Why Cognitive Behavioral Therapy is considered to be a Cognitively-

Oriented Therapy

Cognitive Behavioural Therapy (CBT) is a form of psychotherapy aimed at

transforming a person's negative cognitive patterns and beliefs into more constructive ones

(Chand et al., 2023; Lambert, 2013). CBT is often considered the current gold standard in

psychotherapy due to its evidence-based approach, which aligns with the criteria used in

healthcare research (David et al., 2018). Evidence demonstrating how CBT is 'cognitive'

encompasses its historical background, the incorporation of the cognitive model in its

methodology, the focus on schemas and cognitive distortions, and its limitations when

applied to individuals with cognitive impairments. This essay will delve into each of these

aspects to confirm the role of CBT as a cognitively-oriented therapy.

History

Prior to the Cognitive Revolution in the mid-20th century, the prevailing framework for

human behaviour and the development of therapeutic methods was founded on the two-factor

learning theory of classical and operant conditioning. (Friedman et al., 2007; Rescorla &

Solomon, 1967). This model grounded in behaviourism often overlooks the mental processes

leading to behaviour, instead considering them merely as intervening variables between

stimulus and response. Delving into these 'intervening variables', conceptualised as

hypothetical constructs, served as a pivotal role for the cognitive revolution in psychology

(Dowd, 2004; Lovasz & Slaney, 2013).

In the 1950s, a revolution in cognitive science sought to explore the workings of the

mind and its processes, leading to the development of a novel therapeutic approach. This

method, conceived by Aaron T. Beck, is known as Cognitive Behavioural Therapy (CBT).

CBT diverges from traditional behavioural therapy by focusing on the cognitive processes
implicated in mental disorders (Beck, 2020; Dowd, 2004; Fenn & Byrne, 2013). This

distinction, rooted in the historical context that CBT emerged from the cognitive revolutions,

underscores its identity as a cognitively-oriented therapy.

The Cognitive Model

CBT has its basis on the cognitive model, where people’s emotions and behaviours are

based on their perception of events, rather than the events itself as the primary cause. Beck

identified three levels of cognition that conceptualise the cognitive model: Core Beliefs,

Intermediate Beliefs, and Automatic Thoughts. Analysing and modifying this cognitive

model is the basis of CBT (Beck, 2020; Fenn & Byrne, 2013). To further illustrate that CBT

is cognitively-oriented, the methods employed for modifying this model are also

fundamentally rooted in cognitive science.

Automatic Thoughts and Beliefs

Beck observed that a significant number of his patients with depression demonstrate

negative thinking patterns that appear to be automatic. Consequently, he termed these

patterns 'Negative Automatic Thoughts' (NATs). Some examples of NATs are: “I am going

to fail the test tomorrow”, “Everyone at the party thinks I am boring”, and “I’ll definitely get

fired because of this”. These NATs are usually relating to an event or environment that the

client finds themselves in, and originate from beliefs that the clients have. CBT initially

assists clients in identifying and modifying these NATs. To achieve this, CBT employs the

Socratic questioning method. Socratic questioning helps clients analyse their own NATs, to

ascertain whether the NATs are both accurate and beneficial. Thus, this method utilises the

client’s cognitive capabilities, particularly critical thinking, to transform their NATs into
more positive ones (Beck, 2020). This use of their own cognitive capabilities to modify

NATs underscores the cognitive essence of CBT.

Beliefs are ideas that people develop about themselves, other people, and the world.

They developed and came about from experiences that the client had gone through. For

instance, a client who was frequently reprimanded for every mistake made during their

childhood will have a belief that they will be punished for every mistake that they will make.

On the other hand, a client who was frequently praised for their accomplishments during their

childhood will have a belief that they will be successful in their attempt later in life(Piaget,

1926). Two types of beliefs that Beck identified were intermediate and core beliefs (Beck,

2020; Fenn & Byrne, 2013).

