Cognitive Behavior Therapy Developed by Dr. Aaron T.

Beck, Cognitive Therapy (CT), or Cognitive Behavior Therapy (CBT), is a form of psychotherapy in which the therapist and the client work together as a team to identify and solve problems. Therapists use the Cognitive Model to help clients overcome their difficulties by changing their thinking, behavior, and emotional responses. Cognitive therapy has been found to be effective in more than 1000 outcome studies for a myriad of psychiatric disorders, including depression, anxiety disorders, eating disorders, and substance abuse, among others, and it is currently being tested for personality disorders. It has also been demonstrated to be effective as an adjunctive treatment to medication for serious mental disorders such as bipolar disorder and schizophrenia. Cognitive therapy has been extended to and studied for adolescents and children, couples, and families. Its efficacy has also been established in the treatment of certain medical disorders, such as irritable bowel syndrome, chronic fatigue syndrome, hypertension, fibromyalgia, post-myocardial infarction depression, noncardiac chest pain, cancer, diabetes, migraine, and other chronic pain disorders. Cognitive Therapy (CT), or Cognitive Behavior Therapy (CBT) was pioneered by Dr. Aaron T. Beck in the 1960s, while he was a psychiatrist at the University of Pennsylvania. Having studied and practiced psychoanalysis, Dr. Beck designed and carried out several experiments to test psychoanalytic concepts of depression. Fully expecting the research would validate these fundamental concepts, he was surprised to find the opposite. A new concept of depression: automatic thoughts As a result of his findings, Dr. Beck began to look for other ways of conceptualizing depression. He found that depressed patients experienced streams of negative thoughts that seemed to arise spontaneously. He called these cognitions automatic thoughts. He found that the patients automatic thoughts fell into three categories. The patients had negative ideas about themselves, the world and/or the future. A new clinical approach Dr. Beck began helping patients identify and evaluate these automatic thoughts. He found that by doing so, patients were able to think more realistically. As a result, they felt better emotionally and were able to behave more functionally. When patients changed their underlying beliefs about themselves, their world and other people, therapy resulted in long-lasting change. Dr. Beck called this approach cognitive therapy. It has also become known as cognitive behavior therapy. The future of cognitive therapy In the years since its introduction, CT has been studied and proven effective in treating a wide variety of disorders. More than 500 studies have demonstrated its efficacy for psychiatric disorders, psychological problems and medical problems with a psychiatric component. Today, research continues into cognitive therapies for suicide prevention, and schizophrenia and other psychopathologies. In addition, ongoing research is being conducted to measure the impact of city
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mental health agencies organization structure on the adoption of cognitive therapy by public health systems. Dr. Beck drew on many sources when he developed cognitive therapy. In turn, current researchers and theorists have expanded on his work, and several forms of cognitive therapy have evolved. Although these variants emphasize different things, all share common characteristics of Becks therapy. What is cognitive behavior therapy? Cognitive behavior therapy is one of the few forms of psychotherapy that has been scientifically tested and found to be effective in hundreds of clinical trials for many different disorders. In contrast to other forms of psychotherapy, cognitive therapy is usually more focused on the present, more time-limited, and more problem-solving oriented. In addition, patients learn specific skills that they can use for the rest of their lives. These skills involve identifying distorted thinking, modifying beliefs, relating to others in different ways, and changing behaviors. Q:What is the theory behind cognitive behavior therapy? Cognitive behavior therapy is based on the cognitive model: the way we perceive situations influences how we feel emotionally. For example, one person reading this website might think, "Wow! This sounds good, it's just what I've always been looking for!" and feels happy. Another person reading this information might think, "Well, this sounds good but I don't think I can do it." This person feels sad and discouraged. So it is not a situation that directly affects how people feel emotionally, but rather, their thoughts in that situation. When people are in distress, they often do not think clearly and their thoughts are distorted in some way. 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 change. The Cognitive Model Cognitive behavior therapy is based on a cognitive theory of psychopathology. The cognitive model describes how peoples perceptions of, or spontaneous thoughts about, situations influence their emotional, behavioral (and often physiological) reactions. Individuals perceptions are often distorted and dysfunctional when they are distressed. They can learn to identify and evaluate their automatic thoughts (spontaneously occurring verbal or imaginal cognitions), and to correct their thinking so that it more closely resembles reality. When they do so, their distress usually decreases, they are able to behave more functionally, and (especially in anxiety cases), their physiological arousal abates. Individuals also learn to identify and modify their distorted beliefs: their basic understanding of themselves, their worlds, and other people. These distorted beliefs influence their processing of information, and give rise to their distorted thoughts. Thus, the cognitive model explains individuals emotional, physiological, and behavioral responses as mediated by their perceptions of experience, which are influenced by their beliefs and by their characteristic ways of interacting
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with the world, as well as by the experiences themselves. Therapists use a gentle Socratic questioning process to help patients evaluate and respond to their automatic thoughts and beliefs and they also teach them to engage in this evaluation process themselves. Therapists may also help patients design behavioral experiments to carry out between sessions to test cognitions that are in the form of predictions. When patients thoughts are valid, therapists do problem solving, evaluate patients conclusions, and work with them to accept their difficulties.

