theory and practice of cognitive behavioral therapy l.
Skip this Video
Loading SlideShow in 5 Seconds..
Theory and Practice of Cognitive Behavioral Therapy PowerPoint Presentation
Download Presentation
Theory and Practice of Cognitive Behavioral Therapy

Loading in 2 Seconds...

play fullscreen
1 / 36

Theory and Practice of Cognitive Behavioral Therapy - PowerPoint PPT Presentation

  • Uploaded on

Theory and Practice of Cognitive Behavioral Therapy . Shona N. Vas, Ph.D . Department of Psychiatry & Behavioral Neuroscience Cognitive-Behavior Therapy Program MS-3 Clerkship 2008-2009. Outline. What is Cognitive Behavior Therapy (CBT)? What are the basic principles of treatment?

I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
Download Presentation

Theory and Practice of Cognitive Behavioral Therapy

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.

- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
theory and practice of cognitive behavioral therapy

Theory and Practice of Cognitive Behavioral Therapy

Shona N. Vas, Ph.D.

Department of Psychiatry & Behavioral Neuroscience

Cognitive-Behavior Therapy Program

MS-3 Clerkship 2008-2009

  • What is Cognitive Behavior Therapy (CBT)?
  • What are the basic principles of treatment?
  • What is the course of treatment?
  • What are some examples of interventions?
  • Who is appropriate for CBT?
what is cbt
What is CBT?
  • Set of ‘talk’ psychotherapies that treat psychiatric conditions.
  • Short-term focused treatment.
  • Strong empirical support with randomized clinical trials.
  • As effective as psychiatric medications.
  • Recommended as critical component of treatment, particularly when medications are contraindicated or ineffective.
why so popular
Why So Popular?
  • Clear treatment approach for patients
  • Assumptions make sense to patients
  • Based on patient’s experience
  • Encourages practice and compliance
  • Patients have a sense of control
  • CBT works!
definition of cognitive therapy
Definition of Cognitive Therapy
  • CT is a focused form of psychotherapy based on a model stipulating that psychiatric disorders involve dysfunctional thinking.
  • Dysfunctional/distorted thinking arises from both biological and psychological influences
  • Individuals’ emotional, behavioral, and physiological reactions are influenced by the way they structure their environment.

J. Beck, 1995

definition of ct continued
Definition of CT (continued…)
  • Modifying dysfunctional thinking and behavior leads to improvement in symptoms.
  • Modifying dysfunctional beliefs which underlie dysfunctional thinking leads to more durable improvement
definition of ct continued7
Definition of CT (continued…)
  • Cognitive therapy is defined by a cognitive formulation of the disorder and a cognitive conceptualization of the particular patient.
  • Cognitive therapy is not defined by the use of exclusively cognitive techniques. Techniques from many modalities are used.
  • CT also often referred to as Cognitive-Behavior Therapy (CBT).
rationale for cbt
Rationale for CBT
  • Negative emotions are elicited by cognitive processes developed through influences of learning and temperament.
  • Adverse life events elicit automatic processing, which is viewed as the causal factor.
  • Cognitive triad: Negative automatic thoughts center around our understanding of:
    • Ourselves
    • Others (the world)
    • Future
  • Focus on examination of cognitive beliefs and developing rational responses to negative automatic thoughts.

Beck et al., 1979

cognitive specificity hypothesis
Cognitive Specificity Hypothesis
  • Distorted appraisals follow themes relevant to the specific psychiatric condition.
  • Psychological disorders are characterized by a different psychological profile.
    • Depression: Negative view of self, others, and future. Core beliefs associated with helplessness, failure, incompetence, and unlovability.
    • Anxiety: Overestimation of physical and psychological threats. Core beliefs linked with risk, dangerousness, and uncontrollability.
cognitive specificity
Cognitive Specificity
  • Negative Triad Associated with Depression
    • Self “I am incompetent/unlovable”
    • Others “People do not care about me”
    • Future “The future is bleak”
  • Negative Triad Associated with Anxiety
    • Self “I am unable to protect myself”
    • Others “People will humiliate me”
    • Future “It’s a matter of time before I am embarrassed”
targeted cognitions for different disorders
Targeted Cognitions for Different Disorders
  • OCD: appraisals of obsessive cognitions
  • Anorexia: control, worth, perfection
  • Panic: catastrophic misinterpretation of physical sensations
  • Paranoia: trust, vulnerability
working model of cbt
Working Model of CBT





