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The principles of Cognitive Behavioral Therapy can be of great use to those who are practitioners in positive psychology.
With a deeper understanding of personal cognition and its relationship to behavior, people can change their lives through changing the way they think.
Increasing mindfulness with regard to conscious thought and interrupting automatic negative thoughts can lead people into a healthier outlook and better understanding of their power over their future reactions.
This therapy has been proven effective in preventing relapse in patients with depression and anxiety. It has also been proven to aid patients with a variety of other psychological problems.
Educating patients with the techniques and strategies of this approach will help them in handling future situations. Equipping patients with these tools give CBT the power for self-motivated emotional and psychological healing.
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What is Cognitive Behavioral Therapy?
Cognitive Behavioral Therapy can be defined as the intentional combination of demonstrated readiness and methodological rigor of behavioral procedures with the cognitive-behavioral processes that influence adjustment (Benjamin, 2011). In other words, CBT is utilizing the accurate understanding of our thoughts to purposefully change reactions and behaviors. Our internal thoughts are viewed as mechanisms for change.
This type of therapy is a short-term, goal oriented form of treatment that can be thought of as a combination of behavioral therapy and psychotherapy. The treatment takes a hands-on, practical approach to problem-solving. Psychotherapy focuses on the personal meaning of thought patterns that are believed to have developed in childhood. Behavioral therapy emphasizes the close relationship between personal problems, behavior, and thoughts.
CBT is a way of focusing on the cognitive processes that produce feelings. The approach helps by changing people’s behavior and attitudes with a deeper understanding of thoughts, images, beliefs, and attitudes. The treatment is customized for each patient with regard to differences in personalities and specific needs. CBT can be viewed as an umbrella term for many different forms of therapies aimed at correcting dysfunctional cognition and maladaptive behaviors.
Attitudes grooved in neural pathways during childhood become automatic thoughts. The thoughts resulting in disruption in daily life are negative thoughts around situations that created them.
CBT allows patients to interrupt these thoughts with a deeper understanding of the errors or distortions in the perception of these automatic thoughts. This type of therapy helps patients to correct misinterpretations of the thoughts that have caused disruption in their daily lives.
An Overview and Summary of CBT
Cognitive Behavioral Therapy is utilized in treating multiple types of psychiatric problems. The treatment is typically done between 3 and 6 months, depending on the problem. The following is a list of psychological problems where CBT has been utilized.
- eating disorders
- anger management
- marital crisis
- obsessive-compulsive disorder
- post-traumatic stress disorder
- chronic pain
There are 5 five areas that are believed to be interconnected and affecting one another. For instance, how one feels about a certain situation can cause physical and emotional feelings, resulting in varying behaviors in response.
- physical feelings
CBT breaks problems down into smaller pieces to give detailed attention to each part. The techniques aid patients in disrupting negative, automatic thoughts, and replacing them with more helpful ones. The overall goal is to teach the skill of breaking down negative thought patterns and changing them into a more helpful approach to handling daily life.
A Look at the Psychology
There is a great deal of overlap in the concepts of positive psychology and cognitive behavioral therapy (Karwoski, 2006). Both approaches see the interaction between client and provider as collaborative. Here are other areas where the conceptual principles overlap.
- Strong Therapeutic Alliance
- Cognitive reappraisal
- Focus on decisive goals
- Focus is on the here and now
While positive psychology has developed intervention techniques derived from other therapeutic approaches, several interventions overlap with techniques of CBT.
- Scheduling of pleasant activities
- Identifying and reviewing successes
- Monitoring of mood
- Relaxation training
- Training in problem-solving
Cognitive Behavioral Therapy, like other therapies, focuses on reducing the presence of negative emotions. Positive psychology can be presented as the catalyst that CBT needs to endure as a formidable treatment for psychological problems. The reduction of negative emotions does not create the presence of positive emotions. Introducing positive psychology interventions in addition to reducing negative emotions with CBT has proven to be an effective way to reduce rates of relapse in depressed patients.
While CBT has been proven through various meta-analyses to be an effective treatment for various psychological disorders, it continues to be highly unavailable to those who would most benefit from its introduction (Shafran, 2009). For instance, those suffering from PTSD are most frequently being given supportive counseling, as opposed to the long-term effective strategies provided by cognitive behavioral therapy. There is a widespread lack of training for providers in this type of therapy as well.
