6.4 Cognitive Therapy: Basics and Beyond

1. What Is CBT?

Its Chinese name is cognitive behavioral therapy. It is a therapy that helps patients treat psychological problems by correcting erroneous cognition. Developed by A. T. Beck in the 1960s, it is a structured, short-term, cognitively oriented psychotherapy mainly aimed at psychological disorders such as depression and anxiety, as well as psychological problems caused by irrational cognition. Its primary focus is the patient’s irrational cognition, and it changes psychological problems by changing the patient’s views and attitudes toward themselves, other people, or events.

2. Origins of CBT

1. In the late 1950s and early 1960s, Dr. Beck decided to test the psychoanalytic concept that depression is hostility directed inward at the self.

He investigated the dreams of patients with depression and predicted that their dreams would contain more hostile themes than those of the control group.

To his surprise, he ultimately found very few hostile themes in the dreams of depressed patients, but many themes involving defectiveness, deprivation, and loss. He realized that these themes corresponded to the patients’ thoughts while awake.

2. As Dr. Beck continued listening to his patients, he realized that they sometimes reported two streams of thought: a free-association stream and a stream that rapidly evaluated themselves. He began helping his patients identify, evaluate, and respond to unrealistic and maladaptive thoughts. When he did so, the patients improved quickly.
3. In 1977, they published a randomized controlled study of patients with depression, demonstrating that cognitive therapy had efficacy comparable to imipramine, a commonly used antidepressant.

3. Theoretical Foundation of CBT

The situation itself does not determine how people feel. Feelings depend more on cognition, meaning situation-cognition-feeling, also called the ABC principle.

A: Event/situation: something happens.
B: Cognition: a person’s view of things, including interpretations, ideas, and thoughts about themselves, other people, the environment, or a specific event.
C: Feelings: emotions, behavior, physiological responses, etc.

The key is the cognitive level, and the key at the cognitive level is automatic thoughts.

3.1. Automatic Thoughts

3.1.1. Source of Automatic Thoughts — Beliefs

3.1.1.1. What Are Beliefs?

Beliefs: deeply rooted ideas or patterns of thought.

3.1.1.2. How Are Beliefs Formed?

During development, people form generalized understandings of themselves, other people, and the world through interactions with important people, including parents, and through social comparison with people around them, such as siblings and classmates.

3.1.1.3. Categories of Beliefs

There are three main areas:

1. Beliefs about ability.
2. Beliefs about relationships with other people.
3. Beliefs about personal value or meaning.

3.1.1.4. Beliefs and Compensatory Strategies

Compensatory strategies are different styles developed while coping with core beliefs; in other words, they become different personality characteristics.

When a person has negative core beliefs, they often take measures to package themselves so that they appear capable, lovable, and valuable. These measures are called compensatory strategies. Effort, avoidance, compliance, vigilance, and other approaches are used to make the person appear positive.

3.1.1.5. Self-Defeating Beliefs

3.1.1.5.1. What Self-Defeating Beliefs Are There?

1. Personal self-defeating beliefs: equations based on a combination of self-esteem factors.

They include:

1. Performance perfectionism.

2. Perceived perfectionism.

3. Achievement addiction.

4. Approval addiction.

5. Interpersonal self-defeating beliefs: certain expectations toward people close to you.

They include:

1. Blaming others.
2. Truth.
3. Demandingness toward others.
4. Love addiction.
5. Submission.
6. Perceived narcissism.
7. Fear of conflict.

3.1.1.5.2. How to Find Self-Defeating Beliefs

Continuously apply the downward-arrow technique under negative thoughts.

3.1.1.5.3. How to Modify Self-Defeating Beliefs

1. Cost-benefit analysis.
2. Modify beliefs.
3. Test beliefs.

4. Situations Where CBT Applies

5. Types of CBT

1. Rational emotive therapy.
2. Dialectical behavior therapy.
3. Problem-solving therapy.
4. Acceptance and commitment therapy.
5. Exposure therapy.
6. Cognitive processing therapy.
7. Cognitive psychotherapy.
8. Behavioral analysis system.
9. Behavioral activation therapy.
10. Cognitive behavior modification.

6. How to Apply CBT

Feeling Good: The New Mood Therapy
ACT Made Simple
Beck Depression Inventory self-test - Zhihu

7. CBT vs. Medication

1. The greatest advantage is preventing relapse.
2. The greatest disadvantage is that the course of treatment is relatively long, requiring three to four months.

8. References

Change Yourself by Starting With Inner Awareness - Bilibili
Cognitive Behavioral Therapy - Baidu Baike
Cognitive Therapy: Basics and Beyond (Douban)