Cognitive behavioral therapy (CBT) is a form of talking therapy that can be used to treat people with a wide range of mental health problems.
CBT is based on the idea that how we think (cognition), how we feel (emotion) and 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. When a person suffers from psychological distress, how they interpret situations becomes skewed, which, in turn, has a negative impact on the actions they take.
CBT aims to help people become aware of when they make negative interpretations and of behavioral patterns which reinforce distorted thinking. Cognitive therapy helps people develop alternative ways of thinking and behaving 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.
See Dobson and Block (1988) for a review of the historical basis of cognitive behavioral therapy
In This Article
• The cognitive approach believes that mental illness 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 how 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, 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 behavior part of the therapy involves setting homework for the client to do (e.g., keeping a diary of thoughts). The therapist gives the client tasks to help them challenge their irrational beliefs.
The idea is that the client identifies their own unhelpful beliefs and then 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.
Albert Ellis – REBT
Rational Emotive Behavior Therapy (REBT) is a type of cognitive therapy first used by Albert Ellis, focusing on resolving emotional and behavioral problems.
The goal of this therapy is to change irrational beliefs to more rational ones.
REBT encourages people to identify their general and irrational beliefs (e.g., ‘I must be perfect’) and subsequently persuades them to challenge these false beliefs through reality testing.
Albert Ellis (1957, 1962) proposes that each of us holds a unique set of assumptions about ourselves and our world that guide us through life and determine our reactions to the various situations we encounter.
Unfortunately, some people’s assumptions are largely irrational, guiding them to act and react in inappropriate ways that prejudice their chances of happiness and success. Albert Ellis calls these basic irrational assumptions.
Some people irrationally assume they are failures if they are not loved by everyone they know – they constantly seek approval and repeatedly feel rejected. All their interactions are affected by this assumption so that a great party can leave them dissatisfied because they don’t get enough compliments.
According to Ellis, these are other common irrational assumptions :
• The idea that one should be thoroughly competent at everything.
• The idea that it is catastrophic when things are not the way you want them to be.
• The idea that people have no control over their happiness.
• The idea that you need someone stronger than yourself to depend on.
• The idea that your history greatly influences your present life.
• The idea that there is a perfect solution to human problems, and it’s a disaster if you don’t find it.
Ellis believes that people often forcefully hold on to this illogical way of thinking and therefore employ highly emotive techniques to help them vigorously and forcefully change this irrational thinking.
The ABC Model
A major aid in cognitive therapy is what Albert Ellis (1957) called the ABC Technique of Irrational Beliefs.
The first three steps analyze the process by which a person has developed irrational beliefs and may be recorded in a three-column table.
* A – Activating Event or objective situation. The first column records the objective situation, that is, an event that ultimately leads to some type of high emotional response or negative dysfunctional thinking.
* B – Beliefs. In the second column, the client writes down the negative thoughts that occurred to them.
* C – Consequence. The third column is for the negative feelings and dysfunctional behaviors that ensued. The negative thoughts of the second column are seen as a connecting bridge between the situation and the distressing feelings. The third column, C, is next explained by describing emotions or negative thoughts that the client thinks are caused by A. This could be anger, sorrow, anxiety, etc.
Ellis believes that it is not the activating event ( A ) that causes negative emotional and behavioral consequences ( C ) but rather that a person interprets these events unrealistically and therefore has an irrational belief system ( B ) that helps cause the consequences ( C ).(Video) What is Cognitive Behavioral Therapy?
Gina is upset because she got a low mark on a math test. The Activating event, A, is that she failed her test. The Belief, B, is that she must have good grades or she is worthless. The Consequence, C, is that Gina feels depressed.
After identifying irrational beliefs, the therapist will often work with the client in challenging the negative thoughts based on evidence from the client’s experience by reframing it, meaning to re-interpret it in a more realistic light. This helps the client to develop more rational beliefs and healthy coping strategies.
A therapist would help Gina realize that there is no evidence that she must have good grades to be worthwhile or that getting bad grades is awful. She desires good grades, and it would be good to have them, but it hardly makes her worthless.
If she realizes that getting bad grades is disappointing but not awful and that it means she is currently bad at math or studying but not as a person, she will feel sad or frustrated but not depressed. The sadness and frustration are likely healthy negative emotions and may lead her to study harder from then on.
Rational emotive behavior therapists have cited many studies in support of this approach. Most early studies were conducted on people with experimentally induced anxieties or non-clinical problems such as mild fear of snakes (Kendall & Kriss, 1983).
However, several recent studies have been done on actual clinical subjects and have also found that rational emotive behavior therapy (REBT) is often helpful (Lyons & Woods 1991).
