Cognitive Behavioral Therapy
So it is too that in the eyes of the world it is dangerous to venture. And why?
Because one may lose. But not to venture is shrewd. And yet, by not venturing,
it is so dreadfully easy to lose that which it would be diffi cult to lose in even the
most venturesome venture, and in any case never so easily, so completely as if it
were nothing . . . one’s self.
—Kierkegaard, Th e Sickness Unto Death (1849)
premise of the theory
Thoughts lead to feelings: feeling lead to
actions/behaviors that are harmful or damaging to a
Through close inspection of one’s thoughts, through
which you build a stronger understanding of self, you
can learn, through hard work with a therapist, you
can learn to anticipate these thoughts and avoid
situations where they may be prompted.
Albert Ellis developed Rational Emotive Therapy (RET)
Aaron Beck developed Cognitive therapy (CT)
Edward Thorndike first to use the term behavior modification
Judith Beck followed in her father’s (Aaron Beck) footsteps to become
a prominent figure in the world of cognitive therapy
when it was developed
CBT developed in three waves:
The first wave that developed was Rational Emotive Therapy (RET),
which was originated by Albert Ellis, Ph.D. in the mid-1950's.
The second wave happened in the 1960's, Aaron Beck, M.D.
developed his approach called Cognitive Therapy.
The third wave includes people like Judith Beck who started to
introduce it as a potentially useful technique, from which positive
there were clear beneficial results
key concepts surrounding the theory
“When I know my mind I can see that
while the past behavior is now
understandable, it is no longer
The goal is self understanding.
Structures reduces uncertainty; it
strengthens the possibility of a useful
process and beneficial results.
It is possible to restructure the brain and
reroute well-worn, harmful, unhealthy
key vocabulary relevant to the theory
• Behavioral homework assignments: real-life "behavioral experiments" where clients are encouraged to try out new
responses to situations discussed in therapy sessions.
• Cognitive rehearsal: a technique where the client imagines a difficult situation and the therapist guides him
through the step-by-step process of facing and successfully dealing with it. The client then works on practicing, or
rehearsing, these steps mentally. Ideally, when the situation arises in real life, the client will draw on the rehearsed
behavior to address it.
• Journal: a way the client can keep track of recounting their thoughts, feelings, and actions when specific situations
arise. The journal helps to make the patient aware of his or her maladaptive thoughts and to show their
consequences on behavior. In later stages of therapy, it may serve to demonstrate and reinforce positive behaviors.
• Modeling: role-playing exercises in which the therapist acts out appropriate behaviors or responses to situations.
• Conditioning: reinforcement to encourage a particular behavior.
• Systematic desensitization: where the client imagines a situation they fear and the therapist employs techniques to
help the client cope with their fear reaction and eventually eliminate the anxiety related to doing or not doing the
• Validity testing: testing the validity of the automatic thoughts; asking the client to defend or produce evidence that
a what they are thinking is true.
with what diagnoses or family groups the
theory is best used
Any time there is a behavior problem; CBT is useful. With families,
who are discouraged by repetitive behaviors, it is helpful for the
whole family to understand the process. To parents of a child with
such problems, it is encouraging to know that “work” is being put into
solving the problem. There is homework, forming a plan, then
adjusting the plan, etc.
The diagnosis that CBT is most helpful with are eating disorders,
obsessive compulsive disorder, substance use disorders, and anxiety
a mock case study
A 15 year old female is eventually diagnosed with Anorexia after over a year of
symptomatic behavior resulting in poor healthy a degraded social/school/family life.
In the intervention, a family therapist gathers her family and begins introducing them to
CBT. As a form of behavior therapy, the therapist explains to the family that their
daughter’s aren’t intentional; they are symptomatic of a whole separate problem based
on thoughts and feelings.
Further, the therapist consoles the family that once the root of the problem (what
thoughts and feelings (resulting from mistaken beliefs or past experiences) are fueling
these behaviors) is discovered, healing can begin to happen. However, the behaviors
must be reduced first; a clarity needs to be established before self-inspection can
The therapist tells the family about CBT, how the technique will help their daughter
observe her thoughts/urges to behave a certain way, and not let them affect her. Also
important in the session with the family is that CBT involves trying, and maybe failing
along the way to self-understanding and control of ones thoughts.
• Griffith, Jane & Powers, Robert L. (2012). The Key to Psychotherapy.
Adlerian Psychology Associates, Ltd. WA
• Beck, Judith (2011). Cognitive Behavior Therapy, Second Edition:
Basics and Beyond (2nd edition). The Guilford Press IL
• Corey, Gerald (2013). Theory and Practice of counseling and
psychotherapy (9th edition). Belmont, CA: Brooks/Cole