Aaron Beck’s Cognitive Behavioral Therapy

History & Overview

“Cognitive behavioral approaches look at how cognitions and/or behaviors have been learned and can be re-learned….They all believe that after identifying problematic behaviors and/or cognitions, one can choose, replace, or reinforce new cognitions and behaviors that result in more effective functioning” (Newkurg, 2009).

“The basis of cognitive approach to emotion can be traced as far back as Aristotle…and Epitectetus” (Metcalf, 2011, p. 92).  These historical of CBT focus on how individual’s we give our life experiences meaning and make sense of them.  Kant’s concept of transcendental idealism, that things cannot be known outside of how they might appear to us, has also greatly influenced CBT (Corsini & Wedding, 2011).

Cognitive Behavioral Therapy (CBT) was developed by Aaron Beck in the 1960’s as a result of his research on depression when he noted their thought process contained a negative bias (Corsini & Wedding, 2011).   It is based on the idea that an individual’s experiences are shaped by core beliefs, which in turn determine thoughts, feelings and behaviors.   The goal of CBT is to alter the cognitive appraisals that produce emotional distress and maladaptive behavioral responses (Chaplin, et al, 2013).  Adjusting our information processing begins in a collaborative process between therapist and client in which maladaptive cognitions can be tested and re-examined (Corsini & Wedding, 2011).

In order to achieve this goal, CBT focuses on cognitive schemas which comprise perceptions about ourselves and others alongside personal expectations, goals, memories, and prior earning experiences (Corsini & Wedding, 2011).  Contemporary CBT perspectives describe these schemas as modes “networks of affective, motivational, and behavioral schemas that compose personality and interpret ongoing situations” (Corsini & Wedding, 2011, p. 277).  CBT defines psychological disorders as maladaptive cognitive schema that create a systematic bias between oneself and the world.  Psychological disorders such as anxiety encompass primal modes which encompass, rigid, automatic, survival-based thinking.  The solution to these issues involve: (1) symptom relief; (2)  an acknowledgment of any cognitive bias, and; (3) the “correct[ion] of  faulty information processing” (Corsini & Wedding, 2011, p. 290).

CBT vs. Other Perspectives

Psychodynamic Therapy vs. CBT

While psychodynamic theory and CBT both conceive belief systems as influencing our behaviors, the prior conceives beliefs as components of our unconscious mind (Corsini & Wedding, 2011). Beck disagreed with this.  Consequently, CBT does not focus on uncovering hidden aspects of our unconscious from early childhood.  Instead it focuses on understanding the links between any psychological disorders, symptoms, beliefs, behaviors, and experiences (Corsini & Wedding, 2011).  Finally, while psychoanalysis is a long-process involving cathartic free-association in therapy, CBT tends to a short-term and structured.

Ellis vs. Beck

REBT and CBT both conceive cognitions as useful in understanding psychological dysfunction and focus on maladaptive systems of belief.  However, there are a few key differences as delineated below.

An Inductive CBT Approach vs a Deductive DBT Approach

Ellis’s REBT is a deductive approach, that involves beginning with a general theoretical prediction as a starting point from which we make specific observations about the world (Corsini & Wedding, 2011).  In this respect, it follows closely with the logical of scientific research which begins with a hypothesis that it tests in an experiment with the hopes of making observations that might support it.  In contrast, CBT is an inductive approach that states we make specific observations about daily life and use these to form generalized belief systems about our world.  For example, in Beck’s research on depression he notes people develop negative biases about their world as a result of a set of symptoms stemming from depression.

Two Divergent Conceptions of Psychological Disorder.

As a result of his research on depression and anxiety, Beck noted variations in that these disorders had general cognitive biases (Corsini & Wedding, 2011).  Beck’s CBT approach utilizes the “cognitive profiles” (Corsini & Wedding, 2011, p. 279), for these disorders as a guide to understanding how we should address the issue.  In contrast, REBT focuses on the absolutist nature of any beliefs or our “Musterbating”.   For example, while a CBT therapist would focus on addressing perceptual errors an REBT therapist would focus on our “should’s”.

Two Divergent Interpretations of Belief Systems

REBT conceives faulty belief systems as a philosophical error of irrational thinking.  As a result, an REBT therapist would challenge belief systems that are “incongruent with reality” (Corsini & Wedding, 2011, p. 279).  In contrast, Beck disliked the idea that a client’s cognitions be characterized as irrational (Metcalf, 2011).  Rather than conceiving our beliefs as irrational he felt they existed as automatic thought processes triggered by feelings and not events (Metcalf, 2011).

