The mission of the Beck Institute for Cognitive Behavior Therapy is to disseminate CBT throughout the world, and I am particularly pleased to have an opportunity to address students. I hope that many of you have a goal of increasing your knowledge of evidence-based treatment, especially CBT, which has a far greater research base demonstrating its efficacy than any other form of psychosocial treatment.
Cognitive Behavior Therapy
|Judith S. Beck, PhD, University of Pennsylvania
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What Is CBT?
CBT, also called cognitive therapy, is the most highly researched and effective treatment for psychiatric disorders and psychological problems in the world. In CBT, therapists teach their clients specific skills that they can use for the rest of their lives. These skills involve modifying unrealistic and unhelpful ideas, relating to others in different ways, changing behavior, and learning how to regulate emotion—so clients experience a lasting improvement in mood and functioning.
Aaron T. Beck and the Cognitive Model
Aaron T. Beck, MD, developed cognitive therapy in the 1960s and 1970s. Originally trained in psychoanalysis, Dr. Beck began to look for other ways of understanding and treating depression when his research failed to validate psychoanalytic concepts of depression. Dr. Beck recognized that people’s perceptions, specifically the thoughts that go through their minds, influence their emotional, physiological, and behavioral reactions. This cognitive model helps us understand not only depression, but also psychopathology in general. The cognitive model posits that distorted thinking is common to all psychological disturbances.
How CBT Works
According to the cognitive model, when people are in psychological distress, their thinking is often inaccurate and/or unhelpful. Cognitive behavior therapists help people learn to identify and evaluate their automatic thoughts (fleeting thoughts or images that arise spontaneously), and to modify their thinking so that it more closely resembles reality. When they do so, their distress usually decreases, they are able to behave more functionally, and (especially in anxiety cases) their physiological arousal reduces. When their distressing thinking is accurate, clients focus on solving the related problem, evaluating the conclusions they have drawn, and/or nonjudgmentally accepting the difficulty and shifting their attention, often toward action in the service of valued goals. CBT incorporates techniques from many different psychotherapeutic modalities based on a cognitive conceptualization (understanding) of the client, within the context of the cognitive model. Cognitive behavior therapists work hard to establish and maintain a strong therapeutic relationship with clients.
Goals of CBT
CBT aims to help clients reduce their suffering as quickly as possible and achieve a remission of their disorder. CBT therapists help clients work toward achieving their goals; therapists also facilitate remission and teach clients skills (particularly changing their thinking and behavior) that they can use for the rest of their lives to prevent or reduce relapse.
A Typical CBT Session
Sessions may vary somewhat according to the client’s disorder, developmental level, treatment preferences, and other factors, but here is a typical session format for a depressed client. Before a session begins, I usually ask clients to fill out certain forms (for example, the Beck Depression Inventory) to assess mood, which provides me with an objective method for assessing their symptoms. Then, I ask them to tell me in their own words how they have been feeling in the past week, compared to other weeks. This is what we call a mood check; it helps clients and me make sure they are making progress over time.
Next, I ask clients to name the most important problems they encountered during the week that they would like my help in solving. This is called “setting the agenda,” which allows us to figure out how to best spend our time during that day’s session. (I may have one or more items for the agenda, too.) Then, I create a “bridge” between the previous therapy session and the week’s therapy session. I ask them what happened during the previous week that they think I should know about (both positive and negative experiences). I also ask them what they thought was important during our last therapy session, and we discuss the action plan items they did during the week. To finish this initial part of the session, especially if we have uncovered too many issues to discuss in one session, we will collaboratively “prioritize the agenda,” deciding together which items are most important to the client to cover. I make sure it’s clear to both of us how the client would like to spend our time together. (It is important to note that we may collaboratively decide to deviate from our original plan during the session if something else more important arises.)
In the middle portion of the session, we discuss the problem or problems we put on the agenda. We usually do a combination of problem solving and assessing the accuracy and usefulness of their thoughts and beliefs about the problematic situation. I teach them new skills that will help them modify their maladaptive thinking and behavior and solve problems on their own. Throughout the session, I ask them to draw conclusions and summarize important points in their own words; they or I write these therapy notes down (or they can enter these notes in their smartphone). Reading these notes daily at home will be part of their action plan; self-help assignments specifically tailored to them. I also ask them what they would like to do about the problem this week, for example, implementing solutions to problems, responding to their unhelpful or distorted thinking and/or practicing other cognitive and behavioral skills. I make sure they record the action plan, too.
