Introduction to CBT | The Literature
J. Beck | Cognitive Behaviour Therapy, the Basics and Beyond
Chapter 1 | Introduction to Cognitive Behaviour Therapy
What is CBT?
Aaron Beck developed a form of psychotherapy in the 1960s and 1970s that he
originally named “cognitive therapy,” a term that is often used synonymously with “cognitive
behavior therapy” (CBT) by much of our field. Beck devised a structured, short-term, present-
oriented psychotherapy for depression (Beck, 1964). Since that time, he and others around the
world have successfully adapted this therapy to a surprisingly diverse set of populations with
a wide range of disorders and problems, in many settings and formats.
In all forms of CBT that are derived from Beck’s model, clinicians base treatment on a
cognitive formulation: the maladaptive beliefs, behavioral strategies, and maintaining factors
that characterize a specific disorder.
CBT has been adapted for clients with diverse levels of education and income as well
as a variety of cultures and ages, from young children to older adults. It is now used in
hospitals and clinics, schools, vocational programs, prisons, and many other settings.
The CBT Theoretical Model
In a nutshell, the cognitive model proposes that dysfunctional thinking (which
influences the client’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 a decrease in negative emotion and maladaptive behavior. An automatic thought,
an idea (in words or images) that just seemed to pop up in your mind: “I can’t do anything
right.” This thought then leads to a particular reaction: You might feel sad (emotion) and
retreat to bed (behavior).
In traditional CBT, your therapist would likely help you examine the validity of this
thought, and you might conclude that you had overgeneralized and, in fact, you still do many
things well, despite your depression. In a recovery-oriented approach, your therapist would
help you evaluate your automatic thoughts.
Cognitions (both adaptive and maladaptive) occur at three levels. Automatic thoughts
(e.g., “I’m too tired to do anything”) are at the most superficial level. You also have
intermediate beliefs, such as underlying assumptions (e.g., “If I try to initiate relationships,
I’ll get rejected”). At the deepest level are your core beliefs about yourself, others, and the
world (e.g., “I’m helpless”; “Other people will hurt me”; “The world is dangerous”).
Recovery-Oriented Cognitive Therapy
Recovery- oriented cognitive therapy (CT-R) for individuals diagnosed with a wide
range of conditions. CT-R, an adaptation of traditional CBT, maintains the theoretical
foundation of the cognitive model in conceptualizing individuals and planning and delivering
treatment. But it adds an additional emphasis on the cognitive formulation of clients’ adaptive
beliefs and behavioral strategies, and factors that maintain a positive mood. Rather than
,emphasizing symptoms and psychopathology, CT-R emphasizes clients’ strengths, personal
qualities, skills, and resources. One difference between traditional CBT and CT-R is the time
orientation. In traditional CBT we tend to talk about problems that arose in the past week and
use CBT techniques to address them. In CT-R, we focus more on clients’ aspirations for the
future, their values, and steps they can take each week toward their goals. The usual CBT
techniques are used in overcoming challenges or obstacles clients will face in taking these
steps.
Summary
CBT was developed by Dr. Aaron Beck in the 1960s and 1970s and has since been
demonstrated to be effective in more than 2,000 published outcome studies. Today, it is
considered the “gold standard” of psychotherapy (David et al., 2018). It’s based on the theory
that people’s thinking influences their emotions and behavior. By helping their clients
evaluate and change dysfunctional or unhelpful thinking, CBT therapists can bring about
lasting change in mood and behavior. CBT therapists employ techniques from many different
psychotherapeutic modalities, applied within the context of the cognitive model and of their
individualized conceptualizations of their clients. A recovery orientation focus has recently
been added to traditional CBT, emphasizing values and aspirations, drawing positive
conclusions from their day-to-day activities, and experiencing positive emotion in and outside
of the therapy session.
,Chapter 3, Beck | Cognitive Conceptualisation
Beliefs
Beginning in childhood, people develop certain ideas about them- selves, other people,
and their world. Their most central or core beliefs are enduring understandings so
fundamental and deep that they often do not articulate them, even to themselves. Individuals
regard these ideas as absolute truths—just the way things “are”.
Adaptive beliefs
There are three categories of adaptive beliefs:
1. EFFECTIVE CORE BELIEFS
• “I am reasonably competent, effective, in control, successful, and useful.”
• “I can reasonably do most things, protect myself, and take care of myself.”
• “I have strengths and weaknesses [in terms of effectiveness, productivity,
achievement].”
• “I have relative freedom.”
• “I mostly measure up to other people.”
2. LOVABLE CORE BELIEFS
• “I am reasonably lovable, likeable, desirable, attractive, wanted, and cared for.”
• “I am okay, and my differences don’t impair my relationships.”
• “I am good enough [to be loved by others].”
• “I am unlikely to be abandoned or rejected or end up alone.”
3. WORTHY CORE BELIEFS
• “I am reasonably worthwhile, acceptable, moral, good, and benign.”
Dysfunctional negative beliefs
Negative core beliefs about the self tend to fall into three categories:
1. Helplessness (being ineffective—in getting things done, self- protection, and/or
measuring up to others);
2. Unlovability (having personal qualities resulting in an inability to get or maintain love
and intimacy from others); and
3. Worthlessness (being an immoral sinner or dangerous to others).
Intermediate beliefs: attitudes, rules, and assumptions
Core beliefs are the most
fundamental level of belief; when clients
are depressed, these beliefs tend to be
negative, extreme, global, rigid, and
overgeneralized. Automatic thoughts, the
actual words or images that go through a
person’s mind, are situation specific and
may be considered the most superficial
level of cognition. Intermediate beliefs exist
between the two. Core beliefs influence the
, development of this intermediate class of beliefs, which consists of (often unarticulated)
attitudes, rules, and assumptions.
Summary
Conceptualizing clients in cognitive terms is crucial to determine the most effective
and efficient course of treatment. It also aids in develop- ing empathy, an ingredient that is
critical in establishing a good therapeutic relationship. Conceptualization begins at the first
contact and is an ongoing process, always subject to modification as new data are uncovered
and previous hypotheses are confirmed or rejected. You base your hypotheses on the
information you collect, using the most parsimonious explanations and refraining from
interpretations and inferences not clearly based on actual data. You continually check out the
conceptualization with clients for several reasons: to ensure that it is accurate, to demonstrate
your accurate understanding to them, and to help them understand themselves, their
experiences, and the meanings they put to their experiences. The ongoing process of
conceptualization is emphasized throughout this book, as are techniques to present your
conceptualization to clients.
