Is defined as the use of psychological techniques to modify maladaptive thoughts or behaviors?
The basics of CBTThere are many different types of psychological therapy and each is grounded in its own theory and assumptions about how people ‘work’. There are a number of key insights in the cognitive behavioral therapy model which help to distinguish it from other therapies. These ideas are the foundations upon which cognitive behavioral understandings and treatments have been built. Some definitions of CBT can help to clarify what makes it unique. Show
CBT is about meaningsCBT is fundamentally about the meanings which people make of their experiences. CBT is often misrepresented as being concerned with ‘fixing’ faulty thought processes, being ‘rational’, or only working with ‘surface’ issues: but all of these are mischaracterizations. As we live our lives we interpret what is going on around us: we form beliefs and understandings. These meanings affect how we actually perceive the world. Sometimes our beliefs are distressing to us and can lead to unhelpful ways of acting. The role of a CBT therapist is to help their clients to understand and examine their beliefs: to help them to make sense of meanings. Tamara suffered from obsessive compulsive disorder (OCD) and is a good example of how CBT can be used to unravel meanings.
Appraisals matterThe insight of the CBT model is that it is not events that bother us. Instead, it is the way that we interpret events – the meaning that we give to them – that gives rise to our feelings. This explains why two people experiencing the same event can react in completely different ways. Let’s consider an example: Figure: How we interpret events determines how we feel about them. The first interpretation personalizes the events (“What have I done wrong?”) and results in feelings of anxiety. The second interpretation understands the friend’s behavior in more neutral terms and leads to a different outcome. Figure: Another example of how interpreting events determines how we feel about them. The first interpretation here is an excited one – the offer of a promotion is viewed as a welcome opportunity. The second interpretation is less positive – the person offered a promotion is making a catastrophic prediction about what is likely to happen and the result is anxiety. This idea about how our interpretation of events matters is not new. Nearly 2000 years ago the Greek philosopher Epictetus said:
Shakespeare said something similar in 1602:
It may not be a new idea, but it is a powerful one. It explains why some people are pleased when given the opportunity to sing in front of a crowd (“At last, my talent will be recognized!”) when other people would be terrified at the prospect (“I will make a fool of myself and everyone will laugh at me!”). It can explain why some people often feel very anxious (perhaps they have a habit of interpreting situations as threatening) or very sad (perhaps they have a habit of interpreting situations very negatively). It’s a hopeful idea too: although we may not always be able to change the situations in which we find ourselves (or the people we meet), we are in charge of how we interpret events. The attitude we bring to a situation, and the perspective we choose to take, determines how we feel. Viktor Frankl, a survivor of the Nazi death camps, said this most powerfully:
Thoughts, feelings, body sensations, and behavior are connectedAnother important part of cognitive behavioral theory is that our thoughts, feelings, body sensations, and behavior are all inter-related and can affect one another. Things that we do (or things that happen to us) can affect what we think, which can in turn affect how we feel. If you have ever felt poorly with an illness, then you might have had the experience where your body feelings and emotions made you see the world in a ‘bleaker’ or more ‘catastrophic’ light. CBT therapists have lots of ways of representing the relationships between our attention, perception, thoughts, feelings, and behavior. One traditional way of representing how thoughts, feelings, and behavior interact is with a ‘hot cross bun’ diagram [4]. Figure: Hot cross bun representing thoughts, feelings, and behavior. A more helpful way of representing the relationships – one which explicitly captures meanings – is with a cognitive appraisal model. Figure: We can use a cognitive appraisal model to represent the importance of meanings in the perpetuation of distress. The inter-relatedness of thoughts, emotions, body sensations, and behaviors can lead to problems:
The inter-relatedness works to the advantage of the CBT therapist though. If these nodes are inter-related, it means that making a change in one area can cascade into changes in other areas. For example, people who experience panic attacks often interpret normal body sensations in catastrophic ways. These ‘mistakes’ in interpretation lead to powerful and rapidly escalating feelings of anxiety. Cognitive behavioral treatment for panic involves ‘correcting’ these thinking errors, which results in downstream changes in emotion and behavior. People think on different levelsCognitive behavioral therapy recognizes that human beings think on different levels: we say that people have different levels of cognition [5]. Cognitive behavioral therapists will help their patients to examine their thinking at all of these levels and will choose therapy techniques which target the most appropriate level. The level closest to the surface are automatic thoughts. These are thoughts or images which involuntarily ‘pop’ into our minds. They often appear in response to a trigger which can be an event, feeling, or another thought or memory. Automatic thoughts can be accurate (in which case CBT therapists would tend to leave them alone), or they can be biased (in which case they may merit further discussion). Some examples of automatic thoughts include:
