Cognitive behavioral therapy (CBT): types, techniques, applications (2023)

CBT is based on the idea that the way 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, unrealistic and negative thoughts can cause us distress and lead to problems. When a person suffers from psychological distress, the way he interprets situations is distorted, which, in turn, has a negative impact on the actions he takes.

CBT aims to help people realize when they make negative interpretations and behavior patterns that reinforce distorted thinking. Cognitive therapy helps people develop alternative ways of thinking and behaving to reduce their psychological distress.

Cognitive behavioral therapy is actually an umbrella term for many different therapies that share some common elements. Two of the earliest forms of Cognitive Behavioral Therapy were Rational Emotive Behavioral Therapy ( REBT ), developed by Albert Ellis in the 1950s, andCognitive 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.

General premises

• The cognitive approach believes thatMental illnessit comes from faulty cognitions about others, our world, and ourselves. This faulty thinking may be due to cognitive deficiencies (lack of planning) or cognitive distortions (inaccurate information processing).

• These cognitions cause distortions in the way we see things; Ellis suggested that 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 can become disordered.

The cognitive therapist teaches clients to identify distorted cognitions through an assessment process. Clients learn to discriminate between their own thoughts and reality. They learn the influence cognition has on their feelings and are taught to recognize, observe, and monitor their own thoughts.

The behavioral part of therapy involves assigning tasks for the client (for example, keeping a thought journal). The therapist assigns tasks to the client to help him challenge her irrational beliefs.

The idea is for the client to identify their own unhelpful beliefs and then prove them wrong. As a result, his beliefs begin to change. For example, someone who is anxious in social situations might have an assignment to meet a friend at a bar for a drink.

Albert Ellis – REBT

Albert Ellis (1957, 1962) proposes that each of us has a unique set of assumptions about ourselves and our world that guide us throughout life and determine our reactions to the various situations we face.

Unfortunately, some people's assumptions are largely irrational, causing them to act and react inappropriately, jeopardizing their chances for happiness and success. Albert Ellis calls itbasic irrational assumptions.

Some people irrationally assume they are a failure if they are not loved by everyone they meet: they constantly seek approval and repeatedly feel rejected. All of their interactions are affected by this assumption, so a big party can leave them feeling dissatisfied because they don't get enough praise.

According to Ellis, these are othercommon irrational assumptions:

• The idea that one should be fully competent in 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 to rely on.

• The idea that your history greatly influences your current life.

• The idea that there is a perfect solution to human problems and that it is a disaster if you don't find it.

Ellis believes that people often become attached 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 great help in cognitive therapy is what Albert Ellis (1957) calledABC Technique of Irrational Beliefs.

The first three steps look at the process by which a person developed irrational beliefs and can be recorded in a three column table.

* A - Trigger event or objective situation.The first column records the objective situation, that is, an event that ultimately leads to some kind of heightened emotional response or negative dysfunctional thinking.

* B – Beliefs.In the second column, the client writes down the negative thoughts that occurred to him.

* C – Consequence.The third column is for the negative feelings and dysfunctional behaviors that followed. The negative thoughts in the second column are seen as a bridge between the situation and the distressing feelings. The third column, C, is explained below describing negative emotions or thoughts that the client believes are caused by A. This could be anger, sadness, anxiety, etc.

Ellis believes that it is not the triggering event (A) that causes negative emotional and behavioral consequences (C) but rather a person interprets these events unrealistically and therefore has an irrational belief system (B) that helps cause the consequences (C).

(Video) How Does Cognitive Behavioral Therapy Work?

Example of TREC

Gina is upset because she got a low grade on a math test. The Trigger event, A, is that she failed the 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 the irrational beliefs, the therapist will usually work with the client to challenge the negative thoughts based on evidence from the client's experience.rephrasingthis, that is, reinterpret it in a more realistic way. This helps the client develop more rational beliefs and healthy coping strategies.

A therapist would help Gina realize that there is no evidence that you have to get good grades to be worth your while or that getting bad grades is horrible. She wants good grades and it would be nice to have them, but that hardly makes her useless.

If she perceives that getting bad grades is disappointing but not horrible, and that it means she's bad at math or studies but not as a person, she'll feel sad or frustrated but not depressed. Sadness and frustration are likely healthy negative emotions and can prompt you to study more from then on.

critical appraisal

Rational emotive behavior therapists have cited many studies in support of this approach. Most of the early studies were done in people with experimentally induced anxiety or nonclinical problems, such as a mild fear of snakes (Kendall & Kriss, 1983).

However, several recent studies have been conducted on actual clinical subjects and have also found that rational emotive behavior therapy (REBT) is often useful (Lyons & Woods 1991).

Aaron Beck – Cognitive Therapy

Aaron Beck believes that a person's reaction to specific disturbing thoughts may contribute to the abnormality. As we face the many situations that arise in life, both comforting and disturbing thoughts come to mind. Beck calls these spontaneous cognitions automatic thoughts.

When a person's automatic thought stream is very negative, you can expect them to become depressed (for example, 'I'll never finish this essay, my girlfriend likes my best friend, I'm getting fat, I have no money, my parents hate it, having Have you ever felt like this?').

Often these negative thoughts will persist despite evidence to the contrary.

Beck (1967) identified three mechanisms that he thought were responsible for depression:

1. The cognitive triad (of automatic negative thinking)
2. negative self schemas
3. Errors in logic (i.e. faulty information processing)

The cognitive triad

The cognitive triad is made up of three forms of negative thinking (ie, helpless and critical) that are typical of people with depression: that is, negative thoughts about oneself, the world, and the future. These thoughts tended to be automatic in depressed people, since they occurred spontaneously.

