Beck’s Cognitive Theory

Aaron Beck (1921-2021) is known as the father of cognitive therapy. Beck had developed the
cognitive therapy for the treatment of depression which later extended to treat other mental
health disorders including anxiety, anorexia, bulimia, sexual dysfunction, body dysmorphic
disorder, post-traumatic stress disorder, and substance abuse.

Beck believed that a person's experiences result in thoughts or cognitions. These cognitions
relate to schemas, which are core beliefs developed from early life, to create our view of the
world and determine our emotional states and behaviours. He considered disorders to be
caused by negative attitudes and distorted thinking.

Cognitive therapy helps the clients to question and challenge their dysfunctional thoughts, try
out new interpretations, and ultimately apply alternative ways of thinking to improve their
quality of life.

Mechanisms responsible for depression

Beck identified three mechanisms that were responsible for depression.

Automatic Negative Thoughts

Automatic negative thoughts are unconscious negative perceptions of reality that occur
regularly and cause negative emotions to occur.

These automatic thoughts comprise of a cognitive triad which is a negative view of oneself
“I’m worthless and hate myself”, the world “Why does no one care about me?”, and the
future “Things will never get better”. These thoughts are usually present among individuals
with depression.

When these three components interact, they interfere with normal cognitive processing,
leading to impairments in perception, memory and problem solving. The individual becomes
obsessed with negative thoughts.

Core Beliefs / Negative Self-Schemas

Core beliefs or schemas are learned and influenced by the early childhood experiences. Beck
believed that depression prone individuals develop a negative self-schema. They possess a set
of beliefs and expectations about themselves that are mainly negative and pessimistic. These
negative schemas are acquired because of negative life events. The events may include:
  Demise of a parent or sibling.
 Parental rejection, criticism, overprotection, abandonment, or abuse.
 Bullying at school or refusal from peer group.

People with negative self-schemas become prone to making logical errors in their thinking.
They tend to focus on certain aspects of a situation while ignoring others.

Cognitive Distortions

Cognitive distortions are irrational thought patterns that occur due to focus on the negative
thinking and feelings. This leads to a distorted perception of reality and misinterpretation of
information.

Following are the cognitive distortions explained by Beck:

Arbitrary interpretation / arbitrary inference

It comprises of jumping to conclusions and making assumptions that are not based on any
actual evidence.

Mind Reading

This distortion occurs when one thinks that he knows what the other person is thinking.

When you are spending time with a friend, but they seem distracted or uninterested. You
automatically jump to the conclusion that it has something to do with you. There could be
many reasons, unrelated to you, why they are feeling that way.

Fortune Telling

This distortion is when you make conclusions and predictions based on little or no evidence.

You have a meeting with a person but you predict that the meeting will go bad. You start
making assumptions about how the meeting will go before it even has occurred. The
predictions are not based on any actual evidence.

Polarized Thinking /Absolutistic, dichotomous thinking

It is an “all-or-nothing," or “black and white” thinking pattern.

An individual believes he has to be perfect, or else he is a complete failure i.e., he thinks at

extremes.
A student who gets an A- on an exam feels like a failure because he is used to getting A+
grades only. He thinks, “If I am not successful at everything I do, I am a complete failure”.

Mental Filtering

Selective abstraction

It is when a person focuses on the negatives of a situation and filters out all the positive
aspects. He magnifies those negative details and keeps thinking about them.

An employee who receives a performance review at work gets a good review but focuses on
one negative comment the manager made about him during the review.

Overgeneralization

It occurs when a person focuses on a single event that happened and makes a conclusion
based on this single piece of negative evidence.

A student receives a bad grade on one exam, based on this they think they are stupid and a
failure and believe that all future exams they will get a bad grade as well.

Catastrophizing

Catastrophizing thoughts occur when the magnitude is exaggerated or diminished.

Magnification

Magnification is an over-exaggeration of a thought. This type of thinking leads to worries

escalating quickly and becoming the worst-case scenario. Magnification can occur when
there are unknowns that a person can’t control.

A person is meeting a date for lunch. However, their date is running late and the person starts
assuming the worst. Their worries escalate quickly and the thoughts become exaggerated
when there could be many reasonable explanations why a person is late.

