Born in Providence, Rode Island, on July

18, 1921
Young Aaron developed a near fatal
illness following an infection of a broken
arm, which led him to be anxious and to
believe that he was inept and stupid
Later, his theory and therapy would help
others to overcome the types of negative
beliefs that he himself experienced
He graduated from Brown University
magna cum laude in 1943

The Yale school of medicine granted him

the M.D. in 1946, and the American Board
of Psychiatry and Neurology certified him
in psychiatry in 1953
He received training in psychoanalysis in
from the Philadelphia Psychoanalytic
Institute
He studied depressed peoples dreams,
then Beck hypothesized that their dreams
would contain more hostility than those
nondeppressed peopleInstead their
dreams reflected three common themes:
defeat, deprivation, and loss (1991).

While he psychoanalytically treating a

patient, He discovered that, in spite of
the instruction to free-associate, the
patient was not sharing with him certain
thoughts that preceded and
responsible for her feelings
Prior to feeling anxious, her client had
the thought , I must be boring him.
Soliciting and focusing on these fleeting,
unreported, involuntary thoughts led
him to identify in his patients specific
cognitive patternspreconscious
internal communication systems that
frequently distorted reality yet affected
emotions and behaviors

He began to believe that

depressed people did not seek
failure; rather they distorted reality to
the point where they could not
recognize success when it
happened (Greenberg, 1981).
Aside from his teaching duties at the
University of Pennsylvania, Beck has
researched issues such as
depression, suicide, anxiety and
panic disorders, substance abuse,
marital problems, and personality
disorders

Aaron T. Beck developed an approach

known as cognitive therapy (CT) as a result
of his research on depression (Beck
1963,1967).
He developed CT about the same time Ellis
was developing REBT, yet they appear to
have created their approaches
independently
He observed that depressed clients
revealed that they had a negative bias in
their interpretation of certain life events,
which contributed to their cognitive
distortions (Beck, 1967).

Cognitive therapy has a number of

similarities to both rational emotive
behavior therapy and behavior
therapy. All of these therapies are
active, directive, time-limited, presentcentered, problem-oriented,
collaborative, structured, and
empirical
They make use of homework and
require explicit identification of
problems and the situations in which
they occur (Beck & Weishaar, 2011).

Cognitive Therapy perceives

psychological problems as stemming
from commonplace processes such as
faulty thinking, making incorrect
inferences on the basis of inadequate or
incorrect information, and failing to
distinguish between fantasy and reality
Like REBT, CT is an insight-focused therapy
with a strong psychoeducational
component that emphasizes recognizing
and changing unrealistic negative
thoughts and maladaptive beliefs

Cognitive therapy is highly collaborative

and involves designing specific learning
experiences to help clients monitor their
automatic thoughts; examine the validity of
their automatic thoughts; understand the
relationship among cognition, feeling, and
behavior; develop more accurate and
realistic cognitions; and change underlying
beliefs and assumptions (Dobson & Dozois,
2010; Dozois, & Beck, 2011).

Cognitive therapy is based on the

theoretical rationale that the way
people feel and behave is influenced by
how they perceive and structure their
experiences.

1. That peoples internal communication is

accessible to introspection;
2. That clients beliefs have highly personal
meanings; and
3. That these meanings can be discovered
by the client rather than being taught or
interpreted by the therapist

A primary focus of cognitive therapy is to

assist clients in examining and
restructuring their core beliefs
Therapists help clients bring about
enduring changes in their mood and
their behaviour.
Beck contends that people with
emotional difficulties tend to commit
characteristic logical errors that distort
objective reality.

Becks approach recognizes the importance of

Schemas
Schemas are cognitive structures that consist of
an individuals fundamental core beliefs and
assumptions about how the world operates
Before birth our biology and chemistry
preprogram us with certain types of protoschemas (referring to survival, bonding,
autonomy, etc.), which vary in strength from
person to person (Beck & Hollon, 1993).

The environment facilitates or inhibits the

emergence of the schema in a way that that
may or may not assist in adaptation
Schemas, therefore, develop early in life from
personal experiences and identification with
significant others
Examples of schemas are:
Unless other people approve of me, I am
worthless.
Unless I can do something perfectly, I should not do
it at all.

