Center for Life Management

INTRODUCTION
TO COGNITIVE THERAPY (CT)

“Cognitive therapy is a holistic approach but it is applied in a sequence of discrete, readily understandable steps.”
A.T. Beck, Cognitive Therapy of Depression

Cognitive therapy (CT) is an extensively research-based modality of mental health therapy. CT addresses beliefs, thoughts, and perceptions as the basis for perpetuation of feelings and actions. This encompasses all feelings and actions, irregardless of whether they positive or negative. Typically a client will enter CT, or any other mode of therapy, for relief of feelings and actions causing them, or someone else, discomfort. It is important to note here, in CT these feelings and actions are not seen as “bad”. Instead they are viewed as patterns of behavior developed as ways to protect oneself, or others, from perceived threats.

The premise then becomes in order to alter these feelings and actions, one must first alter perceptions, thoughts, and beliefs. The alteration process is completed in systematic steps. This allows clients to see new possibilities and alternatives regarding thinking. The client then practices new ways of behaving to further “cement” the new ways of thinking.

CT is collaborative and holistic. Furthermore, in CT a therapist and client discuss, clarify, and specify a client’s goals. Each client is treated differently as each client has a different set of life circumstances, perceptions, and goals.

Cognitive Therapy
The fundamental premise of cognitive therapy is that thoughts influence feelings, and that one's emotional response to any situation is a function of one's subjective construal of that situation. To illustrate, imagine you notice your heart racing and your face flushed, and find yourself sweating and struggling to catch your breath. What would you think? How would you feel? Imagine further that you notice all this while sitting on a park bench on a late summer evening, enjoying a cool breeze and the sounds of birds chirping. You might have thoughts or images of having a heart attack or other medical condition and of the necessity to contact a doctor. You might experience the emotions of anxiety or fear. But imagine, instead, that you notice the same physiological symptoms while running on a treadmill. What then would you think and how would you feel? Presumably you would attribute the symptoms to exercise and - however unpleasant you might find them - would not experience anxiety or fear. In short, different interpretations of the same symptoms could lead to entirely different emotions.

Proponents of a cognitive approach believe that pathological emotional states (e.g., as manifest in many psychological disorders) derive from distorted, biased, or illogical thinking processes or cognitive schemas. Two examples of many such processes are the tendency to engage in black-and-white thinking and to focus selectively on weakness or failure while discounting evidence of competence and success. People may, therefore, make unrealistic appraisals about events (e.g., catastrophic misinterpretations about benign bodily sensations) as well as their ability to cope with negative outcomes. Similarly, individuals may overestimate both the likelihood of a negative event occurring, and how terrible it would be if it were to occur.

In cognitive therapy, clients learn to:
• Distinguish between thoughts and feelings.
In casual conversation, we often use the words "think" and "feel" synonymously (e.g., "I feel like it would be a bad decision to buy that model" - That is a thought, not a feeling). In fact, we are sometimes not cognizant of the automatic thoughts that accompany feelings. For example, one might recount feeling particularly sad after receiving criticism from a boss without mention (or awareness) of the thought, "Now I'll never get the promotion and won't be able to afford to purchase a house." In cognitive therapy, clients first practice identifying, attending to, and distinguishing between thoughts and feelings.

• Become aware of the ways in which their thoughts influence their feelings in ways that are not helpful.
Clients in cognitive therapy track their own experiences associated with a shift in mood and link these processed to their behavioral responses. What were you thinking right before you noticed becoming sad? When you have the automatic thought, "I can't do anything right," how do you feel? When you experience these thoughts and feelings are you more likely to do something constructive or to give up? Which behavior increases the likelihood of success?

• Evaluate critically the veracity of their automatic thoughts and assumptions.
Clients in cognitive therapy are encouraged to challenge their automatic thoughts by considering alternative explanations and conducting informal behavioral experiments. The aim is not to adopt an unrealistically optimistic or positive outlook. Rather, one learns to consider good and bad, evidence pro and con, and arrive at more accurate and logical, less biased, and often more nuanced conclusions. For instance, imagine you (a) receive critical feedback from your boss, then (b) have the automatic thought, "I can't do anything right," and then (c) feel sad. You might learn to evaluate critically the actual content of the feedback, the circumstances of the feedback, and what evidence you have (pro and con) that you can't do anything right in order to evaluate the accuracy and utility of that initial automatic thought.

• Develop the skills to notice, interrupt, and intervene at the level of automatic thoughts "on-line," as they happen.

Ultimately, the goal of cognitive therapy is to develop the skills to modify habitual cognitive processes as they happen. As with any skill, it takes time and practice to gain the proficiency to implement cognitive therapy techniques in real time.

BEHAVIOR THERAPY