Cognitive therapy:

• Cognition are thoughts or beliefs that shape behavior and emotions (attention interpretation of events)
• Causal attributions of events can influence behavior because it impacts the meaning given to present
and future events
• Global assumptions: Broad beliefs of oneself, relationships and the world
Designed to be short term

CENTRAL CONSTRUCTS: Beliefs :Core beliefs – contained by schemas; they are the most basic belief we hold and the hardest to
change : Assumptions, rules and attitudes (also called intermediate beliefs) – situated between core belies and automatic thoughts; they
include the “should” and “must” beliefs
Automatic thoughts: result of our core and intermediate beliefs – swift, evaluative statements or images

Helplessness, I am helpless, Unlovability, Worthlessness

HEALTH AND DYSFUNCTION (1 OF 2)
Healthy: information processing that allows the individual to meet his/her goals of survival, reproduction, and sociability Show little
distorted thinking
Has good problem-solving skills: May function with illogical beliefs and irrational thoughts but not creating problems in living
Dysfunction: “... caused by many innate, biological, developmental and environmental factors... no single ‘cause’.”
Cognitive distortions: faulty schemas and their associated core beliefs
Cognitive triad: negative views of self, world, and the future
Cognitive specificity principle: specific distortions of thinking and perceiving

Source of psychological dysfunction is an overactive primal modes

GOAL OF COGNITIVE THERAPY:
•How it works: Identify and challenge negative thoughts and dysfunctional belief systems
Identify and challenge negative thoughts and dysfunctional belief systems
1. Assist clients in identifying their irrational and maladaptive thoughts (diary of thoughts whenever
feels anxious)
[Link] clients to challenge their irrational or maladaptive thoughts and to consider alternative ways of
thinking
Helps to learn effective problem-solving techniques to deal with the concrete problems
[Link] clients to face their worst fears about a situation and recognize ways they could cope
ASSESSING Cognitive APPROACHES
• Proven useful in the treatment of disorders like: • Sexual disorders • substance use disorders
• Difficult to prove that maladaptive cognitions precede and cause disorders
• Rather than being the symptoms or consequences of the disorders
Argue that it is not just rewards and punishments that motivate human behavior

Emerging clinical models

Behavioural approaches: 1behaviour is determined by external events :2. past learning
experiences drive present behaviour(self efficacy beliefs). 3. Behavioural change can be achieved through
direct manipulation of external events; 4. there is no need to explore or change the individual’s
‘psyche’ or ‘inner world’ 5. the principles of learning are subject to scientific exploration and hold
across all species: rats inform our understanding of human behaviour. 6 * Assumes behaviour and
emotions to be governed by the laws of learning: 7. Disorders arise as a consequence of
specific learning experiences and can be treated using the same principles
- It is directive: the therapist actively treats the client using methods based on
learning principles.
- short timeframe Interventions are condition-specific
GOAL => The goal of therapy is behavioural or emotional change, not personality
reconstruction.
How Do Behaviorists Explain Abnormal Functioning?
Learning theorists through conditioning (simple form of learnig) produce abnormal behavior as well as normal behavior.
In operant conditioning, for example, humans and animals learn to behave in certain ways as a result of receiving rewards—
any satisfying consequences—whenever they do so.
In modeling individuals learn responses simply by observing other individuals and repeating their behaviors.
classical conditioning, learning occurs by temporal association. When two events repeatedly occur close together in time, they
become fused in a person’s mind, and before long the person responds in the same way to both events. illustrates how the
behavioral model can account for abnormal functioning.
BEFORE CONDITIONING CS: Tone → No response US: Meat → UR: Salivation
AFTER CONDITIONING CS: Tone → CR: Salivation US: Meat → UR: Salivation
•self-efficacy: The belief that one can master and perform needed behaviors whenever necessary.

