Tag: Cognitive Therapy

What is Personal Construct Theory?

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Introduction

Within personality psychology, personal construct theory (PCT) or personal construct psychology (PCP) is a theory of personality and cognition developed by the American psychologist George Kelly in the 1950s. The theory addresses the psychological reasons for actions. Kelly proposed that individuals can be psychologically evaluated according to similarity–dissimilarity poles, which he called personal constructs (schemas, or ways of seeing the world). The theory is considered by some psychologists as forerunner to theories of cognitive therapy.

From the theory, Kelly derived a psychotherapy approach, as well as a technique called the repertory grid interview, that helped his patients to analyse their own personal constructs with minimal intervention or interpretation by the therapist. The repertory grid was later adapted for various uses within organizations, including decision-making and interpretation of other people’s world-views. The UK Council for Psychotherapy, a regulatory body, classifies PCP therapy within the experiential subset of the constructivist school.

Principles

A main tenet of PCP theory is that a person’s unique psychological processes are channelled by the way they anticipate events. Kelly believed that anticipation and prediction are the main drivers of our mind. “Every man is, in his own particular way, a scientist”, said Kelly: people are constantly building up and refining theories and models about how the world works so that they can anticipate future events. People start doing this at birth (for example, a child discovers that if they start to cry, their mother will come to them) and continue refining their theories as they grow up.

Kelly proposed that every construct is bipolar, specifying how two things are similar to each other (lying on the same pole) and different from a third thing, and they can be expanded with new ideas. (More recent researchers have suggested that constructs need not be bipolar.) People build theories—often stereotypes—about other people and also try to control them or impose on others their own theories so as to be better able to predict others’ actions. All these theories are built up from a system of constructs. A construct has two extreme points, such as “happy–sad,” and people tend to place items at either extreme or at some point in between. People’s minds, said Kelly, are filled up with these constructs at a low level of awareness.

A given person, set of persons, any event, or circumstance can be characterized fairly precisely by the set of constructs applied to it and by the position of the thing within the range of each construct. For example, Fred may feel as though he is not happy or sad (an example of a construct); he feels as though he is between the two. However, he feels he is more clever than he is stupid (another example of a construct). A baby may have a preverbal construct of what behaviours may cause their mother to come to them. Constructs can be applied to anything people put their attention to, and constructs also strongly influence what people fix their attention on. People can construe reality by constructing different constructs. Hence, determining a person’s system of constructs would go a long way towards understanding them, especially the person’s essential constructs that represent their very strong and unchangeable beliefs and their self-construal.

Kelly did not use the concept of the unconscious; instead, he proposed the notion of “levels of awareness” to explain why people did what they did. He identified “construing” as the highest level and “preverbal” as the lowest level of awareness.

Some psychologists have suggested that PCT is not a psychological theory but a metatheory because it is a theory about theories.

Therapy Approach

Kelly believed in a non-invasive or non-directive approach to psychotherapy. Rather than having the therapist interpret the person’s psyche, which would amount to imposing the doctor’s constructs on the patient, the therapist should just act as a facilitator of the patient finding his or her own constructs. The patient’s behaviour is then mainly explained as ways to selectively observe the world, act upon it and update the construct system in such a way as to increase predictability. To help the patient find his or her constructs, Kelly developed the repertory grid interview technique.

Kelly explicitly stated that each individual’s task in understanding their personal psychology is to put in order the facts of his or her own experience. Then the individual, like the scientist, is to test the accuracy of that constructed knowledge by performing those actions the constructs suggest. If the results of their actions are in line with what the knowledge predicted, then they have done a good job of finding the order in their personal experience. If not, then they can modify the construct: their interpretations or their predictions or both. This method of discovering and correcting constructs is roughly analogous to the general scientific method that is applied in various ways by modern sciences to discover truths about the universe.

The Repertory Grid

The repertory grid serves as part of various assessment methods to elicit and examine an individual’s repertoire of personal constructs. There are different formats such as card sorts, verbally administered group format, and the repertory grid technique.

The repertory grid itself is a matrix where the rows represent constructs found, the columns represent the elements, and cells indicate with a number the position of each element within each construct. There is software available to produce several reports and graphs from these grids.

