Cognitive Behavioral Interventions

Cognitive-behavioral treatment (CBT)

This treatment promotes improvement in psychological functioning by correcting maladaptive patterns of thinking and behaving.

Cognitive-behavioral treatment (CBT)

This treatment helps people change how they think and feel about themselves, others, and unpleasant situations they can’t easily control.

problem-solving, communication

Cognitive-behavioral treatment (CBT) fosters better ________, _________, and overall life functioning.

Albert Ellis and Aaron Beck

Pioneers of CBT

Albert Ellis

Developed Rational Emotive Behavior Therapy (REBT) in the 1950s.

Albert Ellis

Pioneered the concept of irrational beliefs as the root of emotional distress

Aaron Beck

Developed Cognitive Therapy in the 1960s.

Aaron Beck

Focused on identifying and modifying distorted thinking patterns (cognitive distortions).

Aaron Beck

Emphasized collaborative empiricism and the testing of negative thoughts.

Cognitive-behavioral treatment (CBT)

This treatment has a strong research support, considered among the most effective psychological interventions, first-line therapy recommendations for numerous DSM disorders, equal or superior efficacy to alternative psychological or psychopharmacological options for many problems in adults and youth.

The Cognitive Model

Situation → Thought → Emotion → Behavior

1. Situation

Something Happens

2. Thought

The situation is interpreted.

3. Emotion

A feeling occurs as a result of the thought.

4. Behavior

An action in response to the emotion.

The ABC Model

Activating Event, Activity, and Adversity

Beliefs

Consequences

1. Activating Event, activity, adversity

This is the situation that happened

2. Beliefs

automatic thoughts, appraisals, perceptions or interpretations of the situation at A

Consequences

emotional and behavioral consequences as a result of B

The Center Role of Cognition

While environment, biology, and learning influence us, cognition (how we think) is the primary driver of emotions and behaviors.

Cognition

Primary Driver of Emotions and Behaviors

Healthy Thinking = Healthy Outcomes

Accurate, balanced thinking leads to positive emotions, adaptive behaviors, and life satisfaction.

Maladaptive Thinking & Distress

Persistent inaccurate or irrational thoughts (e.g., unrealistic standards, negativity bias) lead to emotional distress and problematic behaviors.

Automatic thoughts

These are habitual, often unconscious thought patterns that influence our reactions. They can be positive or negative, and they can affect how you feel and behave.

Types of Automatic Thoughts

Appraisal, Interpretations, Attributions

Appraisals

These are judgments you make about yourself, others, or situations.

For example, you might appraise yourself as being "not good enough" or you might appraise a situation as being "dangerous."

Interpretations

These are the meanings you give to events or situations.

For example, if you see someone walking away from you, you might interpret it as meaning that they don't want to talk to you.

Attribution

These are the explanations you give for why things happen.

For example, if you fail a test, you might attribute it to being "stupid" or "lazy."

Schemas

cognitive frameworks built from our accumulated life experiences and stored in long-term memory, directly influence the formation of automatic thoughts

Peer schema

E.g. Repeated interactions, like those with peers, contribute to specific schemas, such as a ___ ____

automatic thoughts in new situations.

These schemas organize our understanding, shaping expectations and interpretations, which in turn trigger _____ __________ __ ___ ________.

schema

For instance, if a student has a ______ that teachers are critical, seeing a teacher frown might activate the automatic thought, 'They're disappointed in me,' leading to feelings of anxiety and withdrawal.”

schemas

these are cognitive frameworks from our life stored in our long-term memory

Examples of Typical Cognitive Biases and Maladaptive Beliefs in Some Common DSM-5-TR Disorders

Major Depressive Disorder

Generalized Anxiety Disorder

Social Anxiety Disorder

Obsessive-Compulsive Disorder

Panic Disorder

Illness Anxiety Disorder

Major depressive disorder

The tendency to see oneself as a failure, the future as hopeless, and to focus on negative aspects of situations

Generalized anxiety disorder

The tendency to overestimate the probability and severity of a crisis (e.g., losing a job)

Social anxiety disorder

The belief that others are always very critical and that it’s awful to be evaluated negatively.