Classical conditioning-based interventions

1. Systematic desensitization : is one such method, often applied in cases of phobia—a specific and unreasonable fear.
step-by-step procedure to learn and react calmy as a response to a stimulus (the objects or
situations they dread)
 -Hierarchy: they construct a fear hierarchy, a list of feared objects or situations, starting with
those that are less feared and ending with the ones that are most dreaded. In each stage, first
relaxes, then exposed to a stimulus within the hierarchy, starting most distant stimulus from the feared object or situation.
Desensitization therapists next have their clients either imagine or actually confront each
item on the hierarchy while in a state of relaxation , repeating the same procedures until they are able to cope in
the presence of their feared stimulus or situation.
-Mechanism: extinguish the fear response to the stimulus
- Counterconditioning process of is established in which a state of relaxation to the previously feared
stimulus is conditioned.
Flooding: (opposite approach) clients are exposed directly to their most feared stimulus and encouraged to remain with it until they no
longer experience any fear: based on the principles of habituation. Takes hours, We cannot sustain a fear response for prolonged periods of
time – physical exhaustion results in a diminution of a fear response even under circumstances that initially provoke high levels of fear.
2. Social learning theory: we can learn fear responses without having direct experience of the feared object ourselves. Instead, fear can be
acquired from observation of other people’s responses, through the process: vicarious learning

Cognitive Therapies
Cognitive theorists: abnormal functioning can result from several kinds of cognitive problems.
Some people may make assumptions and adopt attitudes that are disturbing and inaccurate Illogical thinking=> Cognitive
distortions eg: overgeneralization
Ccognitive therapy, therapists help clients recognize the negative thoughts, biased interpretations, and errors in
logic that dominate their thinking and, according to Beck, cause them to feel depressed. Therapists also guide
clients Cognitive triad: negative views of self, world, and the future

to challenge their dysfunctional thoughts, try out new interpretations, and ultimately apply the new ways of thinking in their daily
lives. Link between interpretation of experience and how it feels, begin to question the accuracy of her interpretations:
Cognitive behavioral therapies: Therapy approaches that seek to help client change both counterproductive
behaviors and dysfunctional ways of thinking.
Cognitive distortions: faulty schemas and their associated core beliefs
Cognitive specificity principle: specific distortions of thinking and perceiving

Defining Cognitive-beHavioral tHerapy ¨At their core, CBTs share three

fundamental propositions: 1. Cognitive activity affects behavior. 2. Cognitive activity may be
monitored and altered. 3. Desired behavior change may be affected through cognitive
change.
Cognitive-behavioral therapy:
Goal: The therapeutic intervention is to modify dysfunctional thinking & Behavior directed to individuals to solve their problems.
Therapeutic goal to address to core belief of the individual and the improve their cognition behavior, and emotions to change from their current status with a
strong therapeutic alliance, treatment plan

Based on cognitive therapy: Distorted cognitive thought patterns are associated with mental disorders
so it is dysfunctional beliefs & memories that operate in coordination with the AFFECTIVE BEHAVIORAL MOTIVATIONAL & PHYSIOLOGICAL
responses.
Pathological framework in linked to internal and external stimulants (triggers) & cognitive schemas:
Roles of Client and Counselor Collaborative, Counselor is a model and a consultant
Goals: Reduce or eliminate maladaptive behavior & Teach or increase adaptive responses “Prescribe” behavior
Goals: To identify and change faulty information processing To modify beliefsTo teach problem-solving strategiesTo
operate based on reflective, constructive processes

The cognitive model of CBT (Beck, 1963) pathology: pro-posed that cognitive processes are at the
center of behaviors, thoughts, and emotions and that we can best understand abnormal
functioning by looking to cognition—a perspective known as the cognitive model.
Ask questions about the assumptions and attitudes that color a client’s perceptions,
the thoughts running through that person’s mind, and the conclusions to which they are
leading.

MALADAPTIVE COGNITIVE SCHEMAsCognitive distortions drive to vulnerability and psychopathology.