Affective and

Biological Arousal

Behavioral Inclination

Thase et al., 1998

cognitive model
Cognitive Model

Triggering Event

Bill goes to collection


“I can never do anything right…”


Avoidance; withdrawal

Bodily Sensations

Low energy, disruption of

sleep, increased fatigue

Behavioral Inclination

“I don’t want to deal with it”

“It’s too stressful to think about it”

Thase et al., 1998

what are automatic thoughts what was going through your mind
What are Automatic Thoughts?What was going through your mind?
  • Happen spontaneously in response to situation
  • Occur in shorthand: words or images
  • Do not arise from reasoning
  • No logical sequence
  • Hard to turn off
  • May be hard to articulate





Automatic Thoughts

cognitive distortions
Cognitive Distortions
  • Patients tend to make consistent errors in their thinking
  • Often, there is a systematic negative bias in the cognitive processing of patients suffering from psychiatric disorders
  • Help patient identify the cognitive errors s/he is most likely to make
types of cognitive distortions
Types of Cognitive Distortions
  • Emotional reasoning Feelings are facts
  • Anticipating negative outcomes The worst will happen
  • All-or-nothing thinking All good or all bad
  • Mind-reading Knowing what others are thinking
  • Personalization Excess responsibility
  • Mental filter Ignoring the positive
  • Cognitive Distortions
    • Emotional Reasoning: “I feel incompetent, so I know I’ll fail”
    • Catastrophizing: “It is going to be terrible”
    • Personalization: “It’s always my fault”
    • Black or white thinking: “If it isn’t perfect, it’s no good at all.”
core beliefs
Core Beliefs
  • Core beliefs underlie and produce automatic thoughts.
  • These assumptions influence information processing and organize understanding about ourselves, others, and the future.
  • These core beliefs remain dormant until activated by stress or negative life events.
  • Categories of core beliefs (helpless, worthless, unlovable)

Core Beliefs

Automatic Thoughts

examples of core beliefs
Examples of Core Beliefs
  • Helpless core beliefs
    • I am inadequate, ineffective, incompetent, can’t cope
    • I am powerless, out of control, trapped
    • I am vulnerable, weak, needy, a victim, likely to be hurt
    • I am inferior, a failure, a loser, defective, not good enough, don’t measure up
  • Unlovable core beliefs
    • I am unlikable, unwanted, will be rejected or abandoned, always be alone
    • I am undesirable, ugly, unattractive, boring, have nothing to offer
    • I am different, flawed, defective, not good enough to be loved by others
  • Worthless core beliefs
    • I am worthless, unacceptable, bad, crazy, broken, nothing, a waste
    • I am hurtful, dangerous, toxic, evil
    • I don’t deserve to live
cognitive conceptualization
Cognitive Conceptualization






Automatic Thoughts

About self, world

And others


And Early

Life Events



Underlying Assumptions and Core Beliefs

example 1
Example 1


Heart racing

Lump in throat






Seek reassurance




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 upwith me….”

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.”



Be independent and

you’ll be safe.

Watch out – people

are careless with you.



Parental neglect

and criticism

example 2
Example 2


Pit in stomach

Dry mouth


Worry, shame,




Use alcohol,


with homework



exam result

Automatic Thoughts

“I am not going to get

through this program -

I’m not as smart

as everyone else.

