Cognitive behavioral therapy (CBT) was developed in the 1960s by Aaron Beck based on his research challenging the psychoanalytic view of depression. Beck observed that depressed clients had negative biases in interpreting events that contributed to cognitive distortions. He developed CBT which focuses on identifying and modifying dysfunctional thoughts and beliefs. The key assumptions of CBT are that cognitions influence behaviors and emotions, and that maladaptive thinking can be identified and changed. Common techniques include cognitive restructuring to challenge irrational thoughts, behavioral experiments, and homework assignments.

2. ORIGIN OF CBT

3. • Aaron Beck was psychoanalytic psychotherapists.
• In early 1960 Aaron beck developed an approach known
as cognitive therapy as a result of his research on
depression.
• In psychoanalytic depression was thought to be based on
retroflective hostility. But the beck findings did not
support the psychoanalytic formulation.
• Aaron Beck observations of depressed clients revealed
that they had a negative bias in their interpretation of
certain life vents, which contributed to their cognitive
distortions.
•

4. • Beck called it cognitive therapy because of the importance it
places on thinking. It’s now known as cognitive-behavioral
therapy (CBT) because the therapy employs behavioral
techniques as well.

5. WHAT IS COGNITIVE
BEHAVIOR THERAPY

6. “CBT is a process of teaching, coaching, and
reinforcing positive behaviors. CBT helps people
to identify cognitive patterns or thoughts and
emotions that are linked with behaviors.”
• Thinking: Different people can think differently about the
same event. The way in which we think about an event influences
how we feel and how we act. A classic example is that when
looking at a glass of water filled halfway, one person will see it
half empty and feel discouraged and the other sees it half full and
feels optimistic.

7. • Behavior: What we do affects how we feel and
think. The individual, who deals with an upcoming exam
by putting off his studies until the last minute, is likely to
experience more distress on the day of the exam than an
individual who has studied well in advance. CBT helps
people to learn new behaviors and new ways of coping
with events, often involving the learning of particular
skills.
• Therapy : Besides its special focus on the relationships
between how we think, feel and behave, the following are
fundamental to the practice of CBT.
o Qualities of the Therapeutic Relationship
o Goal-setting
o Focus on the Present
o Structure

8. THEORETICAL ASSUMPTIONS
OF CBT

9. • Beck’s is based on the theoretical rationale that the way
people feel and behave is determined by how the perceive
and structure their experience.
• The theoretical assumptions of CBT are
1) that people’s communication is accessible to
introspections.
2) that clients’ beliefs have highly personal
meanings
3) that these meanings can be discovered by the
client rather than being taught or interpreted by
the therapists.

10. PRINCIPLES OF CBT

11. BASIC PRINCIPLES
• Cognitions affect behavior and emotion.
• Cognitions may be made aware, monitored and altered.
• Desired emotional and behavioral change can be
achieved through cognitive change.
• Change mood states by using cognitive and behavioral
strategies:
o Identifying/modifying automatic thoughts & core beliefs,
o Regulating routine, and
o Minimizing avoidance.

12. BASIC PRINCIPLES
• Emphasis on ‘here and now’
• Preference for concrete examples
o Start with specific situation (complete thought log)
• Reliance on Socratic questioning
o Ask open-ended questions
• Empirical approach to test beliefs
o Challenge thoughts not based on evidence
o Cognitive restructuring

13. ELEMENTS OF CBT

14. • CBT has several defining elements. They are as follows:
o ACTIVE: The client must be involved in the
therapeutic process not as an observer or as an
occasional visitor, but as a core and key participant.
o MOTIVATIONAL: The therapist needs to take
responsibility for helping to motivate the client toward
a change in behavior, affect, or thinking. The therapist
must be able to set up the format, and rationale for
the client to consider change of value.
o DIRECTIVE: The therapist must be able to develop a
treatment plan and then to help the client to
understand, contribute to, and see the treatment plan
as a template for change.

15. o STRUCTURED: CBT is structured in two ways. First, the overall
therapy follow structure that approximates the treatment plan.
Sessions have identifiable beginning, middle and end.
o COLLABORATIVE: Therapeutic collaboration cannot be 50/50.
for severe depressed client the possibility to generate 50% of
the therapeutic effort is impossible. Initially, the collaboration
may be 90/10. For each client, the therapist must evaluate the
client’s ability and motivation for the therapy.
o PROBLEM-ORIENTED: CBT focuses on discrete problems rather
than vague and amorphous goals of feeling good, getting better,
or increasing self-esteem

16. o PSYCHO EDUCATION: The therapist works as a change
agent. Many to problems that bring people therapy
involve skills deficits. The therapist may have to teach
by direct instruction , modeling, role playing.
o SOLUTION-FOCUSED: The CBT therapists works with
the client on generating solutions not simply gaining
insight into the problem.
o DYNAMICS: The dynamic level of CBT is to help
clients to identify, understand, modify their schema.
The schema are the basic templates for understanding
one’s world. Schema may be personal, religious,
cultural, gender-related.
o TIME-LIMITED: Each therapy session should, ideally ,
stand alone. A time-limited focus is not a number of
sessions, but rather way of looking at therapy.

