There are certain CBT principles that apply to all patients irrespective of their conditions.
- CBT Can Be Tailored
- CBT Requires a Sound Therapeutic Alliance
- CBT Focuses on Problem and Sets Goals
- CBT Stresses At First On Present
- CBT is Educative
- CBT is Time-Bound
- CBT Sessions are Structured
- CBT Teaches Patients To Recognize, Assess, and Respond To Dysfunctional Thoughts
- CBT Uses a Number of Techniques to Change Behavior
- CBT Lays Stress On Collaboration and Active Participation
CBT Principle 1: Cognitive Behavioral Therapy Can Be Tailored
CBT Therapy is based on the ever-evolving formulation of a patient’s problems. In addition to this, it also involves individual conceptualization of each patient in cognitive terms.
CBT Case Conceptualization Example
Let’s consider Amara’s example. Amara currently thinks that she is a failure and cannot do anything right. She feels that she can never be happy. As a result, she isolates herself and spends a lot of unproductive time in her room. Also, she doesn’t ask anyone to help her out.
Moreover, Amara has a tendency to credit luck over her personal strengths and achievements. In addition to this, she considers her weaknesses to represent her true identity.
CBT Case Conceptualization
As you can see, Amara’s current thinking is the primary reason for her sadness. She believes that she is a failure and can never be happy. This sort of thinking is contributing to a great extent towards her sadness.
Besides this, she isolates herself in her room and spends a great deal of unproductive time there. Thus, this is a part of her Problematic Behaviors. Such behaviors come from and also reinforce her Dysfunctional Thinking.
Then, there are certain precipitating factors that compel Amara to hold a negative perception about herself right at the beginning.
For instance, she was away from home for college for the very first time. Moreover, she was facing a lot of challenges with her studies. All of this contributed to her belief that she is incompetent and cannot perform well.
Finally, we can presume that her significant developmental events and her enduring patterns of interpreting these events. These interpretations may be responsible for making Amara vulnerable to depression.
Now, you come to conceptualize all this about Amara based on the data that Amara provides during the Evaluation Sessions. Furthermore, as a therapist, you also base your conception about Amara on the cognitive formulation of depression.
Also, you continue to enhance this conceptualization with the help of new data you get in each of the evaluation sessions. Then, as a therapist, you share this Conceptualization with Amara to ensure that she validates it.
In addition to this, you also help Amara throughout Cognitive Therapy to see her experience through the cognitive model.
For instance, Amara learns to identify the thoughts that make her depressed. Furthermore, she also assesses and formulates more adaptive responses to her thinking.
All this helps Amara to improvise on her feelings and behave in a more functional manner.
CBT Principle 2: Cognitive Therapy Requires a Sound Therapeutic Alliance
It’s extremely important for you as a therapist to have a therapeutic relationship with your patients during Cognitive Behavior Therapy. This is because the patients always have little difficulty in trusting and working with you as a therapist.
Thus, you must showcase all that is required for counseling a patient. This includes empathy, warmth, caring, genuine regard, and competence.
Furthermore, as a therapist, you must make empathic statements, listen carefully, and precisely summarize your patient’s thoughts and feelings. This would showcase your regard for your patient.
In addition to this, you must also specify the small and large achievements of your patient. And you must also maintain a realistic but cheerful look.
Finally, you must take the feedback of your client after each session ends. This is important as it ensures that your patient feels there is someone to understand her and also feel positive about the session.
Also Read: 20 Best Light Therapy Lamps of 2021
CBT Principle 3: Cognitive Behavior Therapy Lays Stress On Collaboration and Active Participation
Cognitive Behavior Therapy involves teamwork. This means both the therapist and the patient decide the areas on which they are going to work in each session.
Furthermore, they also need to discuss the frequency of their meetings and what the patient can do between sessions for cognitive therapy homework.
In the beginning, the therapist is more active in giving suggestions. These suggestions pertain to giving a direction for the therapy sessions. Furthermore, the therapist also summarizes whatever is discussed in the CBT Therapy session.
