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Subject PSYCHOLOGY

Paper No and Title Paper No.15: Clinical Psychology

Module No and Title Module No.30: Cognitive Behaviour Therapy

Module Tag PSY_P15_M30

TABLE OF CONTENTS

1) Learning Outcomes
2) Introduction
3) Basic assumptions of the approach
4) Role of therapist
5) Key techniques
6) Evaluation : 6.1 Strengths,
6.2 Limitations
7) Summary

PSYCHOLOGY PAPER No. 15:clinical Psychology

MODULE No.30: Cognitive Behavior Therapy
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1. LEARNING OUTCOMES
After studying this module, you should be able to

 Know the origins of Cognitive Behavior Therapy

 Understand the principles of Cognitive Behavior Therapy
 Learn about the basic assumptions of this approach
 Insight into the role of counselor
 Analyze the key techniques
 Evaluate the approach

2. Introduction
Cognitive Behaviour Therapy has its origins in both Cognitive psychology and behaviourism.
The cognitive component focuses on the effects of thoughts on behaviour, with rigorous emphasis
on methodology and performance. A brief historical sketch has been provided by Arnkoff and
Glass (1992). When the behaviour therapy was in its prime, these approaches were initiated. In
the 1950s, Ellis developed the rational therapy, that later became Rational –Emotive Therapy
(RET) and now called as Rational Emotive Behaviour Therapy (REBT). This was so called as the
approach always focused on the reciprocal interaction among cognition, emotion, and behaviour.
In the 1960s, the Behaviour Therapy began to broaden to include cognitions as legitimate
behaviour that could be learned and modified. Mahoney (1977) coined the term cognitive
revolution to describe the new perspective, which recognized private events and inter-personal
factors along with the importance of environmental variables. Further impetus to the cognitive
approach came from Aaron Beck’s cognitive therapy and Donald Meichenbaum’s cognitive
behaviour modification. All cognitive approaches are based on a structured psycho-educational
model. All these place importance on homework, and put responsibility on the client. The client
has to take an active role both inside and outside therapy sessions.

Aaron T Beck was trained in psychoanalysis and he found Freud’s approach lacking as he
examined it in the early 1960s. Hence he developed Cognitive therapy (CT) which was similar to
Ellis’s RET. The basic goal of CT is to understand the nature of an emotional episode or
disturbance by focusing on the cognitive content of an individual’s reaction to the upsetting
event. The goal is to change the client’s thinking by using automatic thoughts to reach the core
schemata and begin to introduce the idea of scheme restructuring.

3. Basic Concept- Cognitions & schemata

The Thought-Feeling-Action model states an environmental stimuli or situation may trigger
thoughts associated with a personal connotation. These thoughts in turn elicit physical and
affective arousal (emotions). These emotions, in turn, effect the thoughts by processing
information and worsens the negative affect. Thus, the individual’s behavioral responses to
stimuli and thoughts are viewed as both a product and a cause of maladaptive cognitions. In CBT,
treatment interventions may be targeted at any or all components i.e thoughts, feelings and /or
actions.

PSYCHOLOGY PAPER No. 15:clinical Psychology

MODULE No.30: Cognitive Behavior Therapy
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Beck (1967) coined the term negative cognitive triad to

describe the content of automatic negative thoughts. Typically,
automatic negative thoughts may be grouped by themes pertaining to (1) self, (2) world (i.e.,
significant others or people in general), and (3) future.

Ingram (1983) divided cognition into four inter-related but conceptually distinct elements:

 Cognitive structure refers to the way in which information is organized and internally
represented. It is a psychological mechanism to store information.

 Cognitive proposition refers to the content stored in the cognitive structures.

 Cognitive operations serves as the mechanism for information processing and involves
selective attention, perception, encoding, storage and retrieval.

 Cognitions are the product of processing of information and manifest as thoughts,

verbalizations and explicitly held outcomes such as beliefs, opinions, attitudes, values,
judgments and conclusions.

Schemata ((Rush & Beck, 1978) are inflexible, general rules or silent assumptions (beliefs,
attitudes, concepts etc) that develop as enduring concepts from past (early) experiences.
 They form the basis for screening, discriminating, weighing and coding stimuli,

 They form the basis for categorizing, evaluating experiences and making judgments and
distorting reality situations.

