Theory of cbt

Beck Institute | Understanding CBT

CBT is based on the theory that the way individuals perceive a situation is more closely connected to their reaction than the situation itself. Individuals’ perceptions are often distorted and unhelpful, particularly when they are distressed. Cognitive Behavior Therapy helps people identify their distressing thoughts and evaluate how realistic the thoughts are. Then they learn to change their distorted thinking. When they think more realistically, they feel better. The emphasis is also consistently on solving problems and initiating behavioral changes.

About Cognitive Behavior Therapy

Cognitive Behavior Therapy (CBT) is a time-sensitive, structured, present-oriented psychotherapy that has been scientifically tested and found to be effective in more than 2,000 studies for the treatment of many different health and mental health conditions. When implemented correctly, CBT helps individuals get better and stay better. 

Cognitive Model

The cognitive model describes how people’s thoughts and perceptions influence the way they feel and behave. The cognitive model is at the core of CBT, and it plays a critical role in helping therapists conceptualize and treat their clients’ difficulties.

Principles of Treatment

CBT therapists use an individual formulation to guide treatment for each client. This formulation is essential to developing a sound therapeutic relationship, setting goals, planning treatment, and selecting interventions.

Fourteen tenets of good CBT:

CBT treatment plans are based on an ever-evolving cognitive conceptualization.
CBT requires a sound therapeutic relationship.
CBT continually monitors client progress.
CBT is culturally adapted and tailors treatment to the individual.
CBT emphasizes the positive.
CBT stresses collaboration and active participation.
CBT is aspirational, values based, and goal oriented.
CBT initially emphasizes the present.
CBT is educative.
CBT is time sensitive.
CBT sessions are structured.
CBT uses guided discovery and teaches clients to respond to their dysfunctional cognitions.
CBT includes action plans (therapy homework).
CBT uses a variety of techniques to change thinking, mood, and behavior.

CBT Assessment Tools

There are a variety of helpful CBT tools to help mental health practitioners in their work with patients, including the Beck Depression Scale, the Beck Hopelessness Scale, the Personality Belief Questionnaire, and more.

Research

People often ask, ‘Does CBT work?’ The answer is clear: yes. More than 2,000 studies have demonstrated the efficacy of CBT for psychiatric disorders, psychological problems and medical problems with a psychiatric component.

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Cognitive Behavior Therapy - StatPearls

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StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-.

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Suma P. Chand; Daniel P. Kuckel; Martin R. Huecker.

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Last Update: September 9, 2022.

Continuing Education Activity

In the 1960s, Aaron Beck developed cognitive behavior therapy (CBT) or cognitive therapy. Since then, it has been extensively researched and found to be effective in a large number of outcome studies for psychiatric disorders including depression, anxiety disorders, eating disorders, substance abuse, and personality disorders. It also has been demonstrated to be effective as an adjunctive treatment to medication for serious mental disorders such as bipolar disorder and schizophrenia. CBT has been adapted and studied for children, adolescents, adults, couples, and families. This activity reviews the efficacy of CBT in both psychiatric and non-psychiatric disorders and the role of the interprofessional team in using it to improve patient outcomes.

Objectives:

Identify the key concepts of cognitive-behavioral therapy.
Describe the indications for cognitive behavioral therapy.
Outline the structure of cognitive behavioral therapy sessions.
Review the clinical significance of cognitive-behavioral therapy and its efficacy in treating common psychiatric illnesses.

