Aaron Beck’s Cognitive Therapy

Cognitive therapy seeks to help the patient overcome difficulties by identifying and changing dysfunctional thinking, behaviour, and emotional responses. This involves helping patients develop skills for modifying beliefs, identifying distorted thinking, relating to others in different ways, and changing behaviors.

Treatment

• • Treatment is based on collaboration between patient and therapist and on testing beliefs. Therapy may consist of testing the assumptions which one makes and identifying how certain of one's usually-unquestioned thoughts are distorted, unrealistic and unhelpful. Once those thoughts have been challenged, one's feelings about the subject matter of those thoughts are more easily subject to change.

Depression

• • Beck initially focused on depression and developed a list of "errors“ in thinking that he proposed could maintain depression.

A simple example may illustrate the principle of how CT works: having made a mistake at work, a person may believe, "I'm useless and can't do anything right at work." Strongly believing this then tends to worsen their mood. The problem may be worsened further if the individual reacts by avoiding activities and then behaviorally confirming the negative belief to themselves.

Self-fulfilling prophecy

• • As a result, any adaptive response and further constructive consequences become unlikely, which reinforces the original belief of being "useless". In therapy, the latter example could be identified as a self-fulfilling prophecy or "problem cycle", and the efforts of the therapist and client would be directed at working together to change it. This is done by addressing the way the client thinks and behaves in response to similar situations and by developing more flexible ways to think and respond, including reducing the avoidance of activities.

Depression

• • • • Depression is a state of low mood and aversion to activity that can affect a person's thoughts, behaviour, feelings and physical well-being.

Depressed people may feel sad, anxious, empty, hopeless, helpless, worthless, guilty, irritable, or restless. They may lose interest in activities that once were pleasurable, experience overeating or loss of appetite, or problems concentrating, remembering details or making decisions; and may contemplate or attempt suicide. Insomnia, excessive sleeping, fatigue, loss of energy, or aches, pains or digestive problems that are resistant to treatment may be present.

List of errors

• • • • • • • Beck initially focused on depression and developed a list of "errors" in thinking that he proposed could maintain depression.

Many cognitive distortions are also logical fallacies; All-or-nothing thinking (splitting) – Thinking of things in absolute terms, like "always", "every", "never", and "there is no alternative". Few aspects of human behavior are so absolute. All-or-nothing-thinking can contribute to depression. Overgeneralization – Taking isolated cases and using them to make wide generalizations. Mental filter – Focusing almost exclusively on certain, usually negative or upsetting, aspects of an event while ignoring other positive aspects. For example, focusing on a tiny imperfection in a piece of otherwise useful clothing. Disqualifying the positive – Continually deemphasizing or "shooting down" positive experiences.

Jumping to conclusions – Drawing conclusions (usually negative) from little (if any) evidence. Two specific subtypes are also identified: – Mind reading – Assuming special knowledge of the intentions or thoughts of others.

– Fortune telling – Exaggerating how things will turn out before they happen.

List of errors

• • Magnification and minimization – Distorting aspects of a memory or situation through magnifying or minimizing them such that they no longer correspond to objective reality. This is common enough in the normal population to popularize idioms such as "make a mountain out of a molehill." In depressed clients, often the positive characteristics of other people are exaggerated and negative characteristics are understated. There is one subtype of magnification: – Catastrophizing – Focusing on the worst possible outcome, however unlikely, or thinking that a situation is unbearable or impossible when it is really just uncomfortable.

• Emotional reasoning – Making decisions and arguments based on intuitions or personal feeling rather than an objective rationale and evidence.

• Should statements – Patterns of thought which imply the way things "should" or "ought" to be rather than the actual situation the patient is faced with, or having rigid rules which the patient believes will "always apply" no matter what the circumstances are. Albert Ellis termed this "Musturbation".

List of errors

• • Labeling and mislabeling – Explaining behaviors or events, merely by naming them; related to overgeneralization. Rather than describing the specific behavior, a patient assigns a label to someone of him- or herself that implies absolute and unalterable terms. Mislabeling involves describing an event with language that is highly colored and emotionally loaded.

Personalization – Attribution of personal responsibility (or causal role) for events over which the patient has no control.

Cognitive distortion by sex offenders

• • • • • • Offenses may be facilitated by cognitive distortions of the sex offender, such as minimization of the abuse, victim blaming, and excuses.

Minimization may also take the form of cognitive distortion: that avoids acknowledging and dealing with negative emotions by reducing the importance and impact of events that give rise to those emotions.

that avoids conscious confrontation with the negative impacts of one's behaviour on others by reducing the perception of such impacts.

that avoids interpersonal confrontation by reducing the perception of the impact of others' behaviour on oneself.

observed in victims of a trauma to downplay that trauma so as to avoid worry and stress in themselves and others.

Victim blaming

• • • People who believe that the world has to be fair may find it hard or impossible to accept a situation in which a person is unfairly and badly hurt. This leads to a sense that, somehow, the victim must have surely done 'something' to deserve their fate.

A global survey of attitudes toward sexual violence by the Global Forum for Health Research shows that victim-blaming concepts are at least partially accepted in many countries. In some countries, victim-blaming is more common, and women who have been raped are sometimes deemed to have behaved improperly. Often, these are countries where there is a significant social divide between the freedoms and status afforded to men and women.

This idea dates from ancient times: the biblical Book of Job offers a refutation of the Just World Hypothesis, in which the main character, Job, maintains his faith through calamity after calamity, all of which are explicitly unrelated to his behavior, which remains devout.

Excuses

• • In psychology and logic, rationalization (or making excuses) is a defense mechanism in which perceived controversial behaviors or feelings are explained in a rational or logical manner to avoid the true explanation. It is also an informal fallacy of reasoning.

This process ranges from fully conscious (e.g. to present an external defense against ridicule from others) to mostly subconscious (e.g. to create a block against internal feelings of guilt).

History

• Becoming disillusioned with long-term psychodynamic approaches based on gaining insight into unconscious emotions and drives, Beck came to the conclusion that the way in which his clients perceived, interpreted and attributed meaning in their daily lives—a process scientifically known as cognition—was a key to therapy.

Application to depression

• • • According to Beck's theory of depression, depressed people acquire a negative schema of the world in childhood and adolescence; children and adolescents who suffer from depression acquire this negative schema earlier. Depressed people acquire such schemas through a loss of a parent, rejection by peers, criticism from teachers or parents, the depressive attitude of a parent and other negative events. When the person with such schemas encounters a situation that resembles the original conditions of the learned schema in some way, even remotely, the negative schemas of the person are activated.

Application to depression

• • • Beck also included a negative triad in his theory. A negative triad is made up of the negative schemas and cognitive biases of the person. A cognitive bias is a view of the world. Depressed people, according to this theory, have views such as "I never do a good job". A negative schema helps give rise to the cognitive bias, and the cognitive bias helps fuel the negative schema. This is the negative triad. Also, Beck proposed that depressed people often have the following cognitive biases: arbitrary inference, selective abstraction, overgeneralization, magnification and minimization. These cognitive biases are quick to make negative, generalized, and personal inferences of the self, thus fueling the negative schema.