The deepest level of cognitions are our core beliefs. These are often unspoken and may never have been verbalized. We often hold core beliefs as ‘truths’ about ourselves, the world, or other people, but it is important to remember that they are opinions and not facts. We are not born with them, but rather they are the product of our life experiences. They can be thought of as our implicit answers to the question “What has life taught you [about yourself, other people, or the world]?”. Core beliefs often take the form of ‘absolute’ statements. Examples of some negative core beliefs include:
The middle level of cognitions are intermediate beliefs, which often take the form of rules and assumptions. These can often be phrased in the form of “If… then” statements or contain the tell-tale words ‘should’ or ‘must’. We may hold on to our rules or assumptions as ways of preventing the worst consequences of our core beliefs from coming true. Examples of rules and assumptions include:
It is important to recognize that cognitions at different levels interact: the kinds of automatic thoughts that we have are often determined by the kinds of core beliefs that we hold (in fact, therapists often look for patterns in automatic thoughts in order to take educated guesses about what core beliefs their patient holds). For example, when confronted with an ambiguous situation where they may have been let down by a friend, the person who holds the core belief “I am unlovable” is more likely to have an automatic thought “I don’t matter to them”. Similarly, when confronted with an ambiguous situation where other people might give good or bad feedback, the person who holds the core beliefs “I’m stupid” and “Other people are critical” is more likely to have the automatic thoughts (predictions in this case) “They’ll think I’m an idiot” and “They’ll make my life hell”. Cognitions at any of the levels can be more or less helpful – CBT therapists will be looking to identify thoughts, beliefs, or rules that are potentially self-defeating. Thinking can be biasedCognitive behavioral therapy recognizes that any of our thoughts, beliefs, or rules can be more or less accurate ways of perceiving the world. A thought can be positive “I did well” or negative “I did badly”, but this is less important than whether it is accurate or inaccurate. Despite what we might prefer, it is unavoidable that bad things will happen to all of us. Trying to avoid every negative event, thought, or emotion is a losing battle and would in any case be counterproductive. More important is that our thinking can be inaccurate. And because our feelings are influenced by the way we think, we often experience negative emotions because we believe inaccurate things – it is as though we feel bad because we are lying to ourselves! Thoughts can become biased for many reasons:
People’s thinking becomes biased in characteristic ways. In Beck’s early work on depression he recognized that “even in mild phases of depression, systematic deviations from realistic and logical thinking occur” [6]. Four of the ‘cognitive distortions’ that Beck identified early on included: Arbitrary interpretation which describes the process of “forming an interpretation of a situation, event, or experience when there is no factual evidence to support the conclusion or when the conclusion is contrary to the evidence”. An example of arbitrary interpretation would be having an interaction with a shopkeeper and having the thought “they think I’m worthless”. Selective abstraction which describes the process of “focusing on detail taken out of context, ignoring other more salient features of the situation, and conceptualizing the whole experience on the basis of this element”. An example of selective abstraction would be receiving a ‘B+’ grade on a piece of schoolwork, paying particular attention to a comment about how it could be improved, and thinking “I did badly”. Overgeneralization describes individual’s patterns of “drawing a general conclusion about their ability, performance, or worth on the basis of a single incident”. An example of overgeneralization would be a father noticing their three-year-old child pushing another child in the playground and thinking to himself “I’m a poor parent because he’s a rude child” Magnification and minimization describe “errors in evaluation which are so gross as to constitute distortions … manifested by underestimation of the individual’s performance, achievement, or ability, and inflation of the magnitude of his problems and tasks … It was frequently observed that the patients’ initial reaction to an unpleasant event was to regard it as a catastrophe”. An example of magnification would be receiving a telephone call from a friend to say they will be late to a meet-up and thinking “well, the evening is ruined”. To learn more about the ways in which people’s thinking can become biased read our Psychology Tools guide to unhelpful thinking styles. Things that we do can have unintended consequencesThe physicist Isaac Newton’s third law of motion states that “Every action has an equal and opposite reaction” [7]. Our actions are similar – everything that we do has a consequence. Some consequences are intended, but others are not. A common step in CBT is to ask the question “What were the consequences of acting that way?”