Principles of cognitive behavioural therapy
10 Principles of Cognitive Behavior Therapy — Mind My Peelings
What is CBT
Cognitive Behavioral Therapy (CBT) is a form of psychological treatment that explores the links between thoughts, emotions, and behaviors.
CBT is a goal-oriented, time-based, structured treatment that is effective for a range of mental illnesses such as anxiety disorders and depression.
It is the most widely researched psychotherapy and has a strong evidence-based framework that supports the effectiveness of the treatment.
Basics of CBT
CBT is focused on learning to alter your thoughts (cognitions) and your actions (behaviors), which is why it is called cognitive-behavioral therapy.
Aaron Beck, known as the Father of CBT, defined three levels of cognition:
Automatic Negative Thoughts
1. Core Beliefs
2. Dysfunctional Assumptions (Cognitive Distortions)
Dysfunctional Assumptions occur because we tend to focus on the negatives. This causes a distorted perception of reality and misinterpretation of information.
These cognitive distortions are irrational thought patterns that are exaggerated by negative thinking and feelings. There are 15 common distortions that distort our perceptions of reality in a negative way.
3. Automatic Negative Thoughts
Automatic Negative Thoughts (ANTs) are involuntary negative perceptions of reality that occur habitually. They can be difficult to recognize because they are fleeting and cause negative emotions to occur.
You can challenge ANTs by altering your thoughts and reframing them more rationally and positively.
Beck’s Cognitive Model
The CBT model was developed by Aaron Beck and used as a framework to understand a person’s mental distress. This framework follows a simple process:
It starts with a distressing situation/trigger → which causes a person to have negative thoughts → this causes negative emotions and physical distress → which leads to negative behaviors.
Here is an example of someone who gets anxious around dogs compared to someone who isn't in the same situation:
This visual representation of your anxiety helps you understand what is actually happening. It can help you realize that your thoughts are not facts and seeing them laid out in this framework can help break the cycle.
History of CBT
The adoption of cognitive-behavioral therapy progressed slowly over time and was considered controversial during its development.
Dr. Albert Ellis pioneered behavior therapy in the 1950s with his work on helping patients identify and challenge irrational thoughts.
In the 1960s Dr. Aaron T. Beck developed the practice for cognitive behavioral therapy. His theories on cognitive distortions helped evolve CBT to what we know today.
Aaron Beck’s approach to psychotherapy was groundbreaking and the scientific evidence today has proven the efficacy of his theories.
Dr. Judith S. Beck followed her father’s footsteps and made a significant impact on CBT as well. She developed 10 principles of cognitive-behavioral therapy to provide an effective CBT treatment program.
Principles of CBT
Although therapy should be tailored to an individual's needs, Judith Beck defined 10 principles that underlie cognitive behavior therapy for all patients. These principles are outlined in her book: Cognitive Therapy: Basics and Beyond.
1. CBT is based on an ever-evolving formulation of patients’ problems and an individual conceptualization of each patient in cognitive terms
The patient's current thinking patterns and problematic behaviors are identified. Several factors must be considered including the patient's life experiences, throughout childhood, and even through the therapy sessions.
A conceptualization of the patient is formulated based on the information gathered to provide an accurate picture of the patient’s whole situation. This conceptualization is refined each session as more information becomes available.
2. CBT requires a sound therapeutic alliance
It is important to have a strong trusting relationship between the therapist and patient. The therapist should be able to provide care, warmth, empathy, and competence.
3. CBT emphasizes collaboration and active participation
Teamwork is encouraged throughout the sessions and decisions of what to work on and how often are decided together. Active participation from the patient is important for making a lasting impact in their treatment.
4. CBT is goal-oriented and problem-focused
The patient should set specific goals during the initial sessions. Goals are necessary to evaluate and respond to thoughts that interfere with those goals. This helps the patient easily identify and interrupt those thoughts.
5. CBT initially emphasizes the present
The treatment should be focused on current problems and specific situations that are distressing to them.
CBT only considers the past when the patient expresses a strong preference to do so or the patient gets stuck in dysfunctional thinking and trying to understand their childhood can potentially help modify their core beliefs.
