Cognitive therapy

Cognitive therapy is a form of psychotherapy that focuses on how a person’s thoughts lead to
feelings of distress.

The idea behind cognitive therapy is that how you think determines how you feel and act.

Cognitive therapists help their clients change dysfunctional thoughts in order to relieve
distress. They help a client see how they misinterpret a situation (cognitive distortion).

Cognitive therapy was developed by psychiatrist Aaron Beck in the 1960s. His initial focus
was on depression and how a client’s self-defeating attitude served to maintain a depression
despite positive factors in her life.

Cognitive-behavioral therapy (CBT) helps clients examine how their thoughts affect their
behavior. It aims to change cognitive distortions and self-defeating behaviors.

Basic principles of cognitive behaviour therapy

 CBT is based on an ever-evolving formulation of the patient and her problems in

cognitive terms.

 CBT requires a good client-therapist relationship.

 CBT emphasizes collaboration and active participation.

 CBT is goal-oriented and problem focused.

 CBT initially emphasizes the present.

 CBT is educative; it aims to teach the client to be his/her own therapist, and
emphasizes relapse prevention.

 CBT aims to be time limited.

 CBT sessions are structured.

 CBT teaches patients to identify, evaluate, and respond to their dysfunctional thoughts
and beliefs.
  CBT uses a variety of techniques to change thinking, mood, and behavior.

 Cognitive Behavioral Therapy values and empowers the individual to take control of
his/her life through psycho-education with a vast array of techniques specific to
individual diagnosis.

 Unconditional self-regard is extended to include the unconditional regard of others,

which is congruent with social work’s strength-based values.

 The goal of CBT is to allow a client to take control of his/her problems and to manage
life in a healthy adaptive way.

 Cognitive Behavioral Therapy assumes that both the individual and the environment
are of fundamental importance and that therapy outside of a holistic approach would
be an injustice to the client.

 The cognitive model hypothesizes that people’s thoughts and feelings are not
determined by a situation, but by their interpretation and construction of the situation.

 Cognitive theory thus emphasizes the role of cognitions (thoughts, assumptions and
core beliefs) in explaining the way people feel.

For example, when people feel anxious it is because they are predicting that an imminent
situation will be threatening in some way. Furthermore, the level of anxiety will be higher the
more a person views the feared event as being likely to happen, the more that is at stake
should it happen, and the less the person views themselves as being able to cope.

Techniques of cognitive behavioural therapy

Purpose

Psychologist Aaron Beck developed the cognitive therapy concept in the 1960s. The
treatment is based on the principle that maladaptive behavior (ineffective, self-defeating
behavior) is triggered by inappropriate or irrational thinking patterns, called automatic
thoughts. Cognitive therapy focuses on changing these thought patterns (also known as
cognitive distortions), by examining the rationality and validity of the assumptions behind
them. This process is termed cognitive restructuring.
Cognitive therapy is a treatment option for a number of mental disorders, including

 Agoraphobia

 Alzheimer's disease

 anxiety or panic disorder

 attention deficit-hyperactivity disorder (ADHD)

 Eating disorders, mood disorders

 obsessive-compulsive disorder (OCD)

 Personality disorders

 post-traumatic stress disorder (PTSD)

 psychotic disorders

 schizophrenia

 social phobia

 Substance abuse disorders

 anger management problems

 insomnia

 It is also frequently prescribed as an adjunct, or complementary, therapy for patients

suffering from back pain, cancer, rheumatoid arthritis, and other chronic pain
conditions.

Cognitive Restructuring Techniques: Cognitive restructuring is a cognitive behavior

therapy technique aimed at helping people identifies thinking patterns responsible for
negative moods and ineffective behavior. There are numerous techniques employed during
cognitive restructuring. The most common technique is tracking dysfunctional thoughts on a
thought record form, and devising healthier, more psychologically flexible patterns of
thinking.
Graded Exposure Assignments: Exposure is a cognitive behavior therapy technique that
helps people systematically approach what they fear. Generally, fear causes people to avoid
situations. Unfortunately, avoidance of feared situations is what maintains feelings of fear
and anxiety.

Through systematic exposure, people master feared situations one-by-one, and then tackle
increasing difficult exposure assignments. Exposure is one of the most effective
psychological treatments that exists, having a 90% effectiveness rate with some anxiety
disorders.

Activity Scheduling: Activity scheduling is a cognitive behavior therapy technique designed

to help people increase behaviors they should be doing more. By identifying and scheduling
helpful behaviors, such as meditating, going for a walk, or working on a project, it increases
the likelihood of their getting done.

This technique is especially helpful for people who do not engage in many rewarding
activities due to depression, or people who have difficulty completing tasks due to
procrastination.

Successive Approximation: This cognitive behavior therapy technique works for people
who have difficulty completing a task, either due to lack of familiarity with the task, or
because the task feels overwhelming for some reason.

The technique works by helping people master an easier task that is similar to the more
difficult task. It’s akin to practicing addition and subtraction before learning long division.
Once you are practiced at addition and subtraction, long division isn’t as daunting. Likewise,
by having rehearsed one behavior, one that is slightly more difficult feels more manageable.