There is a gap between research trials and clinical practice. It has much to do with the belief that participants in the trials are suffering from less severe cases of psychological disorders. More and more evidence is being presented for the case that CBT is effective in more severe cases, however. With the increased availability of appropriate training and effective presentation of the techniques, a wider patient base may be reached.
An additional gap in the usage of CBT is within the area of sport psychology (McArdle, 2012). A strong case can be made for the introduction of the skills of this therapy to athletes. Unthreading negative self-thoughts can, in turn, produce the outcome of improved sports performance.
Key Concepts and Principles of the Approach
The patient’s active participation in therapy is a key principle in CBT. Without it, this goal-oriented and problem focused approach would not be effective. Sessions in CBT are well structured and the client’s better understanding of the role of cognition in correcting behavioral dysfunctions is paramount to their success. This educative approach allows the client-therapist relationship to deepen, which is also an important principle in this therapy.
CBT is a time limited approach, and work outside of the therapy office is vital to success. While this approach is initially present focused, an emphasis on adaptive thinking allows for relapse prevention. It allows the patient to be taught techniques to change their thinking, mood, and behavior with the understanding that they will be utilized in their future.
In cognitive behavior therapy, psychological problems are believed to develop through the use of cognitive distortions. Aaron Beck’s work suggests that by correcting these distortions, a more accurate experience of events is created. Through this work, a patient is better able to develop skills to properly process exposure to life events.
Here is a list of Cognitive Distortions.
- Personalization means the attribution of the negative feelings of others and the world around them. For instance, a gymnastics coach is cross, so a gymnast automatically feels it is her fault.
- Fallacy of change is assuming that other people will change to suit them if pressured enough. This is a common distortion found in relationships. For instance, a woman feeling that if her partner improved himself, she would be happier.
- Emotional reasoning is the distortion that occurs when feelings are considered as facts. For example saying, “I feel that way, it must be true.”
- Fallacy of Fairness is a distortion that measures all things by an imaginary ruler of fairness. A person may feel resentful because they feel that they have a clear definition of fairness, but that others might not agree with them.
- Polarization or “Black and White” Thinking is a distortion that occurs when things are all or nothing. Someone might believe they have to be perfect, or they are a failure.
- Overgeneralization means coming to broad negative conclusions based on a single, insignificant event. An example would be telling yourself you’re a terrible baker based on failing at one recipe attempt.
- Control fallacies are distortions in which a person would feel that everything that happens to you is a result of external actions or of their own behavior. For instance, believing that your work is not good because you’re dealing with disruptive coworkers.
- Jumping to Conclusions is a distortion that occurs when assumptions about another’s feelings or beliefs are made. An example might be a child feeling that they know how someone else feels about them. It can also be described as perceived mind reading.
- Catastrophizing is a distortion that assumes the expectation that the worst is going to happen. An example is believing that a small error at work is going to result in you being fired.
- Always Being Right is a distortion that occurs when the person is always putting others on trial to prove their opinions are absolutely correct.
- Filtering is a distortion that includes both Minimization and Magnification. Minimization means underplaying the significance of an event. For instance, you are praised for your job performance, but you see it as trivial. Magnification means exaggerating the importance of an undesirable event. For instance, allowing getting cut off by another driver as the impetus to ruin your entire day. Filtering also includes selective abstraction. This is focusing on a single aspect of a situation and ignoring others.
- Blaming occurs when a person holds someone else responsible for their emotional pain, or hold themselves responsible for every problem.
- Global labeling is a distortion that occurs when a person generalizes single qualities into a global judgment. For instance, “I failed a test, therefore I’m stupid.”
- Heaven’s Reward Fallacy is the distortion that self-sacrifice will eventually pay off.
- Shoulds are distortions that occur when a person has hard set rules about how every person should behave. An example would be saying, “I should work out. I shouldn’t be so lazy.” The resulting emotional consequence is guilt.
Common Therapy Techniques Used
There are many different techniques used in cognitive behavior therapy. Some are with a therapist, but many can be used without a therapist. Utilizing the techniques in real life situations, either way, is the key to long term effectiveness and reduction of symptoms of psychological problems. The most common are highlighted here.
Albert Ellis developed the ABC technique that is still utilized in CBT today. The ABC Technique of Irrational Beliefs analyzes the first three steps in which someone might develop an irrational belief: A) Activating event B) Belief C) Consequences.