Minimization

Opposite of magnification, this cognitive distortion consists of minimizing positive

experiences. The magnitude of importance for positive qualities is diminished when this
distortion occurs.

An athlete wins an award but does not acknowledge their accomplishment. They minimize
the importance of the award because they might feel others already have the same award.
Labeling

Labeling is an extreme form of Overgeneralization. When this type of thinking occurs, you
assign judgment to yourself or others based on one negative occurrence or incident.

Instead of recognizing you or others made a mistake, you attach a label to it. This mislabeling
of the situation is generally exaggerated and is solely based on that single incident.

You ask a colleague for help with a task you are working on. Your colleague quickly
dismisses your attention and does not help you. Based on this you assume they are a selfish
jerk. However, they could be swamped with work and have immediate deadlines, and is
feeling the pressure. They react negatively to you asking for help but you do not realize the
pressure and stress they are under.

Personalization

When engaging in this type of distortion, an individual will take things personally. This will
cause a direct and personal reaction to everything others do or say even if it was unrelated to
them.

Self-blame for circumstances beyond your control could also occur as well as assuming you
have been intentionally excluded or targeted.

You attend a party but all your friends are busy engaging with other people. You feel like
they do not have any interest in being your friend and engaging in conversation with you.
This makes you think you don’t belong or are unfairly excluded.
Cognitive Behavioural Therapy (CBT)

CBT focuses thoughts, feelings and behaviours that combine together to have impact on

person life quality. It targets unhelpful, irrational or negative thoughts that affect our feelings

and behaviours. For example, in case of social phobia involves thinking that the person is

stupid. This leads to feeling of anxiousness in social situations. Ultimately

leading to particular behaviours in social situations, like blushing, high heartbeat etc.

CBT aims to teach people to have control over your thoughts, feelings and behaviours. It

helps to overcome automatic thoughts and use different strategies to modify the behaviour.

CBT combines the techniques of both the Cognitive therapy and Behavioural therapy.

Techniques used in CBT:

1. Cognitive restructuring:

Cognitive restructuring /cognitive reframing is a therapeutic process that helps the client

identify and change the negative and irrational thoughts. It is a frequently used tool as many

of the problems are caused by faulty ways of thinking about ourselves and the world around

us. Techniques used for Cognitive restructuring

 Socratic Questioning (Guided Discovery)

Socratic Questioning is an effective cognitive restructuring technique that can help to

challenge irrational or negative thoughts.

It encourages a deep dive into the thoughts and offers an opportunity to evaluate them for

truth. This worksheet can be an excellent tool for identifying such negative thoughts and

defusing them.

 Thought Records
To keep a thought record is an excellent way to become aware of any cognitive distortions,

which is the necessary step to restructuring them (Myles & Shafran, 2015).

While recording thoughts, the situation, thoughts, emotions, behaviours and alternate thought

are noted by the client.

 Decatastrophizing or “What If?” Technique

This technique involves asking about the worst that could happen. People often suffer from

assumptions about the worst possible outcomes in future. Its worksheet has two columns with

two separate perspectives about the world, one negative, and other one positive.

 Positive Belief Record

This worksheet offers a simple and evidence-based method to challenge automatic negative

thoughts.

Client records the belief he likes to change, and also s positive new belief, to replace the first

one. Then client records the evidence against current or in favour of new belief. It enables to

identify current belief as negative and is then effectively avoided by the client.

2. Journaling:

The client is asked to make note down the automatic thoughts when he encounters

stressful conditions, and to identify the emotions related to the thoughts. With the help of this

irrational thoughts are identified and modified to positive ones.

3. Validity Testing:

In this technique, the therapist challenges the validity of a client’s beliefs or thoughts.

Client is asked to defend his idea with evidence. If the client fails, therapist discusses the

error in clients thinking and modifies it.

4. Cognitive Rehearsal:

It requires both the therapist and the client to work together to find solution for problem,

by rehearsing that situation (most likely to occur in life). For example, a client wants to have

a positive interaction with her new in-laws. With the therapist’s help, client would mentally

rehearse the steps needed to achieve this outcome (Rice, 2015).

