Cognitive Behaviour

Therapy
 Key Concepts

 It is not events per se that determine our feelings but

the meanings we ascribe to them. (CBT helps in
generation of alternate viewpoints)

 Individuals are actively involved in constructing their

realities

 Information processing becomes distorted when we

experience emotional distress (it underlies all
psychological disorders)
 Activity

Think about your prominent negative

emotion in past one week.

List down all the thoughts that are

associated with that emotion. (at least 5)
 Common Distortion Errors
 • All or nothing thinking: situations and individuals are viewed in
either/or terms, e.g. ‘You’re either trustworthy or not. It’s as simple as
that’.
 • Jumping to conclusions: judgements are rushed rather than
considered, e.g. a client says about a new boss: ‘He just looks so harsh!”
 • Mind-reading: discerning the thoughts of others without any
accompanying evidence to support such claims, e.g. ‘My boss didn’t
smile at me this morning, so that means she is unhappy with my work’.
 • Labelling: attaching global negative labels to oneself, others or the
world, e.g. ‘I didn’t understand what he said unlike others in the group,
so this must mean that I’m stupid’.
 • Emotional reasoning: assuming that feelings are facts, e.g. ‘I feel
incompetent, so it must be true’
Activity Contd …
Out of the thoughts that you had written, identify the distortions!
Three Levels of Thinking
 NATs are situation-specific and involuntarily ‘pop into’ a person’s mind when he is
experiencing emotional distress such as depression or anxiety.

 Underlying assumptions (e.g. ‘If I impress others, then I should get ahead in life’) and
rules (e.g. ‘I should not let people down’) guide behaviour, set standards and provide
rules to follow. They are usually expressed in “Must” and “Should” construction.

 These assumptions and rules are the means by which individuals hope to avoid
coming ‘face to face’ with their negative core beliefs (e.g. ‘I’m incompetent’). Beck
et al. (1985) suggest that maladaptive assumptions often focus on three major
issues: acceptance (e.g. ‘I’m nothing unless I’m loved’), competence (e.g. ‘I am what
I accomplish’) and control (e.g. ‘I can’t ask for help’).
• AT1: I am critical of myself!
• AT2: how couldi be so mstupid?
• AT3: I am not as good as the others!
• AT4: I might be left behind!
• AT5: I will be alone!
• belief: I am not loveable!!
 Contd…
 Core beliefs (also known as schemas are the third level of thought and the
deepest. Negative core beliefs are overgeneralized and unconditional (e.g.
‘I’m hopeless’).

 Once activated, negative core beliefs process information in a biased way

that confirms them and disconfirms contradictory information (e.g. ‘So what
if I’m mostly on time for meetings?’). Core beliefs can be about the self (e.g.
‘I’m unloveable’), others (e.g. ‘I can’t trust anyone’), and/or the world (e.g.
‘Everything is against me’). Once the distress has passed, negative core
beliefs become deactivated
 Contd…

• Cognitive schemas ‘are organized structures of stored

information that contain individual’s perceptions of self
and others, goals, expectations and memories’ (Beck
and Dozois, 2011).

• Core beliefs (e.g. ‘I’m no good’ and ‘People cannot be

trusted’) represent the content of the schemas.

• CBT focuses on maladaptive cognitive schemas that

process incoming information in negatively biased and
rigid ways.
 Contd…

How do these three levels interact?

A person feels depressed when he fails to get ‘A’ grades in

his exams. His dormant core belief, ‘I’m a failure’, is
activated by his inability to live up to his rigid rule of living
that he must be the best at everything he does .

His mind is flooded with NATs: ‘I can’t show my face at

college. Run away and hide.
The cognitive content of syndromes (e.g. anxiety
disorders, depression) have the same theme (e.g.
danger or loss, respectively) as found in ‘normal’
experience.
but cognitive distortions are extreme and,
consequently, so are affect [emotion] and behaviour.
For example, a person looking over his life might
experience sadness at the wasted opportunities but
knows that new opportunities lie ahead; however, his
sadness may intensify and become a prolonged
depression if he sees such wasted opportunities as
the whole story of his life.
  CBT does not claim that dysfunctional thinking alone causes
emotional distress; rather it forms an integral part of this
distress.
 Psychological disturbance is also influenced by genetic,
environmental, familial, cultural, personality and
developmental factors.
 The interplay between these factors helps to form a person’s
idiosyncratic core beliefs, assumptions and rules about
Contd… themselves, others and the world.
 These predisposing factors interact with relevant current
events or stressors (precipitating factors) to trigger emotional
disturbance.
 The cognitive therapist redirects the client’s attention to the
present
Few Misconceptions about
CBT

CBT does not take emotions into

consideration
CBT can be used well by only
intelligent clients
CBT does not consider past
experiences of the client
 Process of CBT
• CBT Assessment involves collecting relevant information about the
clients current problem and putting it into case conceptualization. 3
areas of assessment:
1. The detailed information about the problem (thoughts, feelings,
behaviours and physical responses)
2. What is maintaining the problem (ABCs of the problem
behaviours)
3. Longitudinal Perspective (Vulnerabilities)