Mindfulness Practice: Mindfulness is a cognitive behavior therapy technique borrowed from

Buddhism. The goal of mindfulness is to help people disengage from ruminating or obsessing
about negative things and redirect their attention to what is actually happening in the present
moment.

Skills Training: A lot of people’s problems result from not having the appropriate skills to
achieve their goals. Skills training is a cognitive behavior therapy technique implemented in
remedying such skills deficits.

Common areas for skills training include:

  social skills training

 communication training

 assertiveness training

Usually skills training take place through direct instruction, modeling, and role-plays.

 Cognitive perspective by Albert Ellis

 Cognitive perspective by Aron beck

Cognitive perspective by Albert Ellis

Rational emotive behavior therapy known as REBT is a type of cognitive behavioral

therapy.

 Albert Ellis is known as the father of cognitive-behavioral therapy and founder

of Rational Emotive Behavior Therapy (REBT).

 According to Ellis, "people are not disturbed by things but rather by their view of
things."

 The fundamental assertion of rational emotive behavior therapy (REBT) is that the
way people feel is largely influenced by how they think.

 When people hold irrational beliefs about themselves or the world, problems can
result.

 The goal of REBT is to help people alter illogical beliefs and negative thinking
patterns in order to overcome psychological problems and mental distress.

 REBT is a humanistic approach that focuses on our ability to create our own positive
and negative emotions.

 According to REBT, our belief system impacts whether we achieve success and self-
actualization in our lives.

 The goal of REBT is to make changes to irrational thinking patterns, behaviors and
emotional responses, using reasonable and rational thinking.
The ABC Model

Ellis suggested that people mistakenly blame external events for unhappiness. He argued,
however, that it is our interpretation of these events that truly lies at the heart of our
psychological distress. To explain this process, Ellis developed what he referred to as the
ABC Model:

 A – Activating Event: Something happens in the environment around you.

 B – Beliefs: You hold a belief about the event or situation

 C – Consequence: You have an emotional response to your belief.

According to Ellis, some of the most common irrational beliefs include:

 Feeling excessively upset over other people's mistakes or misconduct.

 Believing that you must be 100 percent competent and successful in everything to
be valued and worthwhile.
  Believing that you will be happier if you avoid life's difficulties or challenges.

 Feeling that you have no control over your own happiness; that your contentment
and joy are dependent upon external forces.

By holding such unyielding beliefs, it becomes almost impossible to respond to situations in a

psychologically healthy way. Possessing such rigid expectations of ourselves and others only
leads to disappointment, recrimination, regret, and anxiety.

The Three Basic Musts

 According to Albert Ellis and REBT, irrational beliefs are the source of psychological
distress.

 Any irrational belief stems from a core 'should,' 'must,' 'have to,' or 'need to' statement.

 Ellis identifies three common irrational beliefs regarding demands about the self,
other people or the world. These beliefs are known as 'The Three Basic Musts,' which
include the following thoughts:

1. 'I must do well or else I'm no good.'

2. 'Other people must treat me fairly and kindly, and if they don't, they are no good
and they deserve to be condemned and punished.'

3. 'I must get what I want when I want it, and I must not get what I don't want. If I
don't get what I want, I can't stand it.'

These irrational thoughts can lead to needless suffering. The first belief often leads to anxiety,
depression, shame and guilt. The second belief often leads to rage, passive-aggression and
acts of violence. And the third belief can lead to self-pity and procrastination.

ABCDE Model of Emotional Disturbance;

Albert Ellis thought people developed irrational beliefs in response to preferential goals being
blocked. He set this up in an ABCDE model.

“A” stands for Activating Event or Adversity. This is any event. It is just a fact.

“B” refers to one’s Irrational Belief about the event at “A.” That belief then leads to “C,” the
emotional and behavioral Consequences.
“D” stands for disputes or arguments against irrational beliefs.

E stands for New Effect or the new, more effective emotions and behaviors that result from
more reasonable thinking about the original event

Cognitive behavioral model

Cognitive behavioral therapy (CBT) can be used to treat people with a wide range of mental
health problems. CBT is based on the idea that;

1. How we think (cognition),

2. How we feel (emotion)

3. How we act (behavior) all interact together.

Specifically, our thoughts determine our feelings and our behavior.

 Therefore, negative and unrealistic thoughts can cause us distress and result in
problems.

 CBT aims to help people become aware of when they make negative interpretations,
and of behavioral patterns which reinforce the distorted thinking.
  Cognitive therapy helps people to develop alternative ways of thinking and behaving
which aims to reduce their psychological distress.

Cognitive behavioral therapy is, in fact, an umbrella term for many different therapies that
share some common elements. Two of the earliest forms of Cognitive behavioral Therapy
were Rational Emotive Behavior Therapy (REBT), developed by Albert Ellis in the 1950s,
and Cognitive Therapy, developed by Aaron T. Beck in the 1960s.

