Cognitive behavior therapy theory and practice
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Cognitive behavioral therapy (CBT) was developed in the 1960s by Aaron Beck based on his research challenging the psychoanalytic view of depression. Beck observed that depressed clients had negative biases in interpreting events that contributed to cognitive distortions. He developed CBT which focuses on identifying and modifying dysfunctional thoughts and beliefs. The key assumptions of CBT are that cognitions influence behaviors and emotions, and that maladaptive thinking can be identified and changed. Common techniques include cognitive restructuring to challenge irrational thoughts, behavioral experiments, and homework assignments.
Cognitive behavior therapy theory and practice
- 3. • Aaron Beck was psychoanalytic psychotherapists. • In early 1960 Aaron beck developed an approach known as cognitive therapy as a result of his research on depression. • In psychoanalytic depression was thought to be based on retroflective hostility. But the beck findings did not support the psychoanalytic formulation. • Aaron Beck observations of depressed clients revealed that they had a negative bias in their interpretation of certain life vents, which contributed to their cognitive distortions. •
- 4. • Beck called it cognitive therapy because of the importance it places on thinking. It’s now known as cognitive-behavioral therapy (CBT) because the therapy employs behavioral techniques as well.
- 5. WHAT IS COGNITIVE BEHAVIOR THERAPY
- 6. “CBT is a process of teaching, coaching, and reinforcing positive behaviors. CBT helps people to identify cognitive patterns or thoughts and emotions that are linked with behaviors.” • Thinking: Different people can think differently about the same event. The way in which we think about an event influences how we feel and how we act. A classic example is that when looking at a glass of water filled halfway, one person will see it half empty and feel discouraged and the other sees it half full and feels optimistic.
- 7. • Behavior: What we do affects how we feel and think. The individual, who deals with an upcoming exam by putting off his studies until the last minute, is likely to experience more distress on the day of the exam than an individual who has studied well in advance. CBT helps people to learn new behaviors and new ways of coping with events, often involving the learning of particular skills. • Therapy : Besides its special focus on the relationships between how we think, feel and behave, the following are fundamental to the practice of CBT. o Qualities of the Therapeutic Relationship o Goal-setting o Focus on the Present o Structure
- 8. THEORETICAL ASSUMPTIONS OF CBT
- 9. • Beck’s is based on the theoretical rationale that the way people feel and behave is determined by how the perceive and structure their experience. • The theoretical assumptions of CBT are 1) that people’s communication is accessible to introspections. 2) that clients’ beliefs have highly personal meanings 3) that these meanings can be discovered by the client rather than being taught or interpreted by the therapists.
- 11. BASIC PRINCIPLES • Cognitions affect behavior and emotion. • Cognitions may be made aware, monitored and altered. • Desired emotional and behavioral change can be achieved through cognitive change. • Change mood states by using cognitive and behavioral strategies: o Identifying/modifying automatic thoughts & core beliefs, o Regulating routine, and o Minimizing avoidance.
- 12. BASIC PRINCIPLES • Emphasis on ‘here and now’ • Preference for concrete examples o Start with specific situation (complete thought log) • Reliance on Socratic questioning o Ask open-ended questions • Empirical approach to test beliefs o Challenge thoughts not based on evidence o Cognitive restructuring
- 13. ELEMENTS OF CBT
- 14. • CBT has several defining elements. They are as follows: o ACTIVE: The client must be involved in the therapeutic process not as an observer or as an occasional visitor, but as a core and key participant. o MOTIVATIONAL: The therapist needs to take responsibility for helping to motivate the client toward a change in behavior, affect, or thinking. The therapist must be able to set up the format, and rationale for the client to consider change of value. o DIRECTIVE: The therapist must be able to develop a treatment plan and then to help the client to understand, contribute to, and see the treatment plan as a template for change.
- 15. o STRUCTURED: CBT is structured in two ways. First, the overall therapy follow structure that approximates the treatment plan. Sessions have identifiable beginning, middle and end. o COLLABORATIVE: Therapeutic collaboration cannot be 50/50. for severe depressed client the possibility to generate 50% of the therapeutic effort is impossible. Initially, the collaboration may be 90/10. For each client, the therapist must evaluate the client’s ability and motivation for the therapy. o PROBLEM-ORIENTED: CBT focuses on discrete problems rather than vague and amorphous goals of feeling good, getting better, or increasing self-esteem
- 16. o PSYCHO EDUCATION: The therapist works as a change agent. Many to problems that bring people therapy involve skills deficits. The therapist may have to teach by direct instruction , modeling, role playing. o SOLUTION-FOCUSED: The CBT therapists works with the client on generating solutions not simply gaining insight into the problem. o DYNAMICS: The dynamic level of CBT is to help clients to identify, understand, modify their schema. The schema are the basic templates for understanding one’s world. Schema may be personal, religious, cultural, gender-related. o TIME-LIMITED: Each therapy session should, ideally , stand alone. A time-limited focus is not a number of sessions, but rather way of looking at therapy.