6. CBT is educative, aims to teach the patient to be their own therapist, and emphasizes relapse prevention
Teaching the patient to understand the process, how their thoughts influence emotions and behavior, how to identify and evaluate their thoughts and beliefs, and plan for behavioral changes is an essential part of CBT.
7. CBT aims to be time-limited
Straightforward anxiety and depression can typically be treated within 6 to 14 sessions. However, for those with more severe mental illnesses and rigid beliefs, the time frame can range from a few months to years if necessary.
8. CBT sessions are structured
Structured treatment helps maximize efficiency and effectiveness. This process includes:
Introduction: doing a mood check, a brief review of the week, collaboratively setting an agenda for the session
Middle: reviewing homework, discussing problems on the agenda, setting new homework, and summarizing
Final: eliciting feedback
9.CBT teaches patients to identify, evaluate, and respond to their dysfunctional thoughts and beliefs
Therapists help patients identify key cognitions and adopt more realistic, rational perspectives.
This is achieved through the process of guided discovery by questioning their thoughts to evaluate their thinking. Also, the therapist creates behavioral experiments for the patient to directly test their thinking.
10. CBT uses a variety of techniques to change thinking, mood, and behavior
Behavioral and problem-solving techniques are essential in CBT. The types of techniques the therapist will select will be influenced by the conceptualization of the patient, the problem you are discussing, and your objectives for the session.
What you can expect to see from a CBT treatment program with a therapist:
Structured and Educational: CBT sessions are well structured and meant to be educational. This means there is as much emphasis on work outside of your therapy session as during.
Collaborative: Your therapist will work with you and expect active participation and commitment to see positive changes.
Goal-Oriented: Your therapist will work with you to define specific goals that solve your existing problems.
Time-Based: Most people can expect their program to have 6-14 sessions. CBT is not meant to be continuous, rather you are expected to learn the skills to be your own therapist.
CBT is a type of therapy that requires active participation from the patient. You need to put in the effort and work to benefit from the treatment.
What You Will Learn in CBT
The main focus of CBT is to alter your negative thoughts and behaviors to be more rational. Throughout your CBT sessions you can expect to learn to:
identify problems and build awareness of your negative thoughts and behavior
recognize your thoughts are opinions and be able to distinguish between facts and irrational thoughts
consciously challenge and reframe dysfunctional assumptions
set achievable goals
be more present and kind to yourself
develop a more positive perspective of situations
be more resilient and in control of your problems
become your own therapist and practice relapse prevention
Basic CBT Techniques
There are various techniques that will be utilized during your CBT treatment. Here are 10 common techniques used in cognitive therapy:
ABC Model: Helps you reinterpret irrational beliefs resulting in alternative behaviors.
Activating Event: An event that would lead to emotional distress or dysfunctional thinking
Belief: The negative thoughts that occurred due to the activating event
Consequences: The negative feelings and behaviors that occurred as a result of the event.
Guided Discovery: The therapist will put themselves in your shoes and try to see things from your viewpoint. They will walk you through the process by asking you questions to challenge and broaden your thinking.
Exposure Therapy: Exposing yourself to the trigger can reduce responses. It may be uncomfortable during the initial sessions but is generally performed in a controlled environment with the therapist's help. This treatment is beneficial for phobias.
Cognitive Restructuring: This treatment focuses on finding and altering irrational thoughts so they are adaptive and reasonable.
Activity Scheduling: The therapist will help identify and schedule helpful behaviors that you enjoy doing. This can include hobbies or fun and rewarding activities.
The Worst Case/Best Case/Most Likely Case Scenario: Letting your thoughts ruminate and explore all three scenarios helps you rationalize your thoughts and develop actionable steps so control of the behavior is realized.
Acceptance and Commitment Therapy: This approach encourages you to accept and embrace the feelings rather than fighting them. This differs from traditional CBT where you’re taught to control the thoughts.
Journaling: Recording your thoughts in a journal or diary can help build awareness of cognitive errors and help better understand your personal cognition.
Behavioral Experiments: These experiments are designed to test and identify negative thought patterns. You’ll be asked to predict what will happen and discuss the results later. It’s better to start with lower anxiety experiments before tackling more distressing ones.
