INTRODUCTION

As psychology shifted in a cognitive direction, it became clear that

thought processes were often as important as environmental influences.
As a result, interventions were developed to modify cognitions that
contribute to maladaptive behavior cognitive - behavioural therapy refers
to these interventions that integrate cognitive and behavioural
approaches.

Cognitive therapies are those derived by Aaron Beck, emerged from

traditional psycho-therapeutic settings. cognitive - behavioural therapy
reflects growing interest in modifying cognitions to influence emotions and
behaviours. This approach combines behavioural techniques such as
graded activities, homework and role - playing, with efforts to identify and
change unrealistic thought. CBT builds on behaviour therapy and in recent
years cognitive and behavioural therapies have increasingly shared
technique, such as beck’s use of homework assignments.

BRIEF HISTORY

CBT is a form of psychotherapy that employs the role of thinking in how

we feel and behave. It does not exist as a single, distinct therapeutic
technique. Beck and Ellis are the two main figures associated with
Cognitive Behavioural Therapy.

Albert Ellis developed Rational Emotive Therapy (RET) in the early 1950s,
the first structured CBT approach, and introduced the ABC model of
emotions, later expanded to the A-B-C-D-E model. In the 1990s, Ellis
renamed his approach Rational Emotive Behaviour Therapy (REBT).
Behavioural therapy focuses on changing behaviour patterns by
addressing a person's actions.

In the 1960s, Aaron T. Beck developed Cognitive Therapy, which focuses

on how thoughts and beliefs influence mood and behaviour, aiming to
make thinking more adaptive. Beck proposed the core CBT principles
applicable to a range of psychiatric and medical problems, based on
identifying and changing maladaptive thinking and related behaviours. His
approach becomes well known for effectively treating depression.

The cognitive - behavioural approach assumes that anxiety, depression

and negative emotions develop from maladaptive though processes

CBT AND THOUGHTS, FEELINGS AND BEHAVIOURS

Cognitive Behaviour Therapy (CBT) is based on the idea that thoughts,

feelings and behaviours are interconnected and influence a person’s
quality of life.

For eg. In social phobia, a person may believe that others will find them
boring or stupid. This thoughts can lead to feelings of anxiety and result in
avoidance or distress in social situations. This negative experience may
then reinforce unhelpful belief and emotion, creating a vicious cycle. CBT
aims to help individuals identify and challenge automatic negative
thoughts and modify unhelpful behaviours leading to more positive
outcomes and improved functioning.

GOALS OF CBT

CBT focuses on a here and now orientation

The goals of CBT are :

(i) To challenge the thoughts about a particular situation by identifying the

cognitive traps.

(ii) To help the patient to identify less threatening alternatives and

(iii) To test out these alternatives in the real world.

(iv) It also aims to leave clients at the completion of therapy with the
freedom to choose their emotions, behaviours and lifestyle (within
physical & social and economic restraints).

(v) To finally effect profound and lasting change in the underlying belief
system of the client.

(vi) To equip the client with self-help techniques that enable long term
coping
PRINCIPLES OF CBT

CBT is based on several principles. There are

(i) Brief and time - limited

(ii) Structured, directive and problem - focused

(iii) Based on the cognitive - behavioural model of emotional disorders.

(iv) Collaborative approach between therapist and client.

LEVEL OF COGNITION

Beck and his colleagues identified three key levels of cognition relevant to
CBT

(i) full consciousness

(ii) automatic thoughts

(iii) schemas

(i) Full consciousness : involves rational decision making with full

awareness

(ii) Automatic thoughts : are rapid, often private cognitions that occur
spontaneously and are not always evaluated for accuracy or relevance

(iii) Schemas : the deepest level of cognition are fundamental rules for
processing information, shaped by development and life experiences and
are a central focus of CBT due to their role in self-worth and coping
behaviour

Examples of automatic thoughts and maladaptive schemas

Automatic thoughts

I should be doing better in life

I have let him/her down

I cannot handle it

It is too much for me

I feel like giving up

Maladaptive schemas

I must be perfect to be accepted

I am fake

I am unlovable

No matter what I do, I won’t succeed

I must always be in control

SEVEN INFERENTIAL (COGNITIVE) DISTORTIONS

According to Aaron Beck, people often experience emotional distress

because they make distorted inferences about reality. These distorted
ways of thinking are known as inferential distortions or cognitive
distortions. They occur when individuals misinterpret events, situations or
other people's behaviour. Like the following :

1. Black and White Thinking (All or Nothing):

This distortion involves seeing situations in extreme, absolute terms, with

no middle ground. Things are viewed as either completely good or
completely bad.

Example: If I don't succeed perfectly, I am a total failure.