To build a repertory grid for a patient, Kelly might first ask the patient to select about seven elements (although there are no fixed rules for the number of elements) whose nature might depend on whatever the patient or therapist are trying to discover. For instance, “Two specific friends, two work-mates, two people you dislike, your mother and yourself”, or something of that sort. Then, three of the elements would be selected at random, and then the therapist would ask: “In relation to … (whatever is of interest), in which way are two of these people alike but different from the third?” The answer is sure to indicate one of the extreme points of one of the patient’s constructs. He might say for instance that Fred and Sarah are very communicative whereas John is not. Further questioning would reveal the other end of the construct (say, introvert) and the positions of the three characters between extremes. Repeating the procedure with different sets of three elements ends up revealing several constructs the patient might not have been fully aware of.

In the book Personal Construct Methodology, researchers Brian R. Gaines and Mildred L.G. Shaw noted that they “have also found concept mapping and semantic network tools to be complementary to repertory grid tools and generally use both in most studies” but that they “see less use of network representations in PCP studies than is appropriate”. They encouraged practitioners to use semantic network techniques in addition to the repertory grid.

Organisational Applications

PCP has always been a minority interest among psychologists. During the last 30 years, it has gradually gained adherents in the US, Canada, the UK, Germany, Australia, Ireland, Italy and Spain. While its chief fields of application remain clinical and educational psychology, there is an increasing interest in its applications to organisational development, employee training and development, job analysis, job description and evaluation. The repertory grid is often used in the qualitative phase of market research, to identify the ways in which consumers construe products and services.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Personal_construct_theory >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is Cognitive Distortion?

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Introduction

A cognitive distortion is an exaggerated or irrational thought pattern involved in the onset or perpetuation of psychopathological states, such as depression and anxiety.

Cognitive distortions are thoughts that cause individuals to perceive reality inaccurately. According to Aaron Beck’s cognitive model, a negative outlook on reality, sometimes called negative schemas (or schemata), is a factor in symptoms of emotional dysfunction and poorer subjective well-being. Specifically, negative thinking patterns reinforce negative emotions and thoughts. During difficult circumstances, these distorted thoughts can contribute to an overall negative outlook on the world and a depressive or anxious mental state. According to hopelessness theory and Beck’s theory, the meaning or interpretation that people give to their experience importantly influences whether they will become depressed and whether they will suffer severe, repeated, or long-duration episodes of depression.

Challenging and changing cognitive distortions is a key element of cognitive behavioural therapy (CBT).

Brief History

In 1957, American psychologist Albert Ellis, though he did not know it yet, would aid cognitive therapy in correcting cognitive distortions and indirectly helping David D. Burns in writing The Feeling Good Handbook. Ellis created what he called the ABC Technique of rational beliefs. The ABC stands for the activating event, beliefs that are irrational, and the consequences that come from the belief. Ellis wanted to prove that the activating event is not what caused the emotional behaviour or the consequences, but the beliefs and how the person irrationally perceive the events that aids the consequences. With this model, Ellis attempted to use rational emotive behaviour therapy (REBT) with his patients, in order to help them “reframe” or reinterpret the experience in a more rational manner. In this model Ellis explains it all for his clients, while Beck helps his clients figure this out on their own. Beck first started to notice these automatic distorted thought processes when practicing psychoanalysis, while his patients followed the rule of saying anything that comes to mind. Aaron realized that his patients had irrational fears, thoughts, and perceptions that were automatic. Beck began noticing his automatic thought processes that he knew his patients had but did not report. Most of the time the thoughts were biased against themselves and very erroneous.

Beck believed that the negative schemas developed and manifested themselves in the perspective and behaviour. The distorted thought processes lead to focusing on degrading the self, amplifying minor external setbacks, experiencing other’s harmless comments as ill-intended, while simultaneously seeing self as inferior. Inevitably cognitions are reflected in their behaviour with a reduced desire to care for oneself, to seek pleasure, and give up. These exaggerated perceptions, due to cognition, feel real and accurate because the schemas, after being reinforced through the behaviour, tend to become automatic and do not allow time for reflection. This cycle is also known as Beck’s cognitive triad, focused on the theory that the person’s negative schema applied to the self, the future, and the environment.

In 1972, psychiatrist, psychoanalyst, and cognitive therapy scholar Aaron T. Beck published Depression: Causes and Treatment. He was dissatisfied with the conventional Freudian treatment of depression, because there was no empirical evidence for the success of Freudian psychoanalysis. Beck’s book provided a comprehensive and empirically-supported theoretical model for depression – its potential causes, symptoms, and treatments. In Chapter 2, titled “Symptomatology of Depression”, he described “cognitive manifestations” of depression, including low self-evaluation, negative expectations, self-blame and self-criticism, indecisiveness, and distortion of the body image.