5. Guided imagery:

Guided imagery is also referred as visualization and imagery. It is a CBT tool used for

stress reduction. It involves imagining a detailed image of peaceful environment.

It can be performed alone, however is mostly paired with relaxation techniques such

as progressive muscle relaxation, and deep breathing. The aim of this pairing is to associate

the relaxation with the peaceful image, so that in future sessions involving imagery alone also

brings the physical relaxation paired with it (“Visualization and guided imagery techniques

for stress reduction,” n.d.).

6. Activity scheduling and behaviour activation:

It helps to increase client’s contact with his environment. It promotes client’s

involvement in pleasant activities. It is mostly used for treatment of depression. It allows

depressive patients to deal with the negativity, and to increase positivity through the re-

development of personal goals (Chan et al., 2017).

7. Modeling / Role playing:

Modelling involves role playing to teach appropriate behaviour for difficult situations.

The client uses the psychotherapist as a model, to learn new behaviour and deal effectively to

solve problems of his life (Rice, 2015).

8. Problem-Solving:
 Problem solving skills are taught that help you identify and solve problems and reduce

their negative impact on life.

While solving a problem, all the possible solutions are listed, and then strengths and

weaknesses of each possible solution are evaluated. After this the solution for a problem is

chosen (“How cognitive behaviour therapy,” n.d.).

9. Relaxation and stress reduction techniques:

Deep breathing, progressive muscle relaxation and imagery are used as CBT tool in

combination with other techniques to provide relaxation to the client. It also helps to improve

concentration, attention, memory and regulates physiological mechanism.

10. Homework:

It involves the assignment given to clients by therapists that aids in progress between

sessions. It might include reading something related to them, thought recording, practicing

coping skills (abdominal breathing) (Rice, 2015).

Strengths and Contributions:

 It is effective for wide range of disorders, including depression and anxiety.

 It focuses on present rather than past.

 It is an evidence-based therapy, proven effective for multiple backgrounds

(Gladding, 2016).

Limitations:

 It requires clients to be active, which means completion of assigned tasks.

  CT is primarily cognitive in nature and not usually the best approach for people who

are intellectually limited or who are unmotivated to change (Gladding, 2016).

References:
Chan, M. S., Jones, C. R., Hall Jamieson, K., & Albarracín, D. (2017). Debunking: A meta-
analysis of the psychological efficacy of messages countering misinformation. Psychological
Science, 28(11), 1531-1546. https://doi.org/10.1177/0956797617714579
How cognitive behavior therapy works. (n.d.). Verywell
Mind. https://www.verywellmind.com/what-is-cognitive-behavior-therapy-2795747
Cognitive behaviour therapy (CBT). (n.d.). Better Health Channel - Better Health
Channel. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/cognitive-
behaviour-therapy
Mills, H., Reiss, N., & Dombeck, M. (n.d.). Cognitive restructuring. Helen Farabee
Centers. https://www.helenfarabee.org/poc/view_doc.php?type=doc&id=15670&cn=117
CBT's cognitive restructuring (CR) for tackling cognitive distortions. (2018, July
20). PositivePsychology.com. https://positivepsychology.com/cbt-cognitive-restructuring-
cognitive-distortions/
Gladding, S. T. (2016). Counseling: A comprehensive profession. Pearson.
Rice, R. H. (2015). Cognitive-Behavioral Therapy. The SAGE Encyclopedia of Theory in
Counseling and Psychotherapy, 1, 194-199. http://dx.doi.org/10.4135/ 9781483346502.n77
Visualization and guided imagery techniques for stress reduction. (n.d.). Mental Health,
Depression, Anxiety, Wellness, Family & Relationship Issues, Sexual Disorders & ADHD
Medications. https://www.mentalhelp.net/stress/visualization-and-guided-imagery-
techniques-for-stress-reduction/
Mindfulness-Based Cognitive Therapy (MBCT)

The thoughts, feelings, and emotions that we experience every day shape the nature of our
reality. Our thoughts define our reality, and we can take control of this reality and make
adjustments to it that can enhance our quality of life.

Mindfulness-based cognitive therapy is one tool that can help us learn to recognize and
understand our thought and feeling patterns, with the goal of creating new, more effective
patterns. .