Schemas are much more stable than cognitions,

but they are somewhat dependent on a persons
moods

Personalized notions that are triggered by

particular stimuli that lead to emotional
responses
Automatic thoughts are involuntary and
unintentional
They often occur at a preconscious level
and are difficult to stop or regulate
It function as self-monologues or inner
voices that may support or berate us

Becks examined the dream content of

depressed clients for anger then he
noticed that rather than retroflected
anger, as Freud theorized with depression,
clients exhibited a negative bias in their
interpretation or thinking

Systematic errors in reasoning that

appears during psychological distress
Faulty assumptions and misconceptions
Distortions in cognitions arise when stressful
events trigger an unrealistic schema
People with emotional difficulties tend to
commit logical errors that distorts
objective reality

Cognitive Distortion

Definition

Example

Arbitrary Inference

Drawing a specific
conclusion without
supporting evidence or
even in the face of
contradictory
evidence. It involves
Catastrophizing, or
thinking of the absolute
worst case scenario

After getting a C rather

than A on the first test,
a student erroneously
concludes that she
would not be able to
pass the course

Selective Abstraction

Conceptualizing a
situation on the basis of
detail taken out of
context and ignoring
all other possible
explanations. The
assumption is that the
events that matter are
those dealing with
failure and deprivation

An individual who is
nervous about getting
into an accident while
driving will zero in on all
the reports about traffic
accidents while
listening to the morning
news, reconfirming the
belief that driving is a
dangerous activity

Cognitive Distortion

Definition

Example

Overgeneralization

A process of holding
extreme beliefs on the
basis of a single incident
and applying them
inappropriately to
dissimilar events or
settings

Hearing about a
robbery in the city leads
one to conclude that
everyone is being
robbed

Magnification and
Minimization

Seeing an event as
more significant or less
significant than actually
is

A high school girl thinks

that if she is not asked
to go to the senor prom,
her life is over

Personalization

A tendency for
individuals to relate
external events to
themselves, even when
there is no basis for
making this connection

Parents assume that

they are to blame every
time their children
misbehave

Cognitive Distortion

Definition

Example

Labeling and
Mislabeling

Attributing a person's
actions to their
character instead of
some accidental
attribute. Rather than
assuming the behavior
to be accidental or
extrinsic, the person
assigns a label to
someone or something
that implies the
character of that person
or thing. Mislabeling
involves describing an
event with language
that has a
strong connotation of a

Instead of believing that

you made a mistake,
you believe that you are
a loser, because only a
loser would make that
kind of mistake

Cognitive Distortion

Definition

Example

Dichotomous Thinking

Involves categorizing
experiences in either-or
extremes. With such
polarized thinking,
events are labeled in
black or white terms

A person sees his or her

performance on a task
as either a complete
success or a total failure

There are some important differences between

these two approaches, especially with respect
to therapeutic methods and style
REBT is often highly directive, persuasive and
confrontational; it also focuses on the teaching
role of the therapist. The therapist models
rational thinking and helps clients to identify and
dispute irrational beliefs
In contrast, CT uses a Socratic dialogue by
posing open-ended questions to clients with the
aim of getting clients to reflect on personal issues
and arrive at their own conclusions

CT places more emphasis on helping

clients identify their misconceptions for
themselves than REBT
Through this reflective questioning process,
the cognitive therapist attempts to
collaborate with clients in testing the
validity of their cognitions ( a process
termed collaborative empiricism)

There are also differences in how Ellis and

Beck view faulty thinking
Ellis works to persuade clients that certain
of their beliefs are irrational and
nonfunctional through rational disputation
while Beck views his clients beliefs as
being more inaccurate than irrational and
asks his clients to conduct behavioral
experiments to test the accuracy of their
beliefs (Hollon & DiGiuseppe, 2011)

For Beck, people live by rules (premises or

formulas); they get into trouble when they
label, interpret, and evaluate by a set of
rules that are unrealistic or when they use
the rules inappropriately and excessively
If clients make the determination that they
are living by the rules that are likely lead to
misery, the therapist may suggest
alternative rules for them to consider,
without indoctrinating them

Empathy and sensitivity + technical

competence = effective therapist (Beck
1897)
To establish a therapeutic alliance with
clients, therapists must also have a cognitive
conceptualization of cases, be creative and
active, be able to engage clients through a
process of Socratic questioning, and be
knowledgeable and skilled in the use of
cognitive and behavioral strategies aimed at
guiding clients in significant self-discoveries
that will lead to change (Weishaar, 1993)

Beck conceptualizes a partnership to

devise personally meaningful evaluations of
the clients negative assumptions, as
opposed to the therapist directly suggesting
alternative cognitions
The therapist functions as a catalyst and a
guide who helps clients understand how
their beliefs and attitudes influence the way
they feel and act.