Role-Playing: This technique can help you practice difficult scenarios you may encounter. It can lessen the fear and help improve problem-solving skills, social interactions, building confidence for specific situations, and improving communication skills.
Pros and Cons of CBT
Although the cognitive-behavioral approach has been proven to be effective for most people with a wide range of applications, it isn’t necessarily for everyone.
Here are the advantages of the CBT approach:
can be completed in a relatively short period of time for most people
can help treat some mental illnesses where medication alone has not improved symptoms
focuses on altering your thoughts and behaviors to make changes to how you feel
teaches you practical strategies that can be applied in your daily life
provides the skills for you to be your own therapist enable you to be proactive and prevent relapses
Some of the disadvantages of CBT are:
requires the patient to play an active role and be committed to the process which can take a lot of effort and your time
proves difficult for people with more severe mental illness or those with learning disabilities
involves confronting your anxiety, this initial exposure can be uncomfortable for some people
addresses the individual’s needs, the patient’s environment (family and interactions) are not addressed and can have a significant impact on their well-being
the cognitive model focuses on a narrow scope and focuses on only present problems instead of underlying causes
Now that you are familiar with the principles of CBT and treatment techniques utilized, start challenging and reframe automatic thoughts today.
The 3 Basic Principles of Cognitive Behavioral Therapy
The main theory behind CBT is that your thoughts, feelings, and behavior all impact each other.
Using specific cognitive behavioral therapy (CBT) techniques, you can replace problematic thought patterns with more positive or helpful ones. This type of therapy can help you reframe your perspective and view life’s challenges in a new way.
Many therapists use CBT principles to help clients develop coping skills and better manage stressful situations.
CBT can help people identify and deconstruct difficult or harmful thought patterns. This can lead to positive outcomes for their emotions and behavior. CBT is a goal-oriented, time-based, structured treatment.
This psychological treatment can help with a wide range of mental health issues, including:
- anxious thoughts
- anxiety disorders
- substance misuse or substance use disorder
- eating disorders
“[CBT is] rooted in the idea that thoughts impact feelings and feelings impact behavior,” says Sarah Kaufman, LMSW. “Therefore, if we can reframe our thoughts, we can subsequently change our feelings and then our behavior.”
Reframing your thoughts can help alleviate anxiety and improve your quality of life.
Easton Gaines, PsyD, a licensed psychologist, explains that there are three levels of cognition in CBT:
1. Core beliefs
Our core beliefs are informed by our childhood experiences. They are deeply rooted in how we view ourselves, our environment, and the future, along with our beliefs about these factors.
2. Dysfunctional assumptions
Humans tend to hold onto the negative more easily than the positive. However, these cognitive distortions are irrational thought patterns that distort our perceptions of reality.
3. Automatic negative thoughts
Automatic negative thoughts are involuntary negative perceptions of reality that occur out of habit. They can be difficult to recognize since they are brief and cause negative emotions.
“If you can change how you think about a situation or how you respond to a situation, then you can change how you feel in a situation,” Kristel Roper, LMFT, LPCC, explains. “This can be a powerful tool, as it’s difficult (if not impossible) to just turn your feelings on or off.”
It’s also important to understand that we all have distorted thoughts at times. These are known as cognitive distortions. Examples of cognitive distortions include:
- all-or-nothing thinking, such as thinking that you’re a failure for making one mistake
- “should” statements, or believing that you should never make mistakes
- overgeneralization, which is the belief that you’ll always get it wrong or that things will never get better
It’s important to understand that we do not have to believe our thoughts. We have a choice in how we respond to our thoughts, and, with practice, we can learn to challenge these thoughts and respond in kinder, more realistic, and more helpful ways, Roper adds.
Example: Reframing automatic negative thoughts
Scenario 1. Someone passes you in the hallway and does not say hello. You think: They don’t like me. “In this scenario, you might feel sad or disappointed, and then as a result, perhaps you avoid that person at work or frequently think about what you might do to get them to like you,” Kaufman explains.
Scenario 2. Someone passes you in the hallway and does not say hello. You think: They must be busy today. “This may cause you to feel neutral or unfazed, and then as a result, you don’t give it another thought and move on with your day,” says Kaufman. “Or, perhaps you feel compassion toward the person and offer to help them with their work.”
