COGNITIVE BEHAVIOR

THERAPY

By- Pastor Sam T Thomas (M.A Psychology, BD)

 OUTLINE

1. Introduction
2. What is CBT?
3. History of CBT
4. Process of CBT
5. Common Therapies
a) ABC Model
b) Five Factor Model
6. Foundations of CBT

a) Cognitive Triad

b) Cognitive distortions

c) Cognitive Schemas

d) Alternative Negative Thoughts

e) Environment

7. Advantages of CBT
8. Disadvantages of CBT
9. Applications of CBT
10. Conclusion
1. Introduction

In this session, we are dealing with Cognitive-Behavior Therapy (CBT). Cognitive

behavioral therapy is used to treat a wide range of issues. It's often the preferred type of
psychotherapy because it can quickly help you identify and cope with specific challenges. It
generally requires fewer sessions than other types of therapy and is done in a structured way.

Cognition

The root word for cognition is the Latin word cognōscere, which means "to know" or "to
learn about". Cognōscere is a combination of the words co means ("together") and gnōscere
means ("to know"). The word cognition dates back to the 15th century means "thinking and
awareness". Cognition is defined as the mental action or process of acquiring knowledge and
understanding through thought, experience, and the senses.

Cognition means ability to perceive process, understand, store information, make

decisions and produce appropriate responses. Cognitive functioning is therefore critical for day
to day life governing our thoughts and actions. We need cognition to help us understand
information about the worlds around us and interact safety with our environment.

Behavior

Behavior is the way in which a person behaves in response to a particular situation or

stimulus (both external and internal).

Therapy

It is an act of caring for someone or the method of caring. It is defined as a treatment of

mental and physical disorders.

Therapist

A therapist is a person who offers any kinds of therapy. They are trained professionals in
the field of services like psychology, social work and counseling. They are helpful in counseling
individuals for various mental and physical issues.

Cognitive Therapy

Cognitive therapy is based on the cognitive model, which states that emotions and behaviors
result from cognitive processes. It is possible for human beings to modify such processes to
achieve different ways of feeling and behaving.
2. What is Cognitive Behavioral Therapy?

CBT is a type of talking treatment that focuses on how your thoughts, feelings and
behavior, and teaches you coping skills for dealing with different problems. It combines
cognitive therapy (examining the things you think) and behavior therapy (examining the things
you do).

CBT is based on the idea that how we think (Cognition), how we feel (Emotion) and how
we act (Behavior) all interact together. For example, if you interpret a situation negatively then
you might experience negative emotions as a result, and those bad feelings might then lead you
to behave in a certain way.

3. History of Cognitive Behavior Therapy

Cognitive Behavior Therapy has its modern origins in the mid 1950’s with the work of
Albert Ellis, a clinical psychologist. He stressed the importance of thoughts/feelings and
behaviors and devised a theory called rational emotive behavior therapy (REBT) in the 1950s.
This is now considered one of the earliest forms of cognitive psychotherapy. It is based on the
idea that a person’s emotional distress arises from their thoughts about an event rather than the
actual event itself. The second major cognitive psychotherapy was developed in the 1960’s by
psychiatrist Aaron Beck. It is based on the cognitive model of mental illness. He called his
approach as Cognitive Therapy (CT). Since the pioneering work of Ellis and Beck, a number of
other cognitive approaches have developed. The term ‘Cognitive Behavior Therapy’ came into
usage around the early 1990’s. This model hypothesis that, people’s emotions and behaviors are
influenced by their perceptions of events.

4. The Process of Cognitive Behavior Therapy

1. Engage Client

In the first session, spend time getting to know the client and building a collaborative
relationship. Providing a positive, empathy, warmth, respect, trustworthy, and comfortable
environment to the client where he feels safe and heard. Incorporating effective response
procedures – both verbal and nonverbal, that can facilitate communication between client and
therapist.

2. Assess the Problem, Person and Situation

Assessment will vary from person to person, but following are some of the most common
areas that will be assessed as part of a CBT intervention.

• Start with the client’s view of what is wrong for them.

