See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/264932879

Cognitive Behavioural Therapy

Chapter · January 2013

CITATIONS READS
0 5,791

1 author:

Barbra Teater
City University of New York - College of Staten Island
72 PUBLICATIONS   280 CITATIONS   

SEE PROFILE

Some of the authors of this publication are also working on these related projects:

Social workers' attitudes, access, and confidence in using evidence-based practice View project

Quantitative Research Methods for Social Work: Making Social Work Count View project

All content following this page was uploaded by Barbra Teater on 18 June 2016.

The user has requested enhancement of the downloaded file.

Cognitive Behavioural Therapy (CBT)

Barbra Teater

What are the essential elements of the theory?

Cognitive behavioural therapy (CBT) is a method that aims to reduce psychological

distress and dysfunction by exploring and addressing how the integration of service users’

thoughts, feelings and behaviours are contributing to the presenting problem. Three assumptions

form the foundation of CBT:

(1) Thinking (cognition) mediates emotions and behaviours;

(2) Faulty cognitions lead to psychological distress and dysfunction;

(3) Psychological distress and dysfunction is reduced or alleviated through

modifications in the faulty cognitions and behaviours.

(Trower et al, 1988; Vonk and Early, 2009). Therefore, CBT seeks to modify and replace

existing faulty or distorted thoughts, feelings and behaviours with more positive and acceptable

ones that will lead to the alleviation of the presenting problem (Teater, 2010).

The implementation of CBT in practice involves three stages: assessment; intervention

and evaluation (Teater, 2010). Assessment consists of exploring jointly with service users how

their thoughts, feelings and behaviours are contributing to the presenting problem in terms of

frequency, intensity and duration. The A-B-C model is often used at the assessment stage; it

requires service users to explore (A) the activating event, (B) their belief system or attitude in

relation to the event; and (C) the consequences as reflected in their behavioural or emotional

reactions.
 The assessment stage will inform the type of intervention to be selected, based on the

thoughts, feelings or behaviours that are the focus of change. Such interventions could include

cognitive restructuring (Frojan-Parga et al, 2009); relaxation techniques (Payne and Donaghy,

2010); social skills training (Sheldon, 1998); assertion training and problem-solving skills

(O’Donohue, 2003); systematic desensitization (Sharf, 2012); and reinforcement, modelling and

role-plays (Sutton and Barto, 1998).

The evaluation stage serves as an opportunity to identify any changes that have occurred

in the intensity, frequency and duration of thoughts, feelings and behaviours and the extent to

which the presenting problem has diminished from pre- to post-intervention.

What are its origins?

CBT is a combination of behavioural and cognitive therapies.

Behavioural therapy, traced back to the 1950s through the works of Ivan Pavlov, John

Watson, and B.F. Skinner, seeks to modify learnt behaviours that are problematic and

undesirable and to replace them with more acceptable positive behaviours, particularly through

the use of consequences and reinforcers (Sharf, 2012). Cognitive therapy, developed during the

1960s primarily through the works of Albert Ellis and Aaron Beck, is based on the notion that

behavioural and emotive aspects are critical in addressing psychological distress and

dysfunction. Ellis developed the A-B-C model in order to explore how activating events lead to

behavioural or emotional consequences by being filtered through the service user’s belief system

(Teater, 2010).

Cognitive therapy places an emphasis on the importance that service users’ established

beliefs or schemas play in the thought process which sustains problematic situations. Cognitive
behavioural therapy acknowledges that both behaviours and cognitions are critical in

contributing to psychological distress and dysfunction and, therefore, that focus should be placed

on the integration of thoughts, feelings, and behaviours.

For whom is it designed?

CBT is designed for individuals:

• who are experiencing psychological distress and/or dysfunction; and

• who are able and willing either to explore how their thoughts, feelings and behaviours are

contributing to the problem or to respond to interventions that aim to modify individuals’

thoughts, feelings and behaviours

• who are able and willing to explore how their thoughts, feelings and behaviours are

contributing to the problem; and

• who are able and willing to respond to interventions that aim to modify individuals’

thoughts, feelings and behaviours.

Although CBT assumes that social workers will be prescriptive in their approach,

research has shown that, in practice, modification may be necessary based on the needs of

service users: for example, by incorporating more aspects of acceptance and reassurance with

service users experiencing eating disorders (Bamford and Mountford, 2012); or by employing

more therapeutic relationship aspects when working with children with Asperger’s Syndrome

(Donoghue, et al, 2011). CBT can be applied to individual and group settings.

What are its limitations?

