Cognitive therapy
Unit III
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Aaron Beck’s daughter, Judith S. Beck – director of Beck
Institute of Cognitive Therapy and Research; Professor at the
University of Pennsylvania.
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Beck published his first outcome study in 1977. Since that time,
he has published more than 500 articles, authored and
coauthored 25 books, and lectured throughout the world.
Only psychiatrist to receive research awards from
Both APAs
Beck is listed as “one of the five most influential
Psychotherapists of all time” (American Psychologist, 1989).
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It is the most widely researched form of therapy
View of Human Nature
Judith Beck (2011) summarized cognitive therapy:
“In a nutshell, the cognitive model proposes that dysfunctional
thinking (which influences the patient’s mood and behavior) is
common to all psychological disturbances. When people learn to
evaluate their thinking in a more realistic and adaptive way, they
experience improvement in their emotional state and in their
behavior.”
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Development of Cognitive Distortions:
Cognitive therapists believe that many factors contribute to the
development of dysfunctional cognitions, including people’s
biology and genetic predispositions, life experiences, and their
accumulation of knowledge and learning.
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Distorted cognitions begin to take shape in childhood and are
reflected in people’s fundamental beliefs; this makes people more
susceptible to problems.
Labeling the Distortion
Evaluation of distorted cognitions can be facilitated by categorizing and
labeling the distortions.
Some cognitive distortions are as follows:
All-or-nothing or polarized thinking
Overgeneralization
Mental filter (selective abstraction)
Disqualifying the positive
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Jumping to conclusions (arbitrary inferences)
Magnification/minimization
Emotional reasoning
“Should” and “must” statements
Labeling and mislabeling
Personalization
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Catastrophizing
Mind reading
Tunnel vision
Reviewing this list can reassure clients that having
cognitive distortions is common and that dysfunctional
thinking can be changed.
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Accurate diagnosis:
Extensive intake interview
Each mental disorder is characterized by relatively predictable types of
underlying cognitive distortions. E.g., feelings of depression stem from
thoughts of loss.
An accurate diagnosis can therefore facilitate identification of those
distortions and ways to change them.
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Interventions target all 3 areas of functioning: thinking, feeling,
& acting.
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Principles of Cognitive Therapy
The following important principles characterize the practice of cognitive
therapy (Beck, 1995, 2011; Beck et al., 2006):
⁕Cognitive therapy is based on the finding that changes in
thinking lead to changes in feeling and acting.
⁕Treatment requires a sound and collaborative therapeutic
alliance.
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⁕Treatment is generally short-term, problem focused, and goal-
oriented.
⁕Cognitive therapy is an active and structured approach to treatment.
⁕It focuses on the present, although attention is paid to the past when
indicated.
⁕Careful assessment, diagnosis, and treatment planning are essential.
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⁕Cognitive therapy uses a broad range of strategies and
interventions to help people evaluate and change their
cognitions.
⁕Inductive reasoning and Socratic questioning are
particularly important strategies.
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⁕This is a psychoeducational model that promotes
emotional health and prevents relapse by teaching
people to identify, evaluate, and modify their own
cognitions.
⁕Task assignments, follow-up, and client feedback are
important in ensuring the success of this approach.
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Levels of Cognitions
Cognitions can be categorized according to 4 levels:
a. Automatic thoughts
b. Intermediate beliefs
c. Core beliefs
d. Schemas
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In cognitive therapy, treatment typically begins with automatic
thoughts, and then proceeds to identification, evaluation, and
modification of intermediate & core beliefs and finally a revision
of schemas.
Automatic thoughts: situation-specific thoughts spontaneously
arise in reaction to our experiences.
Automatic thoughts mediate between a situation and an emotion.
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Intermediate beliefs: often reflect extreme and absolute rules
and attitudes that shape people’s automatic thoughts.
Core beliefs: central ideas about ourselves and underlie many of our
automatic cognitions and usually are reflected in our intermediate
beliefs.
core beliefs can be described as “global, rigid and overgeneralized.”
(Beck, 2011, p. 34)
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They typically stem from childhood experiences, are not necessarily
true, and can be identified and modified.
Core beliefs reflects our views of the world, other people, ourselves, and
the future.
Core beliefs are:
i. Positive
ii. Negative: a) helpless core beliefs (b) unlovable core beliefs
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Schemas: defined as “hypothesized mental structure that
organizes information” that encompasses the core beliefs (Beck,
2011, p. 33).