Situation-event, Automatic thoughts, Reactions (emotions, behaviors, cognitions)
Automatic thoughts: are originated by situational experience, The interpretation of the situation & the
belief: not the events themselves
Activates automatic thoughts (negative flow of the mind) The nature Core beliefs & experience of the
situation.
1. Negative automatic thoughts grow with childhood traumatic experience, cognitive assumption &
attitudes.
2. Result: negativity in their behavior & emotion are a consequence of ‘faulty’ or ‘irrational’
thinking, neg pop ups due to overgeneralization of elective abstraction, personalization and labeling
3. Cognitive schemas: phenomenological experiences of an individual: therapy, to transform NEGATIVE
COGNITIVE FRAMEWORK  into POSITIVE
Cope & Change  learn skills to cope unhealthy-maladaptive (or Negative) cognitive patterns
 List of interventions:
-ABC MODEL: Cognitive response to events, determines our mood, and that mental health problems, behavioral, physiological
and Emotional disorders result from misinterpretations of environmental events.
(Ellis )A-B-C theory of personality functioning, where:
● A refers to an activating event: something that triggers an emotional response
● C is the emotional or behavioral reaction to that event
 B refers to the intervening cognitive processing, the individual’s beliefs about the event that always occur between A
and C.
 Automatic negative assumptions or Surface cognitions: thought we aware of They influence emotions, behaviour
and levels of physiological arousal.
● Cognitive schema (plural schemata): underlying our surface cognitions is a set of uncon- e scious beliefs about ourselves and the
world that influence our surface cognitions.
Functional Analysis:

Cognitive techniques:
Self-instruction training (Meichenbaum 1985): This involves interrupting the flow of negative ‘stressogenic’ thoughts by
replacing them with preprepared realistic or ‘coping’ ones

Cognitive challenge: involves identifying and challenging the reality of the negative assumptions an individual is making. In this,
the person is taught to ‘catch’ their thoughts and identify the association between thoughts, emotions and behaviour.

Cognitive Restructuring:

Three ways to deal with dysfunctional modes: deactivate, modify, and construct
Flexible eclectic techniques that attack dysfunctional thought
Both cognitive and behavioral techniques are used
Cognitive restructuring: anything that changes client cognition structures - to modify or eliminate
schemas, core beliefs, and automatic thoughts

[Link] discovery: is a process whereby the therapist works with the client to appreciate one or more central beliefs related to
psychological change and adaptive functioning.
This involves the therapist helping the client to identify distorted patterns of thinking that are contributing to their problems and
encouraging them to consider and evaluate different sources of information that provide evidence of the reality or unreality of the
beliefs they hold. in an open, interested manner, leading to enlightenment and insight (Clark & Egan, 2015).
Stages:Asking informational questions Listening, Summarise, Examine the evidence
Synthesise
Guided discovery: patient discovers the answers, guided by the therapist : Advisory role as the client
conducts therapy and becomes his/her own counselor
GUIDED DISCOVERY : Process of: Gathering information Looking at the information in different ways, Inviting the
patient to devise their own plans for what to do with the information, True “guided discovery” — not persuasion!
ALL ABOUT DIRECTING CLIENT’S ATTENTION:Involves asking the patient questions which: The client has the
knowledge to answer , Draw patients attention to relevant information which may be outside their current focus,
Generally move from the concrete to the more abstract, Enable clients to apply the new information to either re-
evaluate a previous conclusion or construct a new idea
STAGES OF GUIDED DISCOVERY, Asking informational questions Listening, Summarise, Examine the evidence
Synthesise

[Link] Method: Socratic questions as helping clients define problems, identify the impact of their beliefs and thoughts,
and examine the meaning of events (Beck & Dozois, 2011), aim to help clients to think about their situation from a new
perspective (Beck 1977). The subsequent shift in perspective and the accompanying reevaluation of information and thoughts
can be hugely beneficial. actively participate and take responsibility for moving the discussion forward. It replaces the didactic,
or teaching-based, approach and promotes the value of reflective questioning.
‘productive discomfort,’ but in the absence of fear and panic (Reis, 2003).

[Link] arrow: a technique developed specifically to help identify and challenge core beliefs is known as(Beck et al.
1979). When clients express what seem to be inappropriate thoughts or reactions to events, the downward arrow technique can
be used to identify distortions in core beliefs that are contributing to their problems. Key questions include: What is your concern
about . . . ? What would the implications be . . . ? What would the consequences be . . . ? What would the ultimate consequences
be . . . ?
4. Thought recording

5. Activity scheduling

6. Graded tasks

7. Social skills training

 8. Problem solving Imagery
9. Role playing
10. Homework
Cognitive Restructuring: In challenging your thought patterns, tone, and self-talk, you learn about potential cognitive distortions and
unhealthy thought patterns that could be increasing depressive emotions or suicidal thoughts. Cognitive restructuring helps form
healthier patterns, reduce cognitive errors, and practice ways to rationalize distortions and untrue beliefs.
Three ways to deal with dysfunctional modes: deactivate, modify, and construct
Flexible eclectic techniques that attack dysfunctional thought
Both cognitive and behavioral techniques are used
Cognitive restructuring: anything that changes client cognition structures - to modify or eliminate
schemas, core beliefs, and automatic thoughts

