Cognitive Behaviour
Therapy
CBT- BECK
Introduction
C B T = Cognitive Behaviour Therapy
Cognitive = thinking
Behaviour = doing/feeling
Therapy = changing how we think and
respond to a situation in order to effect
change in feelings and consequent future
behaviour.
Who could benefit from CBT
CBT is particularly helpful for people experiencing
depression, anxiety, eating difficulties, substance abuse and
issues with anger and frustration. There are four major
factors known to affect vulnerability to feelings of
depression.
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Genetic or biological factors such as hereditary factors
Early life experiences such as major losses.
Personality styles such as poor relationships of abuse
Social support system such as lack of support and
loneliness
What is CBT
CBT is a short-term therapy which focuses on specific conflicts or
abnormal thinking. CBT offers problem solving strategies empowering
the person in taking control of their lives and how they are feeling.
All CBT-based techniques assume that how we think about a situation
makes a huge contribution to how we feel and behave. CBT works on
the premise that how we think about an event is more important that the
event itself, in terms of how we feel in relation to the event. CBT also
recognizes however, that the relationship between thinking, feeling and
behaving can be quite complex, in that feelings can influence thinking,
and behaviour can influence thinking and feelings. eg. Someone cuts
me off in traffic
CBT has been modified into a variety of specialised streams,
e.g.:
• Cognitive Therapy
• Schema-Based Therapy
• Acceptance and Commitment Therapy
• Choice Theory
• Rational Emotive Therapy • Dialectical Behaviour Therapy (DBT)
CBT is a recognised, evidence-based therapy that can be used with a
variety of client problems, including:
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Anxiety
Depression
Anger management
PTSD
Chronic pain
Grief and loss
Eating issues
Sexual and relationship problems
What we know about thinking:
• Thinking styles are learnt, not inherited
• Changing thinking is a skill we can all learn – doesn’t necessarily come
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naturally and requires repetitive practice
We can change the way we think about a situation
Thinking about our thinking is a capacity that only humans have – it is a
skill to be developed – called “metacognition”
Prefrontal cortex is the part of the brain that allows us to think about our
thoughts
We are not always aware of what we are actually thinking
We often accept our thoughts as truth because we have thought them
without objectively evaluating them
The more we think a thought, the stronger the neural connections for
that thought become and the easier it is to think that thought in the
future – automatic thoughts
CBT is not “Pollyanna” thinking or simply positive
thinking. It helps people ensure that their thinking is
more realistic and objective.
Family type Resulting Schemas
Unpredictable / rejecting Disempowering
Permissive
Conditional acceptance
Grim & Perfectionistic
Figure 2. Family patterns and associated schema domains
Abandonment/instability
Mistrust/abuse
Emotional deprivation
Defectiveness/shame
Social isolation/alienation
Failure in achievements
Enmeshment/undeveloped self
Vulnerability to danger
Dependence/incompetence
Impaired Autonomy
Insufficient self-control
Impaired limits
Entitlements
Other directedness
Subjugation
Self sacrifice
Over vigilance and inhibition
Vulnerability to error
Over control
Unrelenting standards
Punitiveness
How do we learn to change thinking?
Basic process of CBT:
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Look at each situation specifically
Identify unpleasant feelings in relation to the specific situation
Identify what we are thinking about that situation in the first place
Identify the “cognitive distortions” (wonky thinking) that are present
in our current thoughts
5. “Test” the thoughts with the “evidence, realistic, objective, helpful”
tests (Disputing)
6. Generate some alternative ways of thinking about the situation that
pass the EROH test
7. Choose an alternative way and think about the situation – then
notice how my feelings have changed
8. Practice, practice, practice these new skills of thought disputing
across a variety of situations!
Common Cognitive Distortions
Cognitive Distortion
Black and white thinking – it’s all good or it’s all bad; no
grey areas; no in between; perfectionistic; “always”,
“never”
Questions to ask and Alternatives
The reality is that very few things in life are actually
black and white.
What grey areas might there be in this situation?
I would prefer clarity but I can cope with grey areas.
Life isn’t always fair, but that doesn’t mean I’m not an OK
person.
Personalising – “it’s all about me”; comments are
interpreted as personal attacks; overly guilty about
events that are not actually within the individual’s
control; guilt over others’ negative circumstances or
thoughts;
It’s not all about me!
What other reasons could account for that event other
than something about me?
I am not God and have very limited control over the
world outside me.
Bad things happen to good people.
Catastrophising – making a mountain out of a molehill;
catastrophic language to describe an event such as
“terrible, awful, totally bad, I can’t cope”
“I feel overwhelmed, and this is not the situation I
wanted, however I can find a way to manage.”
Explore worst case scenario – in reality, could I actually
cope if the worst happened?
Should’s/Oughts/Musts – perfectionistic; inflexible
rules about life that the individual applies to him/
herself and often to others as well; usually linked to
black and white thinking.
There are very few shoulds/musts/oughts in this life.
Expectations are the enemy of mental health.
Exactly what am I expecting of myself/other? Are the
expectations realistic of what a human being can
actually do? Who is setting this standard and why?
