Introduction to
Cognitive Behavior
Therapy
By
Ms. Minahil Tahir Khan
M. Sc, ADCP
(Clinical Psychologist)
Cognitive Behavior Therapy
• The therapy that was originally Cognitive therapy, which was pioneered by
Aaran T. Beck (He was a psychiatrist and he gave CBT while working in
University of Pennsylvania) , in 1970’s but later it became Cognitive Behavior
Therapy, as the behavioral component was incorporated in it, it aimed at changing
the behaviors of people along with the thoughts.
• Cognitive Behavior Therapy aims at changing the Cognitions (thoughts) of
people and then helps them in changing their behavior.
• It also helps in tracing that automatic thoughts, which are the most prominent
part of the CBT. These thoughts are found on the surface, it means that they are
easily accessible and the most profoundly approachable.
Historical Context of Cognitive
Therapy
• The history of cognitive behavior therapy can be traced down in the ancient
Greeks as it can be evidenced by “Plato’s Cave”, which was a classic story to proof
the idea that our perception determine the reality we experience.
• Socrates describes how a group of people who were chained in a cave facing the
wall observed shadows dancing across the wall in front of a candle. To these men
the shadows are a reality. One day a man turns and sees that there are figures
moving behind him casting their shadows. From that day reality does not exists
anymore.
Negative Triad
• Hence it can be said that Cognitive Therapy is an attempt to get the
patient to unchain himself to see outside the cave.
• Cognitive Triad
Depression seemed to be characterized by a negative bias in viewing
reality and referred it as negative triad as given below
Negative Triad
Negative view
about self
Negative view Negative view
about experience about future
General Principles of Cognitive Model
Cognitive Distortions
The term is used to define the frequent errors in thought that also cause
negative affect, but it can not be said that all the thoughts that they are having
are not true. Some thoughts might be true.
Cognitive therapy is the power of realistic thinking and not of
positive thinking.
Schemas
• These are the first level of cognitive distortions.
• These are the concepts that the patient habitually uses in viewing reality. These
biases disturb his focus and the information is mostly negatively processed.
• Example
• Schema of rejection
• Schema of control
• Schema of abandonment
• Schema of uniqueness
Schemas are formed in childhood and by selectively focusing the
information processing.
Maladaptive Assumptions
• These are the second level of cognitive distortions. These are the set of
rules that the person has set up for himself and these help him in guiding or
evaluating his own behavior. These rules or standards are made by the
individual himself.
• Example
• If I will speak in English only then my friends will like me.
• If people will come to know me then they will reject me.
• I need to control my feelings all the time.
Automatic Thoughts
• These are the third and the most easily accessible level of cognitive
distortions. These are the thoughts that are present at the surface level and
can be traced easily.
• Example
• I am a bad person.
• I am a failure.
• Nobody is my friend.
• Though they are easily accessible but sometimes they are left unexamined.
Cognitive Diasthesis Stress
Model
• According to this model, the early maladaptive schemas are activated
when the individual faces any stressful situation.
• Example
• The termination of an intimate relationship will activate the schema of
hopelessness in dependent personality.
Cognitiv
e
Distortio
ns
Cognitiv
e
Distortio
ns
Cognitive
Distortion
s
Principles of CBT
Principles of CBT
Collaboration
Focus on behavior Present time (therapist and
Short term therapy
and cognition orientation client
coordination)
Foster
Rejection of
Independence (to Targeted Emphasis on
“readiness for
make the client symptoms continual change
change”
independent)
Requesting for
Use of treatment Continuity across
Problem solving feedback by
plans sessions
patient
Behavior Techniques
Behavior Techniques
• Target behavior
• Deficits or excesses
• Make a baseline
• Carry out the functional analysis of behavior (see table below)
Antecedent Behavior
Consequences
Self monitoring
• When, where, how much?
• It helps the client to have a record of his own behavior, affect or thoughts.
• Example
• A person has to record the number of times he has criticized himself.
Behavioral interventions are based
on the
• Models of Learning
• Reinforcement
• Punishment
• Extinction
• Schedules of reinforcement
• imitation
Positive and Negative Reinforcement
and Punishment
Positive Negative
Reinforcement Adding something desirable Adding something undesirable
Behavior will increase Behavior will increase
Punishment Adding something undesirable Removal of something desirable
Behavior will decrease Behavior will decrease
Escape conditioning
• Removing yourself from a situation where you feel fear or anxiety.