There are several limitations to the use of CBT:

 • Firstly, its focus is primarily on the service user rather than on any social or political

factors that may be contributing to the presenting problem - such as oppression,

discrimination, cultural expectations or poverty, (Sharf, 2012).

• Secondly, the approach requires that service users engage in the process, and this might

be difficult when the social worker is working with mandated service users or those who

do not accept that they are experiencing any problems.

• Thirdly, CBT is concerned with the here-and-now and fails to address any underlying

difficulties that may be contributing to the presenting problem (Teater, 2010).

• Finally, the directive approach of CBT could be viewed as disempowering to service

users.

In what situation/circumstances can it or can it not be used?

CBT is a widely used method in different settings and populations with evidence that it

works across cultural groups (Ross et al, 2008), but the approach may need to be adapted to fit

individuals’ culture and environment (Teater, 2010). CBT assumes that service users have the

capacity to explore how their thoughts, feelings and behaviours are contributing to the presenting

problem, and that they have the capacity to respond to consequences and/or reinforcers; because

of this, CBT may not be appropriate in situations or circumstances where service users do not

have this capacity or it may need to be adapted to fit service users’ needs.

What is the research evidence for it?

The CBT approach has been widely researched and has been shown to be effective when

treating problems such as depression, anxiety and self-esteem (Ekers et al, 2008; Ishikawa, et al,
2007; Morton, et al., 2012), eating disorders (Bamford & Mountford, 2012; Sysko &

Hildebrandt, 2009), obsessive compulsive disorder (Jonsson et al., 2011), substance abuse and

victims of abuse and trauma (Ruffolo & Fischer, 2009), children with externalizing and violent

behaviours (Ozabaci, 2011; Squires & Caddick, 2012), post-traumatic stress disorder (Bohus et

al., 2009; Nixon et al., 2012), and recurrent and chronic self-harm (Slee et al., 2008).

The National Institute for Health and Clinical Excellence (NICE) in the UK encourages

the use of CBT when working with problems such as eating disorders (NICE, 2004a), obsessive

compulsive disorder (NICE, 2005), anxiety (NICE, 2004b), attention deficit hyperactivity

disorder (NICE, 2008), anti-social personality disorder (NICE, 2009), and depression (NICE,

2004c).

Where can I read more about it?

Beck, J.S. (2011). Cognitive behavior therapy: Basics and beyond (2nd ed.). New York, NY: The

Guilford Press.

Ronen, T., & Freeman, A. (Eds.) (2007). Cognitive behaviour therapy in clinical social work

practice. New York: Springer.

Sheldon, B. (2011). Cognitive behavioural therapy: Research and practice in health and social

care (2nd ed.). Abingdon, Oxon: Routledge.

References

Bamford, B.H. & Mountford, V.A. (2012). Cognitive Behavioural Therapy for individuals with

longstanding anorexia nervosa: Adaptations, clinician survival and system issues.

European Eating Disorders Review, 20, 49-59.

Bohus, M., Priebe, K., Dyer, A., & Steil, R. (2009). S-18-01 Dialectical behavioural therapy for

patients with borderline features of posttraumatic stress disorder after childhood sexual

abuse. European Psychiatry, 24, S-91.

Donoghue, K., Stallard, P., & Kucia, J. (2011). The clinical practice of Cognitive Behavioural

Therapy with children and young people with a diagnosis of Asperger’s Syndrome.

Clinical Child Psychology and Psychiatry, 16, 89-102.

Ekers, D., Richards, D., & Gilbody, S. (2008). A meta-analysis of randomized trials of

behavioural treatment for depression. Psychological Medicine, 38, 611-623.

Frojan-Parga, M.X., Calero-Elvira, A., & Montano-Fidalgo, M. (2009). Analysis of the

therapist’s verbal behavior during cognitive restructuring debates: A case study.

Psychotherapy Research, 19, 30-41.

Ishikawa, S., Okajima, I., Matsuoka, H., & Sakano, Y. (2007). Cognitive Behavioural Therapy

for anxiety disorders in children and adolescents: A meta-analysis. Child & Adolescent

Mental Health, 12, 164-172.

Jonsson, H., Hougaard, E., & Bennedsen, B.E. (2011). Randomized comparative study of group

versus individual Cognitive Behavioural Therapy for obsessive compulsive disorder. Acta

Psychiatrica Scandinavica, 123, 387-397.

Morton, L., Roach, L., Reid, H., & Stewart, S.H. (2012). An evaluation of a Cognitive
 Behavioural Therapy group for women with low self-esteem. Behavioural and Cognitive

Psychotherapy, 40, 221-225.