- 17. BASIC FEATURES OF CBT
- 18. Rationale of CBT • Negative emotions are elicited by cognitive processes developed through influences of learning and temperament. • Adverse life events elicit automatic processing, which is viewed as the causal factor. • Cognitive triad: Negative automatic thoughts center around our understanding of: o Ourselves o Others (the world) o Future • Focus on examination of cognitive beliefs and developing rational responses to negative automatic thoughts.
- 19. • Distorted appraisals follow themes relevant to the specific psychiatric condition. • Psychological disorders are characterized by a different psychological profile. o Depression: Negative view of self, others, and future. Core beliefs associated with helplessness, failure, incompetence, and un lovability. o Anxiety: Overestimation of physical and psychological threats. Core beliefs linked with risk, dangerousness, and uncontrollability.
- 20. COGNITIVE SPECIFICITY • Negative Triad Associated with Depression o Self “I am incompetent/unlovable” o Others “People do not care about me” o Future “The future is bleak” • Negative Triad Associated with Anxiety o Self “I am unable to protect myself” o Others “People will humiliate me” o Future “It’s a matter of time before I am embarrassed”
- 21. EVENT Bill goes to collection APPRAISAL MALADAPTIVE “I can never do BEHAVIOR anything right” Withdrawal, avoidance AFFECTIVE & BEHAVIORAL BIOLOGICAL INCLINATION AROUSAL I don’t want to decreased sleep, deal with it low energy
- 22. • Core beliefs underlie and produce automatic thoughts. • These assumptions influence information processing and organize understanding about ourselves, others, and the future. • These core beliefs remain dormant until activated by stress or negative life events. • Categories of core beliefs (helpless, worthless, unlovable)
- 23. AUTOMATIC THOUGHTS • Thoughts that automatically come to mind when a particular situation occurs is called as automatic thoughts. • Happen spontaneously in response to situation • Do not arise from reasoning • No logical sequence
- 24. The systematic errors in reasoning that lead to faulty assumptions and misconceptions which are termed as cognitive distortions. • Arbitrary Inference: refers to making conclusions without supporting and relevant evidence. This includes “catastrophizing” or thinking of absolute worst scenario and outcomes for most situations. • Selective abstraction: consists of forming conclusions based on an isolation detail of an event. In this process other information is ignored and the significance of total context is missed. • Overgeneralization: is a process of holding extreme beliefs on the basis of a single incident and applying them inappropriately to dissimilar events and settings. • Magnification and minimization: consist of perceiving a case or situation in a greater or lesser light than it truly deserves.
- 25. COGNITIVE DISTORTIONS cont. • Personalization: is a tendency for individuals to relate external events to themselves, even when there is no basis for making this connection. • Labeling and Mislabeling: involve portraying one’s identity on the basis of imperfections and mistakes made past and allowing them to define one’s true identity. • Polarized Thinking: involve thinking and interpreting in all-or- nothing terms, or categorizing experiences in either or extremes. With such dichotomous thinking, events are labeled in black or white terms.
- 26. Beck contends that people with emotional difficulties tend to commit characteristic “logical error” that tilt objective reality in the direction of self-destruction. Cognitive therapy perceives psychological problems as stemming from commonplace processes such as faulty thinking, making incorrect inferences on the basis of inadequate or incorrect information and failing to distinguish between fantasy and reality.
- 27. TECHNIQUES OF CBT
- 28. Techniques of CBT The cognitive behavioral therapy techniques are an interesting set of exercises that help modify a person's behavioral patterns. The behavioral patterns are modified in order to bring about positive changes in the personality.
- 29. • In this technique, the patient is asked to recall a problematic situation of the past. • The therapist and patient both work together to find out a solution for the problem or a way in which the difficult situation, if it occurs in the future can be sorted out. • The therapist asks the patient to rehearse positive thoughts cognitively in order to make appropriate changes to the latter's thought processes. • Power of imagination proves to be of great use in such exercises.