Thus, schemata can be identified as etiologically accountable for such problems as:
1. Distortions inn thought processing

2. Maladaptive emotional episodes

3. Faulty exaggerated unrealistic expectations of self, others and environmental conditions.

Improvements in these problems can be achieved by targeting underlying schemata for change
and effectively modify them.

4. Role of Therapist
Beck (1987) emphasized that the quality of the therapeutic relationship is basic to the application
of cognitive therapy. The therapist must be genuine, warm, empathic, non-judgmental, accepting
and have the ability to develop trust and rapport with client. The therapist must also have a
cognitive conceptualization of cases, be creative and active, and be able to engage clients through
a process of Socratic questioning. He should have the knowledge of both cognitive and
behavioural strategies. This will help client to discover themselves.

5. Key Techniques
Cognitions as targets of change

 Cognitions, emotions and behaviours are viewed as interactive within a

social/environmental context. Although cognitions do not cause dysfunction, they are
PSYCHOLOGY PAPER No. 15:clinical Psychology
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inherent part of it. Targets for change include both

cognitive outcomes and processing. Beliefs,
expectations and meanings attached to life events may be the objectives of exploration
and change.

EMOTION COGNITION

BEHAVIOUR

 Locus of control, learned hopelessness and self-efficacy have an influence on people’s

attributional beliefs. People with greater sense of internality will tend to view outcomes
and the products of their own efforts whereas “externals” will tend to view outcomes as
caused by luck, fate etc. Analysis of attributions provides us insight into the affect,
cognition and behaviour and present an intervention point.
 Negative attributions take many forms. Blaming places responsibility for feelings and
outcomes on another. “You make me feel mad/guilty”. “You are a leo”, “h has no will
power-he was born that way”. Attributional style has been associated with a range of
psychological problems and conditions.

COGNITIVE DISTORTIONS

Distortions in the information-processing process can occur in many ways such as:

 Absolutistic thinking- It is the tendency to view experiences in polarized manner such as

good/bad, right/wrong, strong/weak. E.g “I am a complete incompetent”, life’s hell’. This
is dichotomus thinking or All-or-nothing thinking.
 Overgeneralization- such people draw a general rule or conclusion on the basis of one or
more isolated incidents and apply the concept to related and unrelated situations. “I am
no good”, Stores never have shoes of my size”.
 Selective abstraction- it involves focusing on the negative in a situation, ignoring
positive features.
 Arbitrary inference- reaching to a negative inference when there is no evidence for it or
it is vague, unclear, and circumstantial. There are two types of arbitrary inferences- Mind
reading- “she thinks I am weak, I just know it”, “the boss doesn’t like me, I am certain”.
Negative prediction – imagining or anticipating negative/ unpleasant consequences- “I
just know there will be a problem in this vacation”.
 Magnification and minimization- It is an error in evaluating the significance or extent
of a behaviour, condition or events that are so extreme to constitute a distortion.

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Magnifying imperfections in them, minimizing talents.

E.g. becoming extremely emotional or critical of ones
errors.
 Personalization- It is an act of relating a negative event or situation to oneself without
adequate causal evidence to make the connections. E.g. “If I had been at home with dad, I
don’t believe he would have had a heart attack”. ‘They are working on the road because I
am running late for office”.

KEY TECHNIQUES:

1. Socratic questioning teaches the use of rationality and inductive reasoning to ascertain
whether what is thought or felt is actually true. The therapist models the use of Socratic
questioning and encourages the patient to start raising questions about the accuracy and validity
of his or her thinking.
2. Imagery & Role-Playing- When imagery is used, the therapist sets the scene by asking the
patient to visualize the situation that caused distress. In role-playing exercises, the therapist and
patient act out an interpersonal vignette to uncover automatic thoughts or to try out a revised
pattern of thinking.
3. Thought recording- Thought recording is one of the most useful procedures for identifying
and changing automatic thoughts. They can record events, thoughts, and emotions in the three
columns. The purpose of this exercise is to encourage patients to begin to use self-monitoring to
increase awareness of their thought patterns. Next, the strength of the emotion and the
believability of the automatic negative thoughts are rated on a scale of 0 to 100.

