COGNITIVE
BEHAVIORAL
THERAPY
Serena Phan, Marianna
Schroeder, Daniel Luong
TABLE OF CONTENTS
01. HISTORY OF CBT
02. THE THEORY OF CHANGE
03. ROLE OF THERAPIST
04. STRATEGIES FOR HELPING CLIENTS
05. RESEARCH ON EFFICACY
06. EVALUATION
HANDOUT
01.
HISTORY OF CBT
HISTORY OF CBT
B.F. SKINNER: OPERANT CONDITIONING AARON BECK: COGNITIVE THERAPY
(RUDOWSKI, 2022) BELIEVES THAT A PERSON’S
PRECURSOR TO CBT REACTION TO SPECIFIC UPSETTING
BEHAVIOR IS SHAPED BY ITS THOUGHTS MAY CONTRIBUTE TO
CONSEQUENCES AND THAT ABNORMALITY
REINFORCED BEHAVIORS ARE
MORE LIKELY TO BE REPEATED
1930'S 1950'S 1960'S
ALBERT ELLIS: RATIONAL EMOTIVE
BEHAVIOR THERAPY
ENCOURAGES PEOPLE TO IDENTIFY
THEIR GENERAL AND IRRATIONAL
BELIEFS AND SUBSEQUENTLY
PERSUADES THEM TO CHALLENGE
THESE FALSE BELIEFS THROUGH
REALITY TESTING
THEORISTS OF CBT
1950'S 1960'S
ALBERT ELLIS FOUND RATIONAL EMOTIVE AARON T. BECK ADDRESSES THOUGHTS AND
BEHAVIOR THERAPY (REBT) BEHAVIORS IN THERAPY, EMPHASIZING THE
COMBINED HUMANISTIC, COGNITIVE, IMPACT ON A PERSON’S THOUGHTS AND
AND BEHAVIORAL FORMS OF THERAPY EMOTIONS. HE REFERRED TO THIS THERAPY AS
EMPHASIZES IRRATIONAL BELIEFS AND COGNITIVE THERAPY (CT)
SABOTAGE OF INDIVIDUALS' GOALS MODIFIED HIS DEVELOPMENT FROM ELLIS
TO LEAD TO INCREASED PAIN, AND CONDUCTED RESEARCH ON THE ROLE
SUFFERING, AND DISPLEASURE AS A OF THOUGHTS IN CREATING EMOTIONS
ROOT OF EMOTIONAL AND WORKS FROM BANDURA AND
BEHAVIORAL DISTURBANCES MEICHENBAUM HELPED SUPPORT THE BASIS
GIVEN CREDIT TO STOICS IN OF CBT AS IT PROGRESSED
ROMAN TIMES FOR THE USED CT FOR CLIENTS WITH DEPRESSION,
GROUNDWORK OF BASIC CONNECTING “PROCESSING FAULTS AND
COGNITIVE CONCEPTS, DEEP-ROOTED MALADAPTIVE CORE
PARTICULARLY EPICTETUS, WHO BELIEFS”.
