Cognitive Behavior Therapy, or CBT, is a widely used, evidence-based, and proven therapy that many clinicians use for clients with depression, anxiety, and trauma to name a few things. Cognitive Behavior Therapy, founded by Aaron T. Beck, also possesses a handful of variations, therapies of which hold the basics of CBT, but have been altered slightly for differing presenting concerns. This can be seen with Trauma-Focused Cognitive Behavior Therapy, as well as Dialectical Behavior Therapy and Rational Emotive Behavior Therapy.
In this post, the basics of CBT will be discussed, as we break down the foundations of the therapy that assists our clients, and potentially ourselves, in overcoming barriers to a higher quality life. The foundation of CBT is with the Cognitive Model, and will be illustrated shortly.
A good overview is illustrated as follows:
In terms of the provoking situation, or the antecedent, the individual is triggered by some environmental stimulus. This could be anything, from hearing fireworks on July 4th (in the United States), to being yelled by a significant other. This situations result in the progression of the following sequence. It’s important to note, situations do not have be negative. As social workers, however, we primarily work with events, thoughts, feelings, and behaviors that are counterproductive or unhealthy coping mechanisms. Our aim is to assist individuals to live healthier and higher quality lives. The process of CBT can just as easily be seen with positive thoughts, feelings, and behaviors.
When an situation occurs, a person first, and very quickly, has an Automatic Thoughts. Automatic thoughts happen so fast we may not realize we even had a thought or what that thought was. They are spur of the moment. Some examples include:
– I’m never going to pass!
– I’m an idiot!
– I look fat.
– I don’t care about them!
– He hates me!
– They think I’m crazy.
The automatic thoughts we have from a given event or situation is based on further, deeper thoughts and beliefs known as Intermediate Beliefs and Core Beliefs. Intermediate Beliefs are deeply rooted rules, assumptions, and attitudes we hold about life and how we should be living. The following are examples:
Attitude – It is wonderful to succeed! You’re ugly if you’re fat!
Rule – Work hard if you want to be successful. Stop eating if you want to lose weight.
Assumption – If I work hard everyday, I will succeed. If I stop eating and run for two hours, I can be pretty.
Core Beliefs influence how Intermediate Beliefs are developed, and further effect the string of thoughts, feelings, and behaviors after the antecedent. These are the ultra-deep thought processes. These are the significantly broad and overgeneralized statements individuals possess about themselves. Core Beliefs encompass the rules and attitudes we hold (our Intermediate Beliefs), influence our Automatic Thoughts, and ultimately our feelings and reactions to a given event or situation. Examples of core beliefs are as follows:
I am incompetent. I am unlovable.
After having an Automatic Thought about a provoking event or situation, we then begin to have and maybe notice those feelings and emotions. Sadness, frustration, joy, confusion, fear, angst, anger, etc.
Reaction (Behavior, Physiological)
These thoughts and feelings turn into a reaction. This includes a behavior, something that a person physically does or says, as well as a physiological reaction. A reaction to an event could include yelling, slamming a door, or an increased heart rate.
With this overview of the Cognitive Model, I hope you have a better understanding of what the goals are when working with clients and using Cognitive Behavior Therapy. It is with this understanding that we can begin to work with our clients effectively, and begin to have an idea on why people do the things they do.
Laura Swanson, BSW
Cognitive Behavior Therapy Basics and Beyond, 2nd Edition. 2011. Judith S. Beck.