• Determine the presence of any related clinical disorders.

• Obtain a personal and social history.

• Assess the severity of the problem.

• Note any relevant personality factors.

• Check for any secondary disturbance: How does the client feel about having
this problem?

• Check for any non-psychological causative factors: physical conditions;

medications; substance abuse; lifestyle/environmental factors.

In this stage, the therapist can gain insight into the client's thought patterns, behaviors, and
emotions, which serve as the foundation for the subsequent stages.

3. Active Intervention
Once the assessment has done, the therapist and client work together to develop strategies
and interventions tailored to the client's needs. This may involve challenging irrational thoughts,
practicing coping skills, or engaging in exposure exercises to confront fears and anxieties. The
active intervention stage is where the core of CBT takes place, as clients learn to replace
negative thought patterns and behaviors with more adaptive ones.
4. Maintenance and Relapse Prevention
In the fourth stage clients enter the maintenance stage, where they continue to practice
and reinforce the skills learned in the previous stages. This stage is crucial in preventing relapse
and ensuring long-term success. Clients learn how to identify potential triggers and early signs of
regression, enabling them to implement coping strategies effectively.
5. Termination and Evaluation
The final stage marks the end of formal CBT sessions. Therapists and clients evaluate the
progress made and address any remaining concerns or goals. This stage serves as an opportunity
to reflect on the journey, celebrate achievements, and prepare for life beyond therapy. It's
important to recognize that the skills acquired during CBT can continue to benefit individuals in
their daily lives.
5. Common Therapy Techniques Used
a) ABC Model
The ABC model was created by Dr. Albert Ellis, a psychologist and researcher. Its
name refers to the components of the model. The ABC model is part of rational emotive
behavior therapy (REBT), which is considered to be the original form of cognitive-behavioral
theory (CBT). The model is based on the idea that people can feel better by changing their
reactions to their environment, rather than necessarily changing their environment.

A (Activating Event) something happens to you or in the environment around

you

B (Belief) you have a belief or an interpretation regarding the

activating event.

C (Consequences) your belief has consequences that include feelings and

behaviors
The ABC model is a technique used in cognitive behavioral therapy (CBT) that helps
individuals reshape their negative thoughts and feelings in a positive way. CBT trains individuals
to be more aware of how their thoughts and feelings affect their behavior. ABC model is used in
restructuring to help patients develop healthier responses.

b) Five Components of Cognitive Behavioral Therapy (Five Factor Model)

The five-factor model is a foundational part of cognitive behavioral therapy

(CBT). It helps people understand how their environment, thoughts, emotions, physical
sensations, and behavior are all connected and influence each other.
1. Environment or Situation: Environment or Situation is an activating event that triggers a
thought or belief that leads to a feeling or consequence.
eg: Prepare for exam
2. Thoughts: Our thoughts are the ideas, beliefs, and interpretations we have about ourselves,
others, and the world around us. These thoughts can be conscious or unconscious and greatly
influence our emotions and behaviors.
eg: I cannot pass
3. Emotions: Emotions are our subjective experiences that arise in response to certain
situations or thoughts. They can range from positive emotions like joy and excitement to
negative emotions such as sadness, anger, or anxiety.
eg: Sad/Frustrated
4. Physical Sensations: Physical sensations refer to the bodily experiences that accompany our
thoughts and emotions. These sensations can manifest as tension, butterflies in the stomach,
rapid heartbeat, sweating, or any other physiological response.
eg: Headache
5. Behaviors: Behaviors encompass the actions we take in response to our thoughts, emotions,
and physical sensations. These actions can be overt or covert, and they play a crucial role in
shaping our experiences and interactions with the world.
eg: Avoid studying and engage in games.

In conclusion he got failed in exam and the thought process gets confirmed.