Beck’s student David D. Burns continued research on the topic. In his book Feeling Good: The New Mood Therapy, Burns described personal and professional anecdotes related to cognitive distortions and their elimination. When Burns published Feeling Good: The New Mood Therapy, it made Beck’s approach to distorted thinking widely known and popularised. Burns sold over four million copies of the book in the United States alone. It was a book commonly “prescribed” for patients who have cognitive distortions that have led to depression. Beck approved of the book, saying that it would help others alter their depressed moods by simplifying the extensive study and research that had taken place since shortly after Beck had started as a student and practitioner of psychoanalytic psychiatry. Nine years later, The Feeling Good Handbook was published, which was also built on Beck’s work and includes a list of ten specific cognitive distortions that will be discussed throughout this article.

Definition

Cognitive comes from the Medieval Latin cognitīvus, equivalent to Latin cognit(us), ‘known’. Distortion means the act of twisting or altering something out of its true, natural, or original state.

Main Types

John C. Gibbs and Granville Bud Potter propose four categories for cognitive distortions:

  • Self-centred;
  • Blaming others;
  • Minimising-mislabelling; and
  • Assuming the worst.

The cognitive distortions listed below are categories of automatic thinking, and are to be distinguished from logical fallacies.

All-or-Nothing Thinking

Refer to Splitting (Psychology).

The “all-or-nothing thinking distortion” is also referred to as “splitting,” “black-and-white thinking,” and “polarised thinking.” Someone with the all-or-nothing thinking distortion looks at life in black and white categories. Either they are a success or a failure; either they are good or bad; there is no in-between. According to one article, “Because there is always someone who is willing to criticise, this tends to collapse into a tendency for polarized people to view themselves as a total failure. Polarized thinkers have difficulty with the notion of being ‘good enough’ or a partial success.”

  • Example (from The Feeling Good Handbook): A woman eats a spoonful of ice cream. She thinks she is a complete failure for breaking her diet. She becomes so depressed that she ends up eating the whole quart of ice cream.

This example captures the polarised nature of this distortion – the person believes they are totally inadequate if they fall short of perfection. In order to combat this distortion, Burns suggests thinking of the world in terms of shades of gray. Rather than viewing herself as a complete failure for eating a spoonful of ice cream, the woman in the example could still recognise her overall effort to diet as at least a partial success.

This distortion is commonly found in perfectionists.

Jumping to conclusions

Reaching preliminary conclusions (usually negative) with little (if any) evidence. Two specific subtypes are identified:

  • Mind reading:
    • Inferring a person’s possible or probable (usually negative) thoughts from their behaviour and nonverbal communication; taking precautions against the worst suspected case without asking the person.
      • Example 1: A student assumes that the readers of their paper have already made up their minds concerning its topic, and, therefore, writing the paper is a pointless exercise.
      • Example 2: Kevin assumes that because he sits alone at lunch, everyone else must think he is a loser. (This can encourage self-fulfilling prophecy; Kevin may not initiate social contact because of his fear that those around him already perceive him negatively).
  • Fortune-telling:
    • Predicting outcomes (usually negative) of events.
      • Example: A depressed person tells themselves they will never improve; they will continue to be depressed for their whole life.
    • One way to combat this distortion is to ask, “If this is true, does it say more about me or them?”

Emotional Reasoning

In the emotional reasoning distortion, it is assumed that feelings expose the true nature of things and experience reality as a reflection of emotionally linked thoughts; something is believed true solely based on a feeling.

  • Examples: “I feel stupid, therefore I must be stupid”. Feeling fear of flying in planes, and then concluding that planes must be a dangerous way to travel. Feeling overwhelmed by the prospect of cleaning one’s house, therefore concluding that it is hopeless to even start cleaning.

Should/Should Not and Must/Must Not Statements

Making “must” or “should” statements was included by Albert Ellis in his rational emotive behaviour therapy (REBT), an early form of CBT; he termed it “musturbation”. Michael C. Graham called it “expecting the world to be different than it is”. It can be seen as demanding particular achievements or behaviours regardless of the realistic circumstances of the situation.

  • Example: After a performance, a concert pianist believes he or she should not have made so many mistakes.
  • In Feeling Good: The New Mood Therapy, David Burns clearly distinguished between pathological “should statements”, moral imperatives, and social norms.