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Introduction

In the 1960s, Aaron Beck developed cognitive behavior therapy (CBT) or cognitive therapy. Since then, it has been extensively researched and found to be effective in a large number of outcome studies for some psychiatric disorders, including depression, anxiety disorders, eating disorders, substance abuse, and personality disorders. It also has been demonstrated to be effective as an adjunctive treatment to medication for serious mental disorders such as bipolar disorder and schizophrenia. CBT has been adapted and studied for children, adolescents, adults, couples, and families. Its efficacy also has been established in the treatment of non-psychiatric disorders such as irritable bowel syndrome, chronic fatigue syndrome, fibromyalgia, insomnia, migraines, and other chronic pain conditions.[1][2][3]

Issues of Concern

Origins of Cognitive Behavior Therapy

The idea for developing this form of psychotherapy took root when Aaron Beck began to notice that his patients with depression often verbalized thoughts that were lacking in validity and noted characteristic “cognitive distortions” in their thinking. His empirical observations led him to start viewing depression not so much as a mood disorder but as a cognitive disorder. Based on his clinical observations and empirical findings, Beck outlined a new cognitive theory of depression. He published Cognitive Therapy for Depression (Beck, Rush, Shaw, and Emery, 1979) after having published a study that evaluated and demonstrated the efficacy of cognitive therapy. The combination of a detailed treatment protocol manual with outcome research was an innovation in psychotherapy practice that had only previously been attempted by behavior therapists in treating discrete behavioral problems. By accomplishing the same feat with a more complex set of clinical interventions that included cognitive, emotional, and behavioral components, Beck pioneered a model for what psychologists many years later defined as an “empirically validated psychological treatment.”

Other clinicians and researchers became interested and began developing CBT treatment protocols and evaluating their efficacy. Specific treatment protocols were developed for some psychiatric disorders. As behavioral strategies were incorporated, the term cognitive therapy changed to cognitive behavior therapy. Today CBT is the most extensively researched of all psychotherapies with several evidence-based treatment protocols.

Cognitive Model

CBT is based on a straightforward, common-sense model of the relationships among cognition, emotion, and behavior.[4][5][6][7]

Three aspects of cognition are emphasized:

Automatic thoughts
Cognitive distortions
Underlying beliefs or schemas

Automatic Thoughts

An individual’s immediate, unpremeditated interpretations of events are referred to as automatic thoughts. Automatic thoughts shape both the individual’s emotions and their actions in response to events. For example, a friend may cross you in the hallway and not say hello to you. If you were to have an automatic thought of “he hates me,” or “I have done something to anger him,” it is likely to impact your mood and cause you to feel upset and also to behave in an avoidant manner when you see him next. On the other hand, if you had the automatic thought, “he is in a hurry,” you would not be too concerned, and you would not be avoidant when you were to see him next.

CBT is based on the observation that dysfunctional automatic thoughts that are exaggerated, distorted, mistaken, or unrealistic in other ways, play a significant role in psychopathology.

Cognitive Distortions

Errors in logic are quite prevalent in patients with psychological disorders. They lead individuals to erroneous conclusions. Below are some cognitive distortions that are commonly seen in individuals with psychopathology:

Dichotomous thinking: Things are seen regarding two mutually exclusive categories with no shades of gray in between.
Overgeneralization: Taking isolated cases and using them to make wide generalizations.
Selective abstraction: Focusing exclusively on certain, usually negative or upsetting, aspects of something while ignoring the rest.
Disqualifying the positive: Positive experiences that conflict with the individual’s negative views are discounted.
Mind reading: Assuming the thoughts and intentions of others.
Fortune telling: Predicting how things will turn out before they happen.
Minimization: Positive characteristics or experiences are treated as real but insignificant.
Catastrophizing: Focusing on the worst possible outcome, however unlikely, or thinking that a situation is unbearable or impossible when it is just uncomfortable.
Emotional reasoning: Making decisions and arguments based on how you feel rather than objective reality.
“Should” statements: Concentrating on what you think “should” or “ought to be” rather than the actual situation you are faced with or having rigid rules which you always apply no matter the circumstances.
Personalization, blame, or attribution: Assuming you are completely or directly responsible for a negative outcome. When applied to others consistently, the blame is the distortion.

