This document provides an overview of cognitive therapy (CT). It describes CT as focusing on examining cognitive beliefs and developing rational responses to negative automatic thoughts. CT aims to modify dysfunctional thinking and behavior to improve symptoms. The therapist helps clients understand how their beliefs and attitudes influence their feelings and actions, and promotes cognitive change. Clients actively participate by identifying distortions in their thinking, doing homework, and summarizing sessions. Behavioral interventions are also used. Core beliefs and cognitive distortions are discussed, along with examples. The cognitive model relating thoughts, feelings, physiology, and behavior is depicted.

1. CCognitiveognitive TTherapyherapy
Kelly MolitorKelly Molitor
Kelli ScottKelli Scott

2. Think of something thatThink of something that
you believe in...you believe in...
something REALLYsomething REALLY
important to you.important to you.

3. This can be…This can be…
• ReligiousReligious
• Related to raising childrenRelated to raising children
• EducationEducation
• PoliticsPolitics
• Beliefs or rituals you learned as a childBeliefs or rituals you learned as a child
• Etc.Etc.

4. Now we are going to try andNow we are going to try and
change your mind... andchange your mind... and
make you believe somethingmake you believe something
different!different!

5. How does that make youHow does that make you
feel?feel?

6. What is CT?What is CT?
• Developed by Aaron T. Beck (work with depression)Developed by Aaron T. Beck (work with depression)
• Similar to Rational Emotive Behavior Therapy (REBT)Similar to Rational Emotive Behavior Therapy (REBT)
and Behavior Therapy (BT)and Behavior Therapy (BT)
• ““Stems from faulty thinking, making incorrectStems from faulty thinking, making incorrect
inferences on the basis of incorrect information, andinferences on the basis of incorrect information, and
failing to distinguish between fantasy and reality”failing to distinguish between fantasy and reality”
• Dysfunctional/distorted thinking arises from bothDysfunctional/distorted thinking arises from both
biological and psychological influencesbiological and psychological influences
• Modifying dysfunctional thinking and behavior leads toModifying dysfunctional thinking and behavior leads to
improvement in symptoms.improvement in symptoms.
• Short-term focused treatmentShort-term focused treatment

7. Rationale for CBTRationale for CBT
• Negative emotions are elicited by cognitive processes developedNegative emotions are elicited by cognitive processes developed
through influences of learning and temperament.through influences of learning and temperament.
• Adverse life events elicit automatic processing, which is viewedAdverse life events elicit automatic processing, which is viewed
as the causal factor.as the causal factor.
• Cognitive triad: Negative automatic thoughts center around ourCognitive triad: Negative automatic thoughts center around our
understanding of:understanding of:
– OurselvesOurselves
– Others (the world)Others (the world)
– FutureFuture
• Focus on examination of cognitive beliefs and developingFocus on examination of cognitive beliefs and developing
rational responses to negative automatic thoughts.rational responses to negative automatic thoughts.
Beck et al., 1979Beck et al., 1979

8. Cognitive DistortionsCognitive Distortions
(Faulty assumptions/Misconceptions)(Faulty assumptions/Misconceptions)
• Arbitrary inferences: making conclusions without supporting evidenceArbitrary inferences: making conclusions without supporting evidence
• Selective Abstraction: forming conclusions based on an isolated detail orSelective Abstraction: forming conclusions based on an isolated detail or
eventevent
• Overgeneralization: generalizing beliefs based on a single incidentOvergeneralization: generalizing beliefs based on a single incident
• Magnification or minimization: perceiving a situation in a greater or lesserMagnification or minimization: perceiving a situation in a greater or lesser
light than it deserveslight than it deserves
• Personalization: tendency to relate external events to yourselfPersonalization: tendency to relate external events to yourself
• Labeling and mislabeling: portraying your identity based on imperfections andLabeling and mislabeling: portraying your identity based on imperfections and
mistakes made in the past, and allowing them to define your true identitymistakes made in the past, and allowing them to define your true identity
• Emotional reasoning: Feelings are factsEmotional reasoning: Feelings are facts
• All-or-nothing thinking/Black-or-white: All good or all badAll-or-nothing thinking/Black-or-white: All good or all bad
• Mental filter: Ignoring the positiveMental filter: Ignoring the positive
• Anticipating negative outcomes: The worst will happenAnticipating negative outcomes: The worst will happen
• Mind-reading: Knowing what others are thinkingMind-reading: Knowing what others are thinking

9. Examples of Cognitive DistortionsExamples of Cognitive Distortions
• Cognitive DistortionsCognitive Distortions
– Emotional Reasoning:Emotional Reasoning: “I feel incompetent, so I know I’ll fail”“I feel incompetent, so I know I’ll fail”
– Catastrophizing:Catastrophizing: “It is going to be terrible”“It is going to be terrible”
– Personalization:Personalization: “It’s always my fault”“It’s always my fault”
– Black or white thinking:Black or white thinking: “If it isn’t perfect, it’s“If it isn’t perfect, it’s
no good at all.”no good at all.”