A related cognitive distortion, also present in Ellis’ REBT, is a tendency to “awfulise”; to say a future scenario will be awful, rather than to realistically appraise the various negative and positive characteristics of that scenario. According to Burns, “must” and “should” statements are negative because they cause the person to feel guilty and upset at themselves. Some people also direct this distortion at other people, which can cause feelings of anger and frustration when that other person does not do what they should have done. He also mentions how this type of thinking can lead to rebellious thoughts. In other words, trying to whip oneself into doing something with “shoulds” may cause one to desire just the opposite.

Gratitude Traps

A gratitude trap is a type of cognitive distortion that typically arises from misunderstandings regarding the nature or practice of gratitude. The term can refer to one of two related but distinct thought patterns:

  • A self-oriented thought process involving feelings of guilt, shame, or frustration related to one’s expectations of how things “should” be.
  • An “elusive ugliness in many relationships, a deceptive ‘kindness,’ the main purpose of which is to make others feel indebted,” as defined by psychologist Ellen Kenner.

Blaming Others

Personalisation and Blaming

Personalisation is assigning personal blame disproportionate to the level of control a person realistically has in a given situation.

  • Example 1: A foster child assumes that he/she has not been adopted because he/she is not “loveable enough.”
  • Example 2: A child has bad grades. His/her mother believes it is because she is not a good enough parent.

Blaming is the opposite of personalisation. In the blaming distortion, the disproportionate level of blame is placed upon other people, rather than oneself. In this way, the person avoids taking personal responsibility, making way for a “victim mentality.”

  • Example: Placing blame for marital problems entirely on one’s spouse.

Always Being Right

In this cognitive distortion, being wrong is unthinkable. This distortion is characterised by actively trying to prove one’s actions or thoughts to be correct, and sometimes prioritising self-interest over the feelings of another person. In this cognitive distortion, the facts that oneself has about their surroundings are always right while other people’s opinions and perspectives are wrongly seen.

Fallacy of Change

Relying on social control to obtain cooperative actions from another person. The underlying assumption of this thinking style is that one’s happiness depends on the actions of others. The fallacy of change also assumes that other people should change to suit one’s own interests automatically and/or that it is fair to pressure them to change. It may be present in most abusive relationships in which partners’ “visions” of each other are tied into the belief that happiness, love, trust, and perfection would just occur once they or the other person change aspects of their beings.

Minimising-Mislabelling

Magnification and Minimisation

Giving proportionally greater weight to a perceived failure, weakness or threat, or lesser weight to a perceived success, strength or opportunity, so that the weight differs from that assigned by others, such as “making a mountain out of a molehill”. In depressed clients, often the positive characteristics of other people are exaggerated and their negative characteristics are understated.

  • Catastrophising – Giving greater weight to the worst possible outcome, however unlikely, or experiencing a situation as unbearable or impossible when it is just uncomfortable.

Labelling and Mislabelling

A form of overgeneralisation; attributing a person’s actions to their character instead of to an attribute. Rather than assuming the behaviour to be accidental or otherwise extrinsic, one assigns a label to someone or something that is based on the inferred character of that person or thing.

Assuming the Worst

Overgeneralising

Someone who overgeneralises makes faulty generalisations from insufficient evidence. Such as seeing a “single negative event” as a “never-ending pattern of defeat,” and as such drawing a very broad conclusion from a single incident or a single piece of evidence. Even if something bad happens only once, it is expected to happen over and over again.

  • Example 1: A young woman is asked out on a first date, but not a second one. She is distraught as she tells her friend, “This always happens to me! I’ll never find love!”
  • Example 2: A woman is lonely and often spends most of her time at home. Her friends sometimes ask her to dinner and to meet new people. She feels it is useless to even try. No one really could like her. And anyway, all people are the same; petty and selfish.

One suggestion to combat this distortion is to “examine the evidence” by performing an accurate analysis of one’s situation. This aids in avoiding exaggerating one’s circumstances.

Disqualifying the Positive

Disqualifying the positive refers to rejecting positive experiences by insisting they “don’t count” for some reason or other. Negative belief is maintained despite contradiction by everyday experiences. Disqualifying the positive may be the most common fallacy in the cognitive distortion range; it is often analysed with “always being right”, a type of distortion where a person is in an all-or-nothing self-judgment. People in this situation show signs of depression. Examples include:

  • “I will never be as good as Jane”.
  • “Anyone could have done as well”.
  • “They are just congratulating me to be nice”.

Mental Filtering

Filtering distortions occur when an individual dwells only on the negative details of a situation and filters out the positive aspects.