Underlying Beliefs

Underlying beliefs shape the perception and interpretation of events. Belief systems or schemas take shape as we go through life experiences. They are defined as templates or rules for information processing that underlie the most superficial layer of automatic thoughts. Beliefs are understood at two levels in CBT:

Core Beliefs

The central ideas about self and the world
The most fundamental level of belief
They are global, rigid, and overgeneralized

Examples of dysfunctional core beliefs:

Intermediate Beliefs

Consist of assumptions, attitudes, and rules
Influenced in their development by the core beliefs

Examples of dysfunctional intermediate beliefs:

“To be accepted, I should always please others.”
“I should be excellent at everything I do to be considered adequate. ”
“It is best to have as little as possible to do with people.”

Clinical Significance

Cognitive behavior therapy is a structured, didactic, and goal-oriented form of therapy. The approach is hands-on and practical wherein the therapist and patient work in a collaborative manner with the goal of modifying patterns of thinking and behavior to bring about a beneficial change in the patient's mood and way of living his/her life. It is used to help a wide range of problems, and appropriate treatment protocols are applied depending on the diagnosis and problems the patient is facing.[8][9][10][11]

Most psychotherapists who practice CBT personalize and customize the therapy to the specific needs of each patient.

The first step is an assessment of the patient and the initiation of developing an individualized conceptualization of him/her. The conceptualization based on the CBT model is built from session to session and is shared with the patient at an appropriate time later in therapy. The approach to therapy is explained very early at the start of the therapy. The problems patient would like to work on in therapy, and goals for therapy are decided in the first or second session collaboratively. The prioritized problems are worked on first.

The structure of each session:

The session always starts with a brief update and check on mood. This is followed by bridging from the previous session to establish continuity. The agenda of what will be talked about in the session is set up collaboratively, and the homework the patient had to do between the sessions is reviewed before plunging into talking about any problem. Issues on the agenda are talked about punctuated with feedback and summaries. The session ends with setting up further homework and a final summary.

Examples of CBT in practice:

Anxiety: CBT often focuses on replacing negative automatic thoughts that can occur in generalized anxiety disorder and may be used alone or in combination with medications such as selective serotonin reuptake inhibitors, which are typically first-line as benzodiazepines have a greater risk of adverse outcomes. In treating panic disorder, CBT may include desensitization to triggers that provoke anxiety; it is important to note, however, that a potential adverse effect of this technique is a temporary mild increase in anxiety.[12]

Depression: In patients with chronic depression, the combination of CBT and antidepressant medication is more effective than either intervention alone. In patients who are no longer taking part in activities that typically bring them pleasure, CBT may initially focus on reinitiating positive activities to overcome inertia.[13]

Attention deficit hyperactivity disorder (ADHD): Behavioral therapy is the initial recommended treatment for children younger than 6 years old, while stimulant medications are the recommended initial intervention for ADHD in children 6 years and older. Behavioral treatments are also recommended for older children, especially if they have a poor response or adverse effects on medication. Behavioral therapy interventions include parent training and behavioral classroom management with a focus on setting clear rules and expectations for the child with appropriate rewards and punishments and daily feedback. [14][15]

Typical CBT treatments involve approximately 60-minute sessions occurring weekly for 8 to 12 weeks.[15]

Enhancing Healthcare Team Outcomes

CBT is a valid and proven form of psychological therapy for a range of mental health disorders. It is important for physicians and nurses to understand that CBT is often used in conjunction with pharmacological therapy to achieve the best outcomes. Moreover, CBT has been shown to provide additional benefits or similar outcomes compared to medication alone. Patients with psychiatric disorders should be referred to a mental health nurse who can educate the patient on treatment options. Primary care physicians are encouraged to develop collaborative relationships with behavior therapists and introduce and monitor the progress of cognitive-behavioral therapy. An interprofessional team approach will result in the best outcomes.[16][17][15]