STRESS HUMAN BEINGS CANNOT IN OTHER WORDS, LINKING THINKING TO
CONTROL LIFE, ONLY THEIR ONE'S CORE BELIEFS
RESPONSES TO IT
(HANSCOM ET. AL., 2015; HAUSWIRTH, 2022; NEWMAN ET. AL., 2017; WILSON, 2023)
CBT CONTRIBUTORS
ALBERT BANDURA STEVEN C. HAYES MARSHA M. LINEHAN
PRINCIPLES OF BEHAVIOR MODIFICATION ACCEPTANCE AND DIALECTICAL BEHAVIOR
EMPHASIZING THE ROLE OF INTERNAL COMMITMENT THERAPY
AND COGNITIVE FACTORS IN THE THERAPY TO TREATING CLIENTS
CAUSATION AND MAINTENANCE OF INTEGRATE BOTH WITH BORDERLINE
BEHAVIOR, CREATING SOCIAL LEARNING COGNITIVE AND PERSONALITY
IN RESPONSE TO THE LIMITATIONS OF BEHAVIORAL THERAPY DISORDER AND/OR
BEHAVIORAL LEARNING SUICIDAL IDEATION
1960'S 1970'S 1980'S 1980'S 1990'S
DONAL MEICHENBAUM
SELF INSTRUCTIONAL TRAINING (SIT) PHILLIP C. KENDALL
APPROACH TO CBT WAS TO DECREASE THE COPING CAT
IMPULSIVE BEHAVIORS TO EMIT HEALTHY PROGRAM TO HELP
SPEECH THROUGH SELF-GUIDANCE AND CHILDREN LEARN
STRESS INOCULATION (SI) TO PREPARE COPING SKILLS TO
CLIENTS TO DEAL WITH STRESS-INDUCING MANAGE FEAR AND
EVENTS BY TEACHING THEM COPING SKILLS ANXIETY
TO COPE WITH STRESSFUL SITUATIONS
(BEAL, 2023; FREEMAN, 2010)
MODERN DAY STUDY OF CBT
2005
ROTH AND FONAGY REPORT EVIDENCE IN THEIR
BOOK, “WHAT WORKS FOR WHOM?”, SHOWS CBT TO
BE A STRONGER THERAPY FOR MOST ADULTS WITH
PSYCHOLOGICAL DISORDERS THAN OTHER
THERAPIES
2014
COMPUTER-ASSISTED COGNITIVE THERAPY FOR
DEPRESSION. HELPING PATIENTS BUILD CBT SKILLS
THROUGH COMPUTER LESSONS WITH MONITORED
PROGRESSION
2018
CBT PUBLISHED TO BE THE CURRENT GOLD
STANDARD OF PSYCHOTHERAPY
2023
JUDITH BECK SEES AN INCREASED FOCUS ON THE
USE OF TECHNOLOGY TO PROVIDE CBT TREATMENT
USING COMPUTERS, SMARTPHONES AND ARTIFICIAL
INTELLIGENCE (BECK, 2023; DAVID ET AL., 2018; EELLS, 2014)
02.
THE THEORY OF
CHANGE
COGNITIVE BEHAVIORAL THERAPY
CBT combies two types of therapy:
Cognitive Therapy: Behavior Therapy:
How our negative thoughts How we behave and our
contribute to problems reactions contribute to
The goal is to reveal and problems
change false and distressing Aims to find out whether certain
beliefs because it is often not behavioral patterns make your
only the things and situations life difficult or intensify your
that cause problems, but the problems. In the second step,
importance that we attach to you work on changing these
them too behavioral habits
(BECK, 1995; DRAKE ET AL., 2020)
COGNITIVE BEHAVIORAL THERAPY
CBT AIMS TO:
Change how a person thinks and what they do
Help individuals understand their current ways of
thinking and behaving
Equips them with the tools to change their maladaptive
cognitive and behavioral patterns
Modify patterns of thinking and behavior to bring about a
beneficial change in the patient's mood and way of living
his/her life
(BECK, 1995; DRAKE ET AL., 2020)
COGNITIVE-BEHAVIORAL THERAPY
Three Levels of Cognition
CORE BELIEFS COGNITIVE DISTORTION AUTOMATIC THOUGHTS
Or schemas, are Internal mental filters or Negative self-talk that
deeply held beliefs biases that increase our appears without us
about self, others misery, fuel our anxiety, being aware of forming
and the world and make us feel bad a thought, in response
about ourselves to a certain stimulus
(BECK, 1995; CHAND ET AL.,2023; DRAKE ET AL., 2020; GRINSPOON, 2022)
CBT TECNIQUES FOR CHANGE
COGNITIVE BEHAVIORAL CBT HELPS CLIENTS BY
Core Beliefs Homework Face fears
Evidence to Progressive Test beliefs and
support/not support relaxation training assumptions
assumptions Breathing Replace
Thoughts exercises unhelpful habits
Cognitive Triangle ABC model Learn new skills
(BECK, 1995; DRAKE ET AL., 2020)
COGNITIVE TRIANGLE
A visual representation of thoughts,
feelings, and behaviors interconnected
with our thinking. It teaches clients to
make small changes in their thoughts
and behavior to lead to more positive
thinking
ABC MODEL
Identifying Actions, Beliefs, and Consequences from
the Belief
The action is the triggered event
Beliefs are how we respond to the event
The consequences of how we react to our beliefs
The model aims to recognize clients' beliefs by
adjusting cognitive distortions to avoid internalizing
or negative thinking patterns
CBT VS. SFBT
BREAK PROBLEMS SIMILARITIES COME UP WITH IDEAS
DOWN INTO SEPARATE ON HOW THINGS
PARTS COULD BE BETTER IN
FOCUS ON THE FUTURE DESPITE
PROBLEM FOCUSED COGNITIONS AND EXISTING PROBLEMS.
