What is CBT?
CBT stands for Cognitive Behavioural Therapy. Cognitive and behavioural psychotherapies are evidence
based psychological approaches which are based on scientific principles and which research has shown
to be effective for a wide range of problems. CBT is endorsed by The National Institute for Health and
Clinical Excellence (NICE) as the treatment of choice for many prevalent psychological disorders. For further
information about NICE recommendations click here.
In CBT clients and therapists work together in collaboration and as a therapeutic alliance been formed, identify
and understand the presented problems in terms of the relationship between thoughts, feelings behaviour and
The CBT approach usually focuses on difficulties in the here and now, and relies on the therapist and client
developing a shared view of the individual’s problem. This then leads to identification of personalised, tailor
made and usually time-limited therapy goals and strategies which are continually monitored and evaluated.
The treatments are inherently empowering in nature, the outcome being to focus on specific psychological
and practical skills, e.g. in reflecting on and exploring the meaning attributed to events and situations and
re-evaluation of those meanings. CBT interventions aimed at enabling the client to tackle their problems
by harnessing their own resources. The acquisition and utilisation of such skills is seen as the main goal
and the active component is to promoting change with an emphasis on putting what has been learned into
practice between sessions. This is called ‘homework’. Thus the overall aim is for the individual to attribute
improvement in their problems to their own efforts, in collaboration with the psychotherapist.
Cognitive and behavioural psychotherapists work with individuals, families and groups. The CBT approaches
can be used to help people from all walks of life irrespective of age, ability, culture, nationality, race or gender.
Cognitive and behavioural psychotherapies can be used on their own or in conjunction with EMDR, mindfulness,
coaching and/or medication, depending on the severity or nature of each client’s problem.
(Source BABCP, www.babcp.com).
EXAMPLES OF COGNITIVE DISTORTIONS
1. All or nothing thinking: This refers to the tendency to evaluate your performance or personal qualities in extremist, black-or-white categories. For example, a prominent politician said: “Because I lost the race for governor, I am a zero.” A straight ‘A’ student who received a ‘B’ on an exam concluded: “I am a total failure.” All-or-nothing thinking is clearly illogical because things are not usually completely one way or the other. For example, no one is either completely attractive or totally ugly. Similarly, people are neither “absolutely brilliant” nor “hopelessly stupid.” All or nothing thinking forms the basis for perfectionism. It causes you to fear any mistakes or imperfection, because you will then see yourself as a complete zero and feel inferior, worthless and depressed.
2. Over-generalisation: you arbitrarily conclude that a single negative event will happen over and over again. For example, a shy young man mustered up his courage to ask a girl for a date. When she declined he thought: “I am never going to get a date. Girls are always turning me down.” A depressed salesman noticed bird dung on his car and thought: “Just my luck! The birds are always crapping on my car.” When he was questioned about it he admitted that in his 20 yeas of driving he could not remember another similar instance.
3. Selective negative focus: you pick out the negative details in any situation and dwell on them exclusively, thus, concluding that the whole situation is negative. For example, a severely depressed student heard some pre-medical students making fun of her roommate. She became furious because of her thought: “That’s what the human race is like – cruel and insensitive!” She was overlooking the fact that in the previous months, few people, if any, had been cruel or insensitive to her! On another occasion when she completed her first mid-term exam she decided to commit suicide because she thought only about the 17 questions she felt certain she had missed and concluded she could not succeed as a college student. When she got the paper back there was a note attached which read: “you got 83 out of 100 correct. This was by far the highest grade of any student this year. A+.”
4. Disqualifying the positive: When a depressed individual is confronted with data that clearly contradict his negative self-image and pessimistic attitudes, s/he quickly and cleverly finds some way to discount this. For example, a young woman hospitalised for chronic intractable depression said: “No one could possibly care about me because I’m such an awful person.” When she was discharged from the hospital, many patients and staff members paid her a warm tribute and expressed fondness for her. Her immediate reaction was to disqualify this: “They don’t count because they are psychiatric patients or staff. A real person outside the hospital could never care about me.” When she was asked how she reconciled this with the fact that she had numerous friends and family who did seem to care about her she again disqualified the data: “They don’t count because they don’t know the real me.” By disqualifying positive experiences in this manner, the depressed individual can maintain negative beliefs that are clearly unrealistic and inconsistent with everyday experiences.
