Seven Basic Assumptions Beck (1979) provides a list of general assumptions that underlie the theory. CBT is based on the following: Perception and experiencing in general are active processes which involve both inspective and introspective data. The patient's cognitions represent a synthesis of internal and external stimuli. How a person appraises a situation is generally evident in his cognitions (thoughts and visual images). These cognitions constitute the person's “stream of consciousness” or phenomenal field, which reflects the person's configuration of himself, his world, his past and future. Alterations in the content of the person's underlying cognitive structures affect his or her affective state and behavioral pattern. Through psychological therapy a patient can become aware of his cognitive distortions. Correction of these faulty dysfunctional constructs can lead to clinical improvement. 1

Basic Concepts CT is based on the role information processing plays in survival The theory behind cognitive therapy asserts that altering thoughts influences feelings, motivations and behaviors The theory states cognition, behavior, affect, and motivation are connected Therapeutic intervention focuses on the primacy of cognition 2

Basic Concepts Cognitive Schema – a structure containing self-perceptions; thoughts about others and the world; our memories, goals, fantasies; and everything we’ve learned. Structures that contain an individual's core beliefs and assumptions are labeled Cognitive Schemas) Cognitive Theory states that an individual's fundamental beliefs and assumptions are contained in structures termed cognitive schemas.) Cognitive Shift – a systematic bias in information processing Cognitive Vulnerabilities – specific attitudes predisposing the interpretation of experiences Cognitive Distortion - refers to a systematic error in reasoning 3

Pattern that triggers depression: CT’s Cognitive Triad Pattern that triggers depression: Client holds negative view of themselves and blames themselves (self) 2. Client has tendency to interpret experiences in a negative manner (others) 3. Client has a gloomy vision and projections about the future (world) 4

Basic Characteristics of CT Practical Symptom focused Empirically derived techniques Collaboration Acknowledges underlying precursors of symptoms while remaining in present Case conceptualization drives treatment 5

The Cognitive Model Situation Automatic Response Thoughts Emotions Behaviors Situation Automatic Thoughts Emotions Underlying Beliefs Physiological Response 6

The Cognitive Model We all have cognitive vulnerabilities (i.e., core beliefs) which predispose us to interpret information a certain way. These vulnerabilities are developed early When these beliefs are rigid, negative, and ingrained we are predisposed to pathology These core beliefs give rise to conditional assumptions, i.e., rules for living, as we mature In psychopathology there are systematic biases toward selectively interpreting information in a certain manner which are disorder specific. 7

Modifying Core Beliefs creates the most significant change in a dysfunctional mode for a client 8

Situation Automatic Thoughts Emotion Intermediate Beliefs Core Beliefs Hierarchy of Beliefs (Adapted from Judith Beck’s Cognitive Therapy: Basics and Beyond) Situation Automatic Thoughts Emotion Intermediate Beliefs Core Beliefs 9

CT’s View of Personality Thinking is Problematic or Distorted when it is very ... Extreme Broad Catastrophic Negative Unscientific Idealistic Demanding Judgmental Comfort Seeking Obsessive Confusing 10

Cognitive Distortions 3. Overgeneralization: A single negative event is viewed as a never-ending pattern of defeat. Example - Following a job interview an accountant does not receive the job. She/he begins thinking that they will never find a job despite their qualifications 4. Magnification and/or Minimization: The binocular trick. Things seem bigger or smaller than they truly are (depending on which lens you are looking through). Example: An employee believes that a minor mistake will lead to being fire vs. an alcoholic who believes he/she doesn’t have a problem. 11

Cognitive Distortions 9. Emotional Reasoning: You assume your negative feelings result from the fact that things are negative. Example – If you feel bad, then that means that the world or situation is bad. You don’t consider that your feelings are a misrepresentation of the facts. 10. Should Statements: The use of words like should, ought, must rather than “it would be preferred” to guilt self. Example: “I should be perfect”. 11. Labeling and Mislabeling: Labeling yourself or others in a demeaning way. Example: Name calling “I am worthless” or “He’s a total failure”. 12

Process of CBT

General Principles of CT Goal is to correct dysfunctional thinking and help patients modify erroneous assumptions Patient is taught to be a scientist who generate and tests hypotheses Relationship between patient and therapist is collaborative 14

Process of Therapy Initial Sessions – essential to build rapport, focus on problem definition, goal setting, and symptom relief, psychoeducation, behavior interventions. (Symptom relief is a primary goal in the initial cognitive therapy interview) Middle Sessions – emphasis shifts from symptom/behaviors to patterns of thinking Termination – Expectation that therapy is time-limited. 15

Structure Setting the agenda Doing a mood check Briefly reviewing the presenting problem and obtaining an update Identifying problems and setting goals Educating the patient about the cognitive model Eliciting the patient’s expectations for therapy Educating the patient about her disorder Setting homework Eliciting feedback