Eventually, the therapist encourages the patient to become more active in the CBT Therapy session. This is done when the patient becomes less depressed and engages more socially in the treatment.
Thus, the patient can decide the problems she needs to discuss, recognize distortion in her thinking, summarize the key points, and design the homework assignments.
CBT Principle 4: Cognitive Behavior Therapy Focuses on Problem and Sets Goals
In Cognitive Therapy, the patient specifies his or her problems and sets specific goals in the first session. This is done so that both the therapist and the patient understand what the patient is working towards?
Let’s consider Amara’s example. Amara states in the Evaluation Session that she feels isolated. Then, she states a goal in behavioral terms with the help of the therapist.
Her goal is to develop new friendships and spend more time with her current friends. Then, the therapist helps the patient to assess and respond to her thoughts that challenge her not to achieve her goal. Say, the patient thinks that her friends don’t want to hang with her as they think she is boring.
So, as a therapist, the first thing that you need to do is to help your patient assess the potency of these thoughts. How? Well, you can help her analyze the evidence.
This way, the patient may be willing to test her thoughts through undertaking behavioral experiments. Like, she can make plans with her friends and test her own dysfunctional thoughts.
So, this way, your patient is able to reduce her isolation as she identifies and corrects her dysfunctional thinking.
CBT Principle 5: Cognitive Behavior Therapy Stresses At First On Present
As a Cognitive Behavioral Therapist, you have to focus on the current problems and specific situations that are distressing your patient during his or her treatment.
For instance, your patient would start feeling good once she responds to her negative thinking and starts taking steps to enhance her life.
Thus, CBT Therapy begins with studying the here-and-now problems of your patient. This is regardless of what the diagnosis presents.
Remember, you need to focus on your patient’s past in two scenarios. First is when your patient compels you to do so. Here, there is a chance of endangering your therapeutic alliance with your patient if you fail to pay attention to your client’s past events.
The second situation is when you get stuck in the dysfunctional thinking of your patient. This is when an understanding of the childhood events of your patient would help you to change your patient’s rigid thoughts.
For instance, you can help your patient to recognize the set of beliefs that she learned as a child. Like, your patient may have learned as a child that she would be worthwhile only if she achieves highly. And she would be a failure if she doesn’t achieve highly.
Thus, as a Cognitive Behavior Therapist, you can help your patient to assess the validity of such beliefs both in the past and the present. This would help your patient to develop more functional and reasonable beliefs.
However, you could discuss your patient’s developmental history, childhood beliefs, and coping behaviors if she had a Personality Disorder.
CBT Principle 6: Cognitive Behavior Therapy is Educative
Cognitive Therapy aims to teach the patient to be her own therapist. This prevents the recurrence of distorted thinking in your patient.
For instance, you can educate your patient about the nature and course of her disorder in the first session of CBT Therapy. Additionally, you can also teach her about the process of Cognitive Behavior Therapy and the Cognitive Model.
In other words, you can educate your patient on how her thoughts can influence her emotions and behavior. Thus, you could not only help your patient set goals, but also identify, and evaluate her thoughts and her beliefs.
In addition to this, you could also plan a behavioral change and teach your patient how to bring about such a change.
Also, make sure that your patient takes home some therapy notes or any important ideas she had learned during the session. Remember, that your patient could benefit a great deal from her new understanding in the coming weeks as well as the time after her treatment ends.
CBT Principle 7: Cognitive Behavior Therapy is Time-Bound
It is important to note that many patients with anxiety and depression disorders are treated for 6 to 14 sessions. In these sessions, the cognitive therapist aims to provide symptom relief and help the patient in the acquittal of the disorder.
In addition to this, the therapist also helps the patient to resolve their most urgent issues and teaches her skills to avoid a recurrence of the disorder.
However, you can increase the frequency of the sessions in case you believe that your patient’s condition is severe or is suicidal.