2. Activity Scheduling: Activity scheduling involves rewarding yourself for scheduling activities that encourage positive regard and self-care.
By scheduling these activities and rewards, you learn to motivate yourself to complete necessary tasks even when you are feeling low. It
also increases the chances of continuing to complete these tasks after you end your formal therapy sessions.
3. Thought Journaling: By journaling for mental health, exploring things like your emotions, thoughts, and behaviors, you create a space to
process and identify any potential triggers, as well as how your thoughts have been influencing your behavior. This can increase self-
awareness and help you learn coping techniques to use in the future. 4 You can also use specific journal prompts for depression to
understand more where your beliefs and moods have been coming from.
Fact-checking encourages you to review your thoughts and understand that, while you may be stuck in a depressive or harmful thought
pattern, these thoughts are not facts but opinions based on your emotions (e.g., “I am a failure”). Fact-checking can also help you identify
what behaviors you engage in due to your opinions or emotions instead of the actual facts.
6. Successive Approximation or “Breaking It Down”: Breaking down large tasks into smaller goals will help you feel less overwhelmed. By
practicing successive approximation, you will be more likely to complete your goals and be better able to cope with large tasks in the
future, even during times when your depression is heightened.
7. Mindful Meditation: By engaging in meditation for depression, you will learn to reduce focus on negative thoughts and increase your ability
to remain in the present. Meditation can help you recognize and learn to accept your negative thought patterns and detach from them
instead of letting them take over.

Behavioral Assigments:
1. Testing Hypothesis & 2. Gathering information: to help the patient gather evidence concerning his-her beliefs,
to test alternative viewpoints about a situation and try new methods of coping with a situation

Behavioural strategies(commonly used in depression)

[Link] activation and behavioural challenge:
A structured intervention involves increasing levels of activity in a planned progressive manner: planning times to get out of bed,
go to the shops, and so on. (targets people who are significantly depressed )
It may involve engaging in more social or ‘pleasant’ activities. (less depressed)
The idea is that by deliberately practicing certain behaviors, people can “activate” a positive emotional state.
For example, engaging in fulfilling or healthy activities can make someone feel good, which then makes them more likely to
keep participating in those activities.

Behavioural challenge:
Behavioural experiments: involves setting up within the therapy session or as homework that directly test the cognitive beliefs
that clients may hold, in the expectation that negative beliefs are disconfirmed and more positive ones affirmed. For example,
the individual may be encouraged to go to a party and try not to drink, to see whether or not this has the disastrous
consequences they originally hypothesized. To test the validity of a belief: 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. Powerfull tool - BE: improve motivation and give you a sense of achievement. Start with tasks that are
simple and achievable. BUT remember that it is important to BALANCE both responsibilities and pleasurable
activitiesUse the following rating scale to rate your depression, pleasant feelings, and sense of achievement
BEFORE and AFTER the activity.

Progressive muscle relaxation: Relaxation techniques : Some emotional disorders, such as anxiety
and pathological anger, have a large physiological component varying from high levels of physical
tension to hyperventilation Monitoring physical tension: Where high levels of tension are clearly
associated with specific stimuli, an individual may quickly learn to use relaxation techniques to help them relax
at such timen vivo relaxation: After a period of monitoring tension and learning relaxation techniques,
 individuals can begin to integrate them into their daily [Link] inoculation training : The exact
nature of any cognitive behavioural intervention will differ according to the presenting problem and
resources of the individual in therapy.

Token economies

Exposure therapy for anxiety disorder, Exposure and Response Prevention for Obsessive-Compulsive Disorder,
Prolonged Exposure Therapy for Post-Traumatic Stress Disorder Behavioral modification
What Is Exposure Therapy?