  • Example: Andy gets mostly compliments and positive feedback about a presentation he has done at work, but he also has received a small piece of criticism. For several days following his presentation, Andy dwells on this one negative reaction, forgetting all of the positive reactions that he had also been given.

The Feeling Good Handbook notes that filtering is like a “drop of ink that discolours a beaker of water.” One suggestion to combat filtering is a cost–benefit analysis. A person with this distortion may find it helpful to sit down and assess whether filtering out the positive and focusing on the negative is helping or hurting them in the long run.

Conceptualisation

In a series of publications, philosopher Paul Franceschi has proposed a unified conceptual framework for cognitive distortions designed to clarify their relationships and define new ones. This conceptual framework is based on three notions:

  1. The reference class (a set of phenomena or objects, e.g. events in the patient’s life);
  2. Dualities (positive/negative, qualitative/quantitative, …); and
  3. The taxon system (degrees allowing to attribute properties according to a given duality to the elements of a reference class).

In this model, “dichotomous reasoning”, “minimisation”, “maximisation” and “arbitrary focus” constitute general cognitive distortions (applying to any duality), whereas “disqualification of the positive” and “catastrophism” are specific cognitive distortions, applying to the positive/negative duality. This conceptual framework posits two additional cognitive distortion classifications: the “omission of the neutral” and the “requalification in the other pole”.

Cognitive Restructuring

Cognitive restructuring (CR) is a popular form of therapy used to identify and reject maladaptive cognitive distortions, and is typically used with individuals diagnosed with depression. In CR, the therapist and client first examine a stressful event or situation reported by the client. For example, a depressed male college student who experiences difficulty in dating might believe that his “worthlessness” causes women to reject him. Together, therapist and client might then create a more realistic cognition, e.g. “It is within my control to ask girls on dates. However, even though there are some things I can do to influence their decisions, whether or not they say yes is largely out of my control. Thus, I am not responsible if they decline my invitation.” CR therapies are designed to eliminate “automatic thoughts” that include clients’ dysfunctional or negative views. According to Beck, doing so reduces feelings of worthlessness, anxiety, and anhedonia that are symptomatic of several forms of mental illness. CR is the main component of Beck’s and Burns’s CBT.

Narcissistic Defence

Refer to Narcissistic Defences.

Those diagnosed with narcissistic personality disorder tend, unrealistically, to view themselves as superior, overemphasizing their strengths and understating their weaknesses. Narcissists use exaggeration and minimisation this way to shield themselves against psychological pain.

Decatastrophising

In cognitive therapy, decatastrophising or decatastrophisation is a cognitive restructuring technique that may be used to treat cognitive distortions, such as magnification and catastrophising, commonly seen in psychological disorders like anxiety and psychosis. Major features of these disorders are the subjective report of being overwhelmed by life circumstances and the incapability of affecting them.

The goal of CR is to help the client change their perceptions to render the felt experience as less significant.

Criticism

Common criticisms of the diagnosis of cognitive distortion relate to epistemology and the theoretical basis. If the perceptions of the patient differ from those of the therapist, it may not be because of intellectual malfunctions but because the patient has different experiences. In some cases, depressed subjects appear to be “sadder but wiser”.

This page is based on the copyrighted Wikipedia article <https://en.wikipedia.org/wiki/Cognitive_distortion >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is the Beck Institute for Cognitive Behaviour Therapy?

Published on by Andrew Marshall1 Comment

Introduction

Beck Institute for Cognitive Behaviour Therapy, a non-profit organisation located in suburban Philadelphia, is an international cognitive behaviour therapy (CBT) training and resource centre.

Background

It was founded in 1994 by Aaron T. Beck and his daughter Judith S. Beck. Beck Institute offers training in CBT in a variety of forms. Its mission is “improving lives worldwide through excellence in cognitive behaviour therapy.”

Aaron T. Beck is currently Beck Institute’s President Emeritus. He is recognised as the founder of cognitive therapy, one of the elements from which cognitive behaviour therapy developed. His daughter, Judith Beck, is Beck Institute’s current President. Aaron Beck is University Professor Emeritus of Psychiatry at the University of Pennsylvania and continues to do research there, while Judith Beck is a Clinical Professor of Psychology in Psychiatry at the same university. Lisa Pote is Beck Institute’s Executive Director, and Allen R. Miller is CBT Programme Director.

