Cognitive behavior therapy helps people identify their distressing thoughts and evaluate how

realistic the thoughts are. Then they learn to change their distorted thinking. When they think
more realistically, they feel better. The emphasis is also consistently on solving problems and
initiating behavioral change.

Aaron T. Beck developed an approach known as cognitive therapy(CT) as aresult of

his research on depression (Beck 1963, 1967). Beck was designing hiscognitive therapy
about the same time as Ellis was developing REBT, yet both ofthem appear to have
created their approaches independently. Beck’s observa-tions of depressed clients
revealed that they had a negative bias in their inter-pretation of certain life events, which
contributed to their cognitive distortions(Dattilio, 2000a). Cognitive therapy has a
number of similarities to both ratio-nal emotive behavior therapy and behavior
therapy. All of these therapies areactive, directive, time-limited, present-centered,
problem-oriented, collabora-tive, structured, empirical, make use of homework, and
require explicit identi-fication of problems and the situations in which they occur (Beck &
Weishaar,2 0 0 8 ) .
Cognitive therapy perceives psychological problems as stemming fromcommonplace
processes such as faulty thinking, making incorrect inferenceson the basis of
inadequate or incorrect information, and failing to distinguishbetween fantasy and
reality. Like REBT, CT is an insight-focused therapy thatemphasizes recognizing and
changing negative thoughts and maladaptive be-liefs. Thus, it is a psychological
education model of therapy. Cognitive therapyis based on the theoretical rationale that
the way people feel and behave is determined by how they perceive and structure their
experience. The theoreti-cal assumptions of cognitive therapy are (1) that people’s
internal communica-tion is accessible to introspection, (2) that clients’ beliefs have
highly personal meanings, and (3) that these meanings can be discovered by the client
rather than being taught or interpreted by the therapist (Weishaar, 1993).The basic
theory of CT holds that to understand the nature of an emotional episode or disturbance
it is essential to focus on the cognitive content of an individual’s reaction to the upsetting
event or stream of thoughts (DeRubeis & Beck, 1988). The goal is to change the way
clients think by using their automatic thoughts to reach the core schemata and begin to
introduce the idea of schema restructuring. This is done by encouraging clients to
gather and weigh the evi-dence in support of their beliefs.

Basic Principles of Cognitive Therapy

Beck, a practicing psychoanalytic therapist for many years, grew interested in his clients’automatic
thoughts (personalized notions that are triggered by par-ticular stimuli that lead to emotional
responses). As a part of his psychoana-lytic study, he was examining the dream content of depressed
clients for an-ger that they were turning back on themselves. He began to notice that rather than
retroflected anger, as Freud theorized with depression, clients exhibited a negative bias in their
interpretation or thinking. Beck asked clients to observe negative automatic thoughts that persisted
even though they were contrary to objective evidence, and from this he developed a comprehensive
theory of de-pression.Beck contends that people with emotional difficulties tend to commit
characteristic “logical errors” that tilt objective reality in the direction of self-deprecation. Let’s examine
some of the systematic errors in reasoning that lead to faulty assumptions and misconceptions, which
are termedcognitivedistor-tions(Beck & Weishaar, 2008; Dattilio & Freeman, 1992).

Arbitrary inferences refer to making conclusions without supporting and relevant evidence. This
includes “catastrophizing,” or thinking of the absolute worst scenario and outcomes for most situations.
You might begin your first job as a counselor with the conviction that you will not be liked or valued by
either your colleagues or your clients. You are convinced that you fooled your professors and somehow
just managed to get your degree, but now people will certainly see through you!

Selective abstraction consists of forming conclusions based on an isolated detail of an event. In this
process other information is ignored, and the signifi-cance of the total context is missed. The
assumption is that the events that mat-ter are those dealing with failure and deprivation. As a
counselor, you might measure your worth by your errors and weaknesses, not by your successes.

•Overgeneralization is a process of holding extreme beliefs on the basis of a single incident and applying
them inappropriately to dissimilar events or settings. If you have difficulty working with one adolescent,
for example, you might conclude that you will not be effective counseling any adolescents. You might
also conclude that you will not be effective working withany clients!

•Magnification and minimization consist of perceiving a case or situation in a greater or lesser light than
it truly deserves. You might make this cognitive error by assuming that even minor mistakes in
counseling a client could easily create a crisis for the individual and might result in psychological
damage.

•Personalization is a tendency for individuals to relate external events to themselves, even when there
is no basis for making this connection. If a client does not return for a second counseling session, you
might be absolutely con-vinced that this absence is due to your terrible performance during the initial
session. You might tell yourself, “This situation proves that I really let that cli-ent down, and now she
may never seek help again.”

•Labeling and mislabelling involve portraying one’s identity on the basis of im-perfections and mistakes
made in the past and allowing them to define one’s true identity. Thus, if you are not able to live up to
all of a client’s expectations, you might say to yourself, “I’m totally worthless and should turn my profes-
sional license in right away.”

•Dichotomous thinking involves categorizing experiences in either-or ex-tremes. With such polarized
thinking, events are labeled in black or white terms. You might give yourself no latitude for being an
imperfect person and imperfect counselor. You might view yourself as either being the perfectly com-
petent counselor (which means you always succeed with all clients) or as a total flop if you are not fully
competent (which means there is no room for any mis-takes).