Intermediate beliefs are rules, attitudes, and assumptions that the clients create for

themselves and the world. They are easier to modify than core beliefs, are expressed through

negative thoughts, and represent the bridge between core beliefs and NATs. Some examples

of negative intermediate beliefs are: “If I fail the test tomorrow, my life is over”, “I will never

get any friends”, and “I have only been lucky that I got this job” (Beck, 2020; Fenn & Byrne,

2013).

Core beliefs represent the most enduring understandings that an individual has. Often

so fundamental, individuals typically do not articulate them, perceiving them as truths. They

are more general and rigid than intermediate beliefs. According to the cognitive model, they

are the root cause of automatic thoughts that lead to emotions and behaviours. The three core

beliefs that Beck identified were (illustrated with negative examples): beliefs about oneself

(i.e. I am a failure), beliefs about others or the world (i.e. Others think that I am a failure),

and beliefs about the future (i.e. I will never succeed). Since they are so fundamental and are

the root cause of emotions and behaviours, modifying them will then lead to changes that

persist for a considerable time (Beck, 2020; Fenn & Byrne, 2013).
Cognitive Methods for Modifying Beliefs

In order to modify a client’s beliefs, one approach is to strengthen the positive or

adaptive beliefs that the client has. To strengthen these beliefs, one cognitive method would

be to collect data that supports the positive beliefs. The clients were asked to recall and list

moments that validate their positive beliefs. For instance, a depressed client whose core belief

that they are a failure were asked to recall events when they are successful. From those

events, positive conclusions were derived in order to show the client that they are able to be

successful, and that their failure does not define them. This uses the client’s episodic memory

in order to change their own beliefs. The client was then asked to list and remember positive

experiences that they will get until the next session. Another method was for the client to

‘act’ their positive belief. In this case, the depressed client was told to act as if they believed

that they were competent. For example, when the depressed client was going to face an

interview, they were told to imagine what it would feel like if they acted as if they were

competent during the interview. This in turn will strengthen the positive belief that the client

has that they are competent. This uses the client’s social cognition ability through acting in

order to change their own beliefs (Beck, 2020; McDonald et al., 2020).

Another approach is to target their negative or maladaptive beliefs. One method is to

use the socratic questioning method toward the negative belief, as was done with the client’s

NATs. Another method is to reframe events or experience that the client has toward a more

positive belief. In this instance, a client who believes that attending therapy signifies

weakness could be aided by reframing their belief to perceive therapy as an indication of

strength and a commitment to maintaining good health. Reframing can also be done to

childhood events that were the origin of negative beliefs. In this case, the client uses their

memory, critical thinking, and abstraction in reframing their negative belief (Beck, 2020).
The use of memory, social cognition, memory, critical thinking, and abstraction to modify the

clients belief also underscores the cognitive essence of CBT.

Where CBT Lacks

Further evidence supporting the notion that CBT is cognitively-oriented emerges from

observations that traditional CBT may not be highly effective, requiring adaptations for

clients with cognitive impairments (Aharonovich et al., 2003, 2018; Beck, 2020; Carroll et

al., 2011; Gallagher et al., 2019; Spector et al., 2012). The comparatively high cognitive

demand in traditional CBT stems from the fact that it requires multiple cognitive domains

such as memory, language, abstraction, attention, inhibition, and learning (Aharonovich et al.,

2018). Providing psychoeducation on the cognitive model to clients is also a step in

enhancing their understanding of beliefs and thoughts, forming an integral component of

CBT. This process of ‘metacognition’ requires a level of abstraction which may not be

feasible in clients with marked cognitive impairments (Beck, 2020). Some modifications that

can be adapted include using learning aids to help educate the clients (Beck, 2020), or to add

more behavioural techniques such as repetition, daily logs, and diaries to help modify the

client’s belief in a less cognitively demanding manner. (Aharonovich et al., 2018; Carroll et

al., 2011).

Conclusion

Cognitive Behavioural Therapy (CBT), characterised by its origins in the cognitive

revolution, the use of cognitive models, the employment of cognitive methods, and its

constraints in cognitive impairments, highlights CBT as a therapy fundamentally oriented

towards cognitive processes.

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