Among Beck Institute’s training programmes are Philadelphia Workshops held at the Beck Institute, On the Road Workshops held throughout the US, the Beck Institute Supervision programme, and Training for Organisations in which Beck faculty travel around the world to teach. Beck Institute’s workshops cover a variety of topics, including CBT for Depression, Anxiety, Personality Disorders, Youth, PTSD, Schizophrenia, and more. Beck Institute offers scholarships for therapists working with active duty military and veterans through their Soldier Suicide Prevention initiative and holds an annual scholarship competition for graduate students and faculty.

Beck Institute also runs a clinic at its location in suburban Philadelphia.

What is Cognitive Therapy?

Published on by Andrew Marshall11 Comments

Introduction

Cognitive therapy (CT) is a type of psychotherapy developed by American psychiatrist Aaron T. Beck. CT is one of the therapeutic approaches within the larger group of cognitive behavioural therapies (CBT) and was first expounded by Beck in the 1960s.

CT is based on the cognitive model, which states that thoughts, feelings and behaviour are all connected, and that individuals can move toward overcoming difficulties and meeting their goals by identifying and changing unhelpful or inaccurate thinking, problematic behaviour, and distressing emotional responses. This involves the individual working collaboratively with the therapist to develop skills for testing and modifying beliefs, identifying distorted thinking, relating to others in different ways, and changing behaviours. A tailored cognitive case conceptualisation is developed by the cognitive therapist as a roadmap to understand the individual’s internal reality, select appropriate interventions and identify areas of distress.

Brief History

Becoming disillusioned with long-term psychodynamic approaches based on gaining insight into unconscious emotions and drives, Beck came to the conclusion that the way in which his patients perceived, interpreted and attributed meaning in their daily lives – a process scientifically known as cognition – was a key to therapy. Albert Ellis had been working on similar ideas since the 1950s (Ellis, 1956). He called his approach Rational Therapy (RT) at first, then Rational Emotive Therapy (RET) and later Rational Emotive Behaviour Therapy (REBT).

Beck outlined his approach in Depression: Causes and Treatment in 1967. He later expanded his focus to include anxiety disorders, in Cognitive Therapy and the Emotional Disorders in 1976, and other disorders and problems. He also introduced a focus on the underlying “schema” – the fundamental underlying ways in which people process information – about the self, the world or the future.

The new cognitive approach came into conflict with the behaviourism ascendant at the time, which denied that talk of mental causes was scientific or meaningful, rather than simply assessing stimuli and behavioural responses. However, the 1970s saw a general “cognitive revolution” in psychology. Behavioural modification techniques and cognitive therapy techniques became joined together, giving rise to cognitive behavioural therapy. Although cognitive therapy has always included some behavioural components, advocates of Beck’s particular approach seek to maintain and establish its integrity as a distinct, clearly standardised form of cognitive behavioural therapy in which the cognitive shift is the key mechanism of change.

Precursors of certain fundamental aspects of cognitive therapy have been identified in various ancient philosophical traditions, particularly Stoicism. For example, Beck’s original treatment manual for depression states, “The philosophical origins of cognitive therapy can be traced back to the Stoic philosophers”.

As cognitive therapy continued to grow in popularity, the Academy of Cognitive Therapy, a non-profit organisation, was created to accredit cognitive therapists, create a forum for members to share emerging research and interventions, and to educate consumer regarding cognitive therapy and related mental health issues.

Basis

Therapy may consist of testing the assumptions which one makes and looking for new information that could help shift the assumptions in a way that leads to different emotional or behavioral reactions. Change may begin by targeting thoughts (to change emotion and behavior), behavior (to change feelings and thoughts), or the individual’s goals (by identifying thoughts, feelings or behavior that conflict with the goals). Beck initially focused on depression and developed a list of “errors” (cognitive distortion) in thinking that he proposed could maintain depression, including arbitrary inference, selective abstraction, over-generalization, and magnification (of negatives) and minimization (of positives).

As an example of how CT might work: Having made a mistake at work, a man may believe, “I’m useless and can’t do anything right at work.” He may then focus on the mistake (which he takes as evidence that his belief is true), and his thoughts about being “useless” are likely to lead to negative emotion (frustration, sadness, hopelessness). Given these thoughts and feelings, he may then begin to avoid challenges at work, which is behaviour that could provide even more evidence for him that his belief is true. As a result, any adaptive response and further constructive consequences become unlikely, and he may focus even more on any mistakes he may make, which serve to reinforce the original belief of being “useless.” In therapy, this example could be identified as a self-fulfilling prophecy or “problem cycle,” and the efforts of the therapist and patient would be directed at working together to explore and shift this cycle.