BEHAVIORS.
IT HELPS IDENTIFY FUTURE AND GOAL
PATTERNS OF DEALS WITH THE ORIENTED
THOUGHTS, EMOTIONS, PROBLEM RATHER
BODILY FEELINGS, AND THAN AIMING TO CHANGE FRAME OF
ACTIONS. ALTER THE CLIENT'S REFERENCE
PERSONALITY.
THE CLIENT IS VIEWED THE CLIENT IS VIEWED
AS HAVING FAULTY AS HAVING ALL THE
COGNITIONS THAT RESOURCES THEY NEED
LEAD TO PROBLEMATIC
BEHAVIORS
03.
ROLE OF
THERAPIST
HELP THE CLIENT
BECOME THEIR
OWN THERAPIST
COLLABORATE Teach the client rational self-
counseling skills
WITH THE CLIENT Help clients develop coping
Work with the client to skills to learn to change their
develop an understanding of own thinking, emotions, and
the problem behavior
Collaborate to develop a
treatment strategy to help
them accomplish their goals
(AMERICAN PSYCHOLOGICAL ASSOCIATION, 2017; NATIONAL ASSOCIATION OF COGNITIVE-BEHAVIORAL THERAPISTS, 2023)
LISTEN, TEACH, & ENCOURAGE
FOCUS ON THE
Listen, teach, and encourage while the client
CLIENT’S PRESENT expresses concerns, learns, and implements
AND FUTURE what they are learning
Emphasize what is currently
occurring in the client’s life CREATE A STRONG
rather than what has led up to THERAPEUTIC RELATIONSHIP
their difficulties
Demonstrate empathy, genuineness, and
Focus on moving forward to respect toward the client
develop more effective ways of
coping with life Create a positive and trusting relationship
with the client
(AMERICAN PSYCHOLOGICAL ASSOCIATION, 2017; NATIONAL ASSOCIATION OF COGNITIVE-BEHAVIORAL THERAPISTS, 2023)
CBT VS. SFBT
SIMILARITIES
THE THERAPIST IS THE THE CLIENT IS THE
EXPERT EXPERT
SUPPORTIVE AND
EMPATHETIC
SETS OUT THE
DIRECTION AND FLOW THE ROLE IS FOCUSED
FACILITATING AND
MORE ON THE CLIENT
GUIDING THE SESSION
TAKES THE LEAD WHEN
COMING UP WITH HELP CLIENTS FOCUS
SEARCH FOR
HOMEWORK AND ON EXCEPTIONS AND
STRENGTHS
ACTIVITIES TO WORK STRENGTHS
ON
04.