- Activating Event. This is an event that would lead someone to a type of high emotional response, and/ or negative dysfunctional thinking.
- Beliefs. The client would write down the negative thoughts that occurred to them around the activating event.
- Consequences. These are the negative feelings and behaviors that occurred as a result. The beliefs are to be viewed as a bridge to the negative feelings and behaviors that occurred as a result of the activating event.
Ellis believed that it was not the activating event (A) that causes the negative beliefs and consequences (C), but rather how the patient interprets or misinterprets the meaning of the event (B) that helps cause the consequences (C). Helping a patient reinterpret their irrational belief system helps to forge new ways for them to interpret their beliefs resulting in alternative behaviors. A person can utilize this technique, even in the absence of a therapist.
Journaling for the awareness of cognitive distortions is a powerful way to better understand personal cognition. A person keeps track of their automatic thoughts and an analysis of the presence of various distortions is detected. Once better understood, a person can utilize different methods to reevaluate these automatic thoughts with evidence. Well trained practitioners in CBT can aid someone who has difficulty in unraveling these distortions.
Rescripting is a technique used to help patients suffering from nightmares. When the emotion that is brought to the surface from the nightmare is exposed, a therapist can help the patient to redefine the emotion desired and to develop a new image to elicit that emotion.
Exposure therapy is used in OCD and anxiety phobias. Exposing yourself to the trigger reduces the response to the trigger. Many therapists recommend mild exposure 3 times daily. While this may be uncomfortable during the first exposures, the increase in exposure reduces phobic reactions.
The Worst Case/ Best Case/Most Likely Case Scenario technique is used to help people overcome fear or anxiety. Allowing the brain to ruminate to the point of ridiculousness allows the person to “play out” the fear to an unrealistic end. Then the person is brought to the best case and again allowed to let their thoughts “play out” to the ridiculous. Then, a most likely scenario is explored with actionable steps attached, so that control over behavior is realized.
A recent, popular technique being utilized in CBT is called Acceptance and Commitment Therapy. It differs from traditional CBT in that it is not trying to teach people to better control their thoughts around their activating events; instead this approach is teaching people to “just notice,” accept and embrace the feelings around the activating events. This approach utilizes techniques from CBT as well, but ACT focuses on freeing the patient from the grip of the event itself.
Mindfulness techniques like deep breathing and Progressive Muscle Relaxation (PMR) play a big role in CBT. These techniques allow the person to be present in the moment and calmly soothe the unfocused mind. With the relaxation comes the stronger ability to tune in and alter automatic negative thoughts.
Cognitive restructuring is a CBT technique that helps people examine their unhelpful thinking. It helps them to redevelop ways to react in situations that have in the past proven problematic. Keeping a daily record of the automatic negative thoughts creates a way to find the patterns in these thoughts. With an identified pattern, alternative reactions and adaptive thoughts can be forged.
Treating thoughts as guesses is a technique that helps to gather evidence to combat automatic negative thoughts. When a person takes their thoughts to “court” proof of truth must be found for the thought to be held as accurate. If any proof against the thought is found, it must be tossed and replaced with a more accurate thought.
A cognitive pie chart is a fun way for kids to utilize CBT. The first step is identifying the automatic negative thoughts. For example, “I’m dumb because I failed a test.” Step two is devising a list of alternative explanations to those ANTs. Finding as many alternatives as possible is helpful. The third step is giving each explanation a percentage in the contribution to the outcome of failing the test. Step four is placing these explanations in a pie chart.
Activity Scheduling is a powerful technique in CBT. It helps people engage in activities that they are not normally used to doing. It presents as a way to slowly reintroduce rewarding behavior that has been excluded from people’s routines. The technique is helpful in increasing positive emotion when performed incrementally.
Graded exposure is a technique used to help expose anxiety sufferers to contact with what is feared. The underlying theory is that people who avoid situations that induce fear or anxiety will increase the anxiety. The slowly increased exposure aids to decrease that fear.
Many deficits in social skills can be improved through CBT techniques. Modeling, role playing, and instruction can be used to increase social skills like communication and assertiveness. Communication skills, or rather the lack of, are a massive obstacle for many. Improving these skills bolsters confidence and abilities to interact with others, dramatically reducing levels of anxiety inducing situations.
The Pros and Cons
There are advantages and disadvantages to the approach of CBT. Like any therapy, there is always a risk of a negative emotion returning. Let’s have a look at what’s good, and what could hold progress back in treatment.