Aaron Beck – Cognitive Therapy
Beck’s (1967) system of therapy is similar to Ellis’s but has been most widely used in cases of depression. Cognitive therapists help clients to recognize the negative thoughts and errors in logic that cause them to be depressed.
The therapist also guides clients to question and challenge their dysfunctional thoughts, try out new interpretations, and ultimately apply alternative ways of thinking in their daily lives.
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 cognitions automatic thoughts.
When a person’s stream of automatic thoughts is very negative, you would expect a person to become depressed (e.g., ‘I’m never going to get this essay finished, my girlfriend fancies my best friend, I’m getting fat, I have no money, my parents hate me – have you ever felt like this?’).
Quite often, these negative thoughts will persist despite contrary evidence.
Beck (1967) identified three mechanisms that he thought were responsible for depression:
- The cognitive triad (of automatic negative thinking)
- Negative self-schemas
- Errors in Logic (i.e., faulty information processing)
The Cognitive Triad
The cognitive triad is 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. These thoughts tended to be automatic in depressed people as they occurred spontaneously.
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.
Beck believed that depression-prone individuals 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 might be acquired in childhood due to 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 a 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.
Beck (1967) identifies several 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.
• Arbitrary interference: Drawing conclusions on the basis of sufficient or irrelevant evidence: for example, thinking you are worthless because an open-air concert you were going to see has been rained off.
• Selective abstraction: Focusing on a single aspect of a situation and ignoring others: E.g., you feel responsible for your team losing a football match even though you are just one of the players on the field.
• Magnification: exaggerating the importance of undesirable events. E.g., if you scrape a bit of paintwork on your car and, therefore, see yourself as a totally awful driver.
• Minimisation: underplaying the significance of an event. E.g., you get praised by your teachers for an excellent term’s work, but you see this as trivial.
• Overgeneralization: drawing broad negative conclusions on the basis of a single insignificant event. E.g., you get a D for an exam when you normally get straight As and you, therefore, think you are stupid.
• Personalisation: Attributing the negative feelings of others to yourself. E.g., your teacher looks really cross when he comes into the room, so he must be cross with you.
Butler and Beck (2000) reviewed 14 meta-analyses investigating the effectiveness of Beck’s cognitive therapy and concluded that about 80% of adults benefited from the therapy.
It was also found that the therapy was more successful than drug therapy and had a lower relapse rate, supporting the proposition that depression has a cognitive basis.
This suggests that knowledge of the cognitive explanation can improve the quality of people’s lives.
REBT Vs. Cognitive Therapy
• Albert Ellis views the therapist as a teacher and does not think that a warm personal relationship with a client is essential. In contrast, Beck stresses the quality of the therapeutic relationship.
• REBT is often highly directive, persuasive, and confronting. Beck places more emphasis on the client discovering misconceptions for themselves.
• REBT uses different methods depending on the client’s personality; in Beck’s cognitive therapy, the method is based on the particular disorder.
Strengths of CBT
1. Model has great appeal because it focuses on human thought. Human cognitive abilities have been responsible for our many accomplishments, so they may also be responsible for our problems.
2. Cognitive theories lend themselves to testing. When experimental subjects are manipulated into adopting unpleasant assumptions or thoughts, they become more anxious and depressed (Rimm & Litvak, 1969).
3. Many people with psychological disorders, particularly depressive, anxiety, and sexual disorders, have been found to display maladaptive assumptions and thoughts (Beck et al., 1983).
4. Cognitive therapy has been very effective in treating depression (Hollon & Beck, 1994) and moderately effective for anxiety problems (Beck, 1993).
Limitations of CBT
1. The precise role of cognitive processes is yet to be determined. It is not clear whether faulty cognitions are a cause of
psychopathology or a consequence of it.
Lewinsohn (1981) studied a group of participants before any of them became depressed and found that those who later became depressed were no more likely to have negative thoughts than those who did not develop depression. This suggests that hopeless and negative thinking may result from depression rather than the cause of it.
2. The cognitive model is narrow in scope – thinking is just one part of human functioning, and broader issues need to be addressed.
3. Ethical issues: RET is a directive therapy aimed at changing cognitions, sometimes quite forcefully. For some, this may be considered an unethical approach.
Beck, A. T. (1967). Depression: Causes and treatment. Philadelphia: University of Pennsylvania Press.
Beck, A. T., Epstein, N., & Harrison, R. (1983). Cognitions, attitudes and personality dimensions in depression. British Journal of Cognitive Psychotherapy.
Beck, A. T, & Steer, R. A. (1993). Beck Anxiety Inventory Manual. San Antonio: Harcourt Brace and Company.
Butler, A. C., & Beck, J. S. (2000). Cognitive therapy outcomes: A review of meta-analyses. Journal of the Norwegian Psychological Association, 37, 1-9.