Behavioral vs. Cognitive Interventions

Cognitive Interventions

Cognitive interventions focus on the “content and process of” (Ingram, 2012, p197) an individual’s thoughts. The theoretical underpinnings of these interventions come from a diversity of fields including neuroscience, cognitive development, CBT, and even sociology (Ingram, 2012). This is because the manner in which we construct our understanding of the world varies according to our developmental level, cultural perspective, and brain functioning. Examples of cognitive interventions can include addressing dysfunctional self-talk, utilizing a metacognitive perspective, or DBT skills (Ingram, 2012).

Behavioral Interventions

Behavioral interventions are based on the well-known learning principles from the works of Skinner and Pavlov. Additionally, the textbook notes that learning principles can be found in other forms of therapy including the work of Carl Roger (Ingram, 2012). For example, in contrast to cognitive therapy, a behavioral intervention might utilize the process of behavioral analysis. This involves examining the problem, and defining their causes and consequences in order to determine how to utilize interventions like positive and negative reinforcement, or contingency contracting, punishment (Ingram, 2012, p236).   Cognitive therapy, on the other hand, focuses on our thought processes such as the ABC model in which an event produces thoughts and causes our feelings (Ingram, 2012, p210).

CBT on Personality

CBT “views personality as shaped by the interaction between innate disposition and environment” (Corsini & Wedding, 2011, p. 284).  So what makes us who we are?  Our personality is comprised schematic approach towards the world that is comprised of cognitions, emotions, behaviors, and motivations.  Each individual has unique strengths and vulnerabilities related to their own personality structure (Wedding & corsini, 2011).  Psychological disorders and distress are a consequence of both the environment and predisposition.   In this respect, Beck’s view of our developmental history is consistent with social learning theory.

Dimensions of Personality

In his research, Beck was interested in learning how certain aspects of the personality were related to maladaptive emotional responses like anxiety or depression (Corsini & Wedding, 2011). Beck described a continuum-based set of personality dimensions that could help explain an individual’s susceptibility to depression.

Sociotropy

Beck uses the term “Sociotropy” (Corsini & Wedding, 2011, p. 284).  Sociotropic individuals display high levels of social dependence and experience higher levels of depression during instance of relationship disruption.  “The sociotropic dimension is organized around closeneess, nurturance, and dependence” (Corsini & Wedding, 2011, p. 284).

Autonomy

Autonomous people are highly independent and experience depression when they fail to acheive their goals (Corsini & Wedding, 2011).  Autonomous individuals show a preference for “independence, goal setting, self-determination and self-imposed obligations” (Corsini & Wedding, 2011 p. 284).

Cognitive Distortions

As stated earlier, psychological distress is conceived as a byproduct of both innate and environmental factors.  Beck also noted systematic biases in individuals who experience psychological distress (Corsini & Wedding, 2011).  He used the term “cognitive distortion” (Corsini & Wedding, 2011, p 285), to describe many of our systematic biases.  What follows is a list of examples of common cognitive distortions:

  1. ARBITRAY INFERENCE – “Conclusions made in absense of supporting evidence” (Metcalf, 2011, p. 95).  For example, my son believes he is terrible at math because it is hard, when in fact he just earned a B+.
  2. SELECTIVE ABSTRACTIONS – This distortion involves taking information out of context (Corsini & Wedding, 2011).
  3. OVERGENERALIZATION – Overgeneralization involves utilizing single situation as representing all events of this type.
  4. MAGNIFICATION & MINIMIZATION – “Seeing something as more significant or less significant than it actually is” (Corsini & Wedding, 2011, p. 285).
  5. PERSONALIZATION – Personalization happens when we blame ourselves for external events.   We ignore the aspects of the situation that are beyond our control.
  6. DICHOTOMOUS THINKING – This distortion is often called black-and-white thinking and ignores the gray areas.
  7. TUNNEL VISION – This narrowed focus is characterized by a focuses one’s own selfish interests and sacrifices others’ viewpoints.

CBT on Psychological Disorders

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As you can see in the above photo, (Corsini & Wedding, 2011), Beck conceived psychological disorders as evidence of a systematic bias in an individual’s cognitive schema.  In other words, all symptoms are interpreted in terms of their overall view of the world.  For example, depressed individual’s hold a pessimistic cognitive schema and anxious individuals hold exaggerated views of danger.

