1. NİŞANTAŞI ÜNİVERSİTESİ
CLINICAL PSYCHOLOGY
PSYCHOTHERAPIES:Cognitive and Behavioural Therapy (2)
İktisadi, İdari ve Sosyal Bilimler Fakültesi
iisbf.nisantasi.edu.tr
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2. Cognitive Therapy – Aaron T.Beck (1921- … )
Aaron Beck has been a pioneer in the development of modern cognitive- behavioral treatments that have been applied to a variety of clinical problems.
This model of intervention entails the use of both cognitive and behavioral techniques to modify dysfunctional thinking patterns that characterize the problem or disorder in question (Beck, 1993).
Beck first described the development of depression cognitively and used cognitive therapy in the treatment of depression.

3. 1. Basic Concepts in Cognitive Therapy – Negative Triad
Psychopathology results from maladaptive meanings.
Self
Environmental Context (experience)
Future (goals)

4. 2. Concepts in Cognitive Therapy - Schemas
According to Beck, childhood experiences lead to the formation of some basic ideas, assumptions, and belief systems.
These basic ideas and assumptions are called schemas.
These schemes shape the perceptions of people which about themselves, the future and the world.

6. 3. Basic Concepts in Cognitive Therapy – Automatic Negative Thoughts
They are negative thoughts that lead to unpleasant emotions (sadness, guilt, anger, anxiety, etc.). They make sense to person.

7. 4. Basic Concepts in Cognitive Therapy - Cognitive distortions (errors)
Cognitive distortions are exaggerated (abartılı) or irrational thought patterns that are believed to perpetuate the effects of psychopathological states.
The following is a list of the most common cognitive distortions 

8. 1. All-or-Nothing Thinking: Putting experiences in one of two categories.
1) People are all good or all bad. 2) Projects are perfect or failures. 3) I am a sinner, or saint.
2. Overgeneralizing: Believing that something will always happen because it happened once.
1) I will never be able to make friends at a party because I once made an awkward statement to someone, and they didn’t want to be my friend. 2) I will never be able to speak in public because I once had a panic attack before giving a speech.
3. Discounting the Positive: Deciding that if a good thing happens, it must not be important or doesn’t count.
1) I passed the exam this time, but it was a fluke. 2) I didn’t have a panic attack today, but it’s only because I was too busy to be worried.
4. Jumping to Conclusions: Deciding how to respond to a situation without having all the information.
1)The man/woman I am interested in never called me back because he thinks I’m stupid. 2) That person cut me off in traffic because he/she is a jerk!
5. Mind Reading: Believing that you know how someone else is feeling or what they are thinking without any evidence.
1) I know she hates my talk ) That person thinks I’m a loser.
6. Fortunetelling: Believing that you can predict a future outcome, while ignoring other alternatives.
1) I’m going to fail this test ) I’m going to have a panic attack if I go out in public.

9. 7. Magnifying (Catastrophizing) or Minimizing: Distorting the importance of positive and negative events. 1) My nose is so big that no one will ever love me. 2) It doesn’t matter if I’m smart because I will never be attractive, athletic, popular, rich, etc.
8. Emotional Reasoning: Believing something to be true because it feels true.
I am a failure because I feel like a failure ) I am worthless because I feel worthless.
9. “Should-y” Thinking: Telling yourself you should, should not, or should have done something when it is more accurate to say that you would have preferred or wished you had or had not done something.
1) I should be perfect ) I should never make mistakes.
3) I should not be anxious ) I should have done something to help.
10. Labeling (or Mis-Labeling): Using a label to describe a behavior or error.
1) He’s a bad person (instead of “He made a mistake when he lied.”) 2) I’m stupid (instead of “I didn’t study for my test, and I failed it.”)
11. Personalization: Taking blame for some negative event even though you were not responsible, you could not have known to do differently, there were extenuating circumstances, or other people were involved.
1) It’s my fault he hits me ) My mother is unhappy because of me.

10. Basic Principles and Characteristics of Cognitive Behavioral Therapies
1- Based on the cognitive model of emotional disorders.
2- Time-limited and short-term therapies
3- Therapeutic relationship is necessary for effective therapy, but therapeutic relationship is not the main focus in cognitive behavioral therapies
4- Cooperation between therapist and patient is necessary.
5- Socratic method is mostly used
6- Directive and structured
7- Focus on the problem (symptom)
8- Based on educational model
9- Theories and techniques of cognitive therapies are based on inductive (tümevarım) method
10- Homework is the essential element of cognitive-behavioral therapies

13. Cognitive Conceptualization
University of Chicago, Department of Psychiatry, CBT
Cognitive Conceptualization
Physiology
Feelings
Behavior
Current
Situation
Automatic Thoughts
About self, world
And others
Childhood
And Early
Life Events
Compensatory
Strategies
Underlying Assumptions and Core Beliefs

14. University of Chicago, Department of Psychiatry, CBT
Example 1
Physiology
Heart racing
Lump in throat
Feelings
Sadness
Worry
Anger
Behavior
Seek reassurance
Withdraw
Cry
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….”
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.
Childhood
Experiences
Parental neglect
and criticism

15. University of Chicago, Department of Psychiatry, CBT
Example 2
Physiology
Pit in stomach
Dry mouth
Feelings
Worry, shame,
Disappointment
Humiliation.
Behavior
Use alcohol,
Procrastinate
with homework
Situation
Disappointing
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.”
Childhood
Adversities
Parental standards
reinforce academic
achievement
Underlying Assumptions
“If I don’t excel in school, I’m a total failure”
Compensatory
Strategies
Work extra hard
to offset
incompetence.

16. University of Chicago, Department of Psychiatry, CBT
Course of Treatment
Assessment
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

17. Therapy Process
First, the therapist focuses on understanding the problems of the client.
The automatic thoughts that cause the emotional problems are found and examined. (Help the client with various questions while doing this)
After finding automatic thoughts, socratic questioning is used.
What are the evidences of this thought?
What are the advantages and disadvantages of this thought?
What kind of logic error do I make?

18. Therapy Process
4. It can be dicussed which alternative thoughts might be used after it is understood that automatic thought is faulty and harmful to the person and not realistic.
The following questions can be asked to facilitate this:
What would you think if you were feeling better?
If a person you trust has experienced this situation, what would he/she think?
If a friend told you this situation, what would you say him/her?

21. REFERENCES
Beck, A. T., Freeman, A., & Davis, D. (2004). Cognitive Therapy of Personality Disorders 2nd Ed. Guilford Publication Inc. New York.
Beck, A. T., & Weishaar, M. E. (2009). Cognitive Therapy. Current Psychotherapies 8th Ed. Thomson Brooks/Cole. USA.
Seligman, L. (2006). Theories of counseling and psychotherapy: Systems, strategies, and skills. (2nd ed.). Upper Saddle River, New Jersey: Pearson Education, Ltd.
Clinical Psychology, Timothy J. Trull - Mitchell J. Prinstein, Wadsworth Publishing, (2012).
Introduction To Clinical Psychology / Seventh Edition by Geoffrey P. Kramer, Douglas A. Bernstein, Vicky Phares
Clinical Psychology: A Modern Health Profession / 1st Edition by Wolfgang Linden , Paul Hewitt - Nobel
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