Exposure therapy is a psychological treatment that was developed to help people confront their fears. When people are fearful of something, they tend to avoid the feared
objects, activities or situations. Although this avoidance might help reduce feelings of fear in the short term, over the long term it can make the fear become even worse. In
such situations, a psychologist might recommend a program of exposure therapy in order to help break the pattern of avoidance and fear. In this form of therapy,
psychologists create a safe environment in which to “expose” individuals to the things they fear and avoid. The exposure to the feared objects, activities or situations in a safe
environment helps reduce fear and decrease avoidance.

Exposure therapy has been scientifically demonstrated to be a helpful treatment or treatment component for a range of problems, including:
PhobiasPanic DisorderSocial Anxiety DisorderObsessive-Compulsive DisorderPosttraumatic Stress DisorderGeneralized Anxiety Disorder
There are several variations of exposure therapy. Your psychologist can help you determine which strategy is best for you. These include:

In vivo exposure: Directly facing a feared object, situation or activity in real life. For example, someone with a fear of snakes might be instructed to handle a snake, or
someone with social anxiety might be instructed to give a speech in front of an [Link] exposure: Vividly imagining the feared object, situation or activity. For
example, someone with Posttraumatic Stress Disorder might be asked to recall and describe his or her traumatic experience in order to reduce feelings of [Link] reality
exposure: In some cases, virtual reality technology can be used when in vivo exposure is not practical. For example, someone with a fear of flying might take a virtual flight
in the psychologist's office, using equipment that provides the sights, sounds and smells of an [Link] exposure: Deliberately bringing on physical sensations
that are harmless, yet feared. For example, someone with Panic Disorder might be instructed to run in place in order to make his or her heart speed up, and therefore learn that
this sensation is not dangerous.

Exposure therapy can also be paced in different ways. These include:

Graded exposure: The psychologist helps the client construct an exposure fear hierarchy, in which feared objects, activities or situations are ranked according to difficulty.
They begin with mildly or moderately difficult exposures, then progress to harder [Link]: Using the exposure fear hierarchy to begin exposure with the most difficult
[Link] desensitization: In some cases, exposure can be combined with relaxation exercises to make them feel more manageable and to associate the feared objects,
activities or situations with relaxation.
Exposure therapy is thought to help in several ways, including:
Habituation: Over time, people find that their reactions to feared objects or situations [Link]: Exposure can help weaken previously learned associations between
feared objects, activities or situations and bad [Link]-efficacy: Exposure can help show the client that he/she is capable of confronting his/her fears and can manage
the feelings of [Link] processing: During exposure, the client can learn to attach new, more realistic beliefs about feared objects, activities or situations, and can
become more comfortable with the experience of fear.

Therapeutic Atmosphere
Collaborative empiricism - emphasizes a scientific approach “responsible dependency”
Roles of Client and Counselor
Counselor is an expert who teaches (resembles doctor-patient)
Client is a student and a collaborator, who becomes an expert on how CT applies Assessment: focuses on what the
client does – not personality Formal and informal
Relationship is “primary vehicle for therapeutic change” Mixed review on its necessity Only Functional Analysis
PROCESS OF THERAPY : Assessment: functional analysis, Psychoeducation about behavior therapy – teaches the
client the behavioral model , 1st session: Establish rapport, understand, gather info and educate client

PROCESS OF THERAPY (1 OF 2)

1st session> Establish working relationship, goal setting, and socializing; focus on quick
symptom relief to promote rapport and reduce client suffering

Teaching the structure of counseling sessions

Each CT session has three general phases, with specific tasks associated with each

FORMULATION :Establishing formulation collaboratively with the clients

 Helps clients to make sense of their difficulties and understand what can and will be targeted in treatment

PROCESS OF THERAPY (2 OF 2)

[Link]

Collaborative search for the truth through questioning: Use of critical enquiry The
‘Socratic’ Method
Conclusion: “I feel and I do as a result of thinking”
Processes transference via cognitive process
Problems in collaboration can lead to resistance or noncompliance, due to Therapist errors
Lack of collaborative skills of counselor or client
Mistiming of interventions
Unclear or unrealistic therapy goals
Target of change should be behavior
Scientific approach: observable
Current causes of behavior, not the past Developed as a result of psychoanalytic models

ISSUES OF INDIVIDUAL AND CULTURAL DIVERSITY

The content (behavior therapy) fits the context (culture)
Structured approach and directiveness, de-emphasis on expression of emotion may appeal to client from Asian backgrounds
Emphasis on self-help and encouraging self-direction consistent with feminist philosophy
Ignores the sociopolitical context of their clients’ lives – can be seen as supporting the oppressive forces in society

Cognitive-Behavioral Approach
Cognitive-behavioral therapy (CBT) is probably better called cognitive and behavioral therapies. Behavior therapy
developed out of the learning theory traditions of Pavlov and Skinner.
Cognitive therapy was built on principles included in behavior therapy, but with a focus on using such principles to
facilitate the modification of cognitive distortions.

