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Cognitive Behavioural Therapy



Date: 30/12/21

Author Name: Udita Singh

Qualifications: BA (Hons), MA- Applied Psychology (specialisation in clinical psychology).

Designation: Consultant Psychologist, ACRO Mental Health & Wellness.

Word count: 1,721 words

Reading time: 16 minutes

Reviewed by: Aishwarya Krishna Priya, Sareem Athar & Mariyam Mohammed.




What is CBT?

Cognitive Behavioural Therapy (CBT) is a type of therapy that has gained popularity in recent years (1). It is based on intensive scientific research, so it's quite reliable since it is evidence-based (2). It is comparatively shorter in duration than other forms of therapies like psychoanalysis, person-centred therapy, etc (3). Generally, a client could expect around eight to fifteen sessions of CBT to deal with certain mental health issues effectively (4,5).


Aaron Beck founded and developed Cognitive Behavioural Therapy in the 1960s, and it was earlier referred to as “Cognitive Therapy'' (6). CBT has been proven effective in dealing with issues like anger, anxiety, grief, eating disorders, depression, insomnia, panic attacks, bipolar disorder, phobias, low self-esteem, excessive stress, addiction, excessive use of alcohol, Obsessive-Compulsive disorder (OCD), various personality disorders and relationship issues like divorce, separation and breakups (7,8).


Key principles:

The basic principle behind cognitive behaviour therapy is that our thoughts influence our feelings and our feelings influence our behaviours and actions (9). Our thoughts, feelings, and behaviours are interconnected and interrelated to each other (10). One impacts the other (11).



Let’s understand this with a hypothetical example (12). I made plans with a friend that I hadn’t met in a long time (13). We decided to meet in a café at 5 pm. Just before I was about to leave for the café, my friend texted me that she won’t be able to come to meet me today and that she would like to reschedule. My instant thought could be: “She doesn’t want to meet me, and she is just making excuses, and how rude of her to cancel just before the meeting.


She is not a good friend, and this is unforgivable, or maybe I must have done something that made her cancel”. Such an instant thought of mine is quite negative. My thoughts might affect my emotions and feelings, and I might feel annoyed, resentful, and even surprised as to why my friend cancelled at the last moment. I might also feel hurt and feel neglected too. Hence, a wide range of emotions I could experience, all resulting from my negative thoughts about how my friend cancelled at the last moment. This, in turn, might lead me to behave in a way that’s destructive to my friendship with her. I might ignore her as I feel hurt (14-16).


This example portrays what is called “Automatic thoughts” in CBT (13). My automatic thought was that my friend didn’t want to meet me and maybe she had a problem with me. (17,18).


This automatic thought leads to feelings like anger and hurt, and disbelief, which in turn affects my behaviour that I might ignore her as I think she doesn’t want to meet me (19).


Automatic thoughts are those thoughts that come instantly when an event or a situation triggers us in a bad way (20,21). Automatic thoughts come naturally to us, and they are unfiltered(22). Usually, automatic thoughts result from our beliefs, especially our deep-rooted core beliefs (23,24).


What are core beliefs?

Core beliefs are chief and fundamental beliefs that we have and hold regarding ourselves, the people in our lives, and the world we live in (25,26). Core beliefs are usually shaped and developed in us early, and they are quite powerful (27).


People view themselves, others, and the world through particular filters and lenses; these are called “schemas” (28). Schemas too develop in childhood (29). Our thinking, feelings, and behaviours largely depend on our core beliefs(30). They are quite stable and firm and greatly influence the way we perceive ourselves and others (31,32).


When we get triggered by a situation that upsets us, our core beliefs get activated (33). Our core beliefs are our “perceived truths” (34). We strongly believe in them as they are very real (35). Core beliefs also influence the way we think the other people in our lives perceive us, and how we tend to perceive our future (36). Core beliefs could be positive as well as negative in nature (37). CBT tends to focus more on our negative core beliefs, which are the root cause of our maladaptive and dysfunctional thoughts, feelings, and behaviours (38,39).


Hence, our automatic thoughts are usually based on our deep-rooted core beliefs, and if we have more negative core beliefs, our automatic thoughts could be more dysfunctional and maladaptive (40,41). So, CBT focuses on exploring our negative automatic thoughts, and by exploring them, cognitive-behavioural therapists aim at discovering and exploring the clients’ negative core beliefs (42). We tend to make “assumptions” based on our core beliefs (43). These, in turn, lead to particular reactions (our behaviours) to certain situations (44).



The most common negative core beliefs that people tend to have are:

  • I am not good enough

  • I am a failure

  • I am unwanted

  • I am worthless

  • I am unlovable

  • I’m not valuable

  • I am disposable

  • I cannot trust people

  • I am ugly

  • I am stupid

  • I am powerless

  • I will be rejected (45-48).


