Cognitive Behavioral Therapy
Cognitive Behavioral Therapy
Cognitive behavioral therapy CBT is a form of psychotherapy or talking therapy which focuses on faulty thought patterns, emotions and actions. It is a structured, action based, client-oriented and short-term therapy. It deals with how beliefs and attitudes affect behaviors and feelings. It combines cognitive therapy with behavior therapy.
History and Development of Cognitive Behavior Therapy (CBT)
Cognitive behavior therapy was developed by Aaron Beck who was always critical of psychoanalysis because he failed to prove hypotheses of psychoanalysis empirically. Since then he started looking for alternative patterns to explain psychological symptoms and how to treat them. According to psychoanalysis, depression is caused by anger turned towards oneself when a person loses a loved object. While dealing with patients of depression, Beck observed that the hostility content in the dreams of people with depression is not so different from the dream of those who were not depressed which disproved the psychoanalytical hypothesis. However, major difference among depressed and non-depressed patients was in their thought process. People with depression tended to view themselves as rejected, criticized, and disappointments. They have a negative view of themselves, of their environment and also of their future.
Beck’s observations from his private practice helped him to develop another approach of psychotherapy which he termed as cognitive therapy (CT). Later it was named as cognitive behavior therapy CBT. Initially, Beck made a model for the treatment of depression. However, with its success and subsequent observation and research, a model for treatment for other disorders also surfaced. Now cognitive behavior therapy is used effectively in the treatment of almost all psychiatric disorders such as anxiety, schizophrenia, bipolar, substance abuse, and personality disorders.
Thoughts and Feelings Connection
CBT is based on the assumption that feelings are affected by the thoughts which go through a person’s mind rather than external events. For example, we often say to ourselves that, “My boss made me so upset,” or “I am depressed because I failed my exam.” In these instances, we make the assumption that other person or other circumstances determine our feelings. However, if we analyze these situations then we might notice that there is another step between events and feelings that is how we perceive and think about that situation. In the above examples, missing thought that shapes the feelings could be, “My boss is glaring at me because I arrived five minutes late. He thinks that I am incompetent,” or “All my friends passed the exam, they must think that I am a loser. I cannot do anything in my life.”
Scenario 1: He intentionally ignored me, he is avoiding me, and he does not want to be seen in my company.
Scenario 2: He must be preoccupied in his thoughts that’s why he did not see me.
Although the event is the same, But reactions towards both scenarios are different. Read About Clinical Depression
A mind is a complex structure which is constantly engaged in an inner monologue. Just as we are not always conscious of the way we walk, similarly we are not always aware of our automatic thoughts. However, automatic thoughts play a deep in a person’s emotional well-being. Automatic thoughts can be categorized into three forms:
Neutral Thoughts: “I think I will have cereal in the breakfast today.”
Positive Thoughts: “I love to sing because I have a melodious voice.”
Negative Thoughts: “I haven’t done anything worthwhile in my life, I must be a disappointment for my parents.”
If a person wants to improve the way he feels, fundamental step according to CBT is to become more aware of what he is thinking. It is also important to know the difference between thoughts and feelings. Below are some words which are usually used to describe feelings but this list is not exhaustive:
Cognitive Behavioral Therapy Examples
Cognitive distortions are the unhelpful thoughts and beliefs which are associated with negative affect. Here is a list of some cognitive distortions along with examples:
- All-or-nothing thinking/Black and White Thinking: Viewing situations on one extreme or another instead of on a continuum. Ex. “If my child does bad things, it’s because I am a bad parent.”
- Catastrophizing: Predicting only negative outcomes for the future. Ex. “If I fail my final, my life will be over.”
- Disqualifying or discounting the positive: Telling yourself that the good things that happen to you don’t count. Ex. “My daughter told her friend that I was the best Dad in the world, but I’m sure she was just being nice.”
- Emotional reasoning: Letting one’s feeling about something overrule facts to the contrary. Ex. “Even though Steve is here at work late every day, I know I work harder than anyone else at my job.”
- Labeling: Giving oneself, someone or something a label based on a specific situation without finding out more about it/them. Ex. “My daughter would never do anything I disapproved of.”
- Magnification/Minimization: Emphasizing the negative or playing down the positive of a situation. Ex. “My professor said he made some corrections on my paper, so I know I’ll probably fail the class.”
- Mental filter/Tunnel vision: Placing all one’s attention on, or seeing only, the negatives of a situation. Ex. “My husband says he wishes I was better at housekeeping, so I must be a lousy wife.”
- Mind reading/Jumping to a conclusion: Believing you know what others are thinking. Ex. “My house was dirty when my friends came over, so I know they think I’m a slob.” Ex. “My daughter’s boyfriend got suspended from school. He’s a loser and won’t ever amount to anything.”
- Overgeneralization: Making an overall negative conclusion beyond the current situation. Ex. “My husband didn’t kiss me when he came home this evening. Maybe he doesn’t love me anymore.”
- Personalization: Thinking about the negative behavior of others has something to do with you. Ex. “My daughter has been pretty quiet today. I wonder what I did to upset her.”
- “Should” and “must” statements: Having a concrete idea of how people should behave. Ex “I should get all A’s to be a good student.”
What if my thoughts are true?
Sometimes, our negative thoughts may be true such as, “I might fail at interview.” In such instances, the goal of CBT is not to change the thought but to prepare a person to deal with negative outcomes. In some cases, a patient may suffer more because he is not prepared to face negative outcomes. CBT is not about being optimistic all the time. It is about being realistic.
Cognitive Behavioral Therapy Session Outline:
- Structured sessions: Initial 2-3 sessions are based on assessment, then a treatment plan is made which is implemented in the further sessions
- Length of therapy: From 6 up to 20 sessions
- Duration of each session: Approximately 45 minutes to one hour
- Time interval between sessions: Usually weekly or twice a week
- Role of patient: Active, frequent homework assignments
Beck, J. S. (2011). Cognitive behavior therapy: Basics and beyond (2nd ed.). New York: The Guilford Press.
Cully, J. A., & Teten, A. L. (2008). A therapist’s guide to brief cognitive behavioral therapy. Houston: Department of Veterans Affairs South Central MIRECC.
Leahy, R. L. (1996). Cognitive therapy: Basic principles and applications. USA: Rowman & Littlefield Publishers, Inc.
Leahy, R. L., & Dowd, E. T. (2002). Clinical advances in cognitive psychotherapy: Theory and application. New York: Springer Publishing Company, Inc.
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