National Institute for Health and Clinical Excellence (NICE) (2004a). Eating disorders: Core

interventions in the treatment and management of anorexia nervosa, bulimia nervosa and

related eating disorder. Retrieved April 13, 2012 from http://guidance.nice.org.uk/CG9.

National Institute for Health and Clinical Excellence (NICE) (2004b). Anxiety: management of

anxiety (panic disorder, with or without agoraphobia, and generalised anxiety disorder)

in adults in primary, secondary and community care. Retrieved April 13, 2012 from

http://guidance.nice.org.uk/CG22.

National Institute for Health and Clinical Excellence (NICE) (2004c). Depression: Management

of depression in primary and secondary care. Retrieved April 13, 2012 from

http://guidance.nice.org.uk/CG23.

National Institute for Health and Clinical Excellence (NICE) (2005). Obsessive compulsive

disorder: Core interventions in the treatment of obsessive-compulsive disorder and body

dysmorphic disorder. Retrieved April 13, 2012 from http://guidance.nice.org.uk/CG031.

National Institute for Health and Clinical Excellence (NICE) (2008). Attention deficit

hyperactivity disorder: Diagnosis and management of ADHD in children, young people

and adults. Retrieved April 13, 2012 from http://guidance.nice.org.uk/CG72.

National Institute for Health and Clinical Excellence (NICE) (2009). Antisocial personality

disorder: Treatment, management and prevention. Retrieved April 13, 2012 from

http://guidance.nice.org.uk/CG77.

Nixon, R.D.V., Sterk, J., & Pearce, A. (2012). A randomized trial of Cognitive Behavioural
 Therapy and Cognitive Therapy for children with posttraumatic stress disorder following

single-incident trauma. Journal of Abnormal Child Psychology, 40, 327-337.

O’Donohue, W. (2003). Psychological skills training: Issues and controversies. The Behavior

Analyst Today, 4, 331-335.

Ozabaci, N. (2011). Cognitive Behavioural Therapy for violent behaviours in children and

adolescents: A meta-analysis. Children & Youth Services Review, 33, 1989-1993.

Payne, R.A. & Donaghy, M. (2010). Payne’s handbook of relaxation techniques: A practical

guide for the health care professional (4th ed.). Churchill Livingstone, Elsevier.

Ross, L.E., Doctor, F., Dimito, A., Kuehl, D., & Armstrong, S. (2008). Can talking about

oppression reduce depression? Modified CBT group treatment for LGBT people with

depression. Journal of Gay and Lesbian Social Services, 19, 1-15.

Ruffolo, M.C., & Fischer, D. (2009). Using an evidence-based CBT group intervention model

for adolescents with depressive symptoms: Lessons learned from a school-based

adaptation. Child and Family Social Work, 14, 189-197.

Sharf, R.S. (2012). Theories of psychotherapy and counseling: Concepts and cases (5th ed.).

Belmont, CA: Brooks/Cole.

Sheldon, B. (1998). Research and theory. In K. Cigno, & D. Bourn (Eds.), Cognitive-

Behavioural Social Work in Practice (pp. 1-38). Aldershot: Ashgate.

Slee, N., Garnefski, N., van der Leeden, R., Arensman, E., & Spinhoven, P. (2008). Cognitive-

Behavioural intervention for self-harm: Randomised control trial. British Journal of

Psychiatry, 192, 202-211.

Squires, G. & Caddick, K. (2012). Using group Cognitive Behavioural Therapy interventions in
 school settings with pupils who have externalizing behavioural difficulties: An

unexpected result. Emotional & Behavioural Difficulties, 17, 25-45.

Sutton, R.S., & Barto, A.G. (1998). Reinforcement learning: An introduction. Adaptive

computation and machine learning series. Cambridge, MA: MIT Press.

Sysko, R., & Hilderbrandt, T. (2009). Cognitive-Behavioural Therapy for individuals with

bulimia nervosa and a co-occurring substance use disorder. European Eating Disorders

Review, 17, 89-100.

Teater, B. (2010). An introduction to applying social work theories and methods. Basingstoke:

Open University Press.

Trower, P., Casey, A., & Dryden, W. (1988). Cognitive-behavioural counselling in action.

London: Sage.

Vonk, M.E., & Early, T.J. (2009). Cognitive-behavioral therapy. In A.R. Roberts (Ed). Social

Workers’ Desk Reference (2nd ed.). (pp. 242-247). New York: Oxford University Press.

View publication stats