17. BASIC FEATURES OF
CBT

18. Rationale of CBT
• Negative emotions are elicited by cognitive processes
developed through influences of learning and
temperament.
• Adverse life events elicit automatic processing, which is
viewed as the causal factor.
• Cognitive triad: Negative automatic thoughts center
around our understanding of:
o Ourselves
o Others (the world)
o Future
• Focus on examination of cognitive beliefs and developing
rational responses to negative automatic thoughts.

19. • Distorted appraisals follow themes relevant to the specific
psychiatric condition.
• Psychological disorders are characterized by a different
psychological profile.
o Depression: Negative view of self, others, and future. Core
beliefs associated with helplessness, failure, incompetence,
and un lovability.
o Anxiety: Overestimation of physical and psychological
threats. Core beliefs linked with risk, dangerousness, and
uncontrollability.

20. COGNITIVE SPECIFICITY
• Negative Triad Associated with Depression
o Self “I am incompetent/unlovable”
o Others “People do not care about me”
o Future “The future is bleak”
• Negative Triad Associated with Anxiety
o Self “I am unable to protect myself”
o Others “People will humiliate me”
o Future “It’s a matter of time before I am
embarrassed”

21. EVENT
Bill goes to
collection APPRAISAL
MALADAPTIVE “I can never do
BEHAVIOR anything right”
Withdrawal,
avoidance
AFFECTIVE &
BEHAVIORAL
BIOLOGICAL
INCLINATION
AROUSAL
I don’t want to
decreased sleep,
deal with it
low energy

22. • Core beliefs underlie and produce automatic thoughts.
• These assumptions influence information processing and organize
understanding about ourselves, others, and the future.
• These core beliefs remain dormant until activated by stress or
negative life events.
• Categories of core beliefs (helpless, worthless, unlovable)

23. AUTOMATIC THOUGHTS
• Thoughts that automatically come to mind when a
particular situation occurs is called as automatic
thoughts.
• Happen spontaneously in response to situation
• Do not arise from reasoning
• No logical sequence

24. The systematic errors in reasoning that lead to faulty assumptions
and misconceptions which are termed as cognitive distortions.
• Arbitrary Inference: refers to making conclusions without
supporting and relevant evidence. This includes “catastrophizing”
or thinking of absolute worst scenario and outcomes for most
situations.
• Selective abstraction: consists of forming conclusions based on
an isolation detail of an event. In this process other information is
ignored and the significance of total context is missed.
• Overgeneralization: is a process of holding extreme beliefs on the
basis of a single incident and applying them inappropriately to
dissimilar events and settings.
• Magnification and minimization: consist of perceiving a case or
situation in a greater or lesser light than it truly deserves.

25. COGNITIVE DISTORTIONS cont.
• Personalization: is a tendency for individuals to relate external
events to themselves, even when there is no basis for making
this connection.
• Labeling and Mislabeling: involve portraying one’s identity on
the basis of imperfections and mistakes made past and
allowing them to define one’s true identity.
• Polarized Thinking: involve thinking and interpreting in all-or-
nothing terms, or categorizing experiences in either or
extremes. With such dichotomous thinking, events are labeled
in black or white terms.

26. Beck contends that people with emotional difficulties tend
to commit characteristic “logical error” that tilt objective
reality in the direction of self-destruction. Cognitive therapy
perceives psychological problems as stemming from
commonplace processes such as faulty thinking, making
incorrect inferences on the basis of inadequate or incorrect
information and failing to distinguish between fantasy and
reality.

27. TECHNIQUES OF
CBT

28. Techniques of CBT
The cognitive behavioral therapy techniques are an
interesting set of exercises that help modify a person's
behavioral patterns. The behavioral patterns are
modified in order to bring about positive changes in
the personality.

29. • In this technique, the patient is asked to recall a problematic
situation of the past.
• The therapist and patient both work together to find out a solution
for the problem or a way in which the difficult situation, if it occurs
in the future can be sorted out.
• The therapist asks the patient to rehearse positive thoughts
cognitively in order to make appropriate changes to the latter's
thought processes.
• Power of imagination proves to be of great use in such exercises.