STRATEGIES FOR
HELPING CLIENTS
COGNITIVE RESTRUCTURING
The therapist asks about the client’s thought process in situations so the client can
identify negative patterns
Once the client becomes aware of these patterns, they can learn how to reframe
those thoughts so they are more positive and productive
BEHAVIOR ACTIVATION
The therapist encourages the client to deliberately practice desired behaviors to
activate a positive emotional state
The client’s positive feelings following the engagement in these behaviors encourage
them to repeat the behavior
HOMEWORK
The client devotes time outside of the session to completing assignments
Can implement other CBT techniques include keeping lists, filling out diagrams and
charts, etc. (PIETRANGELO, 2019)
GUIDED DISCOVERY
The therapist familiarizes themself with the client’s viewpoint before asking
nonjudgmental, open-ended questions designed to challenge the client’s beliefs
and expand their thinking
The therapist may instruct the client to provide evidence that supports and does
not support their assumptions
Through this Socratic questioning, the client learns to see things from other
perspectives, which may help them choose a more helpful path
EXPOSURE THERAPY
Frequently used to confront fears and phobias
The therapist gradually exposes the client to things that provoke fear or anxiety and
simultaneously provides guidance on how to cope with them
The exposure makes the client feel less vulnerable and more confident in their
coping abilities over time (PIETRANGELO, 2019)
THOUGHT RECORDS
The therapist instructs the client to keep track of their thoughts through writing
The client documents information including their situation, automatic thoughts,
emotions and mood, evidence that supports and does not support their thoughts,
an alternative thought, and ratings of their mood or belief in their thoughts
BEHAVIORAL EXPERIMENTS
Typically used for anxiety disorders that involve catastrophic thinking
The therapist asks the client to predict what will happen before the client engages in
a task that normally makes them anxious (typically will start with lower-anxiety tasks
and build from there)
Following the completion of the task, the therapist and client discuss whether the
prediction came true
This helps the client see that the predicted catastrophe is actually not very likely to
happen
(PIETRANGELO, 2019)
RELAXATION/MINDFULNESS
Lowers the client’s stress and increases their sense of control
Muscle relaxation - the client learns how to relax and how to recognize and pinpoint
tension and relaxation in the body to identify tension and reduce its influence
Deep breathing - reduces rapid and shallow breathing that frequently occurs during
periods of stress, worry, or anxiety
Imagery -increases cognitive, emotional, and physical control by changing the focus
of the client’s thoughts
Typically helpful for phobias, social anxieties, and other stressors
(PIETRANGELO, 2019)
SUCCESSIVE APPROXIMATION
Entails taking tasks that appear to be overwhelming and breaking them into smaller,
more manageable steps
Each successive step builds upon the previous steps, which allows the client to gain
confidence as they progress through each step
ROLE PLAYING
The therapist helps the client work through different behaviors in potentially difficult
situations
Playing out possible scenarios helps lessen the client’s fear surrounding these
situations
Can be used for improving problem-solving skills, practicing social skills, and
enhancing communication skills
(PIETRANGELO, 2019)
ROLE-PLAY
STRATEGY #1
COGNITIVE
RESTRUCTURING
STRATEGY #2
BEHAVIOR
ACTIVATION
STRATEGY #3
HOMEWORK
05.
RESEARCH ON
EFFICACY
Anixety A 2018 study looking at CBT for anxiety in young people found that the
approach appeared to have good long-term results. More than half of
(Kodal et al., 2018) the participants in the study no longer met criteria for anxiety at
(van Starrenburg et al., follow-up, which took place 2 or more years after they completed
2017) therapy.
Coping Cat: A CBT program designed for school-based use
Results showed that from the start of the training to the 3-month
follow-up assessment, children’s self-reported anxiety levels
decreased significantly more in the experimental group compared to
the control group.
After the program, almost two-thirds of the experimental group
returned to anxiety levels that fell into the normal range, while almost
two-thirds of the control group still reported elevated levels of anxiety.
Depression Research published in 2011 suggests that CBT can not only help treat
depression but it may also help reduce the chances of relapse after
(Driessen & Hollon, 2010) treatment.
A 2018 study looking at 104 people found evidence to suggest CBT can
(Yang et al., 2018) also help improve cognitive function for people with major depression
and PTSD
(Shirk et al., 2009) Diverse Lens
Results suggest that CBT was relatively robust across ethnic groups,
across males and females, and for adolescents of different ages.
06.
EVALUATION
STRENGTHS LIMITATIONS
Adolescents are taught that they may Highly stressful life circumstances could
not be able to change the fact that a make it difficult to apply skills acquired
negative activating event happened, but in CBT or might offset gains by
they can change negative beliefs and precipitating negative emotional
feelings surrounding it. reactions to ongoing events.