. You might have escaped a frightening situation with the (intended) consequence that you felt safer. But perhaps some unintended consequences were that you learned that it feels good to escape and escaping became your ‘go to’ strategy for handling tricky situations. Therapists who use CBT are trained to pay particular attention to any sequences that appear to get stuck in a loop or jammed (where an action feeds back to cause more of the problem). Figure: Our actions have intended and unintended consequences. For example, if you suffer from depression you might spend much of the time feeling sad, low, and demotivated. When you feel that way it is difficult to do the things that used to give you pleasure, and so you might avoid situations with the intended consequence of conserving your energy. Unfortunately, the unintended consequence of behaving this way is that you have fewer opportunities for good things to happen to you, and the result is that you stay depressed. CBT is a ‘doing therapy’CBT is a great way of understanding of what is keeping a problem going and when we are armed with that information our job is to take action in order to get it ‘unstuck’. What makes CBT different is that it is not just a ‘talking therapy’. Psychologists have found that to be really helpful, a therapy has to help you to make changes in your life and so it is better to think of CBT as a ‘doing therapy’. CBT therapists can choose from a huge range of strategies and techniques to promote change. Some of the most common CBT strategies for change are:
CBT worksWhat is CBT used for?CBT was originally developed by Aaron Beck as a treatment for depression, but it was quickly adapted to treat a wide range of mental health conditions. Emotional problems that CBT is used to treat include:
How effective is CBT?CBT is an evidence-based form of therapy which means that researchers try to discover what components of therapy work, for which problems, and why. Individual therapy sessions also pay close attention to evidence: clients in CBT are typically encouraged to set personal goals (e.g. “If I was feeling less anxious I would be able to do my shopping by myself without needing to escape”) and then record data (evidence) about whether these goals are being met. When we ask “how effective is CBT?” we really mean “what is it effective for?” and “effective compared to what?” We also need to consider “how often do these conditions get better by themselves?”. One way that researchers address these questions is by conducting randomized controlled trials (RCTs), where different treatments are carefully and systematically compared to one another. The same process is used in medicine to test the safety and effectiveness of new drugs. Over the past few decades thousands of such studies have examined CBT and researchers can now combine the results of these RCTs into ‘meta-analyses’ to show, in even more reliable ways, which treatments work. The graph below shows the result of a meta-analysis of CBT that was published in 2015 [8]. The results are from 48 studies that compared CBT with ‘treatment as usual’ for nearly 7000 people with anxiety, depression, or mixed anxiety & depression. The results show a clear effect in favour of CBT – more people get better when they receive CBT compared with their usual treatment. Figure: The effectiveness of CBT vs treatment as usual (TAU). Another way to measure how effective CBT is for treating psychological problems is to look at ‘response rates’. Somebody is said to ‘respond’ to a therapy if their symptoms have improved significantly by the end of treatment. A study that compared 106 meta-analyses was published in 2012 [9]. The graph below shows the response rates for CBT across a wide variety of conditions. Figure: Response rates for CBT for a variety of conditions (higher is better). These results look good, but you might be thinking “What do the results look like for the alternatives?” Where adequate data were available, that same study also compared the response rates of CBT to other ‘genuine’ forms of therapy or treatment as usual. CBT for depression was at least as effective as medication or other forms of psychotherapy, and more effective than treatment as usual. CBT for anxiety was typically superior to other forms of genuine and placebo therapies and was judged to be a “reliable first-line approach for treatment of this class of disorders”. Figure: Response rates for CBT compared to other treatments, or treatment as usual. The message from these reviews is that for many conditions CBT is as effective