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Cognitive Behavioural Theory (CBT) in psychology


"Men are disturbed not by things, but by the view they take of them."
  
This quote by philosopher Epictetus captures the essence of Cognitive Behavioural Theory (CBT). Cognitive/cognition refers to mental processing i.e. thoughts, thinking and interpreting life events. Cognitive Behavioural Theory, as the name suggests, is a theory about how thoughts shape behaviour and vice versa.

There’s also a third component to the theory- feelings. CBT explains how these three components- thoughts, feelings and behaviours of an individual interact with each other.

CBT focuses mainly on how certain thoughts lead to certain feelings which, in turn, lead to certain behavioural responses. According to CBT, thoughts are changeable and by changing thoughts we can change our feelings and, ultimately, our behaviours.

It also works in reverse. Changing our behaviours can also lead to changes in how we feel and ultimately how we think. So even though feelings cannot be directly manipulated, they can be indirectly changed by changing our thoughts and behaviours.

CBT components

Cognitive Behaviour Therapy

If we can change our feelings by changing our thoughts, then the CBT approach can be a useful way to help someone overcome their bad feelings. The basic assumption in this therapy is that psychological distress is caused by inaccurate thinking aka cognitive distortions.

These cognitive distortions cause people to lose touch with reality and they torture themselves psychologically with self-created falsehoods. The goal of Cognitive Behavioural Therapy is to fix these faulty thinking patterns and bring back people to reality. This reduces psychological distress because people realize that they were wrong in how they were interpreting their life situations.

The distorted ways in which people perceive reality tends to have a sort of inertia and reinforcement associated with them. Psychological distress tends to be self-reinforcing because, under its influence, people are likely to misinterpret situations in ways that confirm their faulty perceptions. 

CBT breaks this cycle by presenting the person with information that disconfirms their faulty perceptions.

CBT aims to overcome psychological distress by attacking the beliefs that form the basis of that psychological distress and providing an opportunity to explore alternate ways of thinking that reduce psychological distress. 

In other words, CBT helps people reframe their negative life situation to allow them to interpret it in a neutral or even positive manner.


Cognitive Behaviour Therapy techniques

1. Rational Emotive Behaviour Therapy (REBT)

Developed by Albert Ellis, this therapy technique focuses on turning irrational beliefs that cause psychological distress into rational ones. Based largely on their past experiences, people tend to hold irrational assumptions about themselves and the world around. Their actions and reactions to life situations tend to be governed by these irrational beliefs.

REBT shows people that their beliefs don’t hold much water when examined thoroughly and tested against reality. In CBT, a change in one component brings about a change in the other two components. When people change their negative beliefs, their feelings change and their behaviours change. 

For example, perfectionists tend to believe they have to do everything perfectly in order to be successful. This makes them hesitant to try anything so as to avoid imperfection. This belief can be challenged by showing them examples of people who weren’t perfect and yet ended up becoming successful.

The ABC model

Say a person starts a business but it fails. They might start believing they’re worthless and end up getting depressed. Now being depressed because the business failed is a natural emotional response that motivates us to re-evaluate our strategies. But being depressed because of thinking you’re worthless is unhealthy and that's what CBT tries to fix.

By challenging the person’s belief that they’re worthless, like bringing their attention to past achievements, alleviates depression arising from a loss of self-worth. To overcome the depression caused solely by the loss of the business (where the person’s self-worth remains intact), starting a new business could be helpful. No amount of CBT can convince this person that their loss isn’t significant.

This subtle difference is what the ABC model of CBT tries to get at. It states that a negative event can have two consequences. It’ll either lead to an irrational belief and an unhealthy negative emotion or a rational belief and a healthy negative emotion.

A = Activating event
B = Belief
C = Consequences
Cognitive behaviour ABC model
2. Cognitive therapy

Cognitive therapy helps individuals see through the logical errors that they make in interpreting their life situations. The focus here is not so much on irrationality vs. rationality, but on positive thoughts vs. negative thoughts. It tries to fix the negative thoughts that people have about themselves, the world, and the future- called the cognitive triad.1 

CBT Cognitive triad
Beck's cognitive triad of depression in Cognitive Therapy

Aaron Beck, who developed this CBT approach, noted that depressed individuals were often stuck in this cognitive triad. Depression distorts their thinking making them focus only on everything that's negative about them, the world and the future.

These thought processes become automatic for the person and as soon as they encounter a negative situation, they again get stuck in the cognitive triad, repeating how everything is negative like a broken record.

Roots of automatic negative thoughts

Beck pointed out that the automatic negative thoughts that feed the negative cognitive triad arise from past traumas. Experiences such as being abused, rejected, criticized, and getting bullied shape how people perceive themselves and the world around them.

People develop self-expectations or self-schemas which get reinforced by their distorted perceptions. They make logical errors in their thinking such as selective abstraction i.e. focusing only on a few aspects of their experiences and arbitrary inference i.e. using irrelevant evidence to draw conclusions.