Can I ever achieve this standard and why should I?
Blaming – “It’s not my fault because….”
If I don’t achieve this standard, is that really the end
of the world?
While I cannot control some of the things that
happen to me or what others do, I am not a
passive player in my life.
I can choose how I respond to people and
circumstances.
My feelings are accurate representations of
reality
Do my feelings sometimes change without the
situation changing?
Does everyone feel the same way about this
situation?
Is it likely that I will feel the same way in a few
days’ time?
Fortune-telling and mind-reading
I might be right, I might be wrong.
I think I know what others are thinking, however
I can never know for sure unless they tell me.
What have they actually said about the
situation?
Why wouldn’t I trust them to be telling the
truth?
Am I exaggerating the probability of some
event occurring?
What are alternative explanations or outcomes
that could occur?
The third aspect is the development of emotional disorders, and this is shown for depression.
Stream of consciousness
(Includes awareness of sensation)
Activating
Event
Emotional Consquences
Logical
Processes
Behaviour (strategies)
Schema
•Formal propositions
•Memories
•Associated emotions
A B C D E Model
A = Antecedent event
B = Belief
C = Consequences (eg. Feelings, behaviour)
D = Dispute – evidence, realistic,
objective,helpful
E = Effect of challenging beliefs
Logical Errors
Ask yourself ‘What Logical Error am I making?’
• Extreme thinking
• Going beyond the facts
• More dire thank justified
• False Absolutes: such as ‘everyone’, ‘always’, ‘never’ when
inconsistent events are possible
• Faulty prediction: You predict that things will turn of worse than is
likely when all the relevant information is considered
• Invalid allocation of responsibility: Allocating disproportionate
amounts of responsibility for negative events either to yourself or a
significant other
•Unjustified conclusions about motive or opinion: Concluding you
know the reason for the person’s behaviour
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Misinterpreting the facts: You consider all the facts but you
misinterpret them. One form is biased weighting, in which you
bias information relating to one situation or person coming from
one source positively or negatively.
Not considering all the facts: You select only the facts which
support one conclusion normally the negative conclusion
Using only dichotomous categories: Otherwise known as
dichotomous thinking or black and white thinking. You polarise
judgments: a person, situation, event or outcome is wither
totally good or totally bad.
Other strategies
Thought-stopping:
δ Awareness of unpleasant feeling
δ Becoming aware of unhelpful thoughts that are driving the feelings
δ STOP – use visual stop-sign or say the word out loud to self “stop!”
δ THINK – what do I actually need to do here?
δ DO – take appropriate action
Example: Making a cup of tea but my mind is elsewhere; replaying an argument I
had years ago with my ex-boss. I realise that I am feeling upset and angry. Use
“stop-think-go” technique using visual sign image in my head. Think – “why am I
going over this again? It’s gone and done and I can do nothing more about it now.
I have learnt from that situation and will approach things differently next time I am
faced with another idiot like him!” Do- what do I need to do right now? Make this
cup of tea, take a couple of deep breaths and return to looking after the kids.
Distraction
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Based on the psychological principle that we can’t actually
think about two things at once – one will win out over the other.
Usually choose pleasant activities to distract with
Mindfulness
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Doing things with a mindful attitude.
Practicing mindfulness as a skill to make it easier to apply in
anxious or preoccupied situations
Do the opposite
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Identify what you want to do in response to a situation, and do
the exact opposite
Structured Problem Solving
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clarify the specific problem
brainstorm alternative solutions
list out pros and cons of each alternative solution
evaluate which solution looks preferable
use goal setting to take action
Goal-setting:
Specific
Measurable
Achievable
Reward
Timeframe
Monitoring language
o “I feel” is for feelings, not thoughts – differentiating between
feelings and thoughts
o Is my descriptive language actually accurate? Am I
minimizing or exaggerating how things are?
Assertive communication
o How to express myself so that I take ownership of my
thoughts and behaviour
o I feel (insert feeling word) when (insert event) because
(insert consequences or thoughts) and I would like (insert
preferred alternative behaviour)
To Counteract Negative Thinking
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Try to obtain all the facts
♥ Interpret all the facts even handedly
♥ Interpret only the facts you have especially about others
notifications and opinions
♥ If you don’t have all the faces allow room for doubt
♥ Make relative (shades of grey) judgments
♥ Instead of should making statement of desire and taking
responsibility for achieving them
♥ Using only facts to verify beliefs
♥ Devise and use Counters for your negative beliefs
References:
• Beck, AT (1897) Cognitive models of depression Journal of
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Cognitive Psychology, An International Quarterly, 1, 5-37
Beck, AT, Brown, G, Steer, RA, and Weissman, AN (1991) Factor
analysis of the dysfunctional attitude scale in a clinical
population Psychological assessment, 3, 478-483
Beck, AT, Rush, AJ, Shaw, BF & Emery, G (1979) Cognitive
therapy of depression New York: The Guilford press.
Beck, AT (1976) Cognitive therapy and the emotional disorders
New York: International Universities Press.
Beck, AT and Emery, G (1985) Anxiety disorders and phobias: A
cognitive perspective New York: Basic Books