making a mess of this. I am a failure, she
doesn’t like me.
If people get to know me, then they will find out how useless I am and
will reject me.
I am unlovable, I am defective.
GOALS
• Primary goal is to teach clients ways to monitor their negative
automatic thoughts.
• Recognize the relationship between thoughts and emotions or
behavior.
• Compile evidence for and against the distorted automatic
thoughts.
THERAPEUTIC REALTIONSHIP
• The cornerstone of cognitive behavioral therapy is collaborative
relationship, within which the client and therapist work to
identify and resolve the client’s difficulties.
• Therapeutic alliance promotes hope which is central to any
therapy.
• Core conditions or general characteristics of any therapist that
facilitate the application of cognitive therapy is included.
THEORY OF COGNITIVE BIAS
• According to Beck depressed individuals feel depressed because
their thinking is biased toward negative interpretations.
NEGATIVE TRIAD NEGATIVE SCHEMA OR BELIEF
COGNTIVE BIAS (OR DISTORTIONS)
DEPRESSION
THE COGNITIVE TRIAD
• Negative view of the self (e.g., I’m unlovable, ineffective.).
• Negative view of the future (e.g., Nothing will work out.).
• Negative view of the world (e.g., World is hostile.).
IDENTIFYING ASSUMPTIONS AND
CORE BELIEFS
• “If…, then…” Statements
• Downward Arrow Technique
- If this thought is true, what’s so bad about that?
- What’s the worst part about that?
- What does it mean to you? About you?
INTERVENTIONS USED BY BECK WITH
DEPRESSED PATIENTS
• Graduated tasks or activities.
• Activity schedule making.
• Mastery and pleasure.
BEHAVIORAL TECNIQUES
• Relaxation
• Systematic Desensitization
• Assertive Training
• Modeling
• Operant Conditioning
• Self Controlling Procedures Including Biofeedback
• Extinction
• Aversive Conditioning
IDENTIFYING EMOTIONS
• Dairy of Emotions
Situation How Did I
Feel?
IDENTIFYNG THOUGHTS
• Diary of Emotions And Thoughts
Situation How Did I What Went
Feel? Through My
(0-100%) Mind?
(0-100%)
SEVEN-COLUMN THOUGHT RECORD
TRIGGER EMOTION NAT EVIDENCE EVIDENCE ALTERN- OUTCOME
FOR NAT AGAINST ATIVE
NAT ADAPTIVE
THOUGHT
TYPICAL CONTENT OF NAT’s IN DIFFERENT
DISORDERS
• Depression: Excessively negative view of the self, the world, and the
future.
• Anxiety: Over-estimation of threat in particular domains.
• Panic: Misinterpretation of anxiety. For e.g., symptoms as indicating
imminent catastrophe (dying or going mad).
• Social Anxiety: Fear of negative evaluation by others.
• OCD: Responsibility for and need to prevent harm to self or others.
SAMPLE
CASE CONCEPTUALIZATION
THANK YOU!