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References

1.: van den Berk Clark C, Moore R, Secrest S, Tuerk P, Norman S, Myers U, Lustman PJ, Schneider FD, Barnes J, Gallamore R, Ovais M, Plurad JA, Scherrer JF. Factors Associated With Receipt of Cognitive-Behavioral Therapy or Prolonged Exposure Therapy Among Individuals With PTSD. Psychiatr Serv. 2019 Aug 01;70(8):703-713. [PMC free article: PMC6702958] [PubMed: 31010409]
2.: Keefe JR, Chambless DL, Barber JP, Milrod BL. Treatment of anxiety and mood comorbidities in cognitive-behavioral and psychodynamic therapies for panic disorder. J Psychiatr Res. 2019 Jul;114:34-40. [PubMed: 31015099]
3.: Zilcha-Mano S, Eubanks CF, Muran JC. Sudden gains in the alliance in cognitive behavioral therapy versus brief relational therapy. J Consult Clin Psychol. 2019 Jun;87(6):501-509. [PMC free article: PMC6533161] [PubMed: 31008637]
4.: de Jonge M, Bockting CLH, Kikkert MJ, van Dijk MK, van Schaik DJF, Peen J, Hollon SD, Dekker JJM. Preventive cognitive therapy versus care as usual in cognitive behavioral therapy responders: A randomized controlled trial. J Consult Clin Psychol. 2019 Jun;87(6):521-529. [PubMed: 31008635]
5.: Tolin DF, Wootton BM, Levy HC, Hallion LS, Worden BL, Diefenbach GJ, Jaccard J, Stevens MC. Efficacy and mediators of a group cognitive-behavioral therapy for hoarding disorder: A randomized trial. J Consult Clin Psychol. 2019 Jul;87(7):590-602. [PubMed: 31008633]
6.: Heenan A, Pipe A, Lemay K, Davidson JR, Tulloch H. Cognitive-Behavioral Therapy for Insomnia Tailored to Patients With Cardiovascular Disease: A Pre-Post Study. Behav Sleep Med. 2020 May-Jun;18(3):372-385. [PubMed: 31007057]
7.: Janse A, Bleijenberg G, Knoop H. Prediction of long-term outcome after cognitive behavioral therapy for chronic fatigue syndrome. J Psychosom Res. 2019 Jun;121:93-99. [PubMed: 31006534]
8.: Webb CA, Stanton CH, Bondy E, Singleton P, Pizzagalli DA, Auerbach RP. Cognitive versus behavioral skills in CBT for depressed adolescents: Disaggregating within-patient versus between-patient effects on symptom change. J Consult Clin Psychol. 2019 May;87(5):484-490. [PMC free article: PMC6506214] [PubMed: 30998049]
9.: Cuijpers P, Noma H, Karyotaki E, Cipriani A, Furukawa TA. Effectiveness and Acceptability of Cognitive Behavior Therapy Delivery Formats in Adults With Depression: A Network Meta-analysis. JAMA Psychiatry. 2019 Jul 01;76(7):700-707. [PMC free article: PMC6583673] [PubMed: 30994877]
10.: O'Cleirigh C, Safren SA, Taylor SW, Goshe BM, Bedoya CA, Marquez SM, Boroughs MS, Shipherd JC. Cognitive Behavioral Therapy for Trauma and Self-Care (CBT-TSC) in Men Who have Sex with Men with a History of Childhood Sexual Abuse: A Randomized Controlled Trial. AIDS Behav. 2019 Sep;23(9):2421-2431. [PMC free article: PMC7271561] [PubMed: 30993478]
11.: Sahranavard S, Esmaeili A, Salehiniya H, Behdani S. The effectiveness of group training of cognitive behavioral therapy-based stress management on anxiety, hardiness and self-efficacy in female medical students. J Educ Health Promot. 2019;8:49. [PMC free article: PMC6432834] [PubMed: 30993142]
12.: Locke AB, Kirst N, Shultz CG. Diagnosis and management of generalized anxiety disorder and panic disorder in adults. Am Fam Physician. 2015 May 01;91(9):617-24. [PubMed: 25955736]
13.: Rupke SJ, Blecke D, Renfrow M. Cognitive therapy for depression. Am Fam Physician. 2006 Jan 01;73(1):83-6. [PubMed: 16417069]
14.: Felt BT, Biermann B, Christner JG, Kochhar P, Harrison RV. Diagnosis and management of ADHD in children. Am Fam Physician. 2014 Oct 01;90(7):456-64. [PubMed: 25369623]
15.: Coffey SF, Banducci AN, Vinci C. Common Questions About Cognitive Behavior Therapy for Psychiatric Disorders. Am Fam Physician. 2015 Nov 01;92(9):807-12. [PubMed: 26554473]
16.: Wu CY, Rodakowski JL, Terhorst L, Karp JF, Fields B, Skidmore ER. A Scoping Review of Nonpharmacological Interventions to Reduce Disability in Older Adults. Gerontologist. 2020 Jan 24;60(1):e52-e65. [PMC free article: PMC7182004] [PubMed: 31002312]
17.: Ngamkham S, Holden JE, Smith EL. A Systematic Review: Mindfulness Intervention for Cancer-Related Pain. Asia Pac J Oncol Nurs. 2019 Apr-Jun;6(2):161-169. [PMC free article: PMC6371675] [PubMed: 30931361]