Adolescents are taught steps of An important issue for school systems
effective problem-solving and cognitive is how to balance the delivery of what is
and behavioral strategies for affect considered to be the most appropriate
management (e.g., cognitive level of intervention with the potential
restructuring, relaxation). risk of stigmatization.
The intervention may be easier to Additional work is needed to establish
implement in schools as it requires less the mediators and moderators of
time and professional resources treatment outcome – essentially, for
whom is CBT more or less effective, and
why does CBT for child anxiety work?
(Haugland et al., 2017; Mychailyszyn et al., 2012; Seligman & Ollendick, 2011; Shrik et al., 2009; Spirito et al., 2011)
IMPLICATIONS FOR FUTURE WORK AS SCHOOL
COUNSELORS AND SCHOOL PSYCHOLOGISTS
Future studies are recommended to go beyond paper-and-pencil questionnaires
to determine whether interventions are leading to changes in functional
outcomes and quality of life.
School-based intervention research should broaden its scope of identified risk
factors beyond those typically investigated (e.g., elevated symptoms, having
divorced parents) to focus on other less-studied factors such as personality
pathology, which has been shown to be a powerful predictor of the recurrence of
major depressive disorder
It is recommended that students and clinicians recognize the significant
prevalence of comorbid presentations of mental health diagnoses and the
psychological supports necessary for effective counseling services.
(Golf et al., 2022; Mychailyszyn et al., 2012)
BLOOKET
ACTIVITY
REFERENCES
American Psychological Association. (2017). What is cognitive behavioral therapy?. American Psychological Association.
https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral
Beck, J.S. (1995). Cognitive therapy: Basics and beyond. New York Guilford Press.
Chand, S, Kuckel, D, Huecker, M. (2023) Cognitive Behavior Therapy. In: StatPearls [Internet]. Treasure Island (FL):
StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470241/
Drake, K., Keeton, C., Ginsburg, G. S. (2020). Cognitive Behavioral Therapy (CBT). John Hopkins Psychiatry Guide.
Driessen, E., & Hollon, S. D. (2010). Cognitive behavioral therapy for mood disorders: efficacy, moderators and mediators.
The Psychiatric clinics of North America, 33(3), 537–555. https://doi.org/10.1016/j.psc.2010.04.00
Eells, T. D., Barrett, M. S., Wright, J. H., & Thase, M. (2014). Computer-assisted cognitive-behavior therapy for depression.
Psychotherapy (Chicago, Ill.), 51(2), 191–197. https://doi.org/10.1037/a0032406
Freeman, Arthur (2010). Cognitive and Behavioral Theories in Clinical Practice. Newyork, NY: The Guilford Press. p. 125.
Grinspoon, Peter M (2022, May 4). How to recognize and Tame your cognitive distortions. Harvard Health.
https://www.health.harvard.edu/blog/how-to-recognize-and-tame-your-cognitive-distortions-
202205042738#:~:text=Cognitive%20distortions%20are%20internal%20mental,continually%20processing%20lots%20of%2
0information.
Goff, T. M., Moody, M. E., Acosta, L. L., & Joyce-Beaulieu, D. (2022). School-based cognitive-behavioral therapy in an inclusion
model for an adolescent with comorbid major depressive disorder, generalized anxiety disorder, and attention deficit
hyperactivity disorder: A case study. Clinical Case Studies, 21(5), 457–473. https://doi-org/10.1177/15346501221078329
REFERENCES
Hanscom, D. A., Brox, J. I., & Bunnage, R. (2015). Defining the Role of Cognitive Behavioral Therapy in Treating Chronic Low
Back Pain: An Overview. Global Spine Journal, 5(6), 496–504. https://doi-org.chapman.idm.oclc.org/10.1055/s-0035-
1567836
Haugland, B. S., Raknes, S., Haaland, A. T., Wergeland, G. J., Bjaastad, J. F., Baste, V., Himle, J., Rapee, R., & Hoffart, A. (2017).