Cognitive therapy is about learning to be aware of understand how you are thinking, behaving, and communicating. Its focus is on discovering how early childhood experiences and past traumas may be affecting your way of thinking, and causing distortions in your perception of a given situation. Identifying specific distortions and learning how to change this way of thinking can be very helpful with the treatment of psychological problems including depression, anxiety, panic, phobias, anger, marital conflict, loneliness, eating disorders, and substance abuse. The way we think about a situation can either calm us down, or worsen anxiety. We often have automatic thoughts that we may be unaware of. This is perfectly normal. Most of us usually have a constant stream of thoughts. But when we begin to notice the frequent recurrence of a strong emotion such as a sense of panic, anxiety, or despair, it is important that we begin to listen to and adjust our internal dialogue. The way we perceive ourselves, others, and our environment greatly affects the way we feel emotionally. Most of us have developed assumptions about things based on our upbringing and past experiences that may be distorted. These assumptions create our set of unspoken beliefs about the world, other people, relationships, and life in general.Cognitive therapy is about learning to identify these distorted beliefs. A few common distorted beliefs are thoughts such as: To be happy, I must be accepted by everyone. I cant do anything right. Nobody likes or understands me. If I fail its because Im stupid. I cant live without you. Most of us learned our assumptions about ourselves and the world around us before we could evaluate these beliefs. We learned by absorbing these assumptions from our parents or other important role models. Not only did we learn specific assumptions, but we also learned a style of
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thinking. As we get older, we may alter some of these ideas but the assumptions we make are usually ones we have held for a long time and arent even aware of. You may not even hear your thoughts when you are having them. But they still affect the way you interpret things, your emotions and behavior. The beliefs systems developed during childhood are usually out of our awareness. They are not really part of our conscious thinking. With cognitive therapy we can examine the truth value of our beliefs. These beliefs often tell us the way we should be or the way the world ought to be. It is when reality doesnt conform to these rules that we react or feel like a failure, angry, or disappointed. These irrational beliefs often take the form of ought, should, always, and never. They tend to set standards that are impossible to live up to and when we dont live up to these standards we feel badly. This is why it is so important to use cognitive therapy to help us identify our internal distortions, and distorted thinking styles. Common Distorted Thinking Styles All or Nothing Thinking. Looking at things in absolute, black and white categories. Refusing to see possible shades of gray. Over Generalization. Viewing a negative event as a never ending pattern of defeat. E.g. Taking a single failure in one segment of your life and drawing conclusions from it for your whole life. The generalizer needs to only fail once to imagine a million failures thereafter and those imagined failures are as painful as the real ones. Mental Filter. Dwelling on the negatives and ignoring the positives. This is a distortion of what really happens and a tendency to only see the negative aspects of an event. Magnification and Minimizing. Catastrophizing(making a mountain out of a molehill) or adopting the attitude that something that is very important doesnt matter anyway. Or accepting unnecessary defeat. Emotional Reasoning. Reasoning from emotions felt rather than from reason or facts. E.g. I feel like an idiot so I really must be. Or , I dont feel like doing this so Ill just put it off.

Shoulding. Legalism. The belief that there is only one way things should be without room for exception. The assumption that anything that falls short of the way it should be is wrong and to be considered failure. Labeling or Mislabeling. Identifying or labeling yours or others shortcomings. Instead of saying I made a mistake, you tell yourself Im a jerk, fool, or loser. This is a form of over generalization. Personalization and Blame. Blaming yourself for something you werent entirely responsible for or you blame other people and overlook ways that your own attitudes and behavior might have contributed to the problem. With the help of cognitive therapy, we can change our underlying beliefs. It is up to each of us to hear our own cognitive distortions and to learn to challenge them. We have power over our feelings and thinking habits. By changing our thoughts and behaviors, we can change our feelings. Conversations with yourself can get it out there so it can be worked on. Cognitive (ABC Model) Behavioral Therapy

Cognitive Behavioral Therapy (ABC Model) could be described as as I think, so I feel (and do)! (The link is to Learning cognitive-behavior therapy: an illustrated guide By Jesse H. Wright, Monica Ramirez Basco, Michael E. Thase.) Understanding it is as simple as A B C. Activating Event the actual event and the clients immediate interpretations of the event Beliefs about the event this evaluation can be rational or irrational Consequences how you feel and what you do or other thoughts

In the charts above and below (from counselingresources.com) you can see how that when a negative event happens, one can interpret it positively or negatively. How one interprets it affects how one feels, thinks and behaves.

Founder: Aaron T Beck (1921 - ) "The stronger person is not the one making the most noise but the one who can quietly direct the conversation toward defining and solving problems." Examples Situation One Negative Perspective A - Mary is walking down the street, and her friend Sarah walks right on by. B Mary thinks, Oh Sarah is such a jerk. C Next time, Mary ignores Sarah. The B may or may not be true. Here is another possibility. Situation Two Positive Perspective A - Mary is walking down the street, and her friend Sarah walks right on by. B Mary thinks, Oh that Sarah, always distracted. C Mary calls out, Sarah apologizes for missing her, and they go for coffee! As you can see, the role of the counselor in cognitive behavioral therapy is to challenge false beliefs what I call ...