or more effective than other genuine forms of therapy and is typically better than ‘treatment as usual’ (which often includes medication or check-ups with doctors) or doing nothing. In recognition of its effectiveness there has been a nationwide push by government in the United Kingdom to make CBT therapies available for free to everyone who needs them. The history (and future) of CBTWhat came before CBT?To really understand the cognitive behavioral therapy (CBT) approach we need to know where it came from and what it was developed in reaction to. CBT emerged in the 1960’s, in an era when psychological therapies were much less established than they are today. Radical new ideas and theories about psychological functioning were emerging and there was much less evidence for the effectiveness of each approach. This meant that therapists were experimenting with new techniques. The dominant models at the time were psychoanalysis and behaviorism. The clinical practice of psychoanalytic psychotherapy was established by Sigmund Freud in the late nineteenth century. Psychoanalysis, and a shorter variant called psychodynamic psychotherapy, are still practiced today. The central proposal of psychoanalytic theory is that we have a dynamic unconscious whereby much of our mental life occurs outside our conscious awareness. Psychoanalysis proposes that some of our thoughts and feelings are kept outside of our awareness by our ‘defenses’ but can still affect our behaviors, attitudes and experiences – which can lead to problems. Resolution is said to come from bringing these difficult thoughts and feelings into our conscious awareness. Perhaps the aspect of psychoanalytic theory that has gained the most traction concerns how peoples’ early relationships with caregivers (their attachment relationships) affect how they form relationships for the rest of their lives. ‘Attachment theory’ is the foundation of many modern approaches to psychotherapy. Psychoanalysis has been criticised on the grounds that many of its claims cannot be tested and that they are not falsifiable. Nevertheless, psychoanalysis and psychodynamic psychotherapy are still practiced today despite no longer being the dominant model in mental healthcare. Behaviorism is an approach grounded in the scientific study of learning and behavior. Compared to psychoanalysis its practice is much more empirical, experimental, and scientifically robust. Early behaviorist researchers including John Watson and Ivan Pavlov discovered the concept of classical conditioning and other ideas about how animals and humans learn. B. F. Skinner is famous for his discovery of operant conditioning – the idea that our behavior can be shaped by contingencies (what comes before and after). An important part of these psychologists’ research explored how fears are learned. These ideas were applied clinically as ‘behavior therapy’ by luminaries including Joseph Wolpe and became the foundation of fear reduction techniques that are still in use today. Behavior therapy led to great progress in the treatment of anxiety disorders and these concepts are still applied today, but therapists found that it had less to offer in the treatment of conditions such as depression and psychosis. Who developed CBT?Aaron T. Beck is responsible for the development of the form of CBT that is most commonly practiced today. No history of CBT is complete without mention of Albert Ellis who was also developing a form of cognitive therapy at the same time as Beck. Ellis’ work became Rational Emotive Behavior Therapy (REBT) and shares many similarities with CBT. Figure: Aaron T. Beck developed cognitive therapy. Aaron Beck was a psychiatrist who was working at the University of Pennsylvania in the 1960’s. He had been trained in psychoanalysis but became disillusioned with the approach of using free association and began to experiment with more direct techniques. Working with depressed clients he found that they experienced streams of negative thoughts which he called ‘automatic thoughts’. He found that he could work effectively with his client’s thoughts and beliefs – the meanings that they created as they came to understand the world around them. He published the seminal Cognitive therapy and the emotional disorders in 1975 and has since authored or co-authored 25 books and over 600 articles. Simultaneously, Albert Ellis was working on a form of cognitive therapy descended from the Stoic idea that it is not events that distress us but the meaning we give to them. Ellis’ ideas were developed as Rational Emotive Behavior Therapy (REBT). There is significant overlap between both approaches but it is arguably Beckian cognitive therapy that has been more influential. What types of CBT are there?CBT has an empirical stance which means that it has changed and developed with the emergence of new scientific discoveries and theoretical advances. Many clinicians and researchers trained with Beck and Ellis and have since gone on to train subsequent generations of therapists, scientists, and scientist-practitioners. Over time CBT has grown to encompass a wide variety of therapeutic practice and modern CBT is best thought of as a ‘family’ of therapies that adapts as scientists make new discoveries about how people ‘work’.