2. Filtering (Mental Filter) : Filtering refers to focusing only on negative

aspects of a situation while ignoring any positive elements.

Example: A student receives good feedback but focuses only on one small
criticism and believe they did bad overall

3. Over-generalization: Over-generalization occurs when a person

draws a broad, negative conclusion based on a single event or limited
evidence.

Example: I made a mistake in this presentation, so I always fail at

everything.

4. Mind Reading: Mind reading involves assuming what others are

thinking without any clear evidence, usually in a negative way.

Example: She didn't reply to my message, she must be annoyed with me.

5. Fortune-Telling: This distortion refers to predicting the future

negatively and treating those predictions as facts.

Example: I will never get better. Things will always be like this.
6. Emotional Reasoning: Emotional reasoning occurs when people
believe that their feelings reflect objective reality.

Example: I feel worthless, so I must be worthless.

7. Personalizing: Personalising involves taking responsibility excessively

for events that are not entirely (or at all) caused by the individual.

Example: The group project failed, so it must be my fault.

Those inferential distortions lead individuals to misinterpret reality, while

in turn contributes to negative emotions and maladaptive behaviour. CBT
aims to help clients identify, challenge and replace these distorted
patterns of thinking with more balanced and realistic thoughts.

Techniques Used in CBT

The CBT techniques, described below, are useful in addressing problems

that arise from maladaptive thoughts and behaviors in a time-limited
manner. The techniques includes:

Cognitive rehearsal: Cognitive restructuring, also called cognitive

reappraisal, is a CBT technique that helps individuals recognize and
change negative, dysfunctional thinking patterns known as cognitive
distortions. Instead of simply promoting positive thinking, it focuses on
developing more rational and realistic ways of interpreting situations. It is
not a single method but a set of tools, including thought tracking,
identifying distortions, and testing thoughts through behavioral
experiments.

Validity Testing: This is one of the first cognitive therapy techniques.

Every disorder or disease must have supporting evidence and the
therapist asks the patient to defend his feelings, thoughts and beliefs,
with objective evidence. The faulty nature or invalidity of the beliefs of the
patient is exposed if he is unable to produce any kind of objective
evidence.

Writing in a diary / Journal: It is the practice of maintaining a diary to

keep an account of the situations that arise in day to day life. This is a
detailed diary, which notes every emotion, thought and belief. The
therapist and the patient, later, collectively assess the diary/ journal, to
analyze how they actually affect the behaviour of the individual

Guided Discovery: Guided discovery is a technique used in cognitive

therapy to help a patient recognize and understand their cognitive
distortions. The therapist first becomes familiar with the patient’s point of
view and then uses a series of questions and answers to gently challenge
the patient’s beliefs. Through this questioning process, the patient
examines evidence that supports or contradicts their assumptions, helping
them recognize distorted thinking. As a result, the patient can view
situations from different perspectives and develop more realistic and
helpful ways of thinking.

Systematic Positive Reinforcement: Cognition can be changed over a

period of time, by positive encouragements and small rewards. It is one of
the cognitive behavioural therapy techniques in which positive behaviours
of a person are rewarded with a positive reinforcement. A reward system
is established for the reinforcement of certain positive behaviours. Just like
positive reinforcement, withholding the reinforcement is also equally
important. It helps in eradicating a maladaptive behaviour.

Aversive Conditioning: This technique makes use of dissuasion for

lessening the appeal of a maladaptive behaviour. The patient is exposed
to an unpleasant stimulus while engaging him in a particular behaviour or
thought for which he has to be treated, thus, the unpleasant stimulus gets
associated with such thoughts/behaviours and then the patient exhibits an
aversive behaviour towards them

Exposure: Exposure is one of the basic behavioral CBT techniques. It is

especially helpful for anxiety disorders, PTSD, and OCD. The premise is
that the client cannot overcome their anxiety through avoidance. They
must confront what they fear in order to learn that it will not harm them.
Most therapists recommend an incremental process of exposure so as to
not overwhelm the client, although some problems may indicate the need
for a “flooding” approach.

Modeling: In Modeling, the patient makes use of the behaviour of the

therapist as a model in order to solve his/her problems. The therapist
performs roleplaying exercises which are aimed at responding in an
appropriate way to overcome difficult situations.

Homework: The therapist gives a set of assignments to patients as

homework. The patient take notes during the session, reviews the
audiotapes of a particular session or reads article/books that are related to
the therapy.