6. Foundations of Cognitive Behavioral Therapy

a) Cognitive triad
The cognitive triad refers to the three categories of negative thoughts that depressed
individuals tend to have about themselves (the self), the world (others) and the future. Aaron
Beck proposed the cognitive triad in 1967 as a cognitive-therapeutic view of depression. It is also
known as the negative triad, which view of the three key elements of a person's belief system
present in depression.
Examples of this negative thinking include:

 The self (yourself)– "I'm worthless and ugly" or "I wish I was different"
 The world (others)– "No one values me" or "people ignore me all the time"
 The future – "I'm hopeless because things will never change" or "things can only get worse!"
b) Cognitive Distortions/ errors
Cognitive distortions are biased ways of thinking that can lead to a distorted view of
oneself, one's life, and other people. Beck proposes that those with depression develop cognitive
distortions, sometimes also referred to as faulty or unhelpful thinking patterns. They can
contribute to mental health conditions such as depression and anxiety. Some examples of
cognitive distortions include:

The main cognitive distortions according to Beck are summarized as below.

 Arbitrary inference - drawing conclusions from insufficient or no evidence.

For eg: My friend did not wish me today morning because she doesn’t like me.
 Selective abstraction - drawing conclusions on the basis of just one of many elements of a
situation.
For eg: For example, someone might feel responsible for their team losing a football match
even though they were just one player.
 Overgeneralization – Overgeneralization is a cognitive distortion that involves making
broad assumptions about something based on limited experience.
For eg: After being rejected from a job interview, thinking "I'm always going to fail at
everything"

 Magnification - exaggerating the importance of an undesirable event.

For eg: If my child goes to the school trip, she will meet with accident
 Minimization - underplaying the significance of a positive event.
For eg: “I got a promotion at work, but it's probably just because the boss felt sorry for me. I'm
not really that good at my job.”
 Personalization - attributing negative feelings of others to oneself.
For eg: A person gets into a car accident and believes that it is because they are a bad driver,
rather than considering other factors such as the weather, road conditions, or the actions of other
drivers.
c) Cognitive Schemas
Cognitive schemas are cognitive structures that help organize thought and perception, and
influence behavior and emotion. Schemas are mental shortcuts that help people make sense of
new information and organize their knowledge of the world. However, some schemas can be
maladaptive and distort how people perceive themselves, others, and the world. Schemas are
defined as: “broad, pervasive themes regarding oneself and one’s relationship with others.
Schemas are considered as an organizing framework of cognitions. Healthy schemas develop
when the basic emotional needs of a person are met. Schemas develop in childhood as a result of
traumatic event, when core needs are not met. The core needs may include such things as safety,
nurturance, acceptance, respect, guidance, direction, love, attention, approval, pleasure and
relaxation. Schemas may remain dormant until they are activated by stress or situations relevant
to that particular schema.
For eg: Father introducing his 8 and 6 years old children to his friends in a party.

d) Automatic Negative thoughts

Automatic negative thoughts (ANTs) are negative self talk that pops into our heads in
response to a trigger or event. ANTs are identified and challenged in order to replace them with
more realistic or positive thoughts. Negative thoughts cause self-destructive feelings and
behaviors. For example, someone who thinks they are unworthy of love or respect may feel
withdrawn in social situations and behave shyly. Cognitive therapy challenges those thoughts
and provides you with healthier strategies.
There are some examples of automatic negative thoughts include:

 Catastrophizing (magnification and minimization): You exaggerate the importance of

things (such as your goof-up or someone else’s achievement), or you inappropriately
shrink things until they appear tiny.
 All-or-nothing thinking: You see things in black-and-white categories. If your
performance falls short of perfect, you see yourself as a total failure.

 Mental Filter: You pick out a single negative detail and dwell on it exclusively so that
your vision of all reality becomes darkened, like the drop of ink that discolors the entire
beaker of water.
 Disqualifying the positive: You reject positive experiences by insisting they “don’t
count” for some reason or other. In this way you can maintain a negative belief that is
contradicted by your everyday experiences.
  Personalization: You see yourself as the cause of some negative external event, which in
fact you were not primarily responsible for.”
 Emotional reasoning: You assume that your negative emotions necessarily reflect the
way things really are: “I feel it, therefore it must be true.”
 Jumping to conclusions: Reaching a negative conclusion without any justifiable facts
 Mind Reading: You arbitrarily conclude that someone is reacting negatively to
you, and you don’t bother to check this out.
 Fortune telling: You anticipate that things will turn out badly, and you feel
convinced that your prediction is an already-established fact.
 Overgeneralization: You see a single negative event as a never-ending pattern of defeat.
 Labeling and Mislabeling: This is an extreme form of overgeneralization. Instead of
describing your error, you attach a negative label to yourself. “I’m a loser.” Mislabeling
involves describing an event with language that is highly colored and emotionally loaded.