Figure: The history and future of CBT. A timeline of what came before and after Beck and Ellis’ cognitive behavioral therapy. What is CBT like?Therapists who practise psychological therapies are trained to focus on particular aspects of a person’s experience and to react in particular ways. We can say that every therapy has a different ‘stance’. For example, systemic therapists are trained to focus on the way people relate to one another and on how an individual responds to the actions of other people in their network. Solution-focused therapists’ training leads them to help their clients to stay focused on the future and on potential solutions to current difficulties. Psychodynamic therapists are trained to notice how patterns from early (attachment) relationships are played out in a person’s later relationships. Some important properties of CBT’s stance are that:
What is CBT like? The process of treatment in cognitive behavioral therapyA helpful way to illustrate how CBT works is to walk through the steps that a therapist might go through with a client. In face-to-face CBT a therapist may go through some or all of the following stages. Remember that although the process is described here in a linear fashion people and their problems are not straightforward and there is often a ‘dance’ back and forth between the stages. Stage 1: Assessment in cognitive behavioral therapyDuring the first session (commonly the first few sessions) a cognitive behavioral therapist wants to find out what kind of problems are troubling their client. They will also want to explore the client’s goals – what would they want to be different by the end of therapy? CBT therapists will conduct an assessment by discussing some or all of the following:
CBT assessment technique 1: Focus on specific events that happened recentlyTo understand their client’s problems, therapists who practice cognitive behavioral therapy often begin by paying close attention to specific events that have happened relatively recently. This means that they attempt to identify specific details like “Yesterday when I saw someone who looked like my attacker I was frozen to the spot with terror” rather than “I’m just always feeling so low that I’m not sure it’s worth it anymore”. It can take some work to extract specifics from examples like the latter: when the therapist asked for some more details she was told “When I watched a programme last night on tv about friendships and realized I didn’t have anyone close anymore I felt so sad that I wondered what the point was in my existing”. The reason that CBT focuses on specific events is because our lives are made up of specific moments all chained together. We live our lives moment-by-moment and feel our feelings that way too. We might tell ourselves stories like “I had the most boring day ever” but chances are that your day was made up of some boring moments, and perhaps some mildly interesting ones too. If we want to pay attention to our thoughts and behaviors, these happen moment-by-moment and we will miss important parts if we gloss over the details. The reason that CBT focuses on things that are problems now is because problems that happened in the past may no longer be a problem. Even if terrible things did happen in the past, our suffering – what we want to relieve – happens in the present. One of the assumptions that CBT makes is that things happening in the here-and-now (perhaps thoughts, perhaps action) are contributing to that suffering. A final advantage of working on current material is that our memory for it is often better, which means that we can explore it in more detail. CBT assessment technique 2: Break moments down into helpful componentsOnce we have identified a specific and relatively recent event, the next job is to break it down into manageable parts. These might include:
The reason that CBT therapists conduct assessments by breaking events down into components is because a cognitive behavioral approach recognizes that these components are interconnected. One component affects other components in understandable ways. Making sense of these connections is called case conceptualization which we will explore in the next section. Some of the most helpful CBT worksheets and information handouts for psychological assessment include:
Stage 2. Case formulation (case conceptualization) in cognitive behavioral therapy (CBT)It’s one thing to identify a problem but in order to find solutions we need to (1) understand what is keeping the problem going and (2) find some ways to stop it. CBT therapists use a process called ‘case conceptualization’ or ‘case formulation’ to come to an understanding of how a problem operates. A formulation is simply a model or set of hypotheses (educated guesses) about what is going on: an idea about how the pieces fit together. A therapist will form their own hypotheses about what is going on, will share hypotheses with their client, will explore any hypotheses the client has, and will try to find ways with the client of testing whether these hypotheses are accurate. CBT therapists will often draw a case formulation diagram together with their client as a way of ensuring sharing their understanding of what might be happening. CBT focuses on relationships and consequencesWhen considering any problem, the therapist will try to gather information about: where and when a problem happens; what kinds of things trigger it; and what thoughts, emotions, body sensations, and behaviors it leads to. The next step is to look for relationships between these components. This is helpful for working out what happened and in what order. As a general rule:
CBT focuses on what keeps a problem goingA fire needs three things to start: heat, fuel, and oxygen. As long as those things are present the fire will keep on burning. We say that a fire’s maintaining factors are heat, fuel, and oxygen. With this knowledge, firefighters can choose which maintaining factor to target. Depending on the type of fire they are faced with they may decide to:
CBT examines problems in a similar way: the focus is on maintaining factors. Like a fire it’s not so important to know what started it, but we do need to know what is keeping it going. Therapists who use CBT are trained to pay particular attention to any sequences that appear to get stuck in a loop or jammed (where an action feeds back to cause more of the problem). There are many different ways that human problems can be maintained. Some of the most common maintaining factors that can keep our problems stuck include:
How the pieces fit together: how problems persistPsychologists have found that maintaining factors often join together in ‘typical’ ways to cause problems. In this section we will look at some common problems and explore the maintaining factors that keep them going. AnxietyPeople who have panic attacks often notice ambiguous body sensations and assume that their presence means something terrible will happen. This way of thinking results in strong emotional reactions followed by understandable attempts to cope. The selective attention, biased thinking, and avoidance are important maintaining factors in panic. These are the areas that CBT treatment for panic will focus on. Figure: The cycle of panic and the mechanisms that keep it going. DepressionSimilarly, for depression, CBT researchers have found that people with low mood experience changes in thinking and behavior and that these changes can keep the depression going. The diagram below shows how ‘depression mode’ can be maintained in some people. Figure: One person’s cycle of depression with the mechanisms that keep it going. Mixed problemsMany people struggle with more than one problem at once and not everyone’s problems fit neatly into models like those above. CBT is flexible though – using the same ‘building blocks’ it provides a framework for understanding problems so that and we can create our own models. Figure: The building blocks of CBT can help us understand a huge variety of problems. When Sally came to therapy she was really struggling. She and her therapist took the time to properly understand how she was feeling and identify the things that were maintaining her distress. Using this new understanding Sally, her therapist, and her parents came up with a plan to help her feel better. Stage 3: Symptom monitoring in cognitive behavioral therapy (CBT)Once a client and therapist have decided on which problem(s) to target, and have ideas about what might be maintaining the problem, cognitive behavioral therapy (CBT) places great emphasis on monitoring the problems and symptoms. In the same way that thoughts can be biased, our impressions about whether therapy is effective can be biased too. Therapists are especially prone to making assumptions about ‘how well’ therapy is going and can easily be mistaken. This bias can be overcome by regularly measuring symptoms and problems, and ‘checking in’ with clients about whether they think therapy is moving in the right direction. Evidence suggests that therapists who regularly monitor outcomes achieve better results for their clients. Symptom monitoring can be as simple as counting how often something occurs – such as counting how often someone with panic experiences panic attacks, or counting how often someone with OCD performs one of their compulsions. CBT practitioners also use standardized questionnaires to measure symptom frequency or intensity. There are general measures which might measure anxiety or depression, to specific measures which explore what kinds of thoughts someone is experiencing.
Figure: Activity monitoring is one way of linking symptoms to behavior. Stage 4: Techniques for change in cognitive behavioral therapy (CBT)Once we have assessed a problem, explored goals, and taken some educated guesses about why the problem is not getting better by itself it is time to take action. Sometimes the case conceptualization stage alone is enough to motivate change: people often feel helped by having spoken about a problem, may feel hopeful when they understand how it is operating, and often spontaneously make changes in their lives (this may explain why people often make ‘early gains’ in CBT treatment). Interventions in CBT are often focused on breaking maintenance cycles – interrupting the vicious cycles that keep problems going. We can separate these into CBT for:
CBT Techniques for changing how you feel by learning something new (psychoeducation)A crucial cognitive behavioral intervention is ensuring that clients have accurate information. According to the CBT model many problems stem from inaccurate interpretations about the meaning of a situation, trigger, or event. For example, a person with panic disorder may notice their heart racing and mistakenly conclude that they are having a heart attack (this would be a mistake: there are many good and safe reasons why our hearts can beat faster). Or a person with post-traumatic stress disorder (PTSD) may assume that the frightening unwanted memories of their trauma mean that they are going mad (they’re not: it’s very common to have ‘flashbacks’ of traumatic events and there are good neurobiological reasons why this happens). In many cases giving people accurate information about why they are experiencing something is a fantastically powerful intervention. As well as having conversations with their clients about psychological concepts and principles that they may not be aware of, another way that CBT therapists give their clients new information is with information handouts and CBT worksheets. Some of the most helpful CBT worksheets and information handouts for psychoeducation include:
CBT Techniques for changing how you feel by changing what you think (cognitive restructuring)An important intervention in CBT is to help clients understand and change unhelpful patterns and types of thinking. One way in which practitioners of cognitive behavioral therapy help their clients to change how they think is by using CBT worksheets to scaffold their thought monitoring and thought modifying practice. There are a huge variety of CBT techniques and resources for helping people to change their thought processes. An essential first step in changing what we are thinking is to identify what is going through our minds – this is called ‘thought monitoring’. Cognitive behavioral therapists use a wide variety of CBT worksheets for thought monitoring. Once clients can reliably identify their negative automatic thoughts the next step is to examine the accuracy and helpfulness of these thoughts – a process called cognitive restructuring. Cognitive behavioral therapists use a wide variety of CBT worksheets for cognitive restructuring. An important type of CBT interventions to help clients consider alternative positions (change what they think) concerns conducting experiments. The classic approach is to conduct a behavioral experiment, of which there are many different variations. We will consider these in more detail in the next section.