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Cognitive Behavioral Therapy (CBT) - Origins

What is Cognitive Behavioral Therapy (CBT)?

What processes led to the emergence of cognitive behavioral therapy (CBT).

What is the place of cognitive behavioral therapy (CBT) among modern psychotherapeutic techniques?

Freud's Theory

At the end of the 19th century, Freud presented to the public his view of the human psyche, its components, the causes of the formation of psychopathology and the principles of its treatment - psychoanalysis. Freud made the main emphasis in his theory on the study of unconscious mental processes, presenting them as the main source of both psychopathology and daily behavioral acts.

See also

Myths about diagnosing mental illness

Behavioral Theory and Behavioral Therapy

At the same end of the 19th century, a behavioral theory began to develop - behaviorism (behaviorism), originating with Pavlov and Bekhterev and presented as a well-formed theory in the works of Skinner and Bandura by the middle of the 20th century. Skinner preferred to explain the human psyche, his personality, behavior and psychopathology in behavioral terms, arguing that one should operate only with those concepts that can be empirically measured. Behaviorists argued that only stimulus and behavior are objectively measurable concepts. At the same time, it was argued that the human brain is a “black box” (black box) - a kind of black hole in which objectively unmeasurable and unknowable processes take place. Therefore, behaviorists in their work addressed only the stimulus and behavior.

New brain data and cognitive behavioral therapy

In the 60s-70s. In the 20th century, new data about the brain and cognitive processes appear. Computer science is developing (knowledge about the brain and cognitive processes is the basis for compiling computer programs, in turn, the brain and cognition are explained by analogy with a computer) and now it becomes impossible to treat the brain as a black hole.

As a consequence, the work of Piaget and his students, describing cognitive processes, occupy an increasing place in the work of a psychologist. Vygotsky's works are being actively translated into other languages and occupy a firm place in Western academic psychology. In psychotherapy, Aron Beck develops cognitive theory and Albert Ellis rational-emotive theory, later merged into cognitive behavioral therapy (CBT). The main emphasis in these theories is on cognitive processes that largely determine the human psyche, his personality, behavior and psychopathology.

Cognitive behavioral therapy at the tip of a knife

CBT explains psychopathological processes by the influence of parasitic thoughts on human behavior. Thoughts-parasites are thoughts that negatively affect human self-esteem, perception of the external and internal world. Such thoughts have different colors: mind-reading (“I know what others think of me”), self-flagellation (“I am to blame for everything”), negative perception of reality, timeline, self or other, called the 'Beck Triad', by name Aaron Beck, who first pointed out this kind of parasitic thought (“everything is bad, it always has been, is and will be, and I will never get out of this hole”). Thoughts-parasites negatively affect the feelings of a person and the interpretation of sensations perceived by human senses (I was specially pushed, the whole world is against me and I feel extremely bad). Such a chain closes with appropriate behavior (if I feel so bad and everyone is against me, then I have no reason to live, I don’t want to leave the house). Accordingly, our actions and our feelings affect our way of thinking.