There are some ways CBT can help with negative thoughts:

 Cognitive restructuring

This technique involves questioning the accuracy of negative thoughts and replacing them with
more realistic and positive ones. For example, someone who thinks they are unworthy of love
might be asked to consider the people who love and respect them.

 Identifying cognitive distortions

Cognitive distortions are biased thought patterns that can lead to negative thought
patterns. Some examples include catastrophizing, overgeneralization, and black-and-white
thinking.

 Learning healthier coping techniques

CBT can teach people how to respond to stress differently, such as through meditation, yoga,
muscle relaxation, or guided imagery.

e) Environment
In cognitive behavioral therapy (CBT), the environment is considered to have a significant
impact on behavior. CBT aims to help people change their behavior patterns by regulating
environmental influences.
Here are some things to consider about the environment in CBT:
  Therapeutic alliance

For CBT to be effective, the therapist and client must establish a strong therapeutic
alliance. The therapist should be supportive, empathetic, and competent.

 Learning environment

Learning CBT in an urban environment can present challenges, such as transportation,

accessibility, and cost.

 Nature connectedness

Research suggests that being connected to nature may be positively associated with well-being.

 Coping mechanisms

CBT can help people develop effective coping mechanisms to deal with stress.

7. Advantages of CBT

 Compared to other “talking” therapies, CBT can be completed in a relatively short

period of time.
 Can be helpful in treating some mental health disorders where medication alone has
not helped improve symptoms.
 In order to make changes in how you feel, CBT focuses on altering thoughts and
behaviors.
 Strategies are helpful and practical
 They can help people cope with future stresses.
 Can improve the quality of life.
 It can be provided in a variety of formats including in-person, online, or workbooks.
 It can even be useful in a group setting.
 It can be used in almost any age group.
 It may improve emotional processing
8. Disadvantages of CBT
 The patient has to be committed to the process.
 A drawback might be that the individual’s needs are met through the therapy, but a
patient’s environment (family, interactions), that might have a significant impact on
the patient’s well-being, is not addressed.
 CBT could prove more difficult for people suffering from severe mental health
difficulties or those with a learning disability.
  As CBT addresses the sources of anxiety or other stress causing emotions, the initial
exposure to this type of treatment could prove uncomfortable.
 This treatment does not fully address possible underlying causes of negative
emotions, as it focuses on the present problems.
9. Applications of CBT

CBT is a relatively flexible therapy that can be adapted to meet your particular needs.
Evidence suggests CBT can be an effective treatment for a range of mental health problems, such
as:

 Anxiety and panic attacks  Obsessive-compulsive disorder (OCD)

 Bipolar disorder  Post-traumatic stress disorder (PTSD)

 Borderline personality disorder `  Phobias
 Depression  Psychosis
 Schizophrenia  Eating problems
 Antisocial behavior  Sexual abuse recovery
 Personality disorders  Pain management
 Relationship and family problems  Child or adolescent behavior disorders
 Adjustment to chronic health problem, physical disability, or mental disorder
 Jealousy
10. Conclusion, CBT can help individuals to manage anxiety, depression, and other mental he
Cognitive Behavioral Therapy is an effective form of psychotherapy that helps
individuals to identify and change negative patterns of thinking and behavior. All humans are
flawed. There is not a single human alive that doesn’t have cognitive distortion from time to
time. Developing a deeper understanding of what these distortions are creating a way to reframe
thoughts, behaviors, and actions can help all humans. By challenging negative thoughts and
beliefs, develop more positive and realistic ways of thinking. CBT can help individuals to
manage anxiety, depression and other mental health conditions.