Date Event Automatic Emotions Rational Outcome

thoughts Thoughts
a. Describe an a. Write automatic a. Specify a. Identify a. Specify
actual event thought(s) that led sad, cognitive and rate
preceding an to emotion(s). anxious, errors. subsequent
unpleasant Angry, b. Write Emotion,
emotion tense, etc. rational 0_100.
b. Stream of b. Rate of belief in b.Rate response
thoughts, automatic degree of To automatic
daydream, or Thought, 0-100. Emotion, 0- thought(s).
memories 100. c. Rate belief
preceding in rational
unpleasant Response,
emotion 0_100%.

4. Psycho-education
CBT integrates psycho-educational procedures as a core element of the treatment process. These
procedures are woven into treatment sessions. The therapy aims at teaching the patient the
significance of challenging automatic thoughts, identifying cognitive distortions/errors, and
practicing implementing a more rational thinking style. Before initiating psycho-education,
behavioural interventions are sought to make the client understand principles of extinction,
reinforcement, self-monitoring, exposure, and response prevention.

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MODULE No.30: Cognitive Behavior Therapy
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THERAPEUTIC PROCESS

1. Teach the client categories of distortions- the therapist identifies the distortions of the
clients.
2. Create a thought diary- clients record their irrational thoughts following a mood affecting
situation, the category the thought belongs to, and more realistic alternative thoughts.
3. Engage in a Socratic dialogue- the counselor questions the client’s thinking processes,
challenges illogical ideas and helps him realize that their negative thoughts do not make
rational sense.
4. Test the evidence- the client is assigned the task of testing the validity of a negative
belief.
5. Breaking big problems into smaller ones- the counselor helps in breaking the bigger goal
into smaller tasks that can be accomplished step by step to reach their goal.
6. Use behavioural exercises- relaxation, physical exercise, practicing new social skills, role
play sessions, assertiveness training, and behavioural desensitization are used.

6. Evaluation of Behaviour Therapy

6.1 STRENGTHS

 CBT has been adapted to a wide range of disorders including depression and anxiety.
 CBT is a well researched, evidence based therapy that has proven effective for clients
from multiple backgrounds.
 It has also led to development of a number of useful and important clinical instruments
such as Beck’s Anxiety Inventory, Beck’s Hopelessness Scale and Beck’s Depression
scale.
 CBT has number of training centers around the US and Europe.

6.2 LIMITATIONS

 It is structured and requires client’s to be active such as completing assignments.

 It is not appropriate for those seeking more unstructured, insight oriented approach that
does not require strong participation.
 It is primarily cognitive in nature and not effective for intellectually limited or those who
are unmotivated to change.
CBT is demanding. Clinicians as well as clients must be active and innovative

7. SUMMARY
 The Thought-Feeling-Action model states an environmental stimuli or situation may
trigger thoughts associated with a personal connotation. These thoughts in turn elicit
physical and affective arousal (emotions). These emotions, in turn, effect the thoughts by
processing information and worsens the negative affect.
 Beck (1967) coined the term negative cognitive triad to describe the content of automatic
negative thoughts. Typically, automatic negative thoughts may be grouped by themes
pertaining to (1) self, (2) world (i.e., significant others or people in general), and (3)
future.

PSYCHOLOGY PAPER No. 15:clinical Psychology

MODULE No.30: Cognitive Behavior Therapy
____________________________________________________________________________________________________

 Schemata ((Rush & Beck, 1978) are inflexible, general

rules or silent assumptions (beliefs, attitudes, concepts etc) that develop as enduring
concepts from past (early) experiences.
 Cognitive distortions are errors in thinking resulting from previous beliefs, mental sets
and schemas. Beck has identified many types of schemas such as: All-or-nothing
thinking, Mind reading, Catastrophizing, Awfulizing, Labeling, Personalization,
Disqualifying the positive, Magnification, Fortune Telling, Abstraction, Generalization.
 CBT is a well- researched, evidence based therapy that has proven effective for clients
from multiple backgrounds.
 CBT is not appropriate for those seeking more unstructured, insight oriented approach
that does not require strong participation.

PSYCHOLOGY PAPER No. 15:clinical Psychology

MODULE No.30: Cognitive Behavior Therapy