Learning cognitive behavioral therapy
Chapter 1 Basic principles of cognitive-behavior therapy
Origins of CBT
CBT is based on two central tenets:
- Our cognitions have a controlling influence on our emotions and behavior
- How we act or behave can strongly affect our thought pattern and emotions
The perspective that developing a healthy style of thinking can reduce distress or give a
greater sense of well-being is a common theme across many generations and cultures
(Greeks, Daila Lama, Benjamin Franklin, European philosophers). The idea was that
conscious cognitive processes play a fundamental role in human existence (finding meaning
as an antidote for despair).
Aaron Beck was the first to develop theories and methods for using cognitive and behavioral
interventions for emotional disorders (still under influence of post-Freudian analysts). Other
contributors to cognitive-behavioral theories and methods are Kelly (theory of personal
construct core beliefs or self-schemas) and Ellis (rational-emotive therapy).
Beck’s theory was based on the role of maladaptive information processing in depression
and anxiety disorders. Negative cognitive triad: a cognitive conceptualization of depression
in which symptoms were related to a negative thinking style in three domains; self, world
and future.
The behavioral component was added in the 1950s and 1960s by Pavlov and Skinner.
Examples include desensitization and relaxation training. There was paid limited attention to
cognitive processes involved in disorders, the focus was on shaping measurable behavior
with reinforcers and extinguishing fearful responses with exposure protocols.
Meichenbaum and Lewinsohn (1977, 1985) began to add cognitive theories and strategies
into treatment, to add context, depth and understanding to behavioral interventions. Beck
started to use behavioral methods because he saw that it was effective to reduce symptoms
and he saw a close relationship between cognition and behavior. Therefore, since the 1960s,
there has been a coalescence of cognitive and behavioral formulations in psychotherapy.
The cognitive-Behavioral Model
, Humans continually appraise the significance of events in the environment around and
within them (stressful events, feedback, memories, to-do’s, bodily sensations) and
cognitions are often associated witch emotional reactions. Thoughts physiological
response behavioral response. This can be a vicious cycle of thoughts, emotions and
behavior. Cognitions, emotions and behaviors are three areas of pathological functioning
that can be targeted in CBT.
The basic CBT model is a construct used to help clinicians conceptualize clinical problems
and implement specific CBT methods. It directs the attention of the clinician to the
relationships among thoughts, emotions and behaviors and guides treatment interventions.
It needs to be recognized that there are complex interactions among biological processes,
environmental and interpersonal influences and cognitive-behavioral elements in the
genesis and treatment of psychiatric disorders. Cognitive and behavioral changes are
modulated by biological processes and medication.
Basic concepts
Levels of Cognitive Processing
There are three primary levels of cognitive processing (Beck):
- Consciousness awareness, rational decision making.
- monitor and assess interactions with the environment
- link past memories with present experiences
- control and plan future actions
- Automatic thoughts stream rapidly through our minds when we are in the midst
of situations. We may be subliminally aware of presence, but no rational analysis is
made.
- Schemas core beliefs that act as templates for information processing. Allow
humans to screen, filter, code and assign meaning to information from the
environment
CBT does not posit specific structures or defenses that block thoughts from awareness. CBT
emphasizes techniques designed to help patients detect and modify their inner thoughts,
especially those that are associated with emotional symptoms. CBT teaches patients to think
about their thinking to bring autonomous cognitions into conscious awareness and control.
Automatic Thoughts
We have many automatic thoughts that are typically private and unspoken and occur rapid
as we evaluate events in our lives. Clark calls these thoughts preconscious thoughts, because
we can only understand them if we draw attention to them. Persons with psychiatric
disorders often experience floods of automatic thoughts that are maladaptive or distorted
which can lead to painful emotional reactions and dysfunctional behavior. The presence of
strong emotions might be a clue that automatic thoughts are occurring. In addition, people
with psychiatric disorders have a high frequency of distorted automatic thoughts.
Depression: hopelessness, low self-esteem, failure. Anxiety disorder: predictions of danger,
