By Nazia Islam, LPC-S, RPT
When people used to think about therapy the image conjured would be a gray bearded man with a pipe, dark leather sofa and psychoanalysis. Now when people think of therapy, a popular term is Cognitive Behavioral Therapy (or CBT). Oftentimes during my initial sessions clients will ask if I implement CBT in my practice or when I am being paneled by an insurance company they will verify my expertise on CBT. “CBT is often referred to as the “gold standard” in psychotherapy because its highly replicable, or repeatable, structure and format makes it great for lab study (LaPera,2021,p.6).
So what is Cognitive Behavioral Therapy? Cognitive Behavioral Therapy highlights maladaptive thinking and its effects on feelings, body sensations and behaviors; the goal is to reframe faulty thoughts to improve overall mood and functioning. Dr. Aaron Beck is the father of Cognitive Behavioral Therapy, which he started practicing in the 1960’s. Beck and Fleming (2021) write that Dr. Aaron Beck started off his career practicing psychoanalysis and engaging in research to validate psychoanalytic therapy. However, he found that his research disaffirmed the major principles of psychoanalysis. He began exploring automatic thoughts and cognitive distortions to help clients understand themselves and to improve mood. He also moved his patients from the couch to the chair.
Cognitive Behavioral Therapy has three core principles; core beliefs, dysfunctional assumptions and negative automatic thoughts. Core beliefs are your understanding and assumptions of the world, yourself and others. Our core beliefs are often embedded within us through our childhood experiences and upbringing. Core beliefs can often be untrue leading to dysfunctional assumptions and automatic negative thoughts which can cause distress. Some examples of core beliefs are “I am worthless,” “people are not trustworthy,” and “the world is scary.” The best way to identify your core beliefs is by noticing and retracing your intermediate/ automatic thoughts after a situation that may have occurred. Intermediate thoughts are arbitrary beliefs or “if… then” rules we have created to make sense of the world. Let’s look at the example below:
Situation – Receiving some constructive criticism from your supervisor at your job.
Maladaptive thinking
Automatic Thought- “I am so stupid, I can never do anything right.”
→Intermediate Belief-” If I am not perfect, I will not succeed.”
→Core Belief- “I will never be successful.”
Healthy thinking
Automatic Thought- “It was helpful for her to provide that constructive criticism, now I can improve my quality of work.”
→Intermediate Belief- “There is always room to improve.”
→Core Belief- “I can achieve my goals.”
In addition to addressing thoughts, feelings and behavior Cognitive Behavioral Therapy has some other basic principles and also employs a number of techniques. CBT is a collaborative approach by the practitioner and client where therapeutic alliance is necessary. CBT is meant to be psychoeducational and teaches clients how to identify and reframe their maladaptive thoughts. The approach itself is goal orientated, solution focused, structured and aims to be time limited. (“What Principles Underlies Cognitive Therapy,” 2021) Some of the techniques employed in CBT are relaxation and stress management, socratic questioning, keeping thought records or journals, role playing and successive approximation. CBT encourages relaxation by teaching deep breathing, practicing guided meditation, progressive muscle relaxation, suggestive relaxation, mindfulness and even yoga. Socratic questioning or also known as guided discovery is the art of meaningful conversation introduced by philosopher Socrates. It is meant to challenge thinking and produce thoughtful dialogue. Socratic type questions include clarifying concepts, probing for assumptions, probing for rational evidence, questioning viewpoints and perspectives, probing for implications and consequences, and lastly questioning the questions. Therapists also may ask the clients to keep record of their thoughts and negative assumptions to help identify patterns and change negative core beliefs. Role play is another way to help clients recognize their negative assumptions in situations and helps with desensitization and feeling more assured in uncomfortable situations. Lastly, successive approximations are taking large tasks and breaking them down into smaller tasks to increase confidence and to help clients complete tasks and improve procrastination.
Cognitive Behavior Therapy is mostly commonly associated with depression and anxiety however can treat a number of disorders and emotional problems. A list of diagnosis CBT could treat would include but not limited to the following: phobias, PTSD, trauma, Obssessive Compulsive Disorder, Eating Disorders, Sleeping Disorder Sexual Disorders, Bipolar Disorder and Schizophrenia. CBT can help with managing symptoms of mental illness, cope with stressful life situations, address traumatic life events, and help with interpersonal relationships. (“Cognitive Behavioral Therapy”,2019)
References
Beck, J.S & Fleming, S. (2021). A Brief of History of Aaron T. Beck, MD, and Cognitive Behavioral Therapy. The Official Academic Journal of the European Association of Clinical Psychology and Psychological Treatment, Vol.(3), 2. https://doi.org/10.32872/cpe.6701
Cognitive Behavioral Therapy. (2019, March 16). Mayo Clinic. Retrieved August 2, 2021, from
https://www.mayoclinic.org/tests-procedures/cognitive-behavioral-therapy/about/pac-20384610
Fenn, M.K, Brynn, M. (2013, September 6). The Key Principles of Cognitive Behavior Therapy. The Sage Journal, 6 (9),579-585 https://doi.org/10.1177/1755738012471029
LePera, N. (2021). How to do The Work: Recognize Your Patterns, Heal From Your Past and Create Your Self. Harper Wave.
Pietrangelo, A. (2019, December). 9 CBT Techniques for Better Mental Health. Healthline. https://www.healthline.com/health/cbt-techniques
Schaffener, A.K. (2020, June 26). Core Beliefs: 12 Worksheets to Challenge Negative Beliefs. PositivePsychology.com.https://positivepsychology.com/core-beliefs-worksheets
Socratic Questioning. (n.d). University of Nebraska-Lincoln. Retrieved Aug 3, 2022 From https://www.unl.edu/gradstudies/connections/socratic-questioning
What Principles Underlies Cognitive Therapy.(2021, February 26). Mind My Peelings. Retrieved August 2, 2022 from https://www.mindmypeelings.com/blog/cbt-principles