BASIC
School-based cognitive behavioral interventions for anxious youth: study protocol for a randomized controlled trial. Trials,
18(1), 100. https://doi.org/10.1186/s13063-017-1831-9
Kodal, A., Fjermestad, K., Bjelland, I., Gjestad, R., Öst, L.-G., Bjaastad, J. F., Haugland, B. S. M., Havik, O. E., Heiervang, E., &
Wergeland, G. J. (2018). Long-term effectiveness of cognitive behavioral therapy for youth with anxiety disorders. Journal of
Anxiety Disorders, 53, 58–67. https://doi-org/10.1016/j.janxdis.2017.11.003
Mychailyszyn, M. P., Brodman, D. M., Read, K. L., & Kendall, P. C. (2012). Cognitive‐behavioral school‐based interventions for
anxious and depressed youth: A meta‐analysis of outcomes. Clinical Psychology: Science and Practice, 19(2), 129–153.
https://doi-org/10.1111/j.1468-2850.2012.01279.x
National Association of Cognitive-Behavioral Therapists. (2023). What is CBT? This is cognitive-behavioral therapy. National
Association of Cognitive-Behavioral Therapists. https://www.nacbt.org/whatiscbt-
htm/#:~:text=Cognitive%2Dbehavioral%20therapists%20seek%20to,learn%2C%20and%20implement%20that%20learning.
Newman, M. G., LaFreniere, L. L., & E., Shin K. (2017). Cognitive-behavioral therapies in
historical perspective. Comprehensive textbook of psychotherapy: Theory and practice (2nd ed., pp. 61-75). New York: Oxford
University Press.
Pietrangelo, A. (2019). 9 CBT techniques for better mental health. Healthline. https://www.healthline.com/health/cbt-techniques
Seligman, L. D., & Ollendick, T. H. (2011). Cognitive-behavioral therapy for anxiety disorders in youth. Child and adolescent
psychiatric clinics of North America, 20(2), 217–238. https://doi.org/10.1016/j.chc.2011.01.003
REFERENCES
Russel, L. (n.d.) What Is The Cognitive Triangle? CBT Tool For Mental Health. They Are The Future.
https://www.theyarethefuture.co.uk/cognitive-triangle-cbt/
Shirk, S. R., Kaplinski, H., & Gudmundsen, G. (2009). School-based cognitive-behavioral therapy for adolescent
depression: A benchmarking study. Journal of Emotional and Behavioral Disorders, 17(2), 106–117. https://doi-
org/10.1177/1063426608326202
Siddique, J., Chung, J. Y., Brown, C. H., & Miranda, J. (2012). Comparative effectiveness of medication versus cognitive-
behavioral therapy in a randomized controlled trial of low-income young minority women with depression. Journal of
Consulting and Clinical Psychology, 80(6), 995–1006. https://doi-org/10.1037/a0030452
Spirito, A., Esposito-Smythers, C., Wolff, J., & Uhl, K. (2011). Cognitive-behavioral therapy for adolescent depression and
suicidality. Child and adolescent psychiatric clinics of North America, 20(2), 191–204.
https://doi.org/10.1016/j.chc.2011.01.012
van Starrenburg, M. L., Kuijpers, R. C., Kleinjan, M., Hutschemaekers, G. J., & Engels, R. C. (2017). Effectiveness of a Cognitive
Behavioral Therapy-Based Indicated Prevention Program for Children with Elevated Anxiety Levels: a Randomized
Controlled Trial. Prevention science : the official journal of the Society for Prevention Research, 18(1), 31–39.
https://doi.org/10.1007/s11121-016-0725-5
Yang, Z., Oathes, D. J., Linn, K. A., Bruce, S. E., Satterthwaite, T. D., Cook, P. A., Satchell, E. K., Shou, H., & Sheline, Y. I. (2018).
Cognitive Behavioral Therapy Is Associated With Enhanced Cognitive Control Network Activity in Major Depression and
Posttraumatic Stress Disorder. Biological psychiatry. Cognitive neuroscience and neuroimaging, 3(4), 311–319.
https://doi.org/10.1016/j.bpsc.2017.12.006
