ORIGIN OF CBT

• Aaron Beck was psychoanalytic psychotherapists.

• In early 1960 Aaron beck developed an approach known
as cognitive therapy as a result of his research on
depression.
• In psychoanalytic depression was thought to be based
on retroflective hostility. But the beck findings did not
support the psychoanalytic formulation.
• Aaron Beck observations of depressed clients revealed
that they had a negative bias in their interpretation of
certain life vents, which contributed to their cognitive
distortions.
•
• Beck called it cognitive therapy because of the importance
it plaĐes oŶ thiŶkiŶg. It’s Ŷoǁ kŶoǁŶ as ĐogŶitiǀe-behavioral
therapy (CBT) because the therapy employs behavioral
techniques as well.
WHAT IS COGNITIVE
BEHAVIOR THERAPY
͞CBT is a proĐess of teaĐhiŶg, ĐoaĐhiŶg, aŶd
reinforcing positive behaviors. CBT helps
people to identify cognitive patterns or
thoughts and eŵotioŶs that are liŶked ǁith
ďehaǀiors.͟
•Thinking: Different people can think differently about the
same event. The way in which we think about an event
influences how we feel and how we act. A classic example is
that when looking at a glass of water filled halfway, one
person will see it half empty and feel discouraged and the
other sees it half full and feels optimistic.
• Behavior: What we do affects how we feel and
think. The individual, who deals with an upcoming exam
by putting off his studies until the last minute, is likely
to experience more distress on the day of the exam
than an individual who has studied well in advance. CBT
helps people to learn new behaviors and new ways of
coping with events, often involving the learning of
particular skills.
•Therapy : Besides its special focus on the relationships
between how we think, feel and behave, the following are
fundamental to the practice of CBT.
o Qualities of the Therapeutic Relationship
oGoal-setting
oFocus on the Present
oStructure
THEORETICAL ASSUMPTIONS
OF CBT
• BeĐk’s is ďased oŶ the theoretiĐal ratioŶale that the ǁay
people feel and behave is determined by how the perceive
and structure their experience.
• The theoretical assumptions of CBT are
1) that people’s ĐoŵŵuŶiĐatioŶ is aĐĐessiďle to
introspections.

2) that ĐlieŶts’ ďeliefs haǀe highly persoŶal

meanings
3) that these meanings can be discovered by the
client rather than being taught or interpreted
by the therapists.
PRINCIPLES OF CBT
 BASIC PRINCIPLES
• Cognitions affect behavior and emotion.

• Cognitions may be made aware, monitored and altered.

• Desired emotional and behavioral change can be

achieved through cognitive change.
• Change mood states by using cognitive and behavioral
strategies:
o Identifying/modifying automatic thoughts & core beliefs,

o Regulating routine, and

o Minimizing avoidance.
 BASIC PRINCIPLES
• Emphasis on ‘here and now’
• Preference for concrete examples
o Start with specific situation (complete thought log)

• Reliance on Socratic questioning

o Ask open-ended questions

• Empirical approach to test beliefs

o Challenge thoughts not based on evidence
o Cognitive restructuring
ELEMENTS OF CBT
• CBT has several defining elements. They are as follows:
o ACTIVE: The client must be involved in the
therapeutic process not as an observer or as an
occasional visitor, but as a core and key participant.

o MOTIVATIONAL: The therapist needs to take

responsibility for helping to motivate the client
toward a change in behavior, affect, or thinking. The
therapist must be able to set up the format, and
rationale for the client to consider change of value.

o DIRECTIVE: The therapist must be able to develop a

treatment plan and then to help the client to understand,
contribute to, and see the treatment plan as a template for
change.
o STRUCTURED: CBT is structured in two ways. First, the overall
therapy follow structure that approximates the treatment plan.
Sessions have identifiable beginning, middle and end.

o COLLABORATIVE: Therapeutic collaboration cannot be 50/50.

for severe depressed client the possibility to generate 50% of
the therapeutic effort is impossible. Initially, the collaboration
may be 90/10. For each client, the therapist must evaluate the
ĐlieŶt’s aďility aŶd ŵotiǀatioŶ for the therapy.

o PROBLEM-ORIENTED: CBT focuses on discrete problems

rather than vague and amorphous goals of feeling good,
getting better, or increasing self-esteem
o PSYCHO EDUCATION: The therapist works as a
change agent. Many to problems that bring people
therapy involve skills deficits. The therapist may have
to teach by direct instruction , modeling, role playing.

o SOLUTION-FOCUSED: The CBT therapists works with

the client on generating solutions not simply
gaining insight into the problem.

