What is Cognitive Behavior Therapy? - Chapter 1

This chapter will discuss Cognitive Behavioral Therapy (CBT) with the use of subquestions.

In the 1960s, Aaron T. Beck, MD, a practicing psychoanalyst, wanted to empirically demonstrate psychoanalytic theories so that they would receive more respect in the scientific community. He identified that distorted, negative cognition was a defining feature of depression and created Cognitive Behavioral Therapy as a short-term treatment that would target those negative cognitions.


What is CBT?

Cognitive Behavioral Therapy (CBT) is a structured, short-term, present-oriented psychotherapy used for depression. It targets dysfunctional thinking and behavior in order to solve current problems in the client’s coping. The therapy has seen countless adaptations and use with a number of different psychological disorders beyond depression. In all forms of CBT, treatment is based on the understanding and conceptualization of individual clients as the therapist seeks different ways to encourage cognitive change and bring about enduring emotional and behavioral change.

What are the different types of CBT?

Variations on CBT tend to emphasize different elements of the treatment. These variations include:

  • Rational emotional behavior therapy.

  • Dialectical behavior therapy.

  • Problem-solving therapy.

  • Acceptance and commitment therapy.

  • Exposure therapy.

  • Cognitive processing therapy.

  • Cognitive behavioral analysis system of psychotherapy.

  • Behavioral activation.

  • Cognitive behavior modification.

  • And others.

CBT often uses techniques from these other therapies, so they are all interconnected. CBT has also been adapted for clients in all levels of socioeconomic status and many different cultures. It can be used in group, couple and family therapy, as well as in child therapy. It can be shortened for clients (like those with schizophrenia) who cannot tolerate a full session.

What is the Cognitive Model?

The Cognitive Model is the theory that underlies Cognitive Behavioral therapy. According to this model, dysfunctional thinking disrupts a client’s mood and behavior and causes psychological disturbances. To recover from psychological disturbance, then, involves developing a more realistic and adaptive way of reflecting on one’s thought processes, and frequently questioning the validity of automatic negative thoughts. Such automatic negative thoughts can lead to damaging emotions like sadness and damaging behaviors like isolating oneself.

Does treatment have a lasting effect?

In order to treat clients in a meaningful and lasting way, CBT therapists will focus on a deeper level of cognition: a client’s fundamental beliefs about themselves, the world, and other people. If a person has an underlying belief that they are incompetent, this may manifest in them frequently underestimating their abilities and feeling powerless. Combating this belief would involve focusing on specific situations in which it is proven false, and would allow one to see that having difficulty with certain tasks does not make one universally incompetent.

What sort of support is there for CBT?

There is overwhelming support (more than 500 outcome studies) for the efficacy of CBT as a therapy for depression and other psychological disorders. Several researchers have found that there are neurobiological changes associated with CBT.

How did CBT come into being?

One of the main concepts of psychoanalysis is that depression is hostility turned inwards. After some research, Beck found instead that depressed people have more feelings of defectiveness, deprivation, and loss. He observed clients having two streams of thoughts – automatic negative thoughts and evaluative thoughts closely tied to emotions. When Beck helped clients identify, evaluate, and respond to these unrealistic thoughts, they rapidly improved. Beck taught his residents to use the treatment, and eventually worked together with A. John Rush on an outcome trial in 1977. This trial established that CBT was at least as effective as a common antidepressant used at the time.

CBT helps clients identify and solve problems, activates their behaviors, and helps curb depressed thinking and beliefs. clients with anxiety not only need to learn to better assess risks, they also need to decrease avoidance and confront scary situations.

What must a CBT therapist be able to do?

CBT seems, from an outsider’s perspective, to be very simple. However, the CBT therapist must be able to conceptualize the case while building up a relationship with their client, as well as socializing and educating them. They must be able to identify problems, collect data, test hypotheses, and summarize. An inexperienced CBT therapist often has trouble doing all of these things at once – this is where the highly-structured format comes into play.

Developing expertise in CBT is a four-stage process:

  • Stage 1: involves learning the basic skills of conceptualizing a case in cognitive terms based on data collected in the initial evaluation and in the sessions that follow. Structure and common sense help the therapist then identify problems and dysfunctional thoughts during the sessions.
  • Stage 2: involves becoming more proficient at integrating the conceptualization with the tools and techniques available to any CBT therapist. Once this becomes easier, the therapist becomes more skilled in identifying critical treatment goals and conceptualizations. 
  • Stage 3: new data is able to be automatically integrated into the conceptualization of the case – hypotheses are easier to formulate, and tools are more easily accessible.
  • Stage 4 is about continueing to learn CBT for the rest of your career.
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