5. Arbitrary inference: you jump to arbitrary, negative conclusions that are not justified by the facts or the situation. Two types of arbitrary inference are “mind reading” and “negative prediction.”
A. Mind reading: You make the assumption that other people are looking down on you and you feel so convince about this that you don’t bother to check it out. You may then respond to this imagined rejection by withdrawal or counter-attack. This self-defeating behaviour patterns may act as self-fulfilling prophecies and set up a negative interaction when none originally existed.
B. Negative prediction: you imagine that something bad is about to happen, and you take this prediction as a fact even though it may be quite unrealistic. For example, during anxiety attacks a high school librarian repeatedly told herself: “I am going to pass out or go crazy.” These predictions were highly unrealistic because she had never once passed out in her entire life, and had no symptoms to suggest impending insanity. During a therapy session an acutely depresses physician explained that he wanted to commit suicide: “I realise I’ll be depressed forever. As I look into the future, I can see this suffering will go on and on, and I’m absolutely convinced that all treatments will be doomed to failure.” Thus, his sense of hopelessness was caused by his negative prediction about his prognosis. His recovery soon after initiating therapy indicated just how off base his “negative prediction” had been.
6. Magnification or minimisation: The ‘binocular trick.’ You are either blowing things up out of proportion or shrinking them. For example, when you look at your mistakes or at other people’s talents, you probably look through the end of the binoculars that makes things seem bigger than they really are. In contrast when you look at your own strengths or other people’s imperfections, you probably look through the opposite end of the binoculars that makes things seem small and distant. Because you magnify your imperfections and minimise your good points, you end up feeling inadequate and inferior to other people.
7. Emotional reasoning: You take your emotions as evidence for the way things really are. Your logic is: “I feel therefore I am.” Examples of emotional reasoning include: “I feel guilty therefore I must be a bad person.” “I feel overwhelmed and hopeless, therefore my problem must be impossible to solve.” “I feel inadequate, therefore I must be a worthless person.” “I feel very nervous around elevators, therefore elevators must be very dangerous.” Such reasoning is erroneous because your feelings simply reflect your thoughts and beliefs.
8. Should statements: You try to motivate yourself to increased activity by saying: “I should do this” or “I must do that”. These statements cause you to feel guilty, pressured and resentful. Paradoxically, you end up feeling apathetic and unmotivated. When you direct should statements towards others, for example: If others are late, you might think: “They shouldn’t be so thoughtless” “They ought to be more prompt” and you probably feel frustrated, angry or indignant.
9. Labelling and mislabelling: Personal labelling involves creating a negative identity for yourself, which is based on your errors and imperfections as if these revealed your true self. Labelling is an extreme form of overgeneralization. The philosophy behind this tendency is: “The measure of a man is the mistakes he makes.” There is a good chance that you are involved in self-labelling whenever you describe yourself with sentences beginning with “I am.” For example: when you goof-up in some way, you might say: “I am a loser” instead of “I lost out on this” or you might think, “I am a failure” instead of: “I made a mistake”. Mislabelling involves describing an event with words that are inaccurate and heavily loaded emotionally. For example: Physician on a diet eat a dish of ice cream and thought “How disgusting and repulsive of me. I am a pig.” These thought made him so upset that he ended up eating the rest of the ice cream.
10. Personalisation: You relate a negative event to yourself when there is no basis for doing so. You arbitrarily conclude that the negative event is your fault, even when you are not responsible for the event and did not cause it. For example: When a patient failed to do a self help assignment that the therapist suggested, the therapist thought: “I must be a lousy therapist, or else he would have done what I recommended.” Similarly, when a mother saw her child’s school report, there was a note that her child was not working effectively. She immediately concluded, “I must be a bad mother. This shows how I am goofing up.”