Dobson, K. S., & Block, L. (1988). Historical and philosophical bases of cognitive behavioral theories. Handbook of Cognitive behavioral Therapies. Guilford Press, London.
Ellis, A. (1957). Rational Psychotherapy and Individual Psychology. Journal of Individual Psychology, 13: 38-44.
Ellis, A. (1962). Reason and Emotion in Psychotherapy. New York: Stuart.
Hollon, S. D., & Beck, A. T. (1994). Cognitive and cognitive-behavioral therapies. In A. E. Bergin & S.L. Garfield (Eds.), Handbook of psychotherapy and behavior change (pp. 428—466). New York: Wiley.
Kendall, P. C., & Kriss, M. R. (1983). Cognitive-behavioral interventions. In: C. E. Walker, ed. The handbook of clinical psychology: theory, research and practice, pp. 770–819. Homewood, IL: Dow Jones-Irwin.
Lewinsohn, P. M., Steinmetz, J. L., Larson, D. W., & Franklin, J. (1981). Depression-related cognitions: antecedent or consequence?. Journal of abnormal psychology, 90(3), 213.
Lyons, L. C., & Woods, P. J. (1991). The efficacy of rational-emotive therapy: A quantitative review of the outcome research. Clinical Psychology Review, 11(4), 357-369.
Rimm, D. C., & Litvak, S. B. (1969). Self-verbalization and emotional arousal. Journal of Abnormal Psychology, 74(2), 181.
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Cognitive and behavioral therapies
An Overview of Psychopathology
An appraisal of rational-emotive therapy Making sense of cognitive behavior therapy (CBT)
What are the 3 CBT techniques? ›
- Thought Records. One of the landmarks of CBT is that patients are given homework after every session. ...
- Exposure Therapy. ...
- Relaxation Training.
- Psychoanalysis and psychodynamic therapies. ...
- Behavior therapy. ...
- Cognitive therapy. ...
- Humanistic therapy. ...
- Integrative or holistic therapy.
- Step One – Make A List.
- Step Two – Record Unproductive Thoughts.
- Step Three – Create Replacement Thoughts.
- Step Four – Read Your List Often.
- Step Five – Notice And Replace.
Two strategies often used in CBT are Calm Breathing, which involves consciously slowing down the breath, and Progressive Muscle Relaxation, which involves systematically tensing and relaxing different muscle groups.Does CBT use relaxation techniques? ›
Relaxation strategies are just one set of skills used in CBT. We all would like to spend more time feeling relaxed, but relaxation skills are not always the right skills to improve our anxiety in the long run.What are the 4 core elements of CBT? ›
CBT is a treatment approach that provides us with a way of understanding our experience of the world, enabling us to make changes if we need to. It does this by dividing our experience into four central components: thoughts (cognitions), feelings (emotions), behaviors and physiology (your biology).What is CBT most commonly used for? ›
Cognitive behavioural therapy (CBT) is a talking therapy that can help you manage your problems by changing the way you think and behave. It's most commonly used to treat anxiety and depression, but can be useful for other mental and physical health problems.What is the most effective CBT? ›
Research shows that CBT is the most effective form of treatment for those coping with depression and anxiety. CBT alone is 50-75% effective for overcoming depression and anxiety after 5 – 15 modules. Medication alone is effective, however, science still does not understand the long-term effects on the brain and body.Which technique is most widely used by therapists? ›
Psychodynamic Counseling is probably the most well-known counseling approach. Rooted in Freudian theory, this type of counseling involves building strong therapist–client alliances. The goal is to aid clients in developing the psychological tools needed to deal with complicated feelings and situations.What is the most common type of therapy? ›
What Is the Most Common Type of Therapy? The most common type of therapy right now may be cognitive behavioral therapy (CBT). As mentioned above, CBT explores the relationship between a person's feelings, thoughts, and behaviors. It often focuses on identifying negative thoughts and replacing them with healthier ones.
How many therapy techniques are there? ›
The Most Common Types of Therapy. There are more than fifty types of therapeutic approaches.What are the key concepts of CBT? ›
Cognitive behavioural therapy (CBT) explores the links between thoughts, emotions and behaviour. It is a directive, time-limited, structured approach used to treat a variety of mental health disorders. It aims to alleviate distress by helping patients to develop more adaptive cognitions and behaviours.How does CBT treatment work? ›
You work with a mental health counselor (psychotherapist or therapist) in a structured way, attending a limited number of sessions. CBT helps you become aware of inaccurate or negative thinking so you can view challenging situations more clearly and respond to them in a more effective way.What is the best technique for anxiety? ›
- Keep physically active. ...
- Avoid alcohol and recreational drugs. ...
- Quit smoking, and cut back or quit drinking caffeinated beverages. ...
- Use stress management and relaxation techniques. ...
- Make sleep a priority. ...
