Cognitive Behavioral Therapy (CBT)

What Is Cognitive Behavioral Therapy?

Assumptions of CBT

• people actively process information;

• our appraisals (the way that we think and interpret events) determine how we feel;

• dysfunctional thinking and biases in information processing (cognition/​thinking) are responsible for the problems that people experience;

• different problems are associated with different cognitive themes (cognitive specificity theory): depression is associated with loss and defeat; anxiety is associated with danger and threat; obsessive-compulsive disorder is associated with inflated responsibility; substance abuse is associated with permissive beliefs; eating disorders are associated with self-criticism; social anxiety is associated with fear of evaluation; and PTSD is associated with appraisals of immediate threat;

• the thoughts that we have can be ‘distorted’ or biased. Common biases include over-generalization, arbitrary inference, selective abstraction, and catastrophizing;

• changing how we think and act will impact how we feel: cognition, emotion, and behavior interact in a reciprocal manner;

• psychopathology is a result of an interaction between stress and vulnerability;

• cognition happens at multiple levels (Alford & Beck, 1997) and all can influence the way that we feel and behave: preconscious, unintentional, automatic (e.g., negative automatic thoughts); the conscious level (e.g., if a patient is asked to explain the meaning of an automatic thought); and the metacognitive level (beliefs about beliefs);

• experiences, memories, thoughts, attitudes, and beliefs are encapsulated as ‘schemas’ and which may become activated and influence our perceptions and behaviors.

Principles of CBT

• cognitive behavioral therapists use formulation to focus their therapeutic work

• cognitive behavioral therapists use formulation to tackle interpersonal and alliance issues

• cognitive behavioral therapy requires a sound therapeutic relationship

• cognitive behavioral therapists stress the importance of collaboration in the therapeutic relationship

• cognitive behavioral therapy is brief and time-limited

• cognitive behavioral therapy is structured and directional

• cognitive behavioral therapy is problem- and goal-oriented

• cognitive behavioral therapy initially emphasizes a focus on the present

• cognitive behavioral therapy uses an educational model

• homework and self-practice is a central feature of cognitive behavioral therapy (incorporating the use of CBT worksheets)

• cognitive behavioral therapists teach clients to evaluate and modify their thoughts

• cognitive behavioral therapy uses various methods to change cognitive content including thought records, behavioral experiments, surveys

• cognitive behavior therapy uses a variety of methods to promote behavioral change including exposure, behavioral experiments, role-play.

Procedures and Techniques of CBT

• Data gathering and symptom monitoring are used to understand problems and to measure change. CBT is an evidence-based approach that relies upon accurate data gathering regarding symptoms and experiences.

• Behavioral activation is a set of techniques for encouraging engagement in meaningful activity and is an effective treatment for depression.

• Case formulation is a method for understanding the origin and maintenance of a problem in cognitive and behavioral terms. CBT therapists may use a mixture of cross-sectional formulation to understand difficulties in the here-and-now, longitudinal formulation to understand the origins and precipitants of a problem, and cognitive behavioral models to understand the mechanisms underlying a problem.

• Cognitive restructuring describes techniques for changing what we think. It often involves the use of thought records, behavioral experiments, data gathering, or psychoeducation.

• Exposure is a technique from behavior therapy that is extensively used by CBT therapists, particularly for the treatment of anxiety. ‘Facing your fears’ is an essential behavioral component of CBT.

• Problem solving describes a series of techniques that are often taught as part of a CBT intervention. Effective problem solving helps people to make adaptive choices.

• Socratic methods are used by CBT therapists to help their clients explore what they know, and to form their own opinions on a topic. Aaron Beck encouraged the use of Socratic-like technique in his original treatment manual “use questioning rather than disputation and indoctrination … it is important to try to elicit from the patient what he is thinking rather than telling the patient what the therapist believes he is thinking” (Beck et al, 1979).

References

• Alford, B. A., & Beck, A. T. (1997). The relation of psychotherapy integration to the established systems of psychotherapy. Journal of psychotherapy integration, 7(4), 275-289.

• Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression. New York: Guilford.

• Beck, J. S. (1995). Cognitive therapy: Basics and beyond. New York: Guilford.

• Wills, F. (2009). Beck’s cognitive therapy. CBT Distinctive Features Series. New York: Routledge.