Mindfulness-Based Cognitive Therapy combines cognitive behavioral techniques with

mindfulness strategies in order to help individuals better understand and manage their
thoughts and emotions in order to achieve relief from feelings of distress. Though originally
developed to address recurrent depression, MBCT may be beneficial to people seeking
treatment for a wide range of mental health concerns,

 Cognitive therapy aims to help clients grow and find relief from symptoms of mental
illness through the modification of dysfunctional thinking (Beck Institute, 2016)
 Mindfulness can be summed up as the practice and state of being aware of our
thoughts, feelings, and emotions on a continuous basis (Greater Good Science Center,
2017). Mindfulness also contributes to an acceptance of the self as it is, without
attaching value judgments to our thought.

Though there is currently no consensus as to how mindfulness should be defined, the basic
concept refers to the practice of developing, in a non-judgmental manner, a deeper awareness
of what is happening within one’s mind and body from moment to moment. According to the
American Psychological Association (APA.org, 2012), mindfulness is:

“A moment-to-moment awareness of one’s experience without judgment. In this sense,

mindfulness is a state and not a trait. While it might be promoted by certain practices or
activities, such as meditation, it is not equivalent to or synonymous with them.”

Mindfulness is believed to promote good health, and many studies have associated
mindfulness with decreases in depression and anxiety Thus, many mental health professionals
have incorporated mindfulness-promoting activities into therapy sessions, and these activities
have been shown to help reduce symptoms of depression, decrease stress, and improve
emotional control, regardless of the specific issues being addressed.
Development of MBCT

MBCT, which was developed by Zindel Segal, Mark Williams, and John Teasdale, is
primarily derived from the earlier work of Teasdale, Jon Kabat-Zinn, and Phillip Barnard.

The approach, which is still relatively new, the first clinical trial was published in 2000.to
help people cope with the mental and physical effects of health concerns,

How does MBCT work?

In this therapy approach, people learn how to use cognitive methods and mindfulness to
interrupt the automatic processes often triggering depression, low mood, negative thoughts,
and certain body sensations often occur together during an episode of depression.
Mindfulness isn't form of meditation, but holistic program of changes aiming to increase
awareness. Researchers have found when people with a history of depression experience a
low mood, they may also experience negative memories and thoughts from the past, which
may, in turn, lead to worry about the future and physical sensations such as fatigue.

MBCT helps participants learn how to recognize their sense of being and see themselves as
separate from their thoughts and moods. After developing an awareness of the separation
between thoughts, emotions, and the self, people in treatment may find that while the self and
the emotions may exist simultaneously, they do not have to exist within the same dimension.
This insight can contribute to healing by helping individuals learn to interject positive
thoughts into negative moods in order to neutralize those negative moods.

In general, MBCT attempts to give participants the necessary tools to combat depressive
symptoms as they arise. People who learn these skills may then be able to revert to these
methods in times of distress or when faced with potentially overwhelming situations

Techniques used in MBCT

There are many techniques specific to MBCT to cope with mental illness and stress. Certain
meditation techniques—breathing meditations, sitting meditations, body scan meditations,
walking meditations, and yoga—may help to improve a person’s mindfulness. In MBCT,
individuals in treatment are also taught cognitive concepts such as the association between
thoughts and feelings

This therapy is delivered as a weekly group treatment program over the course of eight
weeks. Each weekly session lasts for two hours but completing 45-minute homework
assignment six days a week is also required. For homework, participants listen to audio
recordings and practice mindfulness meditation.

People in treatment are also introduced to a technique called the three-minute breathing
space.

Three-Minute Breathing Space

The three-minute breathing space is a quick exercise that is undertaken in three steps:

 The first minute is spent on answering the question, “how am i doing right now?”
while focusing on the feelings, thoughts, and sensations that arise and trying to assign
these words and phrases.
 The second minute is spent on keeping awareness on the breath.
 The last minute is used for an expansion of attention from solely focusing on the
breath, to feeling physical sensations and how they affect the rest of the body.

Body Scan

The body scan exercise begins with the participants lying on their backs with their palms
facing up and their feet falling slightly apart or sitting in a comfortable chair with feet on the
floor. Participants lie very still for the duration of the exercise and move deliberately and with
awareness if they need to adjust their position.