Clients are expected to identify the

distortions in their thinking, summarize
important points in the session, and
collaboratively devise homework
assignments that they agree to carry out
Cognitive therapists aim to teach clients
how to be their own therapist
One way of educating clients is through
Bibliotherapy

Homework is often used as a part of

cognitive therapy
Tompkins writes: Successful
negotiations can strengthen the
therapeutic alliance and thereby foster
greater motivation to try this and future
homework assignments

 In what cases can CT be used?

Suicidal behavior
Borderline personality disorders
Narcissistic personality disorders
Phobias
Psychosomatic disorders
Eating disorders
Anger
Panic disorders and
Generalized anxiety disorders
These are some examples, but the list
goes on.

Techniques are aimed mainly at

correcting errors in information processing
and modifying core beliefs that result in
faulty conclusions. Cognitive techniques
focus on identifying and examining a
clients beliefs, exploring the origins of
these beliefs, and modifying them if the
client cannot support these beliefs.

 Beck

(1987) writes about the

cognitive triad as a pattern that
triggers depression:
clients hold a negative view of
themselves
Tendency to interpret experiences
in a negative manner
clients gloomy vision and
projections about the future

Beck designed a standardized device known

as the Beck Depression Inventory (BDI) to
assess the depth of depression
How can CT be used in dealing with
depression?
Some depressed clients may harbor

suicidal wishes. Cognitive therapy

strategies may include exposing the clients
ambivalence, generating alternatives, and
reducing problems to manageable
proportions.

 A central characteristic of most

depressive people is self-criticism.
Underneath the persons self-hate are
attitudes of weakness, inadequacy, and
lack of responsibility. A number of
therapeutic strategies can be used.
Clients can be asked to identify and
provide reasons for their excessively selfcritical behavior.

Depressed clients typically experience

painful emotions. They may say that they
cannot stand the pain or that nothing can
make them feel better. One procedure to
counteract painful affect is humor. A
therapist can demonstrate the ironic
aspects of a situation.

 Another specific characteristic of

depressed people is an exaggeration of
external demands, problems, and
pressures. Such people often exclaim
that they feel overwhelmed and that
there is so much to accomplish that they
can never do it. A cognitive therapist
might ask clients to list things that need
to be done, set priorities, check off tasks
that have been accomplished, and
break down an external problem into
manageable units.

therapist typically has to take the

lead in helping clients make a list of
their responsibilities, set priorities, and
develop a realistic plan of action.

The

The cognitive behavioral approach

focuses on family interaction patterns,
and family relationships, cognitions,
emotions, and behavior are viewed as
exerting a mutual influence on one
another.

A key aspect of the therapeutic process

involves restructuring distorted beliefs (or
schema), which has a pivotal impact on
changing dysfunctional behaviors
family schemata - These are jointly held
beliefs about the family that have formed
as a result of years of integrated
interaction among members of the family
unit.

Cognitive
Behavior
Modific ation
b y
D onald
Meic henb aum

"I was always fascinated by the process of

understanding human behavior. As a youth,
I was interested in how people come to
engage in destructive aggressive acts."
- Donald Meichenbaum

More commonly known as Cognitive

Behavior Modification
Focuses on changing the clients selfverbalizations
Negative scripts or statements uttered by the
self or stories regarding by the person whom
is shared to others directly affects the
individuals behavior

Its basic premise is that clients, as a

prerequisite to behavor change, must
notice the ff.:
How they think
How they feel
How they behave
The impact they have on others

SIMILARITY (with REBT and Becks

cognitive therapy)
o

Assumption that distressing emotions are

typically
the result of maladaptive thoughts

DIFFERENCE
o REBT is more direct and confrontational in
uncovering irrational thoughts;
Meinchenbaums self-instruction
training focuses more on helping clients
become
aware of their self-talk.

ROLE-PLAY
Together, the therapist and client practice
self-instructions and the desirable
behaviors in role-play situations that
simulate problem situation in the clients
daily life.

COGNITIVE STRUCTURE
o The organizing aspect of thinking, which
seems to monitor and direct the choice of
thoughts
o Implies an executive processor, which
holds the blueprints of thinking that
determine when to continue, interrupt, or
change thinking.