I would like to illustrate how core beliefs get solidified and eventually lead to negative automatic thoughts with a hypothetical example (49): Whenever a girl in her childhood tried to express her feelings or needs to the people in her life. If her feelings were disregarded or if she experienced a lack of attention from her loved ones, she might start to believe that her feelings and needs don’t matter (50).


She might develop core beliefs like “I am not worthy”, “I am unlovable”, or “I will be rejected’. When she becomes an adult and has a romantic relationship, she might be afraid of expressing her feelings and needs to her partner and might display anxious behaviours in her relationship. She might be afraid that her partner will leave and abandon her if she expresses her thoughts and emotions to her partner. So, if an argument happens, her core beliefs can get triggered and her behaviours would result from her core beliefs- she would try to stop the argument to prevent her partner from ‘rejecting’ and abandoning her (51-53).


To illustrate it well:

Early experience: lack of attention or dismissal of feelings and needs

Core beliefs: “I am not worthy”, “I am unlovable”, and “I will be rejected.”

Event/situation: An argument with the partner

Automatic thought: “Don’t fight, he might leave you.”

Reactions: Compromising, staying quiet, withdrawing, feeling anxious, helpless, frightened, and might panic (54).


Let’s take another example: A boy who grew up learning that getting excellent marks in tests and exams in schools is a must might start associating his worth to external factors like the results of exams. If he scores above average, he gets validated and feels accepted. But if he does not, he feels like a failure and might develop the core belief that “I am not good enough”, “I am worthless”, “I am stupid”, etc. So, when he becomes an adult and gets a job, and whenever he is working on a task and his boss comments or gives him a bad review on that task or project, his deep-rooted core beliefs regarding failure might get activated and lead to negative automatic thoughts, which in turn might lead to him overworking and becoming a workaholic and a perfectionist (reaction/behaviour) (55-57).


Early experience: gets validated and receives approval only when scores good in exams, gets criticized and shamed for not getting good marks

Core beliefs: “I am stupid”, “I am worthless”, “I am not good enough”, “I am a failure”

Event/Situation: Gets criticized by the boss

Automatic thought: “I will get fired, and I will lose the respect of my loved ones, I am nothing”.

Reactions: excessive working, only focusing on work, little or no socializing, might feel frightened, anxious, powerless, agitated, etc (58-61).


Hence, as we can see, core beliefs are extremely powerful and they shape and dictate how we think, feel, and behave whenever we get triggered due to a situation (62,63). A key point to be noted here is that it’s not necessarily true for our core beliefs and automatic thoughts to be true (64). They stem from our own ability to perceive and interpret ourselves, others, and various situations (65,66). Hence, CBT therapists aim to change and restructure negative and distorted core beliefs and automatic thoughts to more structured core beliefs and automatic thoughts (67,68).


A range of emotions


Various techniques used in CBT:

Cognitive-behavioural therapists make use of various tools and techniques to alleviate the issues of clients (69,70). The aim is to identify various negative automatic thoughts, which ultimately would lead to the identification of various underlying core beliefs and challenging these maladaptive core beliefs so that the clients’ thoughts become more rational, which in turn would lead to better regulation of difficult emotions and dysfunctional behaviours in interpersonal relationships (71-73).


One of the techniques is called “cognitive restructuring” (74,75). In this, the therapist will help the clients identify various negative thoughts that the clients have, and with the help of the therapist, clients learn how to reframe the negative thoughts into more rational and positive ones (76). Therapists might also suggest maintaining a “thought record” to keep track of the negative thoughts throughout the day (77,78).


The second most common tool employed by therapists is “journaling” (79). In this, the therapist will ask the client to maintain a journal, and some journaling prompts are provided to the client for effective journaling (80,81).


Furthermore, “behavioural experiments” are done, especially with anxiety (82). Therapists also introduce numerous techniques like deep breathing exercises for stress management (83). “Role-playing” is another important technique frequently used by cognitive-behavioural therapists. Role-playing helps the clients boost their self-esteem and practice what to say before a difficult conversation; it also helps them become more assertive and inspires confidence. Many more tools and techniques are utilized by cognitive behavioural therapists that are quite effective (84).




To summarize, CBT is one of the most common types of psychotherapy applied to treat many mental health issues like anxiety, depression, anger, grief, addiction, relationship issues, and various disorders. It is quite goal-oriented, and the focus is primarily on the presenting problem of the clients. CBT is quite structured and is comparatively shorter in duration (8 to 12 sessions) (85). The objective of the therapist is to help clients identify their negative automatic thoughts, underlying and deep-rooted core beliefs, and also identify cognitive distortions (faulty and distorted thinking patterns) (86-87).


AUDIO-VISUAL CREDITS

  1. Image by Mika Baumeister on Unsplash May 15, 2020

  2. Image by Alysha Rosly on Unsplash January 13, 2020

  3. Image by Tengyart on Unsplash February 9, 2021

  4. Image by Finn on Unsplash February 10, 2020

  5. Image by Christina@wocintechchat.com on Unsplash November 12, 2019


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