30. Validity Testing
• In this techniques the therapist tests
validity of beliefs/thoughts of the
patient.
• The patient is allowed to defend his
viewpoint by means of objective
evidence.
• The faulty nature or invalidity of the
beliefs of the patient is exposed if he/she
is unable to produce any kind of
objective evidence

31. • It is the practice of maintaining a diary to keep an account of
situations that arise in day-to-day life
• Thoughts that are associated with these situations and the
behavior exhibited in response to them are also mentioned in
the diary.
• The therapist and patient together review the matter written
in the journal and find out maladaptive thought pattern.
• The discussion that takes place between them proves to be
useful in finding different ways in which behavior of the
patient gets affected

32. Guided Discovery
• The objective or purpose behind using this technique
is that of helping patients by enabling them to
understand their cognitive distortions.
• Patients are made aware of and assisted by therapists
in understanding how they process information.
• The activity of understanding how information is
processed allows patients to alter the same
(information processing) if required.

33. Guided Discovery
• Basically, the patient's perception of the world
undergoes great change and he/she sees things in a
different way than earlier.
• This change in perception allows the patient to
modify his/her behavior in a better manner

34. • It is one of the cognitive therapy techniques in
which therapists perform role-playing
exercises aimed at responding in a way that is
helpful to overcome difficult situations.
• The patient makes use of this behavior of the
therapist as a model in order to solve
problems he/she comes across.

35. Homework:
• The homework is actually a set of
assignments given by therapists to
patients.
• The patient may have to take notes
during sessions with therapists, review
audiotapes of a particular session or
read articles/books related to the
therapy.

36. • Amongst the different CBT techniques used
by therapists, aversive conditioning
technique makes use of dissuasion so as to
lessen the appeal of a maladaptive behavior.
• The patient while being engaged in a
particular behavior or thought for which he
has to be treated, is exposed to an
unpleasant stimulus.

37. • Thus, the unpleasant stimulus gets
associated with these
thoughts/behavior and then the
patient exhibits an aversive
behavior towards them

38. Reinforcement
• The systematic positive reinforcement is one of
the techniques of CBT therapy in which certain
(positive) behavior of a person are rewarded
with positive reinforcement.
• A reinforcement system is established for the
of certain positive behavior.

39. Just like positive reinforcement proves to
be helpful in encouraging a particular
behavior, withholding the reinforcement
deliberately also is instrumental in
eradicating a maladaptive behavior.

40. • In self-instructional coping methods, the therapist attempts not
to completely change the way you think, but rather teaches
coping methods that equip you to handle harmful thought
processes. One such therapeutic process is stress inoculation
training.
• This therapy -- which helps the patient deal with stressful events'
aftermath -- aims to prevent negative reactions to stress-inducing
factors by teaching the patient to break down these situations
into short-term and long-term coping goals

41. Problem-Solving Methods
• Cognitive-behavioral therapy -- which sees irrational
thought processes as resolvable -- incorporates
problem-solving methods. After illogical thought
patterns are found, the patient must suggest several
alternative solutions.
• Through the decision-making process, negative
solutions are weeded out until an acceptable, positive
approach is discovered. This type of therapy sometimes
is used in child psychotherapy when dealing with
oppositional defiant disorder.

42. • One method of conducting cognitive-
behavioral therapy is through computer-based
programs. This therapy tends to decrease time
spent with an actual therapist. Since computer-
assisted CBT is relatively new, as of
publication, most of the information is in the
testing phase.

43. However, primary-care treatment programs that have
begun integrating the method for treating co-morbid
anxiety and mood disorders have found promise in this
type of therapy, states researchers in "Depression and
Anxiety," the official journal of the Anxiety Disorders
Association of America

44. References
Barlow. D. H & Nathar. P. E.,(2011). The Oxford Handbook of Clinical Psychology. Published by
Oxford Press.Inc, New York.
Carson. R.C., Butcher J. N & Mineka. S., (2001). Abnormal Psychology and Modern Life. ( 11th Ed).
Published by Pearson education, Inc. and Dorling Kindersley Publishing Inc.
Doboson. D & Dobson. K., (2009). Evidence-Based Practice of Cognitive -Behavior Therapy.
Published by Guilford publication.Inc.
Ronen. T & Freeman. A.,( 2007) CBT in Social Work Practice. Published by Spring publishing
Company,LLC.
Sheldon. B.,(2011). Cognitive Behavior Therapy Research and Practice in Health and Social Care.
(2nd Ed). Published by Routledge publication New York.