Selfobservation

Starting a
new
internal
dialogue

Learning
new skills

The beginning step in the change

process consists of clients learning
how to observe their own behavior.
CRITICAL FACTOR: willingness and
ability to listen to themselves
Involves an increased sensitivity to
their thoughts, feelings, actions,
physiological reactions, and ways of
reacting to others

e.g.:
If depressed clients hope to make
constructive changes, they must first
realize that they are not victims of
negative thoughts and feelings. Rather,
they are actually contributing to their
depression through the things they tell
themselves.

As a result of the early client-therapist

contacts, clients learn to notice
maladaptive behaviors, and they begin
to see opportunities for adaptive
behavioral alternatives.

INTERNAL DIALOGUE
Clients learn to change their internal
dialogue through therapy. This new
internal dialogue serves as a new guide
to new behavior, thereby impacting the
clients cognitive structure.

Involves teaching clients more

effective coping skills, which are
practiced in real-life situations.
Clients continue to focus on telling
themselves new sentences and
observing and assessing the outcomes

The stability of what they learn is

greatly influenced by what they say to
themselves about their newly acquired
behavior and its consequences.

Consists of a
combination of
information of the
following:

information-giving
Socratic discussion
cognitive restructuring
problem solving
Relaxation training
behavioral rehearsals
self-monitoring
self-instruction
self-reinforcement; and
modifying environmental situations

1. Conceptualeducational
phase

2. Skills
acquisition,
consolidation,
and rehearsal
phase

3. Application
and followthrough phase

FOCUS: creating a working

relationship with clients
Done by helping the clients gain a
better view of the nature of stress and
reconceptualizing it in social-interactive
terms.

The therapist entails the clients s

collaboration during this early phase
and together they rethink the nature
of the problem.
They learn about the role that
cognitions and emotions play in
creating and maintaining stress
through didactic presentations,
Socratic questioning, and by a
process of guided self-discovery.

Teaches clients to become aware of

their own role in creating their stress.

OPEN-ENDED DIARY
Clients typically keep an open-ended
diary in which they systematically
record their specific thoughts, feelings,
and behaviors

FOCUS: giving clients a variety of

behavioral cognitive coping techniques
to apply to stressful situations.

Involves direct actions, such as

gathering information about their
fears, learning specifically what
situations bring about stress,
arranging for ways to lessen the
stress by doing something different,
and learning methods of physical
and psychological relaxation.

How can I prepare for a stressor?

(What do I have to do? Can I develop a
plan to deal with the stress?)
How can I confront and deal with what
is stressing me? (What are some ways I
can handle a stressor? How can I meet
this challenge?)

How can I cope with feeling

overwhelmed? (What can I do right
now? How can I keep my fears in
check?)
How can I make reinforcing selfstatements? (How can I give myself
credit?)

As part of the stress management

program, clients are exposed to
various behavioral interventions,
some of which are:
Relaxation training
Social skills training
Time-management instruction
Self-instructional training

FOCUS: carefully arranging for transfer

and maintenance of change from the
therapeutic situation to everyday life.

Clients need to practice new selfstatements and apply their new skills
in real-life situations
Once clients have become proficient in
cognitive and behavioral coping skills,
they practice behavioral assignments,
which become increasingly demanding

If the clients do not follow through

with the therapist, the therapist and
the client collaboratively consider the
reasons for the failure.

Clients are provided with training in

RELAPSE PREVENTION, which consists of
procedures for dealing with the inevitable
setbacks they are likely to experience as
they apply learning to daily life.
Follow-up and booster sessions typically
take place at 3-, 6-, and 12-month periods
as an incentive for clients to continue
practicing and refining their coping skills.

Application of SIT for a wide variety of

problems:
Anger control
Anxiety management
Assertion training
Improving creative thinking
Treating depression
Dealing with health problems
Anxiety disorders
Posttraumatic disorders (PTSD)

Assumption
Task
Characteristics

Meinchenbaum (1997) has developed

his approach by incorporating the
constructivist narrative perspective
(CNP), which focuses on the stories
people tell about themselves and
others regarding significant events in
their lives

ASSUMPTION: there are multiple

realities
TASK: to help clients appreciate
how they construct their realities
and how they author their own
stories.

Less structured and more discoveryoriented than standard cognitive

therapy
Gives more emphasis to past
development
Tends to target deeper core beliefs
Explores the behavioral impact and
emotional toll a client pays for clinging
to certain root metaphors.