- Eat healthy foods. ...
- Learn about your disorder.
CBT is an umbrella term that refers to a conceptual model of treatment more than any one protocol. Mindfulness and acceptance strategies are consistent with general CBT principles, because they target core processes, such as increased emotional awareness and regulation, cognitive flexibility, and goals-based behaviors.Is distraction a CBT technique? ›
Distraction techniques are a form of coping skill, taught during cognitive behavioural therapy. These techniques are used to distract and draw attention away from the auditory symptoms of schizophrenia, such as auditory hallucinations (e.g. voice-hearing) and intrusive thoughts.What are the three most commonly used relaxation techniques? ›
- Autogenic training. This technique uses both visual imagery and body awareness to move a person into a deep state of relaxation. ...
- Breathing. ...
- Progressive muscle relaxation. ...
- Meditation. ...
- Guided imagery.
Bringing things together: the Five Areas model
1 life situation, relationships and practical problems. 2 altered thinking. 3 altered emotions (also called mood or feelings) 4 altered physical feelings/symptoms.
CBT skills help us create a map from our behavioral problem to our core thinking problem, to our core believing problem. This can assist us in making our own informed decisions about how we want to feel and think, and act, as well as what we want to believe.How does CBT help a client? ›
For adults, CBT has been shown to help with marital problems, sexual dysfunction, depression, mood disorders and substance abuse. It has also been shown to be as useful as antidepressant medication for individuals with depression and appears to be superior to medication in preventing relapses.
How can I practice CBT at home? ›
- Fully Focus on Your Thoughts. CBT requires an intense focus on the thoughts that come to mind throughout the day. ...
- Schedule Your Day with Manageable Tasks. ...
- Relaxation Techniques. ...
- Reframe Your Thought Patterns.
- Scheduling activities that bring you enjoyment and a sense of accomplishment.
- Recognizing how your actions influence your thoughts and emotions.
- Making the best use of your time.
- Breaking down daunting tasks into more manageable ones.
- Facing your fears gradually so they diminish.
- CBT (Cognitive Behavioral Therapy) The belief of Cognitive Behavioral Therapy is that a person's mood is directly related to the person's thoughts. ...
- DBT (Dialectical Behavioral Therapy) Skills. ...
- Play Therapy. ...
- Sand Tray Therapy. ...
- EMDR(Eye Movement Desensitization and Reprocessing)
- Using Silence. At times, it's useful to not speak at all. ...
- Accepting. ...
- Giving Recognition. ...
- Offering Self. ...
- Giving Broad Openings. ...
- Active Listening. ...
- Seeking Clarification. ...
- Placing the Event in Time or Sequence.
This gives them a clearer sense of the patient and their emotional health. Other therapeutic communication techniques include maintaining a deliberate silence to allow their patients to decide what to talk about next or to experience their emotions for a while.What is the best counseling approach? ›
Currently preferred cognitive-theory-based therapies include cognitive behavior therapy, reality therapy, motivational interviewing, and acceptance and commitment therapy. Behavioral: Behavioral counseling theories hold that people engage in problematic thinking and behavior when their environment supports it.What type of therapy is best for trauma? ›
- Cognitive Behavioral Therapy (CBT) ...
- Prolonged Exposure Therapy (PE) ...
- Cognitive Processing Therapy (CPT) ...
- Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) ...
- Eye Movement Desensitization and Reprocessing Therapy (EMDR) ...
- BONUS: Medication.
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There are numerous family therapy techniques, but four main models dominate the spectrum. This blog reviews the main therapy family techniques: structural, Bowenian, strategic and systematic.What is the experimental technique in CBT? ›
They are one of the most powerful techniques available to CBT therapists. Behavioral experiments are an information gathering exercise, the purpose of which is to test the accuracy of an individual's beliefs (about themselves, others, and the world) or to test new, more adaptive beliefs.
What is the main focus of CBT? ›
CBT aims to help you deal with overwhelming problems in a more positive way by breaking them down into smaller parts. You're shown how to change these negative patterns to improve the way you feel. Unlike some other talking treatments, CBT deals with your current problems, rather than focusing on issues from your past.Is cognitive reframing a CBT technique? ›
“Reframing” is a technique used in Cognitive Behavioral Therapy (CBT) to identify automatic thoughts and replace them with more balanced thoughts.Is homework a CBT technique? ›
Homework is an important component of CBT; in the context of CBT, homework can be defined as “specific, structured, therapeutic activities that are routinely discussed in session, to be completed between sessions” .What are the two components of CBT? ›
CBT focuses on changing unhelpful or unhealthy thoughts and behaviours. It is a combination of 2 therapies: 'cognitive therapy' and 'behaviour therapy'. The basis of both these techniques is that healthy thoughts lead to healthy feelings and behaviours.