CBT Techniques for changing how you feel by changing what you do (or by learning new information)The final but by no means least important class of CBT interventions concerns changing how you feel by changing what you do. To give you an idea of the importance of this class of interventions it is often said that “CBT is doing therapy not a talking therapy”. The interconnections in the CBT model mean that our actions / behaviors / responses have powerful feedback effects upon our thoughts, emotions, body sensations, and subsequent behaviors. Positive changes in behavior can result in virtuous circles and cascading improvements in cognition and mood. Many of the most powerful CBT interventions involve helping people to confront situations that they are afraid of, or to test the accuracy of some of their most deeply held beliefs by approaching situations without their normal defenses. Behavioral work in CBT often requires confidence and encouragement on the part of the therapist and courage on the part of the client, but behavioral techniques are some of the most powerful available.
SummaryCBT is a powerful and flexible form of psychological therapy. There is a great deal of evidence that it is a helpful approach for a wide variety of problems including anxiety, depression, pain, and trauma. We know that it works when delivered face-to-face and can be effective as self-help. If you would like to access CBT for yourself then take a look at our finding a therapist page. If you would like to try CBT for yourself as self-help then read our Psychology Tools guides to thoughts, emotions, making sense of difficulties, and our guides to common psychological problems, and techniques for overcoming them. What next?If CBT sounds interesting to you, then the next step is to carry on working through the Psychology Tools Self-Help section. If you read each chapter and practice the exercises you will learn how to make CBT a useful part of your life. The next chapter is A Guide To Emotions. References[1] The Enchiridion of Epictetus [2] Shakespeare, W. (1996). Hamlet. In T. J. Spencer (Ed.), The new Penguin Shakespeare. London, England: Penguin Books. [3] Frankl, V. E. (1984). Man’s search for meaning: An introduction to logotherapy. New York: Simon & Schuster. [4] Padesky, C. A., Mooney, K. A. (1990). Clinical tip: presenting the cognitive model to clients. International Cognitive Therapy Newsletter, 6, 13-14. [5] Beck, J. S. (1995). Cognitive therapy: Basics and beyond. New York: Guilford press. [6] Beck, A. T. (1963). Thinking and depression: I. Idiosyncratic content and cognitive distortions. Archives of General Psychiatry, 9(4), 324-333. [7] Newton, I. (1687) . Philosophiæ Naturalis Principia Mathematica. [8] Watts, S. E., Turnell, A., Kladnitski, N., Newby, J. M., & Andrews, G. (2015). Treatment-as-usual (TAU) is anything but usual: A meta-analysis of CBT versus TAU for anxiety and depression. Journal of Affective Disorders, 175, 152-167. [9] Hoffman, S. G., Asnaani, A., Vonk, I. J. J., Sawyer, A. T., & Fang, A. (2012). The efficacy of cognitive behavioural therapy: a review of meta-analyses. Cognitive Therapy Research, 36, 427-440. Is the use of psychological techniques to modify maladaptive behaviors or thought patterns?Cognitive Behavioral Therapy (CBT) is an action-oriented form of psychosocial therapy. This therapy assumes that maladaptive, or faulty, thinking patterns cause maladaptive behavior and “negative” emotions.
What's maladaptive behavior?Maladaptive behavior is defined as behavior that interferes with an individual's activities of daily living or ability to adjust to and participate in particular settings.
Is defined as the process in psychotherapy in which a client reacts to a person in a present relationship as though that person were someone from the client's past?The transference definition in psychology is when a client redirects their feelings from a significant other or person in their life to the clinician. Think of it as the client projecting their feelings onto you as they would another person in their life.
What type of therapy helps the client modify maladaptive thoughts and actions?Cognitive behavioral therapy (CBT) is an empirically supported approach to psychotherapy characterized by teaching the patient a set of coping skills. The skills are intended to modify maladaptive cognitions, behaviors, and physiological responses that maintain and/or exacerbate psychopathology.
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