- 30. Validity Testing • In this techniques the therapist tests validity of beliefs/thoughts of the patient. • The patient is allowed to defend his viewpoint by means of objective evidence. • The faulty nature or invalidity of the beliefs of the patient is exposed if he/she is unable to produce any kind of objective evidence
- 31. • It is the practice of maintaining a diary to keep an account of situations that arise in day-to-day life • Thoughts that are associated with these situations and the behavior exhibited in response to them are also mentioned in the diary. • The therapist and patient together review the matter written in the journal and find out maladaptive thought pattern. • The discussion that takes place between them proves to be useful in finding different ways in which behavior of the patient gets affected
- 32. Guided Discovery • The objective or purpose behind using this technique is that of helping patients by enabling them to understand their cognitive distortions. • Patients are made aware of and assisted by therapists in understanding how they process information. • The activity of understanding how information is processed allows patients to alter the same (information processing) if required.
- 33. Guided Discovery • Basically, the patient's perception of the world undergoes great change and he/she sees things in a different way than earlier. • This change in perception allows the patient to modify his/her behavior in a better manner
- 34. • It is one of the cognitive therapy techniques in which therapists perform role-playing exercises aimed at responding in a way that is helpful to overcome difficult situations. • The patient makes use of this behavior of the therapist as a model in order to solve problems he/she comes across.
- 35. Homework: • The homework is actually a set of assignments given by therapists to patients. • The patient may have to take notes during sessions with therapists, review audiotapes of a particular session or read articles/books related to the therapy.
- 36. • Amongst the different CBT techniques used by therapists, aversive conditioning technique makes use of dissuasion so as to lessen the appeal of a maladaptive behavior. • The patient while being engaged in a particular behavior or thought for which he has to be treated, is exposed to an unpleasant stimulus.
- 37. • Thus, the unpleasant stimulus gets associated with these thoughts/behavior and then the patient exhibits an aversive behavior towards them
- 38. Reinforcement • The systematic positive reinforcement is one of the techniques of CBT therapy in which certain (positive) behavior of a person are rewarded with positive reinforcement. • A reinforcement system is established for the of certain positive behavior.
- 39. Just like positive reinforcement proves to be helpful in encouraging a particular behavior, withholding the reinforcement deliberately also is instrumental in eradicating a maladaptive behavior.
- 40. • In self-instructional coping methods, the therapist attempts not to completely change the way you think, but rather teaches coping methods that equip you to handle harmful thought processes. One such therapeutic process is stress inoculation training. • This therapy -- which helps the patient deal with stressful events' aftermath -- aims to prevent negative reactions to stress-inducing factors by teaching the patient to break down these situations into short-term and long-term coping goals
- 41. Problem-Solving Methods • Cognitive-behavioral therapy -- which sees irrational thought processes as resolvable -- incorporates problem-solving methods. After illogical thought patterns are found, the patient must suggest several alternative solutions. • Through the decision-making process, negative solutions are weeded out until an acceptable, positive approach is discovered. This type of therapy sometimes is used in child psychotherapy when dealing with oppositional defiant disorder.
- 42. • One method of conducting cognitive- behavioral therapy is through computer-based programs. This therapy tends to decrease time spent with an actual therapist. Since computer- assisted CBT is relatively new, as of publication, most of the information is in the testing phase.
- 43. However, primary-care treatment programs that have begun integrating the method for treating co-morbid anxiety and mood disorders have found promise in this type of therapy, states researchers in "Depression and Anxiety," the official journal of the Anxiety Disorders Association of America
- 44. References Barlow. D. H & Nathar. P. E.,(2011). The Oxford Handbook of Clinical Psychology. Published by Oxford Press.Inc, New York. Carson. R.C., Butcher J. N & Mineka. S., (2001). Abnormal Psychology and Modern Life. ( 11th Ed). Published by Pearson education, Inc. and Dorling Kindersley Publishing Inc. Doboson. D & Dobson. K., (2009). Evidence-Based Practice of Cognitive -Behavior Therapy. Published by Guilford publication.Inc. Ronen. T & Freeman. A.,( 2007) CBT in Social Work Practice. Published by Spring publishing Company,LLC. Sheldon. B.,(2011). Cognitive Behavior Therapy Research and Practice in Health and Social Care. (2nd Ed). Published by Routledge publication New York.
Editor's Notes
- #4: Systematic errors in reasoning that lead to faulty assumptions and misconception which is termed as cognitive distortions.
- #12: Socratic questioning is disciplined questioning that can be used to pursue thoughtin many directions and for many purposes, including: to explore complex ideas, to get to the truthof things, to open up issues and problems, to uncover assumptions, to analyze concepts.
- #13: Socratic questioning is disciplined questioning that can be used to pursue thoughtin many directions and for many purposes, including: to explore complex ideas, to get to the truthof things, to open up issues and problems, to uncover assumptions, to analyze concepts.