• Drawing up of a problem list

• Agreement on Goals (reframing of problems as goals in a concrete
fashion)
 Contd…

• Teaching the cognitive model to clients (thoughts-

feelings connection)

• Developing a case conceptualization

• Teaching skills to monitor thoughts

• Teaching cognitive reconstruction skills

• Teaching Behavioural Skills (e.g. in Anxiety and

Depression)
CHALLENGING CORE BELIEFS
BEHAVIOURAL EXPERIMENTS

VISUALIZATION

CREATIG NEW NARRATIVE

Clients Thoughts
Situation Thoughts Emotions
 Techniques

For Monitoring of Keeping a thought

Situation/Emotion Intervention Skills
Thoughts / record (Daily Writing Journals
Charts (Behavioural)
Behaviours Thought Record)

Conducting
Playlist of Pleasant
Seeking Evidence Behavioural Making a Book Tool Kit
Events
Experiments

Looking at
Constructing
Intervention Identifying Cognitive Advantages and Instant Messaging
Alternate
(Cogntive) Distortions Disadvantages of Worksheet
Explanations
Specific Thoughts
 Activity

Constructing Alternate Explanations for

• Children in my class are talking and smiling at each
other in a small group
• I have not been invited to my friend’s birthday
• The English teacher mostly asks me to answer her
questions in class
Instant Messaging/Wotzaap Worksheet
 Types of Homework Assignment
Bibliotherapy

Listening

Writing (e.g. DTR)

Coping Imagery

Activity Scheduling

Graded Task Assignments

Spotting “Musts” and “Should”

CBT FOR KIDS
Self Instruction and Cognitive Restructuring Techniques

Superhero Cape

Thought Crown

Handprint on the Heart

For Now or Forever

Caring or Control

Impulse Monster Says/Tamer Says

Cut the Knot (Stem and Conditions)

 All children sit in a circle. One group member whispers
a short sentence or thought to the person sitting next to
them. This person in turn whispers what they heard to
the next person, and so on round the circle. The last
person announces what they heard. (it teaches the
children that thoughts can be misinterpreted!)

Thoughts’ game Thought Compass

What’s Bugging You? (monitoring of thoughts)

To identify Emotional Intensity (e.g. of
Anger)
Watch Warn Storm
Contd…
• Different thoughts All of us have different thoughts running through
our minds all the time. Some of these thoughts make us feel happy
inside while others make us feel angry, sad or scared. Make cool
connections by writing some of the thoughts other children may have
in the different situations below:
• Thoughts about themselves

Happy thoughts Sad, worried or angry thoughts

The Bus Driver Metaphor
 Cut The Knot
• Cut the Knot is a self- instructional exercise that works to break inaccurate
contingencies between patients’ views of themselves and others and some
unrealistic standard.
• In one form, Cut the Knot involves identifying various stems such as “If . . . ,
then . . . ,” “I am . . . ,” and “People must . . . .” Often these stems and
conditions are readily recognized through the case conceptualization
processes.
• The stem and condition are tied together and knotted with string, ribbon,
or plastic cording. Once they are connected, the therapist initiates a Socratic
dialogue aimed at breaking this spurious correlation
• After the Socratic dialogue is completed, the therapist invites the child to
cut the knot and replace the absolutistic demand with a more functional
alternative.
Cut The Knot
Others
will love
me
always

I will be in control of things Things will be my way

If I am
Worthy
There will be no disappointment Others will give me what I want
Things/
Situatio
ns will
be
easier
Cut The Knot

Things
will be
easier

Nothing undesirable People will love and

will have to happen If I am Perfect accept me

I will
never
have to
worry
 Nisha, the client, is 4o yr. old lady and is eldest of her 2 siblings.
She is married and has 2 children. Talking about her childhood,
she said that her father was strict and authoritarian and her
mother, a homemaker. She describes her father as distant and
rigid and her relationship with him was of unquestioning, fearful
adherence to his rules and standards. She remembers her
mother as critical and she thought she could never do enough to
please her. At other times, her mother was supportive. The
family demonstrated little affection.

Case Study In many ways, Nisha took the role of caring for her younger
brother and sister in the hope of winning approval of her
parents. When she attempted to have fun, she encountered her
father’s disapproval. In her social relationships, she had difficulty
in making and maintaining friends. She had different set of
morals than most of her classmates.
After her marriage, she has done everything she can, for her
husband and kids but says she still feels guilty of not having done
enough.
 Talking about her present feelings, she says she
doesn’t like the way she is; overweight and
dissatisfied. She also experiences feeling of panic at
different times in day and night, she feels scared
that something might happen to her. As a child she
was often motivated by her parents who would
instil fear that something might happen because of
Contd… her faults.
She wants to pick up a job in a school but is not
able to decide and feels trapped. She expects that
the therapist should tell her what to do and push
her to do the same.
CBT Case Conceptualisation
Precipitating event/trigger

Early experience

Core beliefs

Old rules for living

Presenting problems/effects of old rules

Contd…

Situation

Automatic
Thought

Emotion Behaviour

Bodily Sensation