Imagery: Imagery can be used as a relaxation CBT technique but also to

shift mood and institute calm. The client is asked to imagine a place
where they feel safe and happy. It might be a place where they have fond
memories (their “happy place”) or somewhere they always dreamed of
going.
Problem-Solving: Problem-solving therapy is a useful CBT strategy that
helps clients successfully confront challenging issues and discover
straightforward answers. It can be thought of as developing a toolbox full
of problem-solving tools. This treatment helps people by breaking down
large, complex problems into smaller, more manageable bits, making it
simpler to find answers and a clear path forward. Through the course of
therapy, clients learn to think in smaller steps, brainstorm ideas, and build
strategies to overcome obstacles. So, whether struggling with academic
problems, friendship troubles, or any other difficulty, Problem-solving
therapy provides the tools needed to discover answers and make things
better.

STEPS IN COGNITIVE BEHAVIOUR THERAPY

1. Psycho education: helping the client understand that thoughts and

belief influence emotions and behaviour.

2. Identifying belief: Using the ABC model to uncover irrational or

maladaptive belief to linked to emotional and behavioural responses.

3. Cognitive restructuring: Teaching the client to dispute irrational

beliefs and replace them with more rational alternative (ABC extended to
D and E)

4. Behaviour change: Encouraging action against irrational beliefs

through behavioural tasks and homework assignment.

PROCESS OF COGNITIVE BEHAVIOUR THERAPY (CBT)

1. Engage the client

The first step is to establish a trusting relationship using empathy, warmth

and rapport. Any anxiety or self-criticism about seeking should be
addressed, and the client should be shown early on that positive change is
possible through CBT

2. Assess the problem, gather and situation

environment promotes understanding the client's perspective, identifying

any clinical disorders and evaluating the severity of the problem. Personal,
social and medical history, personality traits and non-psychological factors
such as health or lifestyle are considered. The client's beliefs and attitudes
about their problems are also explored.

3. Prepare the client for therapy

The therapist clarifies treatment goals and assesses motivation to change.

CBT principles, including the link between thoughts, feelings and
behaviours are introduced. The therapy approach is explained and a
collaborative contract is introduced.

4. Implement the treatment programmed

The therapist helps the client identify situations where problems occur,
recognize unhelpful thoughts and challenge them using techniques such
as thought records or rational analysis. Behavioural tasks are assigned to
confront fears or modify behaviours and additional strategies like
relaxation or social skills training may be used. Homework is emphasized
to reinforce learning outside sessions

5. Evaluate Progress:

Progress is monitored to determine whether improvements result from

changes in thinking, behavior or external factors. Therapy is adjusted if
necessary to ensure continued gains.

6. Prepare for Termination:

_The client is prepared for the end of therapy by discussing relapse

prevention and strategies for setbacks. unrealistic expectations, such as
believing they will be “cured forever” are addressed and client are
encouraged to continue using the skills learned and seek help if needed in
the future.

ADVANTAGES OF CBT
1. Evidence - based: CBT is strongly supported by research and is
effective for conditions such as depression, anxiety, phobias and OCD.

2. Short - term: CBT is usually time - limited, which makes it cost -

effective and accessible.

3. Structured and goal - focused: Therapy is organized with clear

goals and practical strategies, making progress easier to measure.

4. Skill building: Clients learn coping skills that can be used long after
therapy ends, encouraging independence.

5. Focus on the present: CBT concentrates on current problems rather

than past experiences, which many people find helpful.

DISADVANTAGES OF CBT

1. Low patient motivation: Can reduce the effectiveness of CBT,

especially among individuals who believe that therapy may lead to
negative consequences.

2. Cognitive limitations: Can hinder progress as individuals with

severe intellectual impairment may struggle with cognitive restructuring
and self-monitoring.

3. Not suitable for all disorders: Certain individuals such as those with
psychopathic traits may have difficulty with self-regulation and attention
required in CBT

4. Cultural difference: May affect treatment outcomes if therapy is not

adapted to the client's cultural beliefs, thinking styles and values.

5. Therapist flexibility is essential: To ensure therapeutic alliance and

accommodate individual and cultural difference.

6. Positive belief about symptoms: example grandiose delusions in

schizophrenia or belief of superiority in anorexia nervosa) may interfere
with treatment and require psychotic interventions.

APPLICATION OF CBT
CBT has been successfully used to help people with a range of clinical and
non-clinical problem. It is a variety of modalities. Typical clinical
applications include

(a) Depression (b) Eating disorders

(c) Addiction (d) sexual dysfunction

(e) anger management (f) hypochondriasis

(g) jealousy (h) sexual abuse recovery

(i) Personality disorders (j) Pain management

(k) Anxiety disorders (l) General stress m management

(m) Anti-social behaviour (n) Relationship or family problems

The most common use of CBT is individual units, but this is followed
closely by group work, for which CBT is uniquely suited. CBT is also
frequently used with couples and increasingly with families.