People will

discover this and I

will be humiliated.”



Parental standards

reinforce academic


Underlying Assumptions

“If I don’t excel in school, I’m a total failure”



Work extra hard

to offset


responding to negative thoughts
Responding to Negative Thoughts
  • Define Situation
  • Clarify meaning of cognitive appraisal
    • What was going through your mind just then?
    • What did the situation mean for you?
  • Evaluate interpretation
    • Evidence: For and against this belief?
    • Alternatives: Any other explanation(s)?
    • Implications: So what….?
evaluating negative thoughts
Evaluating Negative Thoughts
  • What is the effect of telling myself this thought?
  • What could be the effect of changing my thinking?
  • What would I tell ___ (a friend/family member) if s/he viewed this situation in this way?
  • What can I do now?
common components of cbt
Common Components of CBT
  • Establish good therapeutic relationship
  • Educate patients - model, disorder, therapy
  • Assess illness objectively, set goals
  • Use evidence to guide treatment decisions
  • Structure treatment sessions with agenda
  • Limit treatment length
  • Issue and review homework to generalize learning
course of treatment

Course of Treatment


Provide rationale

Training in self-monitoring

Behavioral strategies

Monitor relationship between situation/action and mood.

Applying new coping strategies to larger issues.

Identifying beliefs and biases

Evaluating and changing beliefs

Core beliefs and assumptions

Relapse prevention and termination

basic principles
Basic Principles
  • Change mood states by using cognitive and behavioral strategies:
    • Identifying/modifying automatic thoughts & core beliefs,
    • Regulating routine, and
    • Minimizing avoidance.
  • Emphasis on ‘here and now’
  • Preference for concrete examples
    • Start with specific situation (complete thought log)
  • Reliance on Socratic questioning
    • Ask open-ended questions
  • Empirical approach to test beliefs
    • Challenge thoughts not based on evidence
    • Cognitive restructuring
  • Promote rapid symptom change
behavioral interventions
Behavioral Interventions
  • Breathing retraining
  • Relaxation
  • Behavioral activation
  • Interpersonal effectiveness training
  • Problem-solving skills
  • Exposure and response prevention
  • Social skills training
  • Graded task assignment
cognitive interventions
Cognitive Interventions
  • Monitor automatic thoughts
  • Teach imagery techniques
  • Promote cognitive restructuring
  • Examine alternative evidence
  • Modify core beliefs
  • Generate rational alternatives
  • Cognitive and behavioral approaches are effective
  • Supported by over 325 controlled outcome studies
  • State-of-the-art therapy, manualized
applications of cbt
Mood Disorders

Unipolar Depression (1979)

Bipolar Disorder (1996)

Dysthymia and Chronic MDD (2000)

Anxiety Disorders

GAD (1985)

Social Phobia (1985)

Panic Disorder (1986)

OCD (1988)

PTSD (1991)

Emotional Disorders (2006)

Applications of CBT
applications of cbt continued
Eating Disorders (1981)

Marital Problems

Behavioral Medicine

Headaches (1985)

Insomnia (1987)

Chronic Pain (1988)

Smoking Cessation


Body Dysmorphic Disorder

Applications of CBT(Continued…)
controlled outcome studies on cbt
Unipolar Depression (~30)

Eating Disorders

Anorexia (~5)

Bulimia (~15)

Generalized Anxiety Disorder (~12)

Social Phobia (~14)

Panic Disorder (~10)

Borderline P.D. (2)

Schizophrenia (~45)

C/A Depression (8)

Chronic Depression (1)

Controlled Outcome Studies on CBT
  • System of psychotherapies
  • Unified theory of psychopathology
  • Short-term treatment
  • Objective assessment and monitoring
  • Strong empirical support
  • As effective as pharmacotherapy
questions comments

Questions? Comments?

Dr. Shona Vas

(773) 702-1517

Psychiatry Department Office: A-312