by Aoun Ali

1. COGNITIVE
BEHAVIORAL THERAPY
BY AOUN ALI WADHO
M-PHIL-1
ICP KARACHI

2. COGNITIVE THERAPY
Psychotherapy aimed at changing way of thinking Several
approaches to cognitive-behavioral therapy
 Cognitive behavioral therapy (CBT)
 Rational Behavior Therapy
 Rational Living Therapy
 Dialectic Behavior Therapy
 Rational Emotive Behavior Therapy

3. COGNITIVE BEHAVIORAL THERAPY
It is a talking therapy that can help you manage your problems by changing the way you think and behave.
It is most commonly used to treat anxiety and depression, but can be useful for other mental and physical
health problems.

4. CAUSATION AND PSYCHOLOGICAL DISORDERS
According Aron Beck distress can be caused by a combination of
 biological
 environmental
 Social
 early childhood experiences
 Lack of experience
These factors, interacting in a variety of ways, and lead to later so that causes for disorders

5. AUTOMATIC THOUGHTS
 The automatic thought is a key concept in Beck’s
cognitive psychotherapy.
 Such thoughts occur spontaneously, without effort or
choice.
 In psychological disorders, automatic thoughts are often distorted,
extreme, or otherwise inaccurate.
Example, Nancy put off applying to department stores for a job as an assistant buyer. Unhappy with her job as a
sales clerk,
she had such thoughts as “I’m too busy now,” “When the holiday season is over,
I will apply for a job,” and “I cannot get time off to go to other stores to get job
applications.” Recognizing these thoughts as excuses,

6. Cognitive Development model
Early
childhood
experiences
Development o
schemas, basic
beliefs, and
conditional belief
Critical
incidents
Automatic
thoughts
Emotions Behaviors
Physiologic
responses

7. COGNITIVE SCHEMAS IN THERAPY
schemas develop
from personal experience and interaction with others.
There are two types of basic cognitive schemas
positive (adaptive)
negative (maladaptive)

8. COGNITIVE CONCEPTUALIZATION
Current
Situation
Automatic Thoughts
About self, world
And others
Physiology
Feelings
Behavior
Childhood
And Early
Life Events
Underlying Assumptions
and Core Beliefs
Compensatory
Strategies

9. EXAMPLE 1
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….”
Physiology
Heart racing
Lump in throat
Feelings
Sadness
Worry
Anger
Behavior
Seek reassurance
Withdraw
Cry
Childhood
Experiences
Parental neglect
and 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
Strategies
Be independent and
you’ll be safe.
Watch out – people
are careless with you.

10. EXAMPLE 2
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.”
Physiology
Pit in stomach
Dry mouth
Feelings
Worry, shame,
Disappointment
Humiliation.
Behavior
Use alcohol,
Procrastinate
with homework
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.

11. COGNITIVE DISTORTIONS
• All-or-nothing thinking. By thinking that something has to be either exactly as
we want it or it is a failure, we are engaging in all-or-nothing, or dichotomous,
thinking.
• Selective abstraction. Sometimes individuals pick out an idea or fact from an
event to support their depressed or negative thinking
• Mind reading. This refers to the idea that we know what another person is
thinking about us
• Negative prediction. When an individual believes that something bad is going
to happen, and there is no evidence to support this, this is a negative prediction.

12. COGNITIVE DISTORTIONS
• Catastrophizing. In this cognitive distortion, individuals take one event they are
concerned about and exaggerate it so that they become fearful.
• Overgeneralization. Making a rule based on a few negative events, individuals
distort their thinking through overgeneralization.
• Labeling and mislabeling. A negative view of oneself is created by self-labeling
based on some errors or mistakes.

13. COGNITIVE DISTORTIONS
• Magnification or minimization. Cognitive distortions can occur when individuals magnify imperfections
or minimize good points
• Personalization. Taking an event that is unrelated to the individual and making it meaningful produces
the cognitive distortion of personalization.

14. 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)
Automatic ThoughtsCore Beliefs

15. 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

16. SAMPLE THOUGHT LOG
Situation Thoughts Emotions Rational
Response
Outcome
Going on vacation—
Ask a colleague to
do some work for
me
She’ll say no…
I’m not doing a good job
The boss thinks I take
too much time off
Anxiety (70%)
Guilt (40%)
Sadness (20%)
Cognitive
Distortions:
All/nothing
Mindreading
Fortune-Telling
Over-generalization
I haven’t taken a
day off in 6 months.
We work as a team,
so it’s also her job to
track the samples.
Anxiety (10%)
Guilt (0%)
Relief (40%)

17. GOALS OF THERAPY
• Remove biases or distortions in thinking so that individuals may function more effectively
Attention is paid to the way individuals process information, which may maintain feelings and behaviors
that are not adaptive
Patients’ cognitive distortions are challenged, tested, and discussed to bring about more positive
feelings, behaviors, and thinking
• Changing cognitive schemas can be done at three different levels
schema reinterpretation

18. THERAPEUTIC PROCESS
Guided
discovery
The three-question technique.
1. What is the evidence for the belief?
2. How else can you interpret the situation?
3. If it is true, what are the implications?
Specifying
automatic thoughts
Homework
Session
format.
Termination.

19. THERAPEUTIC TECHNIQUES
• idiosyncratic meaning. Different words can have different
meanings for people, depending on their automatic thoughts and cognitive
schemas
• Challenging absolutes. Clients often present their distress through making
extreme statements such as “Everyone at work is smarter than I am.” Such statements use
words like everyone, always, never, no one, and all the time
• Reattribution. Clients may attribute responsibility for situations or events to
themselves when they have little responsibility for the event

20. THERAPEUTIC TECHNIQUES
• Labeling of distortions. Previously, several cognitive distortions such as all-or nothing
thinking, overgeneralization, and selective abstraction were described. Labeling such
distortions can be helpful to clients in categorizing automatic thoughts that interfere with
their reasoning
• Challenging all-or-nothing thinking. Sometimes clients describe things as all or
nothing or as all black or all white
• Listing advantages and disadvantages. Sometimes it is helpful for patients to
write down the advantages and disadvantages of their particular beliefs or behaviors

21. THERAPEUTIC TECHNIQUES
• Cognitive rehearsal. Use of imagination in dealing with upcoming events can be helpful
• Decatastrophizing. Clients may be very afraid of an outcome that is unlikely to happen. A technique that
often works with this fear is the “what-if” technique. It is particularly appropriate when clients overreact to
a possible outcome,

22. Assessmentin
CognitiveTherapy
•Interview
•Self-monitoring
•Thought sampling
•Scales and questionnaires.

23. 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)

24. APPLICATIONS OF CBT (CONTINUED…)
• Eating Disorders (1981)
• Marital Problems
• Behavioral Medicine
• Headaches (1985)
• Insomnia (1987)
• Chronic Pain (1988)
• Smoking Cessation
• Hypochondriasis
• Body Dysmorphic Disorder