Obsessive-compulsive disorder

Overestimates of threat and responsibility, beliefs that intrusive thoughts are highly significant and need to be controlled, and the intolerance of uncertainty and imperfection

Panic disorder

The idea that experiencing anxiety is dangerous or harmful (e.g., when my heart beats fast, I worry I’m having a heart attack)

Illness anxiety disorder

Beliefs that one is medically ill (despite a lack of evidence) and that any pain or discomfort is a sign of a serious medical problem

Common types of Dysfunctional or Irrational Beliefs

All-or-nothing thinking

Overgeneralization

Mental Filter

Disqualifying the positive

Jumping to conclusions

Mind reading

Catastrophizing

Emotional Reasoning

“Should” and “must” statements

Labeling and mislabeling

Personalization

Maladaptive thoughts

All-or-nothing thinking

Seeing things in either “black or white: categories

All-or-nothing thinking

“If I don’t get an A in the course, I might as well get an F.”

Overgeneralization

Seeing a single negative event as a never-ending pattern

Overgeneralization

“No one ever wants to be with me.”

Mental Filter

Exclusively focusing on a negative aspect(s) of a situation

Mental Filter

“I ruined the whole presentation because I couldn’t answer one audience member’s question.”

Disqualifying the positive

Rejecting positive experiences by insisting that they do not “count,” for one reason or another

Disqualifying the positive

“Only 25 people ‘liked’ my social media post, so it must not have been witty enough.”

Jumping to conclusions

Making negative interpretations without adequate evidence

Jumping to conclusions

“My doctor wants me to have another test, so there must be something seriously wrong with me.”

Mind reading

Assuming you know what others are thinking without adequate evidence

Mind reading

“She didn’t text me back immediately, so she must be upset with me.”

Catastrophizing

Attributing or anticipating extremely awful consequences to events

Catastrophizing

“If I get anxious and stumble over my words, my boss will think I’m not fit to work here and fire me; then I’ll be unemployed for the rest of my life.”

Emotional Reasoning

Assuming that negative emotions necessarily reflect the situational reality

Emotional Reasoning

“I’m feeling depressed; therefore, I must be seriously flawed.”

“Should” and “must” statements

Endorsing rigid yet arbitrary rules

“Should” and “must” statements

“Professors should give students study guides before every exam.”

Labeling and mislabeling

Taking one behavior or characteristic of oneself (or others) and applying it to the whole person

Labeling and mislabeling

“He won’t go on roller coasters, so he’s just a big wuss.”

Personalization

Entirely blaming oneself, or someone else, for a situation that involved many factors or was out of your control

Personalization

“If I had been on time, she wouldn't have had to run down the stairs, so it’s completely my fault that she fell and broke her leg.”

Maladaptive thoughts

Endorsing thoughts that are not necessarily irrational or distorted, but are nevertheless unproductive or unhelpful

Maladaptive thoughts

“It’s not fair that social situations are so much harder for me than other people.”

“Malas ako.”

“When something good happens, it will be followed by a negative event.”

Treatment Implications of ABC Model

Changing Thinking (B) Over Circumstances (A)

Rational Thinking vs. Positive Thinking

Accepting Negative Emotions

Unconditional Self-Acceptance

Changing Thinking (B) Over Circumstances (A)

CBT prioritizes modifying maladaptive thinking patterns (B) as the primary way to manage emotional distress, rather than solely focusing on changing uncontrollable external situations (A).

Rational Thinking vs. Positive Thinking

CBT emphasizes rational thinking, which objectively considers all evidence, over simplistic positive thinking that may ignore crucial, albeit unpleasant, realities.

Accepting Negative Emotions

CBT acknowledges that experiencing negative emotions is a normal and sometimes adaptive part of life, distinguishing between healthy, constructive negative emotions and destructive, debilitating ones.

Unconditional Self-Acceptance

CBT promotes viewing oneself as inherently worthy, regardless of flaws or negative experiences, fostering a sense of self-acceptance that is separate from one's actions or circumstances.

ABCDE Model

A - Activating Event

B - Beliefs

C - Consequences

D - Disputation

E - Effective New Beliefs

A - Activating Event

This is the trigger, the event or situation that sets off a chain of thoughts and feelings. It's "what happened."

B - Beliefs

These are the thoughts and interpretations that arise in response to the activating event. They can be rational or irrational, helpful or unhelpful.

C - Consequences

These are the emotional and behavioral outcomes that result from the beliefs. They are the feelings and actions that follow.

D - Disputation

This is the process of challenging and questioning the irrational or unhelpful beliefs. It involves examining the evidence and considering alternative perspectives.

E - Effective New Beliefs

This refers to the development of more rational and helpful beliefs that replace the original, unhelpful ones. It also refers to the new emotions and behaviors that follow those new beliefs.

Applications of CBT

Depression

Anxiety

PTSD

Panic attacks

Eating and sleeping disorders

Childhood attentional and conduct problems

Anger and impulse control problems

Problems with addiction and substance use

(and many more ... )