Cognitive-Behavioral Approach
Current status of CBT theories can be viewed as an integrative approach considering:
◦ Cognitive◦ Behavioral◦ Emotional◦ Interpersonal ◦ biological issues in treatment.

Models of Function and Dysfunction

The basic tenets of CBT theory of human functioning and mental illness:
◦ psychopathology is comprised of maladaptive associations among thoughts, behaviors, and emotions
◦ are maintained by cognitive (attention, interpretation, memory) and behavioral processes (avoidance,
reinforcement, etc.)
Interventions are aimed at interrupting or modifying cognitive, behavioral, emotional, and physiological processes
that are involved in the maintenance of maladaptive or problematic behaviors.

Models of Function and Dysfunction

Early theories suggested that associations between stimuli (S–S relationships) and between stimuli and responses
(S–R relationships) led to learning maladaptive behaviors.
Early cognitive theories proposed that idiosyncratic negative cognitive schemas underlay the cognitive, behavioral,
and physiological symptoms of depression and other pathology.

Models of Function and Dysfunction

Theories have expanded on the early cognitive and behavioral theories to create idiographic cognitive models for
most disorders of psychopathology.
Each of these models attempt to explain the core symptoms of specific disorders by developing a model of:
◦ interacting cognitions, behaviors, and physiological responses
◦ that are maintained through lower- and higher-level cognitive processes ◦ Attention
◦ Interpretation
◦ Memory
◦ Appraisal processes

Models of Function and Dysfunction

(1) Revised helplessness model of depression and
(2) Emotional processing theories of anxiety and habituation
The helplessness model of depression:
◦ attribution of negative events to personal, permanent, and pervasive factors maintains depressogenic beliefs
Emotional processing theory:
◦ fear structures are propositional networks that contain information about stimuli; verbal, behavioral, and
physiological responses; and the meaning of the stimuli and responses

Models of Function and Dysfunction

For modification of a fear structure to occur, there are two necessary components: ◦ activation of the fear
structure
◦ incorporation of new, disconfirmatory information into the fear structure
Newer theories have focused specifically on the accumulation of information on competing information in
memory, others have attempted to understand psychopathology in terms of multiple levels of information
processing.

Models of Function and Dysfunction

One of the earliest multilevel theories was the Interactive Cognitive Subsystems (ICS) of Teasdale and Barnard:
◦ there are multiple codes (various forms of information)
◦ stored at two levels of meaning: generic and specific
◦ codes can be converted to one another, but are stored in separate memory systems
Emotion-related schematic models contain features of prototypical situations that have elicited the emotion in the
past.
Generic meanings typically activate such schema and are overgeneralized and maintained in a cognitive loop in
most forms of psychopathology.

Models of Function and Dysfunction

Current CBT theories of psychopathology have incorporated findings from many areas of:
◦ experimental psychopathology ◦ basic areas of psychology
◦ neuroscience
allowing for further development of current notions of psychological processes in our understanding of the nature
and treatment of psychopathology.

The Process of Therapy

CBT is conducted within the context of a therapeutic relationship.
The therapeutic alliance in CBT is quite strong and positive, and therapists are seen as warm,
caring, and authoritative (although not authoritarian).
The therapeutic stance is one of:
◦ genuineness
◦ transparency (therapist provides a general framework of what will happen in therapy) ◦ collaborative empiricism
(explicitly working together toward a common goal)

The Process of Therapy

The basic focus in most forms of CBT is on the:
◦ thoughts
◦ behaviors
◦ physical sensations
◦ and emotions experienced by the patient
which are typically related to their presenting complaint or form of psychopathology.
The main concept is to understand the context of problematic situations for the patient by examining recent
situations in which the individual experienced an extreme or excessive emotional or behavioral response.