The end goal of these cognitive distortions is to maintain an identity that was formed in the past, even if it means perceiving reality incorrectly.


3. Exposure therapy

In the beginning of this article, I mentioned that while feelings can’t be directly changed, thoughts and actions can be. So far, we’ve been discussing CBT’s role in helping people change their irrational thoughts to change their undesirable feelings and behaviours. Now we discuss how changing actions can lead to a change in feelings and thoughts.

Exposure therapy is based on learning, and despite logically following from CBT premises, existed long before CBT. It has proven to be very effective in helping people overcome and cope with social anxiety, phobias, fears and PTSD.

Raj has a fear of dogs because he was chased by them when he was a kid. He can’t get close to them, let alone touch or hold them. So, for Raj:

Thought: Dogs are dangerous.

Feeling: Fear.

Action: Avoiding dogs.

The reason why Raj avoids dogs is because avoidance helps him maintain his belief that dogs are dangerous. His mind is trying to stick to the previous information. In exposure therapy, he’s repeatedly exposed to dogs but in a relatively safe environment. This new behaviour disconfirms his previous behaviour of avoiding dogs.

Therefore, his previous feelings and thoughts associated with the behaviour also change when the therapy is successful. He no longer thinks dogs are dangerous nor feels fear when he’s near them.

Before the therapy, Raj’s mind had overgeneralized one incident of dogs attacking him to all his future interactions with dogs. When he’s exposed to dogs, he experiences the same stimulus but in a safer context. This allows his mind to differentiate his current experience from the past traumatic event.

Instead of seeing his past traumatic event as the reality of how things are with dogs, he begins to realize that his past traumatic event isn’t always how things are. This way, he overcomes his cognitive distortion of overgeneralization.

Exposure therapy teaches a person that avoidance is no longer necessary to reduce anxiety. It provides a corrective cognitive experience of the trauma-related stimulus.2

online therapy

Limitations of Cognitive Behavioural Theory

CBT has proven to be effective in alleviating the symptoms of anxiety and depression.3 It’s the most widely researched therapy and is recommended by top mental health organizations. However, critics of CBT argue that it confounds the symptoms of the disorder with its causes.

In other words, do negative thoughts lead to negative feelings or do negative feelings lead to negative thoughts? The answer is that both these phenomena occur but our minds cannot readily accept this answer because we tend to think in 'either this or that' manner.

The relationship between thoughts, feelings and actions is two-way and all the three factors can affect each other in either direction.

Other critics point out that CBT fails to address the root cause of problems that have their origins in traumatic childhood experiences. They deem CBT as a “quick-fix” solution that doesn’t have long-term psychological benefits.

At the end of the day, feelings are signals from our minds that must be addressed, negative or positive. Any attempt to ignore negative emotions or distract yourself from them is going to fail. CBT does not encourage that. It contends that negative emotions are ‘false alarms’ that are needlessly triggered by distorted thoughts.

This position of CBT is problematic because, many times, feelings are not really false alarms that need to be snoozed but helpful signals asking us to take appropriate action. But CBT predominantly sees negative emotions as false alarms. You could say CBT needs CBT to fix this distorted view.

When dealing with feelings and using the CBT approach, the first step should be trying to understand where the feelings are coming from.

If the feelings are indeed false alarms triggered by false thoughts, then those thoughts need to be corrected. 

Inferring and understanding causation of behavioural phenomena is often complex so our minds look for shortcuts to attribute causation to such phenomena. 

Therefore, the mind sees it best to err on the side of safety until more information is available. A negative situation represents a threat and we are quick to think negatively about situations so that we quickly know we're in danger. Later, if the situation does turn out to be dangerous, we’ll be more prepared.

On the other hand, when negative feelings aren’t triggered by false alarms, they should be seen as accurate alarms. They’re there to warn us that ‘something is wrong’ and that we need to take action to fix it.

CBT allows individuals to fix their false alarms by providing them with something called cognitive flexibility. It’s a key thinking skill to learn if one wants to manage their emotions and become more self-aware. Here’s how it works:

You have a negative thought and you feel a negative emotion. Immediately question your thought. Is what I am thinking true? Where’s the evidence for it? What if I’m interpreting this situation incorrectly? What are the alternative possibilities? How likely is each possibility?

Sure it takes some cognitive effort and considerable knowledge of human psychology but it’s worth it. You’ll become more self-aware and your thinking will become more balanced. Balanced thinking doesn't happen automatically. It needs to be learned and CBT can greatly help with that.



References:

1. Beck, A. T. (Ed.). (1979). Cognitive therapy of depression. Guilford press.

2. González-Prendes, A., & Resko, S. M. (2012). Cognitive-behavioral theory. Trauma: Contemporary directions in theory, practice, and research, 14-41.

3. Kuyken, W., Watkins, E., & Beck, A. T. (2005). Cognitive-behavior therapy for mood disorders.


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