1 Cognitive Behavioral Therapy (CBT)

Overview and History

Cognitive Behavioral Therapy (CBT) is a goal-oriented, problem-focused, short-term (8 to 20 sessions) therapeutic treatment created in the 1960s by Aaron T. Beck (Boyd-Franklin et al., 2016; Martin, 2019). Beck, a psychoanalytic practitioner at the time, noticed that clients he was working with had an internal dialogue going on in their minds and theorized that if that dialogue was explored and challenged, people could change how they responded to various symptoms and situations that they were experiencing (Gillihan, 2018; Martin, 2019). CBT is focused on the here and now, where clinicians and clients work together to identify automatic-thoughts, core beliefs, feelings, and behaviors that clients are experiencing in distressful moments (Boyd-Franklin et al., 2016; Gillihan, 2018; Martin, 2019). Once those are identified, CBT focuses on changing automatic thoughts into thoughts that are more grounded in reality. This is done through a series of homework assignments, mindfulness techniques, role plays, and other various techniques that develop a client’s ability to identify negative behaviors and thoughts and change them to reflect more positive or non-reactive outcomes. (Boyd-Franklin et al., 2016; Gillihan, 2018; Martin, 2019).

Effective For:

Core Principles and Terms

Automatic Thoughts: thoughts that are instantaneous, habitual, and nonconscious that can affect a person’s mood and actions. (APA)

The aim of CBT is to identify the client’s negative automatic thoughts that lead to experiencing distressing emotional states and negative behavioral patterns.

Core Beliefs: Ideas people begin to develop in childhood that influence the ways in which they view themselves, their families, other individuals, and their world (Boyd-Franklin et al., 2016).

Thoughts-Emotions-Behaviors :

CBT is often explained through this triangle, which shows that thoughts, behaviors and emotions are interconnected and affect each other. Some charts have “core beliefs” in the middle of the triangle showing that  it all starts with what we believe. (Gillihan, 2018)

Cognitive Restructuring: A technique used to help the client identify their self-defeating beliefs or cognitive distortions, refute them, and then modify them so that they are adaptive and reasonable (APA).

Cognitive Distortions or Thinking Errors: An automatic way of repeatedly interpreting a situation that causes someone to not consider other ways of thinking about it. (Beck, 2011; Boyd-Franklin et al., 2016; Gillihan, 2018; Martin, 2019)

• All-or-nothing thinking (black and white, polarized, or dichotomous thinking): If a situation or action falls short of perfect, you see it as a total failure. Example: “I’ve completely blown my diet because I ate that donut yesterday.”
• Disqualifying or discounting the positive: Telling yourself that positive experiences and qualities don’t count. Often shows up as explaining good things as a fluke or sheer luck instead of based on your own actions. Example: Being told by a coworker that you did a good job, but saying to yourself that you didn’t do the job well enough.
• Emotional Reasoning: Judging yourself or your circumstances based on your emotions. Example: “If I feel that way, it must be true.”
• Jumping to Conclusions: Interpreting things negatively when there are no facts to support your conclusion.
  • Mind Reading: Believing that you know what someone else is thinking without checking in.
  • Fortune Telling: Predicting that events will unfold in a particular way often trying to avoid something difficult.
• Labeling: Placing a fixed, global label on yourself or others without considering other options. Example: Using “Becky is always so rude” or “I’m just a drunk.”
• Magnifying and minimizing: The importance of something relatively insignificant (e.g. a small mistake) is exaggerated, while positive aspects are lessened.
  • Catastrophizing: A form of magnification (or fortune telling) where you take meaning from one negative event and apply it to all events. Example: “I messed up at work and I’m going to get fired, then won’t be able to find a job because the economy is bad, and I won’t be able to pay my rent so I’ll be homeless.
• Mental Filtering: Taking negative details and magnifying those details while filtering out positive aspects of a situation.
• Overgeneralizing: Reaching a conclusion about one event and then incorrectly applying it to other situations, people, behaviors etc. Example: You fail a math test so you conclude that you are completely hopeless at math in general.
• Should Statements: “I shouldn’t feel this anxious getting on a plane.” “I ought to be in more control of myself.”
• Personalization (Blaming one’s self): Believing anything that others do or say is a direct or personal reaction to you or your actions when the event or reactions are not connected to you at all.

Critiques and Limitations

CBT involves a commitment to outside homework that can take up a lot of time.

CBT is highly structured, which may not be suitable for people with more complex mental health needs or learning difficulties.

CBT addresses current problems and focuses on specific issues, which may not address possible underlying causes of mental health conditions.

CBT focuses on an individual’s capacity to change themselves, and does not address wider, systemic problems or ruptured family systems that have a significant impact on an individual’s health and wellbeing.

CBT uses language such as “dysfunctional,” “negative self-concepts,” “irrational beliefs,” which can feel invalidating and perpetuate negative stereotypes of mental health.

(Sun, 2009; Roes, 2011; Windermere, 2018;)

Resources

https://www.psychologytools.com/downloads/cbt-worksheets-and-therapy-resources/

https://beckinstitute.org/get-informed/tools-and-resources/professionals/cbt-basics-and-beyond-patient-worksheets/

https://www.therapistaid.com/therapy-worksheets/cbt/none