People who are working with a cognitive therapist often practice the use of more flexible ways to think and respond, learning to ask themselves whether their thoughts are completely true, and whether those thoughts are helping them to meet their goals. Thoughts that do not meet this description may then be shifted to something more accurate or helpful, leading to more positive emotion, more desirable behaviour, and movement toward the person’s goals. Cognitive therapy takes a skill-building approach, where the therapist helps the person to learn and practice these skills independently, eventually “becoming his or her own therapist.”

Cognitive Model

The cognitive model was originally constructed following research studies conducted by Aaron Beck to explain the psychological processes in depression. It divides the mind beliefs in three levels:

  • Automatic thought.
  • Intermediate belief.
  • Core belief or basic belief.

In 2014, an update of the cognitive model was proposed, called the Generic Cognitive Model (GCM). The GCM is an update of Beck’s model that proposes that mental disorders can be differentiated by the nature of their dysfunctional beliefs. The GCM includes a conceptual framework and a clinical approach for understanding common cognitive processes of mental disorders while specifying the unique features of the specific disorders.

Consistent with the cognitive theory of psychopathology, CT is designed to be structured, directive, active, and time-limited, with the express purpose of identifying, reality-testing, and correcting distorted cognition and underlying dysfunctional beliefs.

Cognitive Restructuring (Methods)

Cognitive restructuring involves four steps:

  • Identification of problematic cognitions known as “automatic thoughts” (ATs) which are dysfunctional or negative views of the self, world, or future based upon already existing beliefs about oneself, the world, or the future.
  • Identification of the cognitive distortions in the ATs.
  • Rational disputation of ATs with the Socratic method.
  • Development of a rational rebuttal to the ATs.

There are six types of automatic thoughts:

  • Self-evaluated thoughts.
  • Thoughts about the evaluations of others.
  • Evaluative thoughts about the other person with whom they are interacting.
  • Thoughts about coping strategies and behavioural plans.
  • Thoughts of avoidance.
  • Any other thoughts that were not categorised.

Other major techniques include:

  • Activity monitoring and activity scheduling.
  • Behavioural experiments.
  • Catching, checking, and changing thoughts.
  • Collaborative empiricism:
    • Therapist and patient become investigators by examining the evidence to support or reject the patient’s cognitions.
    • Empirical evidence is used to determine whether particular cognitions serve any useful purpose.
  • Downward arrow technique.
  • Exposure and response prevention.
  • Cost benefit analysis.
  • Acting ‘as if’.
  • Guided discovery:
    • Therapist elucidates behavioural problems and faulty thinking by designing new experiences that lead to acquisition of new skills and perspectives.
    • Through both cognitive and behavioural methods, the patient discovers more adaptive ways of thinking and coping with environmental stressors by correcting cognitive processing.
  • Mastery and pleasure technique.
  • Problem solving.
  • Socratic questioning: involves the creation of a series of questions to
    • Clarify and define problems;
    • Assist in the identification of thoughts, images and assumptions;
    • Examine the meanings of events for the patient; and
    • Assess the consequences of maintaining maladaptive thoughts and behaviours.

Socratic Questioning

Socratic questions are the archetypal cognitive restructuring techniques. These kinds of questions are designed to challenge assumptions by:

  • Conceiving reasonable alternatives:
    • ‘What might be another explanation or viewpoint of the situation? Why else did it happen?’
  • Evaluating those consequences:
    • ‘What’s the effect of thinking or believing this?
    • What could be the effect of thinking differently and no longer holding onto this belief?’
  • Distancing:
    • ‘Imagine a specific friend/family member in the same situation or if they viewed the situation this way, what would I tell them?’
  • Examples of socratic questions include:
    • ‘Describe the way you formed your viewpoint originally.‘
    • ‘What initially convinced you that your current view is the best one available?‘
    • ‘Think of three pieces of evidence that contradict this view, or that support the opposite view. Think about the opposite of this viewpoint and reflect on it for a moment. What’s the strongest argument in favour of this opposite view?‘
    • ‘Write down any specific benefits you get from holding this belief, such as social or psychological benefits. For example, getting to be part of a community of like-minded people, feeling good about yourself or the world, feeling that your viewpoint is superior to others’, etc Are there any reasons that you might hold this view other than because it’s true?‘
    • ‘For instance, does holding this viewpoint provide some peace of mind that holding a different viewpoint would not?‘
    • ‘In order to refine your viewpoint so that it’s as accurate as possible, it’s important to challenge it directly on occasion and consider whether there are reasons that it might not be true. What do you think the best or strongest argument against this perspective is?‘
    • What would you have to experience or find out in order for you to change your ‘mind about this viewpoint?‘
    • Given your thoughts so far, do you think that there may be a truer, more accurate, or more nuanced version of your original view that you could state right ‘now?‘