As these three components interact, they interfere with normal cognitive processing, leading to problems with perception, memory, and problem solving, and the person becomes obsessed with negative thoughts.

negative self schemas

Beck believed that people prone to depression develop a negative self-schema.

They have a set of beliefs and expectations about themselves that are essentially negative and pessimistic.

Beck stated that negative schemas can be acquired in childhood due to a traumatic event. Experiences that can contribute to negative schemas include:

• Death of a parent or sibling.
• Rejection, criticism, overprotection, neglect or abuse of parents.
• Bullying at school or exclusion from a peer group.

People with negative self-schemas become prone to logical errors in their thinking and tend to selectively focus on certain aspects of a situation, ignoring equally relevant information.

Cognitive distortions

Beck (1967) identifies several illogical thought processes (i.e.,distortions of thought processes). These illogical thought patterns are counterproductive and can causegreat anxietyor depression for the individual.

•arbitrary interference: Drawing conclusions based on insufficient or irrelevant evidence: for example, thinking that you are worthless because it rained on an outdoor concert that you were going to see.

•selective abstraction: Focusing on one aspect of a situation and ignoring the others: for example, you feel responsible for your team losing a soccer game, even though you are only one of the players on the field.

•expansion: exaggerate the importance of undesirable events. For example, if he scratches the paint on your car a bit and therefore considers himself a terrible driver.

•minimization: underestimating the importance of an event. For example, your teachers praise you for an excellent semester paper, but you see it as trivial.

•overgeneralization: Drawing broad negative conclusions based on a single insignificant event. For example, you get a D on a test when you normally get an A, and therefore you think you're stupid.

•Personalization: Attributing to oneself the negative feelings of others. For example, your teacher looks very angry when he enters the room, so he must be angry with you.

critical appraisal

Butler and Beck (2000) reviewed 14 meta-analyses investigating the efficacy of Beck's cognitive therapy and concluded that approximately 80% of adults benefited from the therapy.

The therapy was also found to be 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 people's quality of life.

REBT vs. cognitive therapy

• Albert Ellis views the therapist as a teacher and does not consider a warm personal relationship with the client essential. In contrast, Beck emphasizes the quality of the therapeutic relationship.

•REBTis often very directive, persuasive and confrontational. Beck places more emphasis on the client discovering misconceptions for himself.

• REBT uses different methods depending on the personality of the client; in Beck's cognitive therapy, the approach is based on the specific disorder.

strengths ofTCC

1. The model has great appeal because it focuses on human thought. Human cognitive abilities have been responsible for our many achievements, so they might as well be responsible for our problems.

2. Cognitive theories lend themselves to testing. When experimental subjects are manipulated into 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 exhibit maladaptive thinking and assumptions (Beck et al., 1983).

4. Cognitive therapy has been highly effective in treating depression (Hollon & Beck, 1994) and moderately effective for anxiety problems (Beck, 1993).

limitations ofTCC

1. The precise role of cognitive processes has not yet been determined. It is not clear if faulty cognitions are a cause of
psychopathology or its consequences.

Lewinsohn (1981) studied a group of participants before any of them became depressed and found that those who subsequently became depressed were no more likely to have negative thoughts than those who did not develop depression. This suggests that negative and hopeless thinking may be the result of depression rather than its cause.

2. The cognitive model is limited in scope: thinking is only one part of human functioning and broader issues need to be addressed.

3. Ethical issues: RET is a directive therapy designed to change cognitions, sometimes quite forcefully. For some, this could be considered an unethical approach.

References

Beck, A. T. (1967).Depression: causes and treatment. Filadelfia: University of Pennsylvania Press.

Beck, A.T., Epstein, N. & Harrison, R. (1983). Cognitions, attitudes and dimensions of personality in depression.British journal of cognitive psychotherapy.

Beck, AT y Steer, R.A. (1993).Beck's Anxiety Inventory Manual. San Antonio: Harcourt Brace and Company.

Butler, A.C. & Beck, J.S. (2000). Cognitive therapy outcomes: a meta-analysis review.Journal of the Norwegian Psychological Association, 37, 1-9.

Dobson, KS y Block, L. (1988).Historical and philosophical bases of cognitive-behavioral theories. Manual of cognitive-behavioral therapies.Guilford Press, Londres.

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., and Beck, A.T. (1994). Cognitive and cognitive-behavioral therapies. In A.E. Bergin & S.L. Garfield (Eds.),manual of psychotherapy and behavior change(pp. 428-466). New York: Willey.

Kendall, P.C. and Kriss, M.R. (1983). Cognitive-behavioral interventions. In: CE Walker, ed.The handbook of clinical psychology: theory, research and practice,págs. 770–819. Homewood, IL: Dow Jones-Irwin.

Lewinsohn, P.M., Steinmetz, J.L., Larson, D.W. and Franklin, J. (1981). Cognitions related to depression: antecedent or consequence?.diary of abnormal psychology, 90(3), 213.

Lyons, L.C. and Woods, P.J. (1991). The effectiveness of rational emotive therapy: a quantitative review of outcomes research.Clinical Psychology Review, 11(4), 357-369.

Rimm, DC, and Litvak, SB (1969). Self-verbalization and emotional arousal.Abnormal Psychology Journal, 74(2), 181.