Here is a list of pros:
- Compared to other “talking” therapies, CBT can be completed in a relatively short period of time.
- Can be helpful in treating some mental health disorders where medication alone has not helped improve symptoms.
- In order to make changes in how you feel, CBT focuses on altering thoughts and behaviors.
- Strategies are helpful and practical. They can help people cope with future stresses.
- Can improve the quality of life.
- It can be provided in a variety of formats including in-person, online, or workbooks. It can even be useful in a group setting.
- It can be used in almost any age group.
- It may improve emotional processing (Baker, 2011)
Here is a list of cons:
- The patient has to be committed to the process. There is no magic wand that a therapist might wave to make a patient’s problems go away.
- A drawback might be that the individual’s needs are met through the therapy, but a patient’s environment (family, interactions), that might have a significant impact on the patient’s well-being, is not addressed.
- CBT could prove more difficult for people suffering from severe mental health difficulties or those with a learning disability.
- As CBT addresses the sources of anxiety or other stress causing emotions, the initial exposure to this type of treatment could prove uncomfortable.
- This treatment does not fully address possible underlying causes of negative emotions, as it focuses on the present problems.
- Doing the work in real life takes time.
The History of CBT
The evolution of cognitive behavioral therapy can be traced back to developments in psychology as early as 1913. The work of behaviorist John B. Watson laid the foundation for later advancement in the field.
Behaviorism is the theory of learning on the idea that all behaviors are acquired through conditioning. This conditioning happens when people interact with their environment, cueing signals to shape their actions. BF Skinner’s conditioning theories also had foundational influence over the development of cognitive behavioral therapy.
Before cognitive behavioral therapy, there was an approach called behavior therapy that was controversial at the time of its development. One of the first treatments in this approach was done with youth and the correction of enuresis (bed-wetting). Initial respondent conditioning strategies for better understanding anxiety were also vital in creating theories behind CBT. Extinction, habituation, and counter conditioning were all discovered with respondent conditioning.
Operant learning theory also played a large role in behavioral therapy and childhood CBT development. Out of this theory developed positive and negative reinforcement in children’s development. The deeper understanding of the cognition behind behavior contributed to the deeper understanding of their use in CBT.
In the 1950s, Albert Ellis practiced Rational Emotive Behavior Therapy. The goal was to help patients identify their irrational thoughts. Through this identification, encouragement for the challenge of the thought and a shift to a more rational one would be made. The therapy was thought to give patients a more rational view of the world and their place in it.
The practice of cognitive behavioral therapy was first developed in the 1960s. Dr. Aaron T. Beck at the University of Pennsylvania designed and carried out experiments to test psychoanalytic concepts and found some surprising results. What he found was that in depressed patients, there were consistent instances of a stream of negative thoughts that seemed to emanate spontaneously.
Dr. Beck categorized these automatic negative thoughts into three categories. The patients were having negative ideas about themselves, the world, and/ or the future. With these findings, he began to theorize alternative ways of viewing depression.
The theory of cognitive distortions by Beck and the theory of irrational thinking by Dr. Albert Ellis helped to better explain psychological problems. Beck theorized that in childhood, the development of maladaptive processes led to these problems. His theory was based around the cognitive triad. Dr. Ellis’s theory was based around a set of defined irrational beliefs, also known as common irrational assumptions.
With his approach, Dr. Beck began to help his patients reevaluate their thoughts about themselves. He found that by doing so, his patients were developing a better resilience for handling daily functions of life. Patients found that this therapy resulted in long-lasting change.
The efficacy of this therapy has been examined in many meta-analyses (Butler, 2006). Since its introduction, it has grown into a viable treatment modality for a variety of mental health problems. There are therapists who now specialize in this therapeutic approach.
The practice of CBT grew in the mid-1970s to aid in the treatment of higher functioning patients. This transition did not happen automatically, but rather through the trial and error and the development in areas of behavioral therapy and a better understanding of emotional self-control.
As the practice of CBT became stronger over time, new expansions and developments in the field began to emerge. The Tripartite Model (Clark,1991) is one of these developments. This model proposes that there is a significant overlap in the negative affect presented in patients with depression and anxiety.
Barlow’s triple vulnerability model of emotional disorders has further expanded work in CBT. The model focuses on children’s perception of control over their environments. In this approach, parents are trained to help children better understand and function in their environments.