The cognitive therapist operates on the assumption that the most direct way to change dysfunctional
emotions and behaviors is to modify inaccurate and dysfunctional thinking. The cognitive therapist
teaches clients how to identify these distorted and dysfunctional cognitions through a process of
evaluation. Through a collaborative effort, clients learn the influence that cognition has on their feelings
and behaviors and even on environmental events. In cognitive therapy, clients learn to engage in more
realistic thinking, especially if they con-sistently notice times when they tend to get caught up in
catastrophic thinking.After they have gained insight into how their unrealistically negative thoughts are
affecting them, clients are trained to test these automatic thoughts against reality by examining and
weighing the evidence for and against them. They can begin to monitor the frequency with which these
beliefs intrude in situations in everyday life. The frequently asked question is, “Where is the evi-dence
for _____?” If this question is raised often enough, clients are likely to make it a practice to ask
themselves this question, especially as they become more adept at identifying dysfunctional thoughts.
This process of critically ex-amining their core beliefs involves empirically testing them by actively engag-
ing in a Socratic dialogue with the therapist, carrying out homework assign-ments, gathering data on
assumptions they make, keeping a record of activities, and forming alternative interpretations (Dattilio,
2000a; Freeman & Dattilio, 1994; Tompkins, 2004, 2006). Clients form hypotheses about their behavior
and eventually learn to employ specific problem-solving and coping skills. Through a process of guided
discovery, clients acquire insight about the connection be-tween their thinking and the ways they act
and feel.
Applications of Cognitive Therap y

Cognitive therapy initially gained recognition as an approach to treating de-pression, but extensive
research has also been devoted to the study and treat-ment of anxiety disorders. These two clinical
problems have been the most extensively researched using cognitive therapy (Beck, 1991; Dattilio,
2000a). One of the reasons for the popularity of cognitive therapy is due to “strong empirical support for
its theoretical framework and to the large number of outcome studies with clinical populations” (Beck &
Weishaar, 2008, p. 291). Cognitive therapy has been successfully used in a wide variety of other disor-
ders and clinical areas, some of which include treating phobias, psychosomatic disorders, eating
disorders, anger, panic disorders, and generalized anxiety disorders (Chambless & Peterman, 2006;
Dattilio & Kendall, 2007; Riskind, 2006); posttraumatic stress disorder, suicidal behavior, borderline
personal-ity disorders, narcissistic personality disorders, and schizophrenic disorders (Dattilio &
Freeman, 2007); personality disorders (Pretzer & Beck, 2006); sub-stance abuse (Beck, Wright, Newman,
& Liese, 1993; Newman, 2006); chronic pain (Beck, 1987); medical illness (Dattilio & Castaldo, 2001);
crisis interven-tion (Dattilio & Freeman, 2007); couples and families therapy (Dattilio, 1993, 1998, 2001,
2005, 2006; Dattilio & Padesky, 1990; Epstein, 2006); child abusers, divorce counseling, skills training,
and stress management (Dattilio, 1998; Granvold, 1994; Reinecke, Dattilio, & Freeman, 2002). Clearly,
cognitive be-havioral programs have been designed for all ages and for a variety of client populations.
For an excellent resource on the clinical applications of CBT to a wide range of disorders and
populations, see Contemporary Cognitive Therapy (Leahy, 2006a).

APPLY ING COGNITIVE TECHNIQUES

Beck and Weishaar (2008) describe both cognitive and behavioral techniques that are part of the overall
strategies used by cognitive therapists. Techniques are aimed mainly at correcting errors in in-formation
processing and modifying core beliefs that result in faulty conclu-sions. Cognitive techniques focus on
identifying and examining a client’s beliefs, exploring the origins of these beliefs, and modifying them if
the client cannot support these beliefs. Examples of behavioral techniques typically used by cog-nitive
therapists include skills training, role playing, behavioral rehearsal, and exposure therapy. Regardless of
the nature of the specific problem, the cognitive therapist is mainly interested in applying procedures
that will assist individuals in making alternative interpretations of events in their daily living. Think about
how you might apply the principles of CT to yourself in this classroom situation and change your feelings
surrounding the situation:

Your professor does not call on you during a particular class session. You feeldepressed.Cognitively you
are telling yourself: “My professor thinks I’m stu-pid and that I really don’t have much of value to offer
the class. Furthermore, she’s right, because everyone else is brighter and more articulate than I am. It’s
been this way most of my life!”Some possiblealternative interpretations are that the professor wants to
include others in the discussion, that she is short on time and wants to move ahead, that she already
knows your views, or that you are self-conscious about being singled out or called on.The therapist
would have you become aware of the distortions in your thinking patterns by examining your automatic
thoughts. The therapist would ask you to look at your inferences, which may be faulty, and then trace
them back to earlier experiences in your life. Then the therapist would help you see how you sometimes
come to a conclusion (your decision that you are stupid, with little of value to offer) when evidence for
such a conclusion is either lack-ing or based on distorted information from the past.As a client in
cognitive therapy, you would also learn about the process of magnification or minimization of thinking,
which involves either exaggerating the meaning of an event (you believe the professor thinks you are
stupid be-cause she did not acknowledge you on this one occasion) or minimizing it (you belittle your
value as a student in the class). The therapist would assist you in learning how you disregard important
aspects of a situation, engage in overly simplified and rigid thinking, and generalize from a single
incident of failure. Can you think of other situations where you could apply CT procedures? TREATMENT
OF DEPRESSION

Beck challenged the notion that depression results from anger turned inward. Instead, he focuses on
the content of the depressive’s negative thinking and biased interpretation of events (DeRubeis & Beck,
1988). In an earlier study that provided much of the backbone of his theory, Beck (1963) even found
cognitive errors in the dream content of de-pressed clients.Beck (1987) writes about the cognitive triad
as a pattern that triggers depres-sion. In the first component of the triad, clients hold a negative view of
themselves.