General CBT Assumptions:

 The cognitive approach believes that abnormality stems from faulty cognitions about
others, our world and us. This faulty thinking may be through cognitive deficiencies
(lack of planning) or cognitive distortions (processing information inaccurately).

 These cognitions cause distortions in the way we see things; Ellis suggested it is
through irrational thinking, while Beck proposed the cognitive triad.

 We interact with the world through our mental representation of it. If our mental
representations are inaccurate or our ways of reasoning are inadequate then our
emotions and behavior may become disordered.
 The cognitive therapist teaches clients how to identify distorted cognitions through a
process of evaluation. The clients learn to discriminate between their own thoughts
and reality. They learn the influence that cognition has on their feelings, and they are
taught to recognize observe and monitor their own thoughts.

The idea is that the client identifies their own unhelpful beliefs and them proves them wrong.
As a result, their beliefs begin to change. For example, someone who is anxious in social
situations may be set a homework assignment to meet a friend at the pub for a drink.
Cognitive perspective by Aaron Beck

Aaron Beck believes that a person’s reaction to specific upsetting thoughts may contribute to
abnormality. As we confront the many situations that arise in life, both comforting and
upsetting thoughts come into our heads. Beck calls these unbidden cognition’s automatic
thoughts.

Beck identified three mechanisms that he thought were responsible for depression:

1. The cognitive triad of negative automatic thinking

2. Negative self schemas

3. Errors in Logic (i.e. faulty information processing).

The Cognitive Triad

The cognitive triads are three forms of negative;

 (I.e. helpless and critical) thinking that are typical of individuals with depression

 Namely negative thoughts about the self,

 The world and the future.

As these three components interact, they interfere with normal cognitive processing, leading
to impairments in

 perception,
  memory

 and problem solving

With the person becoming obsessed with negative thoughts.

Negative Self-Schemas

Beck believed that depression cause individuals to develop a negative self-schema. They
possess a set of beliefs and expectations about themselves that are essentially negative and
pessimistic.

Beck claimed that negative schemas may be acquired in childhood as a result of a traumatic
event. Experiences that might contribute to negative schemas include:

 Death of a parent or sibling.

 Parental rejection, criticism, overprotection, neglect or abuse.

 Bullying at school or exclusion from peer group.

People with negative self schemas become prone to making logical errors in their thinking
and they tend to focus selectively on certain aspects of a situation while ignoring equally
relevant information.

Cognitive Distortions
Beck (1967) identifies a number of illogical thinking processes i.e. distortions of thought
processes. These illogical thought patterns are self-defeating, and can cause great anxiety or
depression for the individual.

Filtering
 A person engaging in filter (or “mental filtering) takes the negative details and
magnifies those details while filtering out all positive aspects of a situation.

 When a cognitive filter is applied, the person sees only the negative and ignores
anything positive.

Polarized Thinking (or “Black and White” Thinking)

 In polarized thinking, things are either “black-or-white” — all or nothing. We have to

be perfect or we’re a complete and abject failure — there is no middle ground.

 A person with polarized thinking places people or situations in “either/or” categories,

with no shades of gray or allowing for the complexity of most people and most
situations.

 A person with black-and-white thinking sees things only in extremes.

Overgeneralization

 In this cognitive distortion, a person comes to a general conclusion based on a single

incident or a single piece of evidence.

 If something bad happens just once, they expect it to happen over and over again. A
person may see a single, unpleasant event as part of a never-ending pattern of defeat.
Catastrophizing
When a person engages in catastrophizing, they expect disaster to strike, no matter what.
This is also referred to as magnifying, and can also come out in its opposite behavior,
minimizing.
 In this distortion, a person hears about a problem and uses what if questions (e.g.,
“What if tragedy strikes?” “What if it happens to me?”) to imagine the absolute worst
occurring.
Personalization
Personalization and blame is a cognitive distortion whereby you entirely blame yourself, or
someone else, for a situation that in reality involved many factors and was out of your
control.
Control Fallacies
 This distortion involves two different but related beliefs about being in complete
control of every situation in a person’s life.
 In the first, if we feel externally controlled, we see ourselves as helpless a victim of
fate.
Blaming
 When a person engages in blaming, they hold other people responsible for their
emotional pain. They may also take the opposite track and instead blame themselves
for every problem — even those clearly outside their own control.

 For example, “Stop making me feels bad about myself!” Nobody can “make” us feel
any particular way — only we have control over our own emotions and emotional
reactions.

Emotional reasoning

 Emotional reasoning is the false belief that your emotions are the truth — that the way
you feel about a situation is a reliable indicator of reality.

 Researchers have found Trusted Source that emotional reasoning is a common

cognitive distortion.

 It’s a pattern of thinking that’s used by people with and without anxiety or depression.

Labeling
Labeling is a cognitive distortion in which people reduce themselves or other people to a
single usually negative — characteristic or descriptor, like “drunk” or “failure.”

When people label, they define themselves and others based on a single event or behavior.
Labeling can cause people to berate themselves. It can also cause the thinker to
misunderstand or underestimate others.

Emotional reasoning is a way of judging yourself or your circumstances based on your

emotions.