Next, the facilitator begins guiding participants through the body scan, beginning with
bringing awareness to the breath: noticing the rhythm and the experience of breathing in and
out. The facilitator explains that participants should not try to change the way they are
breathing, just hold gentle awareness on the breath. The facilitator brings attention to the
body next: how it feels, the texture of clothing against the skin, the contours of the surface on
which the body is resting, the temperature of the body and the environment.

Participants are then instructed to bring their awareness to parts of the body that are tingling,
sore, or feeling particularly heavy or light. The facilitator asks the participants to note any
areas of their body where they don’t feel any sensations at all or, conversely, areas that are
hypersensitive. After the body scan is complete, participants are instructed to bring awareness
back to the room when they are ready. It is recommended that participants open their eyes
slowly and move naturally to a comfortable sitting position

Mindfulness Stretching
Mindfulness can be practiced in many situations throughout the day, including exercise.
There are several yoga poses that facilitate mindful stretching, stretching before a workout is
important for several reasons, including:

 It’s a natural and instinctive movement for humans.

 Regular stretching improves flexibility and range of motion.
 Stretching improves and increases circulation by bringing a rush of oxygen to the
muscles.
 It feels good to stretch (Crain).

Daily Mindfulness

Sometimes the simplest exercises can be the most helpful. In the case of MBCT, this is
especially true. Practicing mindfulness throughout the day is the best way to make sure it is
woven into your life.

Mindful Showering

This exercise is an easy one for beginners. While showering, direct your attention to the
temperature of the water as it hits your body, the feel of the spray, the smell of the shampoo,
and the sensation of lathered soap against your skin. If your mind begins to wander, a
common problem during showers, gently bring it back to the present with thoughts about
what you are seeing, hearing, smelling, and feeling.

Mindful Eating

Mindful eating is turning your full attention to whatever you are eating. One helpful tip that
has not yet been mentioned is to turn off any distractions like the computer, TV, radio, and
smartphone, to allow all your senses to focus on the task of eating.

Benefits

A primary assumption of cognitive therapy is that thoughts precede moods and that false self-
beliefs lead to negative emotions such as depression. MBCT utilizes elements of cognitive
therapy to help you recognize and reassess your patterns of negative thoughts and replace
them with positive thoughts that more closely reflect reality

This approach helps people review their thoughts without getting caught up in what could
have been or might occur in the future. MBCT encourages clarity of thought and provides
you the tools needed to easily let go of negative thoughts instead of letting them feed your
depression.

A study published in The Lancet found that MBCT helped prevent depression recurrence as
effectively as maintenance antidepressant medication did.

Limitations and Concerns

The effectiveness of mindfulness based cognitive therapy is supported by considerable

empirical evidence. According to research, generally produced positive results for people in
treatment. However, because it is a relatively new treatment modality, the long-term benefits
of this approach may not yet be fully determinable. A growing body of empirical evidence
supports the approach, but further research may provide greater support for its effectiveness
when treating bipolar, eating issues, psychosis, and other conditions.

References

Fleming, J. E., & Kocovski, N. L. (2007). Mindfulness and acceptance-based group therapy
for social anxiety disorder: A treatment manual. Retrieved from https://contextualscience.org

Good Therapy. (2016). Mindfulness-Based Cognitive Therapy. Retrieved from

www.goodtherapy.org

Greater Good Science Center. (2017). Mindfulness. Retrieved from

www.greatergood.berkeley.edu

mindfulness.pdf

Webb, T. L., Miles, E., Sheeran, P., 2012. Dealing with feeling: A meta-analysis of the
effectiveness of strategies derived from the process model of emotion regulation.
Psychological Bulletin 138, 775-808.

Wood, A. M., Froh, J. J, Geraghty, A. W. A., 2010. Gratitude and well-being: A review and
theoretical integration. Clinical Psychology Review 30, 890-905.

Wood, A. M., Tarrier, N., 2010. Positive Clinical Psychology: A new vision and strategy for
integrated research and practice. Clinical Psychology Review 30, 819-829.

Acceptance and Mindfulness Cognitive Behavior Therapy.pdf