At the end of the session, I ask for feedback: How did they think the session went? Is there anything that bothered them or that they thought I didn’t understand? Is there anything they would like to see changed in future sessions? It’s very important that clients feel safe with us in session, that we vary our style when necessary, and that we treat every client the way we ourselves would like to be treated.
I don’t wait until the end of the session to ask for feedback if I detect that clients are looking or sounding distressed during the session itself. I may need to compromise and modify the standard structure if clients object to it. Flexibly following a structure ensures that clients have the opportunity to think through what is most important to them to discuss in session. I also want them to leave each session with a specific plan that will help them solve their problems and feel better.
How Is CBT Different From Other Talk Therapies?
CBT is time-sensitive, structured, goal-oriented, and problem-solving focused. Treatment is collaborative, meaning that clients and therapists act as a team to decide which problems to address in treatment, which solutions to try, which thoughts and beliefs to focus on, which skills clients need to learn, and which self-help assignments they would like to set for themselves. Cognitive behavior therapists emphasize relapse prevention—our goal is to help clients learn skills in order to become their own therapist.
How Effective Is CBT?
CBT has been shown to be effective in over 1,000 outcome studies. Research supports its efficacy for scores of psychiatric disorders, psychological problems, and medical conditions with psychological components including anxiety disorders, schizophrenia and bipolar disorder (combined with medication), addictions, personality disorders, eating disorders, couples and family problems, attention deficit disorder, insomnia, infertility, chronic pain, fibromyalgia, irritable bowel syndrome, obesity, and many others. It has been modified, and studies show it is effective with children, adolescents, older adults, and in group treatment. It is used in a variety of settings: in outpatient psychotherapy, inpatient treatment, forensic settings, schools, community mental health, and many others.
How do I Become a Cognitive Behavior Therapist?
CBT courses are often available in mental health graduate programs, but becoming a proficient therapist requires practice, experience, and a commitment to life-long learning. A number of organizations offer workshops and supervision for therapists, and an increasing number of books are published each year that guide students and clinicians in learning CBT for a variety of diagnostic categories and populations.
Judith S. Beck, PhD, is president of the Beck Institute for Cognitive Behavior Therapy, a nonprofit organization in suburban Philadelphia, which she cofounded with Aaron T. Beck, MD, in 1994. Through the Institute, she has trained thousands of health and mental health professionals, nationally and internationally. She is also Clinical Associate Professor of Psychology in Psychiatry at the University of Pennsylvania.
Dr. Beck has written over 100 articles and chapters, and made hundreds of presentations in the United States and worldwide on a variety of topics related to cognitive behavior therapy. She is the author of the widely adopted textbooks, Cognitive Therapy: Basics and Beyond and Cognitive Therapy for Challenging Problems. Her other books include Cognitive Therapy of Personality Disorders and The Oxford Textbook of Psychotherapy. She has written extensively on a cognitive behavioral approach to weight loss including books for consumers: The Diet Trap Solution, The Beck Diet Solution and workbook, and The Complete Beck Diet for Life.
Dr. Beck has been a consultant for several NIMH research studies and is an editorial board member for several peer-reviewed journals. She has established an extensive presence on social media to educate professionals and the public.
Beck Institute offers a variety of CBT workshops each month, with an annual graduate student workshop on CBT for depression. You can learn more, attend a variety of CBT workshops, and sign up for a cutting edge newsletter at www.beckinstitute.org, www.facebook.com/beckinstitute, and www.twitter.com/beckinstitute For more information on the Beck Depression Inventory, the Beck Anxiety Inventory, and more, visit www.beckscales.com
Copyright 2015 (Volume 20, Issue 1) by Psi Chi, the
International Honor Society in Psychology
Eye on Psi Chi is a magazine designed to keep members
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Terms to Know
Action Plan (also referred to as homework): The individualized assignments the client agrees to do at home
Automatic Thoughts: Spontaneously occurring thoughts or images
Cognitive Behavior Therapy (CBT): One of the few forms of psychotherapy that has been scientifically tested and found to be effective. In contrast to other forms of psychotherapy, cognitive therapy is usually more focused on the present, more timelimited, and more problem-solving oriented. In addition, clients learn specific skills that they can use for the rest of their lives.
Cognitive Model: The underlying theory of cognitive therapy that explains individuals’ emotional, physiological, and behavioral responses as mediated by their perceptions of their experience, which are influenced by their beliefs and by their characteristic ways of interacting with the world, as well as by the experiences themselves.
Mood Check: Asking the client to describe how he or she has been feeling this week compared to other weeks with a combination of 0–10 or 0–100 ratings or assessment forms and narrative self-reports.