Beck on Anxiety…

Click here for a Beck’s Anxiety Inventory…

With anxiety disorders, Beck notes that individual’s act on a “worst-case-scenario” basis that involves an overestimation of a potential outcome and underestimates one’s ability to cope (Corsini & Wedding, 2011).  The body is in flight-or-flight mode as physiological responses to a self-perceived threat.  We can tend to create them even when they might not exist.

Beck on Depression…

Click here for Beck’s Depression Inventory…

In his research, Beck noted depressed individuals display negative beliefs about themselves, the world, and the future overall.  These belief systems influence one’s cognitions and emotional states, making it difficult to see beyond our view of things.  The world is experienced through a pessimistic lens, leading to a sense of hopelessness and motivational paralysis.

Beck on Suicidal Behavior…

Click here for Beck’s Suicidal Risk Assessment…

Beck describes the thought processes associated with suicidal individuals as containing two features: hopelessness and cognitive deficit (Corsini & Wedding, 2011).  Additionally, a suicidal individual’s thought process become rigid with suicide appearing as the only alternative (Corsini & Wedding, 2011).

Overview of Counseling Process

Goals of CBT

The goal of CBT is to “correct faulty information and help patients modify assumptions that maintain maladaptive behaviors and emotions” (Corsini & Wedding, 2011, p. 290).  It treats belief systems as hypotheses that can be tested in a therapeutic setting.  Cognitive changes in one’s belief systems, are thought to lead behavioral changes.  Emotions are influenced by our perception of events.

Therapeutic Relationship

Corsini & Wedding, (2011) describe the therapeutic relationship as a “collaborative empiricism” (p. 277).  Client and therapist share responsibility for therapeutic goal setting.  The therapist is a guide who helps the client better understand their attitudes and belief systems.  This reality testing process occurs within an accepting and empathetic setting where beliefs are tested as hypotheses one has about their reality.

Strategies & Techniques

What follows is a “quick and dirty” overview of techniques often utilized in Beck’s Cognitive Behavioral Therapy.

Guided Discovery

Guided discovery involves a gradual process of discovering threads in one’s thinking like links in a chain (Corsini & Wedding, 2011).  “The therapist guides the client through a scenario, enabling them to understand any cognitive distortions” (Metcalf, 2011, p. 114), by linking linking misperceptions to past experience.

Socratic dialogue

CBT involves the use of reality testing methods that are similar in many respects to a socratic dialogue.  This involves deconstructing our current preconceptions of a matter and analyzing any ignorance.  With this ignorance defined, it can then be possible to uncover its solution – a greater knowable truth that was previously invisible.

Validity Testing

Validity testing involves a critical examination of our beliefs and thoughts and requires the establishment of a solid therapeutic relationship to occur.  “If the client cannot defend their beliefs and thoughts they are said to be invalid” (Metcalf, 2011, p. 108).

Modeling

Clients are given role-playing exercises with the therapist in which they can practice new ways of responding to specific situations (Metcalf, 2011).  This technique is often utilized with autism clients in an effort to develop greater effectiveness in social situations.

Approaches to Dysfunctional Schema

“There are three major approaches to treating dysfunctional modes: (1) deactivating them, (2) modifying their content and structure, and (3) constructing more adaptive modes to neutralize them” (Corsini & Wedding, 2011, p. 278).

Exposure Therapy

Utilized frequently in trauma and anxiety-related disorders this involves addressing cognitive distortions and physiological symptoms when presented with anxiety-related objects.  “By dealing directly with a patient’s idiosyncratic thoughts, cognitive therapy is able to focus on that patient’s particular needs.

Treatment Planning

I dug up another course textbook that provides an interesting perspective, titled “Clinical Case Formulations,” (Ingram, 2012).  It’s purpose is as follows. “A clinical case formulation is a ‘conceptual scheme that organizes, explains, or makes sense of large amounts of data and influences the treatment decisions’ (Ingram, 2012 p. viii).”  What I love about this book is it provides clinical hypotheses that are useful in providing “a single explanatory idea that helps us structure data about a given client (Ingram, 2012 p. 11).”  Chapter ten of this textbook discusses “Cognitive Models” (Ingram, 2012), an individual’s cognitive functioning and thought processes.  Several clinical hypotheses are worth mentioning in order to get an idea of how this therapy method can be applied directly to a case.  

(C1) Metacognitive Perspective (Ingram, 2012)

Metacognition is a term which means “thinking about thinking” (Ingram, 2012).  This clinical hypothesis is useful when a person needs to hone their critical thinking skills and gain awareness of their inner experiences.  It is useful in anxiety and trauma-related disorders, or instances in which rumination, and emotional dysregulation are a problem.  However, states five cognitive capacities are critical when using this hypothesis: “(1) nonreactivity to inner experience…(2) able to separate self from thoughts…(3) not giving power or control in thoughts…(4) evaluating one’s thinking in terms of goals…(5) taking the role of executive over one’s own thoughts” (Ingram, 2012, p. 200).