Though each CBT session is different, here are some popular CBT techniques that many therapists use.
Catastrophic thinking, or catastrophizing, is a common cognitive distortion where you automatically believe the worst possible outcome will happen, no matter how unlikely it is.
A decatastrophizing exercise can be helpful if you find yourself worrying about something specific over and over again.
When you find yourself caught in catastrophic thinking, Kaufman recommends asking yourself the following questions:
- What am I worried about?
- How likely is it that my worry will come true?
- If my worry comes true, what’s the worst that could happen?
- If my worry comes true, what’s most likely to happen?
- If my worry comes true, what are the chances I’ll be okay?
The ABC technique
When using this technique, you consider the activating event (A), your behaviors (B), and the consequences (C). For instance:
- Bobby said something mean to me (A)
- I responded by kicking him (B)
- I got into trouble at school (C)
“The ABC technique looks at what happened, how you acted, and what happened next,” Jessica Biren Caverly, PhD, a licensed psychologist, explains. “We often use this same theory for criminals. What caused you to steal (A), you then stole (B), and then you went to jail (C).”
The goal of this exercise is to change your way of thinking, which can then help change your behavior.
“The purpose of incarceration is to help people connect how they react to situations with the consequences in hopes that the person can again experience A, but react differently, as to change B and C,” Caverly adds.
Keeping a journal
This involves writing down things that happen and how you feel about them. The goal is to gain a deeper understanding of your thought processes.
Over time, you can identify common challenges that arise in your thinking. You can then talk about them with your therapist and work on finding ways to manage them.
Keen to start journaling, but unsure where to begin? Consider reading Psych Central’s 64 journaling prompts.
The core of CBT lies in the understanding that thoughts, feelings, and actions are all connected. Changing how you think can make positive, lasting changes in how you feel. Becoming aware of our thought patterns allows us to identify dysfunctional thoughts and create new ones.
By learning how to manage the way you think, you can change the way you feel and behave.
What is Cognitive Behavioral Therapy (CBT)
The here and now principle
Help is focused on the person's present problems, we put out the fire, our task is to reduce suffering in the present, but we also explore the past, look for vulnerability and try to strengthen our defenses.
Problem oriented work, i.e. we prioritize, set goals and develop a therapy plan.
Cognitive Behavioral Therapy is always researching its effectiveness because we need to be sure that the treatment actually works, which is why CBT is considered evidence-based treatment.
The principle of cooperation and active participation
A person is involved in the process of therapy, receives the necessary knowledge and skills to successfully cope with difficulties in his life, to be his own therapist.
It is believed that mental health problems are best viewed as an extreme version of the norm, this is the segment along which we move throughout life, from mental well-being to certain difficulties. Statistics show that one in five people will have one or another mental disorder during their lifetime.
Integrative System Principle
Human problems are seen as the interaction between thoughts/emotions/behavior and physiology and environment in a broad sense, ie social, family, physical and cultural environment.
Our thoughts about a particular situation can often influence how we feel, both physically and emotionally, and how we act in response. For example: Situation, a person is texting a close friend and although they typically respond immediately, many hours have passed with no response.
Here are some examples. One person thinks, "Something bad must have happened to him." He may feel anxious, his heart rate increases, it is more difficult to breathe, and he begins to call everyone he knows, trying to find out what happened. Another person thinks: “I am no longer interesting to him, I am a boring person.” Then sadness, oppression may appear, and he stops writing to a friend. Thus, our interpretations affect our state and the further development of the situation.
Our actions can contribute to the maintenance of problems and vice versa. In the last example, by changing the behavior by asking a friend why he took so long to answer, you could find out that he did not have a connection, or that he was very busy, instead of trusting the opinion that "I'm boring man" and quit trying to find out, and as a result it would change our mood and the development of the situation.
Cognitive Behavioral Therapy | psychologist Oksana Korolovich
Cognitive-behavioral psychotherapy (CBT) is one of the most effective and frequently used areas of short-term therapy. CBT gained worldwide fame due not only to its simplicity in the perception of clients, but also to a completely new positioning of the method - this is not a classic psychotherapy, but a democratic way of social adaptation through learning. Thus, CBT removes the psychological barrier that worries many, where the “patient” becomes a “client or student”.