The Process of Therapy

The thoughts, appraisals, and beliefs, behavioral responses, and physiological responses are examined in a detailed
fashion in order to understand the pattern of responses that the patient engages in (i.e., a careful functional
analysis).
CBT encourages a process of emotional engaging in the memory of the situation (to facilitate “hot cognitions” or
“emotional processing”) followed by some level of distancing.
 The distancing may be in the form of cognitive challenging or examining the alternative behaviors that could have
been engaged in.

The Process of Therapy

CBT attempts to actively create new learning experiences, although different streams of CBT will emphasize
different methods of doing so.
More behavioral forms of treatment will emphasize changes in behavior to facilitate new learning, whereas
cognitive approaches will emphasize methods of testing predictions and thoughts via cognitive challenging and
behavioral experiments.

The Process of Therapy: A number of techniques are common to most forms of CBT:
◦ psychoeducation
monitoring
◦ cognitiverestructuring
◦ in-vivoexposure
◦ imaginalexposure
◦ behavioralactivation
◦ homeworkassignments.
These techniques are tailored to the individual patient, to target the core problems that appear to be maintaining
pathological emotions, thoughts, and behaviors.

The Process of Therapy

Most cognitive, behavioral, emotional patterns of living cannot be changed via treatment occurring one hour a
week.
This means doing therapy outside of the office (especially with exposures) to facilitate generalization, but it most
commonly includes completing homework assignments, one of the sine qua non of CBT.

The Process of Therapy

Homework’s importance has been researched relatively thoroughly and shown to be a significant predictor of
outcome in CBT.
Conceptually, the use of homework in CBT is similar to that of learning a new language.
Although the therapy sessions may provide the basics of grammar and vocabulary for the language, only by using
it in every opportunity can one truly master it and be able to use it independently even long after treatment.

Empirical Support
Over the last 30 years, there have been many advances and developments in both behavioral and cognitive
aspects of the treatment.
There is an abundance of treatment outcome studies demonstrating CBT’s efficacy for most forms of
psychopathology including anxiety disorders, depression, eating disorders, schizophrenia, personality disorders,
and more.

Activity Chart & Pleasure and Mastery Rating Scale

Graded Task Assignment
Identifying Thoughts
Questions to Identify Automatic Thoughts
Thought Records
Testing Your Thoughts
Advantage/Disadvantage Analysis
Problem Solving
Core Beliefs About the Self
Belief Change

Common CBT Techniques for Depression

How Does CBT Help With Depression?

CBT uses a combination of cognitive and behavioral approaches to reduce depression.2 Therapists may challenge
depressive thinking patterns that are leading to inaction or self-harming behaviors. CBT aims to change someone’s
feelings, positing this as the best way to then influence behavior.

Cognitive Methods to Change Depressive Thinking Patterns

Cognitive methods teach you to challenge and rationalize negative thoughts, eventually reducing their power over
you. Techniques like cognitive restructuring can help you understand your thought patterns, the emotion or trigger
behind them, and the actual reality of the situation. Then, the therapist could present a more rational or realistic
perspective to help reduce cognitive distortions.
 A common cognitive distortion among those with depression is “mind reading,” where you believe you know what
others are thinking. By challenging this and other depressive thoughts, you can build a healthier pattern of
thinking and self-talk.2,3

Behavioral Methods to Improve Energy & Motivation

Behavioral methods are highly effective in treating depression. They typically involve rewarding yourself for small
behavioral changes. For example, depression can cause a lack of motivation or low energy. By rewarding yourself
for engaging in a task like putting away a dish or two, you change the chemical outputs in your brain. Adding a
reward makes you more likely to repeat the behavior in the future.2

Cognitive Theory (Beck, Meichenbaum, Ellis):