o DYNAMICS: The dynamic level of CBT is to help

clients to identify, understand, modify their schema.
The schema are the basic templates for
understanding oŶe’s ǁorld. SĐheŵa ŵay ďe persoŶal,
religious, cultural, gender-related.
o TIME-LIMITED: Each therapy session should,
ideally , stand alone. A time-limited focus is not a
number of sessions, but rather way of looking at
BASIC FEATURES OF
CBT
 Rationale of CBT
• Negative emotions are elicited by cognitive processes
developed through influences of learning and
temperament.
• Adverse life events elicit automatic processing, which is
viewed as the causal factor.
• Cognitive triad: Negative automatic thoughts center
around our understanding of:
o Ourselves
o Others (the world)
o Future
• Focus on examination of cognitive beliefs and
developing rational responses to negative automatic
thoughts.
• Distorted appraisals follow themes relevant to the specific
psychiatric condition.
• Psychological disorders are characterized by a different
psychological profile.
o Depression: Negative view of self, others, and future. Core
beliefs associated with helplessness, failure,
incompetence, and un lovability.
o Anxiety: Overestimation of physical and psychological
threats. Core beliefs linked with risk, dangerousness, and
uncontrollability.
 COGNITIVE SPECIFICITY
• Negative Triad Associated with
Depression
oSelf ͞I aŵ iŶĐoŵpeteŶt/uŶloǀaďle͟ o
Others ͞People do Ŷot Đare aďout ŵe͟ o
Future ͞The future is ďleak͟

• Negative Triad Associated with Anxiety

oSelf ͞I aŵ uŶaďle to proteĐt ŵyself͟
oOthers ͞People ǁill huŵiliate ŵe͟
oFuture ͞It’s a ŵatter of tiŵe ďefore I aŵ
eŵďarrassed͟
 EVENT
Bill goes to
collection APPRAISAL
MALADAPTIVE ͞I ĐaŶ Ŷeǀer do
BEHAVIOR aŶythiŶg right͟
Withdrawal,
avoidance

AFFECTIVE &
BEHAVIORAL
BIOLOGICAL
INCLINATION
AROUSAL
I doŶ’t ǁaŶt
decreased
to
sleep,
deal with it
low energy
• Core beliefs underlie and produce automatic thoughts.
• These assumptions influence information processing and organize
understanding about ourselves, others, and the future.
• These core beliefs remain dormant until activated by stress
or negative life events.
• Categories of core beliefs (helpless, worthless, unlovable)
 AUTOMATIC THOUGHTS
• Thoughts that automatically come to mind when
a particular situation occurs is called as automatic
thoughts.
• Happen spontaneously in response to situation
• Do not arise from reasoning
• No logical sequence
The systematic errors in reasoning that lead to faulty assumptions
and misconceptions which are termed as cognitive distortions.
• Arbitrary Inference: refers to making conclusions without
supportiŶg aŶd releǀaŶt eǀideŶĐe. This iŶĐludes ͞ĐatastrophiziŶg͟
or thinking of absolute worst scenario and outcomes for most
situations.
• Selective abstraction: consists of forming conclusions based
on an isolation detail of an event. In this process other
information is ignored and the significance of total context is
missed.
• Overgeneralization: is a process of holding extreme beliefs on
the basis of a single incident and applying them
inappropriately to dissimilar events and settings.
• Magnification and minimization: consist of perceiving a case
 COGNITIVE DISTORTIONS cont.
• Personalization: is a tendency for individuals to relate
external events to themselves, even when there is no basis for
making this connection.
• Labeling and Mislabeling: iŶǀolǀe portrayiŶg oŶe’s ideŶtity oŶ
the basis of imperfections and mistakes made past and alloǁiŶg
theŵ to defiŶe oŶe’s true ideŶtity.
• Polarized Thinking: involve thinking and interpreting in all-or-
nothing terms, or categorizing experiences in either or
extremes. With such dichotomous thinking, events are labeled
in black or white terms.
Beck contends that people with emotional difficulties tend
to Đoŵŵit ĐharaĐteristiĐ ͞logiĐal error͟ that tilt oďjeĐtiǀe
reality in the direction of self-destruction. Cognitive
therapy perceives psychological problems as stemming
from commonplace processes such as faulty thinking,
making incorrect inferences on the basis of inadequate or
incorrect information and failing to distinguish between
fantasy and reality.
TECHNIQUES OF
CBT
 Techniques of CBT

