Cognitive Behavior Therapy


Author: Shumaiza Iqb


Cogitive Beviour therapy (CBT) is a combination of cognitive and behavioural therapeutic approaches to deal the dysfunctional thoughts, emotions and maladaptive behaviour through a specific goal-oriented and systematic procedure. The revolution of the cognitive behavioural therapy in the field of psychotherapies was first introduced by the Aron Beck in the 1960s, and he originally named this therapy as ‘Cognitive Therapy’ but later on with modifications it turned into ‘Cognitive behavioural therapy’. Beck first introduced CBT on depression patients as short-term, structured and person oriented. CBT is based on the assumptions-the way the people behave, that depends on their thinking pattern. It is a self-help strategy that teaches the people how to control over their thoughts, feelings and behaviours and helped them to challenge and overcome their automatic believe by useful strategies to change and modify into positive thoughts and behaviour (Clark & Beck, 2010).
In Cognitive Behavioral Therapy (CBT) therapist have to care about the good ‘Therapeutic Alliance’ that play a great role in the treatment of the client. For therapeutic alliance therapists should care about their good counselling skills and understandings with the client’s problem, sharing the conceptualisation of the client’s problem and treatment plan with them as well as making collaborative decisions with them (Williams et al., 2017).
Effectiveness of the CBT based on the through assessment or evolution from the birth to the current state of the client. Therapist’s formulation of the problem, case conceptualisation and the treatment plan all depends on the assessment sessions. Once a therapist went through all the phases of the client’s history deeply, then it’s easier to manage a client effectively. Therapeutic alliance palys more important role in taking a history from the client as it was more personal and not easy to share more crucial things of once life with anyone else. The assessment process is not restricted to the initial sessions, but it continues in all the sessions as with more therapeutic alliance a client able to open up their more problems with the therapist then these will be added into the client’s formulation, case conceptualisation and treatment plans(Khanna & Kendall, 2010).
    CBT mainly based on the ‘Cognitive Model’ by which a therapist assess the people emotions, behaviour and physiology depend on its perception or response of events.
Cognitive Model


In the cognitive model, the interpretation of the situation is much more important as in the same situation every person interpret the situation in different ways, and this interpretation leads the person to react emotionally, behaviorally and physically different. Sometimes, people’s reaction did not depend on the exact situation, but it depends on the perception of that situation that already has it in their mind. CBT practitioners mainly were interested in particular level of thinking-automatic thoughts(Real images, actual words that a person have in his mind about a particular situation are known as automatic thoughts) and worked on that thinking level for dealing a person’s problem(Wright, Basco&Thase, 2016).
Besides, automatic thoughts people develop certain images or ideas about themselves, others and about the world that is mostly linked from their childhood. These ideas or beliefs are worked for the person as absolute truth, and the person did not want to articulate these beliefs. These beliefs known as central or core beliefs as these are more rigid, universal and overgeneralized for the person. Automatic thought arises from these core beliefs. As core beliefs developed in childhood and it leads to some rules and assumptions about a particular situation. These assumptions are common beliefs that exist between core beliefs and automatic thoughts (Williams et al., 2017).


CBT helps the person to think about these construct, and when a person able to know about their beliefs, they can understand and interpret about the threatening situation or their problem in a more reasonable way. After assessing the person’s problem, a CBT therapist works on these beliefs for increasing the efficacy of the problem. As when a person himself know about the main cause of this problem, he can understand the onset of a problem and deal with it quickly and with more mannerable way. Through repeated experiences of getting relief by working on their beliefs, a person able to work and evaluate deeply on their beliefs and change their perceptions with the help of CBT therapist. Deeply evaluation and change of the beliefs makes the person to relapse into their problem less frequently(Wright, Basco&Thase, 2016).
    Cognitive conceptualisation can be thought by the therapist by explaining the hierarchy of the relationship of the behaviour to the automatic thoughts.

In CBT, Structure of the sessions also took an important part in treating the client effectively. Initial therapy sessions will be different from the management therapy session because initially, the main therapist focuses on the assessment and evaluation of the client while the management therapy session emphasis on treating the client effectively. Session’s duration will be 40-45 minutes that is divided into three parts. Agenda setting, mood check of the client, obtaining an update, disusing the diagnosis and psychoeducation, homework checking includes in the first part of the therapy session. In central part problem, identification, goal settings, discussion on the problem will be included whereas in the end part therapist provide a summary of the session to the client, review of the homework assignment and then getting feedback from the client. Collaborative work between the therapist and the client and the home assignments are crucial parts in CBT treatment(Kuyken, Padesky, & Dudley, 2009).
Cognitive model based on the cognition of a person, so it’s important to teach thought process so that the person can easily elicit their automatic thoughts that leads them to specific psychological problems. CBT therapist collaboratively works with the person to teach how they can elicit their automatic thoughts and how automatic thoughts lead the change in behaviour, emotions and physiology. Sometimes clients easily understood their automatic thoughts and elicited them, but sometimes it’s the most difficult task for the CBT therapist. To teach the clients how they can elicit their problematic automatic thought therapist use different ways like role-playing, asking about specific situations, imaginary, changing questioning techniques etc. Evaluations and differentiation of the emotions from automatic thoughts is the next step in the cognitive model(Clark & Beck, 2010).
Evaluation of the automatic thoughts comes after the differentiation of the emotion. Teaching cognitive errors, self-closure and using alternative questionings are the techniques that a therapist used to teach the evaluation of the client. After the evaluation either client’s automatic thoughts are true or not CBT therapist teach them identifications cognitive errors, i.e. all and none thinking, metal filter, personalization, labelling, magnification, mind reading, catastrophizing, discontinue the positives etc. by which  the clients able to understand where their automatic thoughts are to be distorted and how they can manage these thoughts. Once clients competent to evaluate the true automatic thoughts, then problem-solving techniques will be thought to the clients so that they can quickly evaluate their thinking in future if their thinking will be problematic (Kuyken, Padesky, & Dudley, 2009).