Acronym:
S - Systematic bias (error in processing information, lenses distorted, selective attending to negative, discounting the positive)
U - Underlying assumptions
C - Cognitive distortions (errors in evaluating information, overgeneralization, black/white thinking)
S - Schema (belief of world) (refers to the Cognitive Triad of self, world, future)
General Concepts:
 - Self-defeating ideas are learned and can be unlearned
 - Thoughts and beliefs determine affect and behavior
 - Dysfunctional beliefs about events – not the events – are
the basis of emotionally charged consequences
 - Cognitive triad – beliefs about self, world, future
 - Systematic bias – error in information processing
Role of the Therapist: Active collaborator; trainer/educator;
directive -
Automatic thoughts –immediate, situation-specific cognitions (instant reaction)
Underlying assumption – cross-situational belief
Schemas (core beliefs) – beliefs formed early in childhood
Cognitive Distortions:
- Cognitive Distortions are errors in information evaluation - Selective Abstraction: taking a detail out of context,
missing the significance of the total situation
- Catastrophizing: anticipation of unfavorable outcomes - Arbitrary Inference: jumping to a conclusion without evidence to
support it
- Labeling: extreme form of overgeneralization
- Polarized Thinking: thinking in extremes with events
labeled as “good” or “bad”
- Disqualifying the Positive: rejecting positive experiences - Overgeneralizations: an unjustified generalization based
on a single incident
- Personalization: a person seeing him or herself as the cause of a negative external event when this isn’t so
Termination Criteria:
Timeframe: Present and Future
Duration: 12 – 16 week model with Booster session Unit of Treatment: Individuals, Couples, Families
How Change Occurs: By altering dysfunctional thought patterns

Early Stage Goals:

 - Form a collaborative therapeutic relationship
 - Set collaborative goals
 - Symptom reduction
 - Socialize to the cognitive model
Middle Stage Goals:
 - Establish more balanced ways of thinking
 - Correct faulty cognitions
 - Improve communication skills
 - Evaluate underlying assumptions and schemas
Dysfunctional thought patterns impacting emotional/behavioral disturbances have been recognized and corrected
New cognitive and behavioral patterns which are more adaptive have been established
Clients demonstrate flexibility, self-acceptance, and responsibility for own life

Early Stage Interventions:

- Conduct a structured interview to clarify problem - Create a problem list
- Develop a therapeutic contract of goals and responsibilities
- Ask clients to chart and track problem behavior
- Teach relaxation; develop action plan, e.g. activity schedule
 - Activate collateral resources
- Explain theoretical model, teach automatic thought record
Middle Stage Interventions:
- Use automatic thought record and downward arrow technique to facilitate the guided discovery of underlying assumptions
and schema
- Teach thought stopping and other diversion techniques
- Teach communication skills (“I” statements, role playing) - Assign homework, e.g. journaling, automatic thought
records, Bibliotherapy, etc
- Shape desired behavior by identifying positive and
negative behavioral reinforcers in the family
- Systematic desensitization
- Negotiate quid pro quo and contingency contracts - Specific discernable acts
- Downward arrow – auto thoughts to schema

Late Stage Goals:


 - Evaluate therapeutic progress
 - Strategize to prevent symptom reoccurrence

Late Stage Interventions:

- Review the problem list
- Highlight therapeutic gains
- Cognitive rehearsal: anticipate future obstacles and rehearse ways to cope with them
- Identify behavioral reinforcers likely to maintain changes - Establish booster session schedule

Assessing the Cognitive Model: Many cognitive clinicians focus exclusively on client interpretations, attitudes, assumptions, and
other cognitive processes: 28 percent of today’s clinical psychologists identify their approach as cognitive (Sharf, 2012; Prochaska &
Norcross, 2010).
Pros: a process unique to human beings—the process of human thought—and many theorists from varied backgrounds find themselves
drawn to a model that considers thought to be the primary cause of normal and abnormal behavior.
+ research *proved very effective for treating depression, panic disorder, social phobia, and sexual dysfunctions, for example
Cons: drawbacks. First, although disturbed cognitive processes are found in many forms of abnormality, their precise role has yet to be
determined.
The cognitions seen in psychologically troubled people could well be a result rather than a cause of their difficulties.
Second, although cognitive and cognitive- behavioral therapies are clearly of help to many people, they do not help everyone.
Is it enough simply to change cognitions? Can such changes make a general and lasting difference in the way people feel and behave?
Moreover, a growing body of research suggests that the kinds of cognitive changes proposed by Beck and other cognitive therapists are
not always possible to achieve (Sharf, 2012).
ACT Acceptance Commitment therapy new wave