The cognitive behavioral therapy techniques are an

interesting set of exercises that help modify a
person's behavioral patterns. The behavioral patterns
are modified in order to bring about positive changes
in the personality.
• In this technique, the patient is asked to recall a problematic
situation of the past.
• The therapist and patient both work together to find out a
solution for the problem or a way in which the difficult situation,
if it occurs in the future can be sorted out.
• The therapist asks the patient to rehearse positive thoughts
cognitively in order to make appropriate changes to the latter's
thought processes.
• Power of imagination proves to be of great use in such exercises.
 Validity Testing
• In this techniques the therapist tests
validity of beliefs/thoughts of the
patient.
• The patient is allowed to defend his
viewpoint by means of objective
evidence.
• The faulty nature or invalidity of the
beliefs of the patient is exposed if
he/she is unable to produce any kind of
objective evidence
• It is the practice of maintaining a diary to keep an account of
situations that arise in day-to-day life
• Thoughts that are associated with these situations and the
behavior exhibited in response to them are also mentioned
in the diary.
• The therapist and patient together review the matter written
in the journal and find out maladaptive thought pattern.
• The discussion that takes place between them proves to be
useful in finding different ways in which behavior of the
patient gets affected
 Guided Discovery
• The objective or purpose behind using this technique
is that of helping patients by enabling them to
understand their cognitive distortions.

• Patients are made aware of and assisted by

therapists in understanding how they process
information.

• The activity of understanding how information is

processed allows patients to alter the same
(information processing) if required.
 Guided Discovery
• Basically, the patient's perception of the world

undergoes great change and he/she sees things in a

different way than earlier.

• This change in perception allows the patient to

modify his/her behavior in a better manner

• It is one of the cognitive therapy techniques in
which therapists perform role-playing
exercises aimed at responding in a way that is
helpful to overcome difficult situations.

• The patient makes use of this behavior of the

therapist as a model in order to solve
problems he/she comes across.
 Homework:
• The homework is actually a set of
assignments given by therapists to
patients.

• The patient may have to take notes

during sessions with therapists,
review audiotapes of a particular
session or read articles/books related
to the therapy.
• Amongst the different CBT techniques used
by therapists, aversive conditioning
technique makes use of dissuasion so as to
lessen the appeal of a maladaptive
behavior.
• The patient while being engaged in a
particular behavior or thought for which he
has to be treated, is exposed to an
unpleasant stimulus.
• Thus, the unpleasant stimulus gets
associated with these
thoughts/behavior and then the
patient exhibits an aversive
behavior towards them
 Reinforcement
• The systematic positive reinforcement is one
of the techniques of CBT therapy in which
certain (positive) behavior of a person are
rewarded with positive reinforcement.

• A reinforcement system is established for the

of certain positive behavior.
Just like positive reinforcement proves to
be helpful in encouraging a particular
behavior, withholding the reinforcement
deliberately also is instrumental in
eradicating a maladaptive behavior.
• In self-instructional coping methods, the therapist attempts not
to completely change the way you think, but rather teaches
coping methods that equip you to handle harmful thought
processes. One such therapeutic process is stress inoculation
training.

• This therapy -- which helps the patient deal with stressful

events' aftermath -- aims to prevent negative reactions to stress-
inducing factors by teaching the patient to break down these
situations into short-term and long-term coping goals
 Problem-Solving Methods
• Cognitive-behavioral therapy -- which sees irrational
thought processes as resolvable -- incorporates
problem-solving methods. After illogical thought
patterns are found, the patient must suggest several
alternative solutions.

• Through the decision-making process, negative

solutions are weeded out until an acceptable, positive
approach is discovered. This type of therapy sometimes
is used in child psychotherapy when dealing with
oppositional defiant disorder.
• One method of conducting cognitive-
behavioral therapy is through computer-based
programs. This therapy tends to decrease time
spent with an actual therapist. Since computer-
assisted CBT is relatively new, as of
publication, most of the information is in the
testing phase.
However, primary-care treatment programs that have
begun integrating the method for treating co-morbid
anxiety and mood disorders have found promise in this
type of therapy, states researchers in "Depression and
Anxiety," the official journal of the Anxiety Disorders
Association of America
 References
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Oxford Press.Inc, New York.

Carson. R.C., Butcher J. N & Mineka. S., (2001). Abnormal Psychology and Modern Life. ( 11 th Ed).

Published by Pearson education, Inc. and Dorling Kindersley Publishing Inc.

Doboson. D & Dobson. K., (2009). Evidence-Based Practice of Cognitive -Behavior Therapy.

Published by Guilford publication.Inc.

Ronen. T & Freeman. A.,( 2007) CBT in Social Work Practice. Published by Spring publishing

Company,LLC.

Sheldon. B.,(2011). Cognitive Behavior Therapy Research and Practice in Health and Social Care.

(2nd Ed). Published by Routledge publication New York.