They go beyond core beliefs, in breadth and depth, and include
thoughts, emotions, and actions
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Schemas lead us to have experiences, events, and roles
and to amplify those with information contained in our
schemas.
Schemas can act as mental filters, affecting the way we
perceive reality.
Schemas are idiosyncratic and habitual ways of viewing
ourselves, the world, and the future.
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Examples of maladaptive schemas include
dependence / incompetence and deprivation.
Schemas may be activated by a particular stimulus or
lie dormant until triggered.
Beck viewed schema work as the heart of the
therapeutic process (Beck et al., 2006).
Role of the Counselor
o Therapy is time-limited (6 to 14 sessions)
o Carefully planned & structured sessions
o Completion of inventories & intake questionnaires
o Reviewed by clinicians before the 1st session.
o Each session has clear goals and an agenda.
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Goals:
• Specify goals
• Overall goal – help people to recognize and correct errors in their
information-processing systems.
• Clinician and client collaborate on determining specific goals.
• Goals are referred to regularly to assess progress.
• Clear, specific, measurable goals
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Therapeutic Alliance:
o Cognitive therapist is active, collaborative, goal oriented &
problem focused.
o Nonjudgmental
o Cognitive therapists use Socratic questioning to lead clients
through what Scott & Freeman (2010) refer to as “guided
discovery” (p. 35).
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The 4 stages of guided discovery are:
1) Socratic questioning to elicit the clients’ concern.
2) Active listening for clarification, inconsistencies, and emotional reactions.
3) Summarization to provide feedback and enhance clarification.
4) Synthesis or analytical questions that pull all the information together,
along with client’s original concern, and pose an analytical question
(Scott & Freeman, 2010).
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Example:
The therapist asks the client:
a) What evidence is there for the belief?
b) How else could the situation interpreted?
c) If it is true, what would the implications be?
Techniques
Techniques / strategies are as follows:
Challenging absolute statements. The clinician gives the client
an opportunity to retract the absolute statement and clarify
the behavior more accurately.
Activity scheduling encourages people to plan and try out new
behaviors and ways of thinking as well as to remain active
despite feelings of sadness or apprehension.
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Keeping diaries of events, realistic and distorted cognitions,
emotions, and efforts to make positive changes can increase
people’s awareness of their inner and outer experiences.
Relabeling or reframing experiences or perceptions can help
people think differently about them.
Role-playing a dialogue between old and new thoughts, clients
can use 2 chairs to represent both their old and new thoughts.
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Graded task assignments are activities that clients
complete between sessions.
Strengths & Contributions
Cognitive therapy is unique in its contribution to counseling in the following ways:
• CT has been adapted to a wide range of disorders, including depression and
anxiety (Puterbaugh, 2006).
• CT has spawned, in conjunction with cognitive–behavioral therapy, dialectical
behavior therapy, an intensive psychosocial treatment for individuals who are at
risk for self-harm, such as people diagnosed with borderline personality disorder
(BPD). The objective is to help clients be more mindful and accepting of things that
cannot be easily changed and live lives worth living (Day, 2008).
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• CT is applicable in a number of cultural settings. For instance, Beck’s model of
cognitive therapy was introduced in China in 1989 and a variation of it has been
popular there since (Chang, Tong, Shi, & Zeng, 2005).
• CT is a well-researched, evidence-based therapy that has proven effective for clients
from multiple backgrounds.
• CT has spawned a number of useful and important clinical instruments including the
Beck Anxiety Inventory, the Beck Hopelessness Scale, and the Beck Depression Scale
(Beck & Weishaar, 2014).
• CT has a number of training centers around the United States and Europe including
the Beck Institute in Bala Cynwyd, Pennsylvania (Beck & Weishaar, 2014).
Limitations
The CT approach has several limitations, among which are the
following:
• CT is structured and requires clients to be active, which often
means completing homework assignments.
• CT is not an appropriate therapy for people seeking a more
unstructured, insight-oriented approach that does not require
their strong participation (Seligman & Reichenberg, 2014).
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• CT is primarily cognitive in nature and not usually the
best approach for people who are intellectually limited or
who are unmotivated to change.
• CT is demanding. Clinicians as well as clients must be
active and innovative. The approach is more complex
than it would appear on the surface.