Then, you could mutually agree to take up biweekly sessions, say, after two months of therapy. Following this, you could go for monthly sessions. Furthermore, you also plan for periodic booster sessions after every 3 months for a year once the CBT Therapy sessions terminate.
Remember, not all patients showcase speedy recovery in just a few months. Some patients need 1 or 2 years of Cognitive Therapy to modify their dysfunctional beliefs and patterns of behavior that result in chronic stress. While others may even take longer to bring about such a change.
And there may be patients with severe mental disorders who are in need of periodic treatment for a long period of time to achieve stability.
CBT Principle 8: Cognitive-Behavior Therapy Sessions are Structured
Following a specific structure in each of the CBT sessions maximizes the efficiency and effectiveness of the CBT treatment. Thus, each CBT session must have a specific structure regardless of the diagnosis and the stage of treatment.
Now, the structure includes the following elements:
- An Introduction including week review, mood check, and mutually setting the agenda for the session
- The Middle section including reviewing homework, discussing problems on the agenda, setting new homework, and summarizing
- Lastly, the Final part including asking for feedback from the patient
Thus, such a structure makes the process of CBT Therapy more understandable to the patient. Moreover, it increases the chances that they may engage in self-therapy after the treatment terminates.
CBT Principle 9: Cognitive Behavioral Therapy Teaches Patients To Recognize, Assess, and Respond To Dysfunctional Thoughts
Your patients can have innumerable automatic thoughts in a day that impact their mood, behavior, and physiology.
As a Cognitive Behavior Therapist, you help your patients to recognize the significant cognitions. Furthermore, you also help them to have more realistic and adaptive perspectives.
Such perspectives would help your patients to feel better emotionally, behave more functionally, and reduce their physical arousal.
Now, you may be wondering how this change occurs? Well, your patients adopt change in perspectives through the Guided Discovery process.
Guided Discovery is a process in which the patient adapts a new perspective using ‘Questioning’ to evaluate their thinking. This process does not include persuasion, debate, or lecturing.
Besides this, as a therapist, you also create experiences for your patients so that they can directly test their thinking. These experiences are ‘ Behavioral Experiments’.
Thus, you engage in collaborative empiricism with your patients using the above-mentioned processes.
Remember, as a therapist, you cannot know in advance the degree to which your patients’ automatic thoughts are valid or invalid.
However, you could collaborate with your patients and test their thinking in order to develop more helpful and accurate responses.
Cognitive Behavioral Therapy Example
Let’s consider Amara’s example. Amara had a lot of automatic thoughts throughout the day when she was depressed. Now, Amara could report a few of these thoughts instantaneously.
However, you can ask her about what’s going on in her mind when she is upset to know the other set of thoughts she didn’t report.
Thus, you could discuss Amara’s specific problems to identify other important automatic thoughts. Further, you can check for the validity and utility of those thoughts collaboratively with Amara.
Say, for instance, you can ask Amara to summarize her new viewpoints and make a note of them in writing. Thus, Amara could read these notes about adaptive responses throughout the week. This would help Amara to prepare for the automatic thoughts.
Remember, you need not encourage your patient to adopt a positive viewpoint or challenge the validity of her automatic thoughts. Furthermore, you should also not try to convince your patient that her thoughts are unrealistically pessimistic.
Instead, you should collaborate with your patient to explore the evidence of her dysfunctional thinking.
CBT Principle 10: Cognitive Behavior Therapy Uses a Number of Techniques to Change Behavior
Cognitive Therapy uses a variety of techniques to change the thinking, mood, or behavior of your patient. And some of these techniques like Socratic Questioning and Guided Discovery play an important role in CBT therapy.
However, behavioral and problem-solving techniques are of utmost importance. In addition to this, the techniques from other orientations implemented within a cognitive framework are also equally important.
In other words, CBT Therapy can vary significantly according to the individual patients.
Furthermore, Cognitive Therapy may also vary depending on the nature of challenges that the patients face and their stage of life.