See also

What are cognitive biases?

Treatment with cognitive behavioral therapy (CBT)

There are many approaches and techniques emerging from the theoretical developments of cognitive behavioral therapy (CBT). A cognitive behavioral therapy (CBT) psychotherapist will offer to identify parasitic thoughts and change their direction with the help of the so-called Socratic questions: who said that everything is bad?; where did you get the idea that it will be like this forever? etc. Many other cognitive techniques allow you to change the negative train of thought. But just changing the way you think is not enough to alleviate mental pain or build relationships. A certain cognitive-behavioral therapy is required (auto-training, meditative techniques, communication training, etc.), the use of which leads the patient both to change negative thinking to a more optimistic one, and to acquire more adaptive behavior patterns.

Effectiveness of Cognitive Behavioral Therapy (CBT)

According to current research in the field of psychotherapy, conducted by both the WHO (World Health Organization) and the US Department of Health, cognitive behavioral therapy is the most effective treatment for most mental disorders. Among the problems that can be successfully treated with this method of psychotherapy are anxiety disorders, addictions, obsessions, post-traumatic stress disorder, phobias, sexual disorders, etc. It also gives excellent results in such areas as the treatment of neuroses, the treatment of depression and the treatment of panic attacks. A rare psychologist or psychiatrist denies the effectiveness of this method. In Western psychotherapy, cognitive behavioral therapy (CBT) is the most common treatment technique, showing good results in a relatively short time.

Diagnostics
Alcoholism

CBT - What is CBT?

Change your thoughts - you will change your destiny!

What is CBT?

Cognitive Behavioral Therapy (CBT) is a psychological approach based on scientific principles and research has shown it to be effective for a wide range of problems.

CBT focuses on how your thoughts, beliefs, and attitudes affect your feelings and behaviors and helps you learn the skills you need to deal with various problems.

It combines cognitive therapy (exploring what you think) and behavioral therapy (exploring what you do).

What is the theory of CBT?

CBT is based on the idea that how we think about situations can affect how we feel and behave. For example, if you interpret a situation in a negative way, then you may encounter negative emotions, and these bad feelings may lead you to behave in a certain way.

How does negative thinking start?

Negative thought patterns can start from childhood. For example, if you didn't get much attention or praise from your parents or teachers at school, you might think, "I'm useless, I'm not good enough."

Over time, you can believe these assumptions, and with age, these negative thoughts will become automatic. This way of thinking can affect how you feel at work, at university, or in life in general.

If your negative interpretation of situations is accepted without objection, then these patterns in your thoughts, feelings and behavior can become part of a continuous cycle:

How does CBT work?

In CBT, you work with a therapist to identify and challenge any negative thought or behavior patterns that may be causing you problems. In turn, this can change how you feel about situations and give you the opportunity to change your behavior in the future.

You and your therapist can focus on what is happening in your life right now, but you can also look at your past and think about how your past experiences affect how you see the world.

How can CBT help?

CBT is a relatively flexible therapy that can be tailored to meet your specific needs. Scientific evidence and clinical practice suggest that CBT may be effective for a range of mental health issues, such as:

Anxiety and panic attacks
Bipolar disorder
Borderline personality disorder
Depression
Eating disorders
Obsessive Compulsive Disorder
Phobias
Post-traumatic stress disorder
Psychoses
Schizophrenia

CBT may also be offered and can help you find new ways to deal with problems such as:

Anger regulation problems
Alcohol and drug abuse
Sexual and relationship problems
Insomnia (sleep problems)
Chronic fatigue syndrome
Chronic pain

You can also use CBT if you have a mental health problem along with a physical health problem.

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