• Example
• . Taking a leave on the day of your speech
Behavior Techniques used
• Activity scheduling
1. Self monitoring pleasure and mastery
2. Pleasure predicting
3. Assigning activities
4. Examine the negative thoughts relevant to the inactivity
5. Low reward activities
Activity schedule example
Time Activity Pleasure = P Mastery = M
6.00 Travel to work 3 4
Cognitive Techniques
Cognitive Techniques
• identifying the automatic thoughts
• Testing the automatic thoughts
following are the list of questions that will aid in testing if the
automatic thought is logical or not?
What is the If anyone else had If anyone else had
cognitive this issue, what this issue, would you
distortion would be your judge him
advice? negatively?
used?
Questionin Even if it is true,
could you think of
any other positive
How many times did
this thought cross
g an
Rate your belief behaviors that you? Was it ever
you can engage wrong?
in?
Automatic What are the
advantages and
What if the
thought is
Is there anything
you can do to find
thought
disadvantages of out if it is true or
these thoughts? true? not?
Do you have What is the quality
any evidence of your evidence? If it is true, are there
Can you convince any chances to
for and against others that it is improve it?
it? true?
Challenging the Thought
Examine the Why would that Challenge the You can use the
evidence be so bad? thought continuum
technique, if 100
percent is the worst
thing then imagine
0 as the absence of
anything negative.
Continuum Technique
• In this scale 0 means that nothing is negative, 50 is the minimal range and
100 is the extreme of negativity.
0 10 20 30 40 50 60 70 80 90 100
Continued….
What is the best Past history
Exactly what will
or worst and most
happen?
probable result? of predictions
Double Standard Technique
• If someone else has performed as you have but you consider her as a
failure. Why? You consider yourself as a successful person. What is
the rationale of holding yourself to a higher standard?
• This technique focuses on applying the assumptions to other people,
like if a person feels that he is a faiure because he is single. Ask him
about his friends that who are single but are they a failure?
Pie Chart to divide responsibility
• You can use a pie chart and divide it into portions focusing on questions like
• Would others have done better than you? If you feel that you are a failure.
• What could you do in future to get better?
Point Counter Point Technique
• In this technique, negative thought and rational responses are challenged. In this technique,
the person’s assumption that the underlying assumption that it will be difficult to disconfirm
the negative beliefs.
• Examples
Point Counterpoint
I’m failure I succeed at some things.
these don’t count. They are positive so that they stand for something.
they are positive but trivial what makes them trivial?
Because I could do better. Everyone could do better.
If I accept less than perfection. I will become mediocre
Testing Assumptions
Steps
1. Identify the assumptions
2. Perform Cost benefit analysis (see the table in next slide)
3. Examining the criteria (defining the assumption operationally)
Example If a person says that I’m failure. Then he has to define what success is for him
4. Detect the logical errors
5. Apply double standard technique
6. Act in opposition to assumptions
7. Replacing the maladaptive assumption with the adaptive ones
8. Examining the evidence (see table of maladaptive vs pragmatic assumptions)
Cost benefit Analysis
Costs Benefits
Depression, anxiety, dissatisfaction Motivates me to try harder
Costs= 65percent
Benefits= 35percent
Resultant= 30 %
Maladaptive vs Pragmatic
Assumptions
Maladaptive Pragmatic
I must always be successful It is rewarding to be successful but I can learn
from my mistakes.
Testing Schemas
Testing Schemas
Schemas Compensation Schema Avoidance
Sometimes, people perform actions that are in favour In "avoidance" the person tries to avoid situations
of his desire that activate the schema.
Example Example
A person having the fear of abandonment will have having imagined a threat of abandonment in a
the try to be extra pleasing, non-assertive to avoid relationship and feeling sad and panicky, a person
abandonment. using an avoidance coping style might then behave in
ways to limit the closeness in the relationship to try to
protect themself from being abandoned. The resulting
loneliness or even actual loss of the relationship could
easily reinforce the person's Abandonment schema.
Steps of testing schemas
1. Identify the schemas
2. Replacing the maladaptive schemas with adaptive ones (see the next slide)
Maladaptive schemas New schema
I must be good in everything It is good to be good at everything but ill
learn from my mistakes.
Other Cognitive Techniques
• Evidence for and Against
The automatic thought that is considered as distressing will be ad
mistered and the client will have to give the evidence for and against the
thought. What is the evidence which supports your thought? What is the
evidence which is against the thought?
Testing the thought through evidence
for and against
For Against
Evidence
for an
Against
Situation Emotion Automatic Rational Outcome
thought response
Daily
Record of
Dysfunction
al Thought
(DRDT)
Thankou