Besides this, an individual’s developmental and intellectual level, gender, and cultural background may also influence Cognitive Behavior Therapy.
Not only this, Cognitive Behavioral Therapy varies depending on the following factors:
- Patient’s goals
- The patient’s ability to form a strong therapeutic bond
- Patient’s motivation to change
- His previous experience with Therapy, and
- Patient’s preferences for treatment
In addition to this, the patient’s particular disorder also influences the CBT Therapy treatment. But the basic principles underlying CBT Treatment remain the same.
What is CBT Therapy?
Cognitive Behavioral Therapy in Psychology is an intensive, short-term, and problem-oriented approach.
In such an approach, both the therapist and the patient work together to identify and understand the problems. They study the problems in the context of the relationship between thoughts, feelings, and behavior of the patient.
The focus of CBT Therapy is on the here-and-now. In other words, cognitive therapy focuses on the problems that a person faces in his or her day-to-day life. It is a form of cognitive psychotherapy intending to solve a person’s current problems.
Furthermore, this approach modifies the person’s dysfunctional thinking and behavior.
Now, let us consider a hypothetical example to understand various CBT Principles underlying Cognitive Behavior Therapy.
Cognitive Behavioral Therapy Example
Amara is a 20-year-old girl who goes to college and is undergoing depression and anxiety treatment. She developed symptoms of depression and anxiety soon after joining the college.
As a result, the following were the symptoms that Amara was undergoing:
- Emotional Symptoms: Sadness, Anxiety, Loneliness, Loss of Pleasure
- Cognitive Symptoms: Pessimism, Self-Criticism, Difficulty in Concentrating and Making Decisions
- Behavioral Symptoms: Avoiding Challenging Situations like Talking to Roommate, Social Withdrawal
- Physiological Symptoms: Fatigue, Loss of Energy, Disturbed Sleep, Lowered Libido, Crying
Now, Amara’s depressive disorder increased because she left home for college first time and had challenges studying. Thus, her anxiety interfered with effective studying and eventually, she became self-critical.
In addition to this, her social withdrawal and isolation contributed to her low mood.
Now, the current challenge that Amara is facing in college is that she is finding difficulty in studying. When she attempts to study, she gets automatic thoughts like ‘I can’t do this, ‘I am a Failure’, etc. Moreover, she has a negative self-image.
Thus, all of this compels her not to focus on her studies and hence she lies on her bed. Besides this, Amara also has a tendency to see herself as incompetent. She was never amongst the brightest students during her school days. Though her performance as a student was above average.
Academic success was important to her and hence she had developed certain assumptions like I’ll fail etc. So she used to study extremely hard to compensate for such thoughts. And her beliefs about other people were always positive.
So, considering this example, let’s understand what are the basic principles of Cognitive Behavioral Therapy.
Let’s take Amara’s example again. As a Cognitive Behavior Therapist, you use Gestalt-inspired techniques to help Amara. Through these techniques, you try to help Amara understand how her experiences with her family contributed to her belief that she is incompetent.
Thus, as a therapist, the following things would influence the types of Cognitive Behavioral Techniques that you would select:
- Your conceptualization of your patient
- The Problem that you would be discussing, and
- Your objectives for a CBT Session
Cognitive Therapy involves individual conceptualization of each patient and requires you to have a therapeutic relationship with your patients. In CBT, both the therapist and the patient decide the areas on which they are going to work in each session. Furthermore, you have to focus on the current problems and specific situations that are distressing your patient during his or her treatment. And you have to teach your patient to be her own therapist. Finally, you need to follow a specific structure in each of the CBT sessions to maximize the efficiency and effectiveness of the CBT treatment.
Also Read: Best Paint By Numbers Kit for Stress Relief
Need To Talk To A Therapist? Consider These Online Therapy Programs!
* Basic Package @ $31.96 per wk
* Standard Package @ $47.96 per wk
* Premium Package @ $63.96 per wk
* Silver Package @ $67.95
* Gold Package @ $97
* Platinum Package @ $97