The wealth of knowledge of CBT and its application with children is shown throughout psychology. the efficacy of treatment in children and adolescents is far-reaching. This type of therapy helps kids better understand their environment and their role in mastering it.
A new “third” wave of CBT is developing, as a result of various empirical studies failing to prove the hypotheses developed around the efficacy of CBT (Gaudino, 2008). The shift is within the language of cognition. The approach is acceptance-based strategies. The theory places less stress on altering the cognitive distortions, as the alteration may not be deemed necessary.
With an acceptance-based strategy, the patient is becoming aware of the distortion without trying to control it. The focus is rather on the commitment to the change in behavior.
The Founders and Pioneers
Development of cognitive behavioral therapy progressed over time. Dr. Albert Ellis was a pioneer in behavior therapy in the 1950s. His work with irrational thinking was foundational in the development of CBT. His ABC technique of Irrational Beliefs is still utilized in CBT today.
The work of Joseph Wolpe and Arnold Lazarus in the 1960s also contributed to the evolution of CBT. Their work in behavior therapy techniques to reduce neuroses is foundational. Their theory of systematic desensitization led to the development of many of the techniques still utilized in this approach today.
Dr. Aaron Beck is the founding father of the cognitive behavior therapy movement. His work began as a clinician in the 1960s. His approach to psychotherapy at that time was radical and groundbreaking. Scientific evidence for his approach has been proven time and again. The efficacy of his theories is far-reaching in the field of psychology.
Dr. Judith Beck has made a significant impact on cognitive behavior therapy as well. She followed her father’s path in research and development of treatments significant in cognitive behavioral therapy. Her work in the area of copping and mechanisms for change advanced the science in a progressive direction.
A Closer Look at Aaron Beck
Dr. Aaron T Beck is given the title of Father of Cognitive Behavior Therapy. He was also named one of the top 5 most influential psychotherapists of all time. Beck is also named as an American in history that shaped the history of psychiatry.
Dr. Beck has published over 600 articles. He has authored or coauthored 25 books. The work he did in developing various scales for measuring depression is still in use today.
His work in cognitive behavioral therapy grew from the work of other psychologists like George Kelly and the vocabulary of Frederic Bartlett and Jean Piaget. The cognitive constructs theory of Kelly and the vocabulary created by Bartlett around the theories of schemas and the vocabulary of Piaget’s theory of cognitive development were very influential in Beck’s initial work in CBT.
As a clinical psychologist, Dr. Beck was noticing a remission of patients’ symptoms. With this realization, came the understanding that his patients were presenting with repeated stories around activating events that he later labeled automatic negative thoughts.
Through his work with depressed patients, Dr. Beck developed the Negative Cognitive Triad. He found 3 types of dysfunctional beliefs, or thoughts, that depressed people were experiencing. His findings suggested that these types of thoughts dominated the thinking of people with depression.
- “I am defective or inadequate.”
- “All of my experiences result in defeats or failure.”
- “The future is hopeless.”
Dr. Beck believed that a close, personal relationship with the patient was crucial. The development of a trusting relationship was necessary to allow for the exploration of automatic negative thoughts. The mere admission of these thoughts was unsettling for some of his patients. The reframing of these thoughts through work with Dr. Beck resulted in significant numbers of patients’ self-reported improvement.
The Beck Institute for Cognitive Behavior Therapy was founded to further investigate the usage of his groundbreaking theory in helping people suffering from various psychological disorders. The institute was founded with his daughter, Dr. Judith Beck, to further investigate and serve a worldwide resource for CBT.
A Take Home Message
Mental health is a field of study that has come with a tremendous stigma. The rates of psychological disorders are astoundingly high, yet the number of people in treatment for these disorders is astoundingly low because of that stigma. If learning the concepts of cognitive behavioral therapy could help all people, through the examination of their cognitive distortions, an impact on reducing that stigma might be made.
All humans are flawed. There is not a single human alive that doesn’t have cognitive distortion from time to time. Developing a deeper understanding of what these distortions are and creating a way to reframe thoughts, behaviors, and actions can help all humans. What an incredible impact mental well-being training could have on the world! Thanks for reading.
If you are having thoughts of self-harm, please seek help. If depression and anxiety are disrupting your daily life, please seek help. No stigma is worth continued suffering.
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