1. Cognitive Behaviour Therapy

2. Judith Beck
Christine Padesky Donald Miechenbaum

3. CBT: Basic Principles
1. The cognitive principle
Interpretations of events
Event Emotion
Event Cognition Emotion

4. CBT: Basic Principles
2. The behaviour principle: What we do has
powerful influence on our thoughts & emotions.

5. CBT: Basic Principles
3. The continuum principle: Mental health
problems as exaggerations of normal processes
Normal Mental illness

6. CBT: Basic Principles
4. The here and now principle: Focus on
current processes rather than the past

7. THE INTERACTING SYSTEMS
Generic problem development model

8. CBT: Basic Principles
6. The empirical principle: Evaluation of
theories and therapy based on observation and
evaluation

9. LEVELS OF COGNITION
Negative Automatic More accessible Easier to
More specific change
Thoughts (NATs)
‘’I’m being boring; I don’t know what
to say. They think I’m stupid; I’m a
failure; She doesn’t like me’’
Dysfunctional assumptions
‘’If people get to know me, then they
will find out how useless I am &
reject me; I must be good at
everything I do, Otherwise my
uselessness will be revealed’’
Core beliefs
‘’I am unlovable; I am useless’’ More general Less Harder to
accessible change

10. COGNITIVE DISTORTIONS
Cognitive Distortion Definition Example
Arbitrary Interference Drawing conclusions without Believing that you had been laid
sufficient evidence, or when the off for a job because of personal
evidence is actually contradictory. incompetence, although the
company has gone out of business.
Over Generalisation Drawing a general conclusion on Concluding that you will never
the basis of a single incident. succeed after failing on the first
attempt.
Selective Abstraction Attending to a detail while Feeling rejected because a friend
ignoring the total context. who was rushing to catch a bus did
not stop to talk.
Personalisation Erroneously attributing an external Thinking that people who are
event to yourself. laughing are laughing at you.
Polarised Thinking (Dichotomous) Thinking in extremes, in a black- Believing that you are a pauper
or-white or-all-or-none fashion. after having lost your wallet.
Magnification and Minimization Viewing something as far more or Thinking that you are poor writer
less important than it is. after getting back a paper with
several corrections.

11. TEMPLATE FORMATION

12. THE PROCESS OF
ASSESSMENT

13. TECHNIQUES
Socratic Dialogue
Helps to reveal what clients already know but not yet
considered, or forgotten.

14. Cognitive Techniques
1. Distraction
2. Identifying cognitive biases
3. Appraising onto thoughts & images
4. Testing NATs and images
5. Modifying core beliefs
6. Behavioural experiments

15. Distraction
We can concentrate on one thing at a time.
- Breaking unhelpful cycles of thought
- Changing attitudes towards negative
congnitions

16. Distraction: Practice
• Physical Exercise: Walk, Yoga, Pelvic floor
• Refocusing: Focus on external world
• Mental Exercises: Counting backwards, Recite
mantra, reconstruct an image/song, imagery
of a scene
• Just counting thoughts: without much
attention

17. Identifying Cognitive Biases
Through Dysfunctional Thought Record
(DTR)

18. Date/ Situation Automatic Emotions Adaptive Outcome
Time
Dysfunctional Thought1)Record
1) What actual
Thoughts
1) What 1) What What
response
1) How much
event / stream thoughts / emotions cognitive do you believe
of thoughts / emotions went (sad, anxiety, distortions did each
daydreaming / through your anger) did you you make? automatic
recollection led mind? feel at the thought?
to unpleasant time? 2) Use Qs given
sensations? 2) How much to compose a 2) What
did you believe 2) How response to the emotions do
2) What (if any) each one at the intense (0- automatic you feel now?
distressing time? 100%) was thoughts How intense
physical the emotion? 3) How much (0-100%)
sensations did do you believe
you have? each response? 3) What
will/did you
do?

19. Qs to help Alternative Response
1) What is the evidence that the AT is true? Not
true?
2) Is there any alternative explanation?
3) What’s the worst that could happen? could I
live through it? What is the best that can
happen? What is the most realistic
outcome?

20. Qs to help Alternative Response
(contd.)
4) What is the effect of my believing the AT?
What could be the effect of my changing my
thinking?
5) What should I do about it?
6) If ____ (a friend) was in the situation & had
this thought, what would I tell him/her?

21. Appraising ATs & Images
• Taking a step back or ‘decentring’: view
cognitions as mental events rather than as
expressions of reality. Focus on process than
content.
• Understanding the origin of a cognition
• Weighing up pros and cons
• What is the worst, and how do you cope?
• Identifying cognitive themes

22. Testing ATs & Images:
Behavioural Experiments
Automatic Thought Behavioural Experiment
I don’t know what to say to him. Client role-plays herself while
therapist plays the other part.
I can’t (get myself to) call for a Client makes phone call in the office.
doctor’s appointment
Client reviews wanted ads with
There are no jobs I’m qualified for. therapist.
Client creates dizziness through
If I get more and more dizzy, I’ll pass hyperventilating while spinning in a
out. chair.

23. Modifying Core Beliefs
• Historically test the source of core belief.
• Carry out BEs to test the core belief
• Record the evidence that a core belief is not
100% true.
• Identify alternative (more helpful) core belief.
• Rating confidence in new core beliefs.

24. Physical Techniques
• Relaxation
• Controlled breathing
• Physical exercises
• Applied tension (useful in phobic anxiety
due to blood / injury)
• Sleep

25. BEHAVIOURAL EXPERIMENTS
Planned experiential activities, based on
experimentation or observation, undertaken by
clients in or between therapy sessions.

26. Types of Behavioural Experiments
Client primary role as actor (Generating Information)
E.g. Client doing E.g. Client doing something
something to see whether to see what happens in an
predicted consequences open – ended way.
follow.
Testing clear hypothesis Open-Ended Discovery
E.g. A survey of other E.g. The therapist collapses
people’s reactions. in a supermarket so client
can see what happens.
Client primary role as an observer (Receiving Information)

27. THE ADULT LEARNING CYCLE
Experience
Planning Observation
Conceptualisation