CBT: History, Principles, and Treatment Approaches Explained

This report provides a comprehensive overview of Cognitive Behaviour Therapy (CBT). It begins by defining CBT and its approach to solving various problems, including sleeping difficulties, relationship issues, and mental health disorders like anxiety and depression. The report explains how CBT works by changing attitudes and behaviors through cognitive processes. It emphasizes the therapy's short duration and structured sessions. The historical context of CBT is explored, tracing back to Aaron T. Beck's observations of 'automatic thoughts'. The report details the importance of negative thoughts in CBT and the model that events are interpreted and given meaning. It then describes how dysfunctional thinking patterns develop in childhood and how CBT helps individuals challenge and correct these misinterpretations. The structure of CBT treatment sessions is outlined, including goal setting, homework assignments, and structured discussions, highlighting its differences from other therapeutic approaches.

What is cognitive behaviour therapy?
Cognitive behaviour therapy (CBT) describes a number of therapies that all have a similar
approach to solving problems - these can range from sleeping difficulties or relationship
problems, to drug and alcohol abuse or anxiety and depression. CBT works by changing
people's attitudes and their behaviour. The therapies focus on the thoughts, images, beliefs
and attitudes that we hold (our cognitive processes) and how this relates to the way we
behave, as a way of dealing with emotional problems.
An important advantage of CBT is that it tends to be short, taking three to six months for
most emotional problems. Clients attend a session a week, each session lasting either 50
minutes or an hour. During this time, the client and therapist are working together to
understand what the problems are and to develop a new strategy for tackling them. CBT
introduces them to a set of principles that they can apply whenever they need to, and which
will stand them in good stead throughout their lives.
CBT is a form of psychotherapy which combines cognitive and behavioural therapy.
Cognitive therapy looks at how our thoughts can create our feelings and mood. Behavioural
therapy pays close attention to the relationship between our problems, our behaviour and our
thoughts. CBT may focus on what is going on in the present rather than the past, but often the
therapy will also look at how thinking patterns may have begun in early childhood and the
impact patterns of thinking may have on how we interpret the world as adults.
What's the history of CBT?
In the 1960s, a US psychiatrist and psychotherapist called Aaron T. Beck observed that,
during his analytical sessions, his patients tended to have an 'internal dialogue' going on in
their minds, almost as if they were talking to themselves. But they would only report a
fraction of this kind of thinking to him.
For example, in a therapy session the client might be thinking to him- or herself: 'He (the
therapist) hasn't said much today. I wonder if he's annoyed with me?' These thoughts might
make the client feel slightly anxious or perhaps annoyed. He or she could then respond to this
thought with a further thought: 'He's probably tired, or perhaps I haven't been talking about
the most important things'. The second thought might change how the client was feeling.
Beck realised that the link between thoughts and feelings was very important. He invented
the term 'automatic thoughts' to describe emotion-filled or 'hot' thoughts that might pop up in
the mind. Beck found that people weren't always fully aware of such thoughts, but could
learn to identify and report them. If a person was feeling upset in some way, the thoughts
were usually negative and neither realistic nor helpful. Beck found that identifying these
thoughts was the key to the client understanding and overcoming his or her difficulties.
Beck called it cognitive therapy because of the importance it places on thinking. It's now
known as CBT because the therapy incorporated behavioural techniques as well. The balance
between the cognitive and the behavioural elements varies among the different therapies of
this type, but all come under the general term 'cognitive behaviour therapy'. CBT has since
undergone scientific trials in many places by different teams, and has been applied to a wide
variety of problems.

What's so important about negative thoughts?
CBT is based on a 'model' or theory that it's not events themselves that upset us, but the
meanings we give them. Our thoughts can block us seeing things that don't fit with what we
believe is true. In other words, we continue to hold on to the same old thoughts and fail to
learn anything new.
For example, a depressed woman may think, 'I can't face going into work today: I can't do it.
Nothing will go right. I'll feel awful.' As a result of having these thoughts - and of believing
them - she may ring in sick. By behaving like this, she won't have the chance to find out that
her prediction was wrong. She might have found some things she could do, and at least some
things that were OK. But if she stays at home, brooding about her failure to go in, she may
end up thinking: 'I've let everyone down. They will be angry with me. Why can't I do what
everyone else does? I'm so weak and useless.' She will probably end up feeling worse, and
have even more difficulty going in to work the next day. Thinking, behaving and feeling like
this may start a downward spiral. This vicious circle can apply to many different kinds of
problems.
How does this kind of problem start?
Beck suggested that these thinking patterns are set up in childhood, and become automatic
and relatively fixed. So, a child who didn't get much open affection from their parents but
was praised for school work, might come to think, 'I have to do well all the time. If I don't,
people will reject me'. Such a rule for living (known as a 'dysfunctional assumption') may do
well for the person a lot of the time and help them to work hard.
But if something happens that's beyond their control and they experience failure, then the
dysfunctional thought pattern may be triggered. The person may then begin to have
'automatic' thoughts like, 'I've completely failed. No one will like me. I can't face them'.
CBT acts to help the person understand that this is what's going on. It helps him or her to step
outside their automatic thoughts and test them out. CBT would encourage the depressed
woman mentioned earlier to examine real-life experiences to see what happens to her, or to
others, in similar situations. Then, in the light of a more realistic perspective, she may be able
to take the chance of testing out what other people think, by revealing something of her
difficulties to friends.
Clearly, negative things can and do happen. But when we are in a disturbed state of mind, we
may be basing our predictions and interpretations on a biased view of the situation, making
the difficulty that we face seem much worse. CBT helps people to correct these
misinterpretations.
What form does treatment take?
CBT differs from other therapies because sessions have a structure, rather than the person
talking freely about whatever comes to mind. At the beginning of the therapy, the client
meets the therapist to describe specific problems and to set goals they want to work towards.
The problems may be troublesome symptoms, such as sleeping badly, not being able to
socialise with friends, or difficulty concentrating on reading or work. Or they could be life

problems, such as being unhappy at work, having trouble dealing with an adolescent child, or
being in an unhappy marriage.
These problems and goals then become the basis for planning the content of sessions and
discussing how to deal with them. Typically, at the beginning of a session, the client and
therapist will jointly decide on the main topics they want to work on that week. They will
also allow time for discussing the conclusions from the previous session. And they will look
at the progress made with the 'homework' the client set for him- or herself last time. At the
end of the session, they will plan another assignment to do outside the sessions.