Principles of CBT

Principle1:CBT is based on the cognitive Model

• IN CBT cognitive model of mental illness, initially developed
by Beck (1964)is used as a basis of intervention. Cognitive
model hypothesizes that people’s emotions and behaviors are
determined by their perception of things, not the situations.
• Therapist needs to be versed in grasping difference between
cognition, emotion, behavior and physiological responses. He
must be able to communicate clearly that psychological
disturbance is maintained by mistaken or dysfunctional
appraisal of situation.
• He gives this explanation in the first session and reiterates it
throughout therapy.
Principle:2 CBT is brief and time- limited

• Pace of therapy is relatively brisk, task oriented n

focuses on problem solving, Time is a limited
recourse , therapist covers important material but
moves quickly.
• Brief therapy discourages patients dependency and
encourages patients self sufficiency
• A typical course of CBT for non comorbid anxiety
and depression consists of between 5 to 20 sessions
but in some cases greater number of sessions are
required.
 Strategies for keeping therapy brief

• Keep it simple: Complicating the conceptualization

and treatment process prolongs treatment and
makes it less effective
• Make it specific n concrete: Abstract
conceptualization and treatment will make it longer.
For example, Instead of referring four basic emotions
as anxiety, depression, anger and and euphoria,
therapist may call them as scared, sad, mad and glad.
 Continued
• Stress home work: it makes recovery fast
• Make ongoing assessments: IN most of anxiety cases,
elaborate assessment is unnecessary. Required info for
proper intervention is obtained throughout treatment.
• Use time management procedures: e.g., setting and
sticking to agenda for each session, give hand outs,
audio tapes, using posters for techniques etc.
• Develop brief intervention mental set: Research
indicates, long term treatment is not effective.
• Lenghth of session: Generally,a session is one hour,
 Principle 3: Building a sound therapeutic
relationship is a necessary condition in CBT
• Therapist must give high priority to the establishment
of good therapeutic alliance. It’s a trust between the
patient and the therapist that allows them to work
effectively
• He has to build rapport with patients with such
methods as sincerity, accurate empathy, active
listening(correctly understanding what the patient is
saying and conveying this understanding to him), and
the expression of warmth and acceptance.
Principle 4: Therapy is a collaborative effort
between therapist and Patient
• The cognitive therapist implies the patient to view
therapy as a teamwork to solve the patients
problem. He fosters the attitude ‘two heads are
better than one’ in approaching personal difficulties .
• Initially therapist takes the lead, as therapy
progresses, the patient is encouraged to become
increasingly active in the therapy session:deciding
which problems to talk about, identifying the
distortions in his thinking, summarizing important
points and devising homework assignments.
Principle 5:CBT is Structured and Directive

• Standard procedures are used to structure therapy that maximize

efficiency and effectiveness. This structure includes;
• An Introductory Part: i.e., mood check, briefly reviewing week,
collaboratively setting agenda for the session.
• Middle Part: reviewing home work, discussing problems on agenda,
setting home work and summarizing.
• Final Part: eliciting feedback
• Following this format makes therapy process understandable and facilitate
the patient to do self -therapy after termination
 Principle 6: CBT is Goal Oriented and
.Problem Focused
• CBT is problem focused, Initial focus of CBT is on solving
present problems. Later, past material is restructured and
then plans for future are made.
• The problem list of patient provides details of ‘what's
wrong’ and this should be changed into a goal or a
statement of “what the patient would like to happen’.
Mutually agreed goals are set.
• Goals should be smart i.e., specific, measurable, achievable
and time -limited. For example, ‘I want to feel better’,or ‘I
want not to feel isolated ‘is a vague term. It needs
operational ising ( should be measurable and observable)
 Principle: 7
CBT is Based on an Educational Model
• CBT is educative, aims to teach the patient to be his own
therapist and emphasizes relapse prevention.
• CBT incorporates didactive techniques such as giving
information, assigning reading , listening to audio tapes,
and written homework
• Patient is given information about nature and course of
his disorder, about the process of cbt, about cognitive
model (i.e.,how her thoughts influence his emotions and
behavior).
• A therapist help set goals, identify and evaluate thoughts
and beliefs and plan behavioral change.
 Principle:8 CBT Relies on The Inductive
Method/Collaborative Empiricism
• The development of CBT was based on inductive
reasoning and empirical research.
• Patients are trained in a scientific way of thinking.
• Patient is taught to work as a scientist with
therapist, consider beliefs as hypotheses not
facts, and gather data to support or negate those
hypotheses.
• Emphasis throughout the therapy is ‘getting the
facts’.
Principle 9: CBT teaches patients to identify, evaluate
and restructure their dysfunctional thoughts
• Patients may have dozens or even hundreds of
automatic thoughts a day that affect their mood,
behavior or/and physiology.
• Therapist help them to identify key cognitions and
adopt more realistic and adaptive perspective which
leads patients to feel better emotionally, behave
more functionally and / or decrease their
physiological arousal.
• Therapists do so using cognitive and behavioral
techniques.
 Principle 10: Homework is a Central
Feature of Cognitive Therapy
• The therapist should explain the practical reason
for doing homework i.e., Once a week visit is
insufficient for overcoming long- held beliefs and
that change would occur between the session not
within the session.
• Research shows that the degree of recovery is
related to how much effort one puts into
treatment.
• Therapist should look for blocks that prevent
patient from doing home assignment.