(C2) Limitations of Cognitive Map (Ingram, 2012)

This hypothesis is useful when individuals have maladaptive schemas or self-fulfilling belief systems.  Since these schemas provide a framework of meaning around which they understand their world, it is thought to influence their behaviors, emotions, and experiences (Ingram, 2012).

(C3) Deficiencies in Cognitive Processing (Ingram, 2012)

Useful for clients who display “faulty information processing, poor reality testing, and an inflexible cognitive style (Ingram, 2012, p. 214).  Useful with depression and anxiety disorders, many of Beck’s concepts are discussed here (Ingram, 2012).

Phases of Therapy

Building Rapport

As noted earlier the CBT approach involves a Socratic dialog that includes a collaborative empiricism.  Testing one’s views about the world entails a great deal of vulnerability as an individual’s perceptions are called into question.  For this reason, the initial goal of therapy involves building a solid relationship with the client (Corsini & Wedding, 2011).  “Therapists should be genuine, empathetic, and active listeners” (Metcalf, 2011, p. 114).

WHY SEEKING THERAPY –  “How did you make the decision to come into therapy?…”What are your present concerns in life?” (Ingram, 2012, p. 114).  
UNDERSTANDING THE PRESENTING PROBLEM -“What feelings are you experiencing when you think of these situations…What thoughts make you feel worse? How would you feel if you did not have these thoughts?” (Ingram, 2012, p. 114).

Developing Goals

“In CBT the client’s decide the therapeutic goals” (Ingram, 2912, p. 115).  In this respect, a greater amount of responsibility falls on the shoulders of clients in determining the direction that therapy will take.

Amplifying Change

Corsini & Wedding (2011), notes that change occurs when the client “experiences a problematic situation as a real threat” (p 298).  This is because, when emotions and affective arousal are linked to systems of belief they are easier to access and acknowledge (Corsini & Wedding, 2011).  The therapist is responsible for acting as a guide.  Ingram, (2012) notes that this involves monitoring their improvements and overall functioning.  The therapist notes these changes and inquires about the changes in beliefs and thoughts that coincide with these mood and behavioral alterations (Ingram, 2012).

Termination

CBT is a short-term and goal directed approach to therapy.   In this structured approach, symptom reduction is an initial goal (Godfried, 2002).   Helping clients manage difficult emotions is important in order to begin addressing their underlying causes.   Cognitive therapy helps client’s develop general skills to deal with life’s difficulties. Once the client experiences a reduction in symptoms and has developed skills to address these issues, a new phase of therapy can begin. CBT approaches view “termination as a time of consolidation and preparation for the next phase of independent application” (Prout & Wadkins, 2014, p284). Godfried (2002) describes this as the maintenance phase of therapy. During this phase the therapist monitors a client’s utilization of coping skills when confronted with significant life events. Essentially, in this respect the termination process can be understood as a “relapse prevention model” (Godfried, 2002, p384). The goal is to help clients develop a sense of self-efficacy when utilizing key CBT skills independently in the context of their lives.

References

Charman, T., & Stone, W. (Eds.). (2006). Social and communication development in autism spectrum disorders: Early identification, diagnosis, and intervention. New York, NY, USA: Guilford Press.
Corsini, R. J. & Wedding, W. (2011). Current Psychotherapies. Belmont, CA: Brooks/Cole
Goldfried, M. R. (2002). A cognitive-behavioral perspective on termination. Journal of Psychotherapy Integration, 12(3), 364-372. doi:10.1037/1053-0479.12.3.364
Ingram, B.L. (2012). Clinical Case Formulations: Matching the Integrative Treatment Plan to the Client. (2nd ed.). Hoboken, NJ: Wiley.
Metcalf, L, (2011). Marriage and family therapy: A practice oriented approach. New York: Springer Publishing Company
Newkurg, E. (2009) Assessment of Your View of Human Nature and Conceptual  Orientation. Norfolk, VA: Old Dominion University. Retrieved from: http://ww2.odu.edu/~eneukrug/therapists/survey.html
Prout, T.A. & Wadkins, M.J. (2014).  Essential Interviewing and Counseling Skills.  NewYork, NY: Springer Publishing Company.
Rosenthal, H. (2005). Vital Information and Review Questions for the NCE and State Counseling Exams. Routledge.

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