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

11. Examples of Core BeliefsExamples of Core Beliefs
• Helpless core beliefsHelpless core beliefs
– I am inadequate, ineffective, incompetent, can’t copeI am inadequate, ineffective, incompetent, can’t cope
– I am powerless, out of control, trappedI am powerless, out of control, trapped
– I am vulnerable, weak, needy, a victim, likely to be hurtI am vulnerable, weak, needy, a victim, likely to be hurt
– I am inferior, a failure, a loser, defective, not good enough, don’t measure upI am inferior, a failure, a loser, defective, not good enough, don’t measure up
• Unlovable core beliefsUnlovable core beliefs
– I am unlikable, unwanted, will be rejected or abandoned, always be aloneI am unlikable, unwanted, will be rejected or abandoned, always be alone
– I am undesirable, ugly, unattractive, boring, have nothing to offerI am undesirable, ugly, unattractive, boring, have nothing to offer
– I am different, flawed, defective, not good enough to be loved by othersI am different, flawed, defective, not good enough to be loved by others
• Worthless core beliefsWorthless core beliefs
– I am worthless, unacceptable, bad, crazy, broken, nothing, a wasteI am worthless, unacceptable, bad, crazy, broken, nothing, a waste
– I am hurtful, dangerous, toxic, evilI am hurtful, dangerous, toxic, evil
– I don’t deserve to liveI don’t deserve to live

12. What are Automatic Thoughts?What are Automatic Thoughts?
What was going through your mind?What was going through your mind?
• Happen spontaneously in response to situationHappen spontaneously in response to situation
• Occur in shorthand: words or imagesOccur in shorthand: words or images
• Do not arise from reasoningDo not arise from reasoning
• No logical sequenceNo logical sequence
• Hard to turn offHard to turn off
• May be hard to articulateMay be hard to articulate
Stressful
Situation
Automatic Thoughts
Negative
Emotions

13. The Cognitive ModelThe Cognitive Model
Core Beliefs
Assumptions
Compensatory/coping strategies
Situation
Automatic thoughts/images
Reaction (emotional/behavioral physiological)

14. ExampleExample
Situation
Partner says:
“I need time to
be with my friends”
Automatic Thoughts
Automatic response:
“Oh no, he’s losing interest
and is going to break up
with me….”
Physiology
Heart racing
Lump in throat
Feelings
Sadness
Worry
Anger
Behavior
Seek reassurance
Withdraw
Cry
Childhood
Experiences
Parental neglect
and criticism
Underlying Assumptions
& Core Beliefs
“I’m flawed in numerous ways,
which means I’m not worthy of
consistent attention and care.
People only care when they want
something.”
Compensatory
Strategies
Be independent and
you’ll be safe.
Watch out – people
are careless with you.

15. Therapist RoleTherapist Role
• Emphasis on therapeutic relationshipEmphasis on therapeutic relationship
• GenuineGenuine
• WarmWarm
• EmpatheticEmpathetic
• AcceptingAccepting
• Creative ActiveCreative Active
• Knowledgeable of cognitive and behavioral strategiesKnowledgeable of cognitive and behavioral strategies
• GuideGuide
• Help client understand how their beliefs and attitudes influence the way they feel andHelp client understand how their beliefs and attitudes influence the way they feel and
actact
• Promote cognitive changePromote cognitive change
• Assist client in acquiring new skillsAssist client in acquiring new skills
• Clients bring up topics to exploreClients bring up topics to explore
• Ask open-ended questionsAsk open-ended questions
• Identify distortions in their thinkingIdentify distortions in their thinking
• Devise homework assignmentsDevise homework assignments
• Teach client how to be their own therapistTeach client how to be their own therapist

16. Client’s RoleClient’s Role
• ActiveActive
• ParticipateParticipate
• Do homework (very important)Do homework (very important)
• Complete outside readingsComplete outside readings
• Bring up topics to exploreBring up topics to explore
• Identify distortions in their own thinkingIdentify distortions in their own thinking
• Summarize important points in the sessionSummarize important points in the session

17. Behavioral InterventionsBehavioral Interventions
• Breathing retrainingBreathing retraining
• RelaxationRelaxation
• Behavioral activationBehavioral activation
• Interpersonal effectiveness trainingInterpersonal effectiveness training
• Problem-solving skillsProblem-solving skills
• Exposure and response preventionExposure and response prevention
• Social skills trainingSocial skills training
• Graded task assignmentGraded task assignment

18. CT on TV?CT on TV?

20. How could minorHow could minor
behavior like this causebehavior like this cause
bigger issues inbigger issues in
someone’s life?someone’s life?

21. ???Questions??????Questions???