The origins of cognitive behavioral therapy lie in the experiments and writings of I. Pavlov and F. Skinner. Thanks to studies of the behavioral reactions of animals, they came to the conclusion that behavior is due to an external stimulus: “stimulus - reaction”.
To reinforce the desired reaction, it is necessary to reinforce it positively. Forms of behavior that are not reinforced by anything, on the contrary, atrophy or die out altogether (operant conditioning).
The modern cognitive-behavioral approach in psychotherapy is somewhat different from the classical one. After all, he was based solely on social determinism (life is determined only by factors of the social environment) and did not explain the emergence of a palette of internal and external reactions, factors of socialization of the individual.
In 1961, Bandura published the article "Psychotherapy as a learning process" which defined CBT as we know and use it today. Namely, human behavior is determined not only by the mechanisms of operant and classical learning, but also by cognitions: beliefs, self-perception, the way of information processing, ideas about oneself and the world, etc. For example: “all people are kind”, “the world is dangerous”, “you need to get married before the age of 30”.
It is cognitions that trigger behavioral reactions and the formation of action patterns.
Principles of Cognitive Behavioral Therapy
I increasingly choose CBT because of its versatility and inspiring speed of therapeutic effect. Although not so long ago (about 10 years ago), very few people used it in the expanses of the post-Soviet space.
Cognitive Behavioral Therapy is based on the following principles:
- Behavioral problems are the result of educational and training gaps. The therapist carefully examines the client's life history to determine the psychological and social factors that triggered the maladaptive (undesirable) behavior.
- Unwanted behavior is the result of a person's natural desire to satisfy basic needs for love, acceptance, security, significance, freedom.
- The main psychotherapeutic tool is the modeling of a desirable ("benign") cognitive system with automatic change in behavior in a familiar environment.
- The learning methodology involves not only the client, but also significant persons from his environment in the therapeutic process to ensure high efficiency. For example, in order for a person to overcome the fear of public speaking, it is important to change the usual strategy of reactions of loved ones from “Oh, you are a coward!” to "Everything will work out, I believe in you!".
Thus, the psychotherapist sees the strategic goal of working in this method in identifying and replacing a maladaptive belief (cognition) with a desirable one. How?
To do this, use the tools of classical, operant, observational and cognitive learning with an emphasis on the development of behavioral self-regulation. So, the psychologist and the client draw up a plan with a list of achievable goals and indicators with which they will check the result. The sequence of work with each goal is determined by learning and consolidating the previous one (if you haven’t learned it, we don’t start a new one).
The goal is formulated in the format “I want”, and not “I would like”, which allows you to fix what you want and not be limited to thematic fantasizing.
Causes of behavioral problems
In the sessions, the psychotherapist deeply explores the origins of certain unwanted, limiting cognitions (parental education, situational formation, etc.), which in the process change to the desired ones. Their client daily reads and comprehends and restructures his behavior for them.
Thus, Ellis gives a list of the most common limiting beliefs that lead to many behavioral problems:
- You must be loved and approved by everyone you meet, especially close people.
- One must be competent in all areas and areas.
- Most people are evil.
- If the situation does not develop according to plan, a "terrible horror" will happen.
- All misfortunes and problems depend on external factors and a person has no power to change anything.
- All the negativity in life must be humbly accepted.
- The best way to solve problems is to avoid them.
- The strong rule the world.
- If you can't solve a problem, you're a loser.
Depending on inner conviction, a person manifests himself in the social environment, which leads to problems, neurosis, psychological trauma, dissatisfaction.
So, a convinced woman “all men are goats” organizes her life in such a way that the attitude is reinforced by the level of every man she meets and the “happy” young lady exclaims: “What did I say!?”. Cognitive behavioral therapy will help such a woman to find out the source of the position, change the old belief to a new one (for example: “there are better men in my environment”) and change the style of behavior with a stronger half. And this will lead to the desire to confirm cognition (as in the case of limiting) and she will actually meet the best.
What I like the most is that the client is fully involved in the therapeutic process and determines the appropriate method to achieve the set goals.