False Assumptions

False assumptions are based on ‘cognitive distortions’, such as:

  • Always Being Right: “We are continually on trial to prove that our opinions and actions are correct. Being wrong is unthinkable and we will go to any length to demonstrate our rightness. For example, “I don’t care how badly arguing with me makes you feel, I’m going to win this argument no matter what because I’m right.” Being right often is more important than the feelings of others around a person who engages in this cognitive distortion, even loved ones.”
  • Heaven’s Reward Fallacy: “We expect our sacrifice and self-denial to pay off, as if someone is keeping score. We feel bitter when the reward doesn’t come.”

Awfulising and Must-ing

Rational emotive behaviour therapy (REBT) includes awfulising, when a person causes themselves disturbance by labelling an upcoming situation as ‘awful’, rather than envisaging how the situation may actually unfold, and Must-ing, when a person places a false demand on themselves that something ‘must’ happen (e.g. ‘I must get an A in this exam’.)

Types

Cognitive Therapy

based on the cognitive model, stating that thoughts, feelings and behaviour are mutually influenced by each other. Shifting cognition is seen as the main mechanism by which lasting emotional and behavioural changes take place. Treatment is very collaborative, tailored, skill-focused, and based on a case conceptualisation.

Rational Emotive Behaviour Therapy (REBT)

Based on the belief that most problems originate in erroneous or irrational thought. For instance, perfectionists and pessimists usually suffer from issues related to irrational thinking; for example, if a perfectionist encounters a small failure, he or she might perceive it as a much bigger failure. It is better to establish a reasonable standard emotionally, so the individual can live a balanced life. This form of cognitive therapy is an opportunity for the patient to learn of their current distortions and successfully eliminate them.

Cognitive Behavioural Therapy (CBT)

A system of approaches drawing from both the cognitive and behavioural systems of psychotherapy. CBT is an umbrella term for a group of therapies, where as CT is a discrete form of therapy.

Application

Depression

According to Beck’s theory of the aetiology of depression, depressed people acquire a negative schema of the world in childhood and adolescence; children and adolescents who experience depression acquire this negative schema earlier. Depressed people acquire such schemas through a loss of a parent, rejection by peers, bullying, criticism from teachers or parents, the depressive attitude of a parent and other negative events. When the person with such schemas encounters a situation that resembles the original conditions of the learned schema in some way, the negative schemas of the person are activated.

Beck’s negative triad holds that depressed people have negative thoughts about themselves, their experiences in the world, and the future. For instance, a depressed person might think, “I didn’t get the job because I’m terrible at interviews. Interviewers never like me, and no one will ever want to hire me.” In the same situation, a person who is not depressed might think, “The interviewer wasn’t paying much attention to me. Maybe she already had someone else in mind for the job. Next time I’ll have better luck, and I’ll get a job soon.” Beck also identified a number of other cognitive distortions, which can contribute to depression, including the following:

  • Arbitrary inference;
  • Selective abstraction;
  • Overgeneralisation;
  • Magnification; and
  • Minimisation.

In 2008 Beck proposed an integrative developmental model of depression that aims to incorporate research in genetics and neuroscience of depression. This model was updated in 2016 to incorporate multiple levels of analyses, new research, and key concepts (e.g. resilience) within the framework of an evolutionary perspective.

Other Applications

Cognitive therapy has been applied to a very wide range of behavioural health issues including:

  • Academic achievement.
  • Addiction.
  • Anxiety disorders.
  • Bipolar disorder.
  • Low self-esteem.
  • Phobia.
  • Schizophrenia.
  • Substance abuse.
  • Suicidal ideation.
  • Weight loss.

Criticisms

A criticism has been that clinical studies of CBT efficacy (or any psychotherapy) are not double-blind (i.e. neither subjects nor therapists in psychotherapy studies are blind to the type of treatment). They may be single-blinded, the rater may not know the treatment the patient received, but neither the patients nor the therapists are blinded to the type of therapy given (two out of three of the persons involved in the trial, i.e., all of the persons involved in the treatment, are unblinded). The patient is an active participant in correcting negative distorted thoughts, thus quite aware of the treatment group they are in.