CCognitive ognitive TTherapyherapy

Kelly MolitorKelly Molitor

Kelli ScottKelli Scott

Think of something that you Think of something that you believe in... something believe in... something

REALLY important to you.REALLY important to you.

This can be…This can be…

• Religious Religious • Related to raising childrenRelated to raising children• EducationEducation• PoliticsPolitics• Beliefs or rituals you learned as a Beliefs or rituals you learned as a

childchild• Etc.Etc.

Now we are going to Now we are going to try and change your try and change your

mind... and make you mind... and make you believe something believe something

different!different!

How does that How does that make you feel?make you feel?

What is CT?What is CT?• Developed by Aaron T. Beck (work with Developed by Aaron T. Beck (work with

depression)depression)• Similar to Rational Emotive Behavior Therapy Similar to Rational Emotive Behavior Therapy

(REBT) and Behavior Therapy (BT)(REBT) and Behavior Therapy (BT)• ““Stems from faulty thinking, making incorrect Stems from faulty thinking, making incorrect

inferences on the basis of incorrect inferences on the basis of incorrect information, and failing to distinguish between information, and failing to distinguish between fantasy and reality”fantasy and reality”

• Dysfunctional/distorted thinking arises from Dysfunctional/distorted thinking arises from both biological and psychological influencesboth biological and psychological influences

• Modifying dysfunctional thinking and behavior Modifying dysfunctional thinking and behavior leads to improvement in symptoms.leads to improvement in symptoms.

• Short-term focused treatmentShort-term focused treatment

Rationale for CBTRationale for CBT

• Negative emotions are elicited by cognitive processes Negative emotions are elicited by cognitive processes developed through influences of learning and developed through influences of learning and temperament. temperament.

• Adverse life events elicit automatic processing, which Adverse life events elicit automatic processing, which is viewed as the causal factor. is viewed as the causal factor.

• Cognitive triad: Negative automatic thoughts center Cognitive triad: Negative automatic thoughts center around our understanding of:around our understanding of:– OurselvesOurselves– Others (the world)Others (the world)– Future Future

• Focus on examination of cognitive beliefs and Focus on examination of cognitive beliefs and developing rational responses to negative automatic developing rational responses to negative automatic thoughts. thoughts.

Beck et al., 1979Beck et al., 1979

Cognitive DistortionsCognitive Distortions(Faulty assumptions/Misconceptions)(Faulty assumptions/Misconceptions)

• Arbitrary inferences: making conclusions without supporting Arbitrary inferences: making conclusions without supporting evidenceevidence

• Selective Abstraction: forming conclusions based on an isolated Selective Abstraction: forming conclusions based on an isolated detail or eventdetail or event

• Overgeneralization: generalizing beliefs based on a single Overgeneralization: generalizing beliefs based on a single incidentincident

• Magnification or minimization: perceiving a situation in a Magnification or minimization: perceiving a situation in a greater or lesser light than it deservesgreater or lesser light 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 Labeling and mislabeling: portraying your identity based on

imperfections and mistakes made in the past, and allowing imperfections and mistakes made in the past, and allowing them to define your true identitythem 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

Examples of Cognitive Examples of Cognitive DistortionsDistortions

• Cognitive DistortionsCognitive Distortions– Emotional Reasoning: Emotional Reasoning: “I feel incompetent, so I “I feel incompetent, so I

know I’ll fail”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 no good at all.”all.”

Core BeliefsCore Beliefs• Core beliefs underlie and produce Core beliefs underlie and produce

automatic thoughts.automatic thoughts.• These assumptions influence These assumptions influence

information processing and organize information processing and organize understanding about ourselves, others, understanding about ourselves, others, and the future.and the future.

• These core beliefs remain dormant until These core beliefs remain dormant until activated by stress or negative life activated by stress or negative life events. events.

• Categories of core beliefs (helpless, Categories of core beliefs (helpless, worthless, unlovable)worthless, unlovable)

Automatic ThoughtsCore Beliefs

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 I am inferior, a failure, a loser, defective, not good enough, don’t

measure upmeasure up• Unlovable core beliefsUnlovable core beliefs

– I am unlikable, unwanted, will be rejected or abandoned, always I am unlikable, unwanted, will be rejected or abandoned, always be alonebe alone

– I am undesirable, ugly, unattractive, boring, have nothing to I am undesirable, ugly, unattractive, boring, have nothing to offeroffer

– I am different, flawed, defective, not good enough to be loved by I am different, flawed, defective, not good enough to be loved by othersothers

• Worthless core beliefsWorthless core beliefs– I am worthless, unacceptable, bad, crazy, broken, nothing, a I am worthless, unacceptable, bad, crazy, broken, nothing, a

wastewaste– I am hurtful, dangerous, toxic, evilI am hurtful, dangerous, toxic, evil– I don’t deserve to liveI don’t deserve to live

What are Automatic What are Automatic Thoughts?Thoughts?

What was going through What was going through your mind?your mind?• Happen spontaneously in response to Happen spontaneously in response to

situationsituation• 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

The Cognitive ModelThe Cognitive ModelCore Beliefs

Assumptions

Compensatory/coping strategies

Situation

Automatic thoughts/images

Reaction (emotional/behavioral physiological)

ExampleExample

SituationPartner says: “I need time to be with my friends”

Automatic ThoughtsAutomatic response:

“Oh no, he’s losing interest and is going to break up

with me….”

PhysiologyHeart racingLump in throat

FeelingsSadnessWorryAnger

BehaviorSeek reassuranceWithdrawCry

Childhood ExperiencesParental neglectand 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 StrategiesBe independent and you’ll be safe.Watch out – people are careless with you.

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 Help client understand how their beliefs and attitudes influence

the way they feel and actthe way they feel and act• 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

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 Summarize important points in the

sessionsession

Behavioral InterventionsBehavioral Interventions

• Breathing retrainingBreathing retraining• Relaxation Relaxation • Behavioral activation Behavioral activation • Interpersonal effectiveness training Interpersonal effectiveness training • Problem-solving skillsProblem-solving skills• Exposure and response preventionExposure and response prevention• Social skills trainingSocial skills training• Graded task assignmentGraded task assignment

CT on TV?CT on TV?

How could minor How could minor behavior like this behavior like this

cause bigger issues cause bigger issues in someone’s life? in someone’s life?

???Questions??????Questions???