Cognitive Therapy & Cognitive Behavioral Therapy (CBT) (College Board AP® Psychology): Revision Note

Focus & techniques of cognitive therapy

• Cognitive therapy, developed by Aaron Beck, proposes that psychological disorders arise not from external events but from the way people think about those events

  • The goal of cognitive therapy is to identify and modify maladaptive thinking

  • Beck argued that clients develop negative schemas that lead to cognitive distortions

• Cognitive therapy focuses on the cognitive triad, which is Beck's model of depression in which negative automatic thoughts cluster around three themes:

  • Negative view of self

    • "I am worthless, inadequate, or a failure"

  • Negative view of the world

    • "The world places insurmountable obstacles in my path"

  • Negative view of the future

    • "Things will never improve; there is no hope"

Maladaptive schemas & cognitive distortions

• Maladaptive schemas are deeply held, negative patterns of thinking that develop through experience and lead to distorted interpretations of events

• Common types of cognitive distortion include:

  • arbitrary inference: drawing conclusions without evidence

    • E.g. a person who receives no reply to a message and thinks "They must hate me" despite there being no evidence

  • all-or-nothing thinking: seeing things in extremes only

    • E.g. a person who thinks "If I don't get this job, I'll be a complete failure"

  • overgeneralization: applying one negative event to all situations

    • E.g. a person who fails one job interview and concludes "I will never get any job"

Cognitive restructuring

• Cognitive restructuring is the core technique of cognitive therapy, in which the therapist helps the client:

  • identify, challenge, and replace maladaptive thoughts

• The therapist challenges irrational or distorted thoughts by asking the client to examine the evidence for and against them

  • The client is encouraged to develop more balanced, realistic interpretations of events in place of distorted ones

    • E.g. a client who fails an exam and thinks "I am stupid and will always fail everything" is helped to recognize more balanced explanations, such as "I did not prepare enough for this particular exam and can do better next time"

• Cognitive therapy also uses fear hierarchies to address anxiety

  • The therapist helps the client work through feared thoughts or situations in a graded way while challenging the accompanying distorted beliefs

Focus & techniques of cognitive behavioral therapy (CBT)

• CBT combines techniques from both cognitive and behavioral traditions to treat mental and behavioral disorders

  • CBT proposes that thoughts, feelings, and behaviors are interconnected

    • Changing one element produces changes in the others

• The therapist works with the client on:

  • the cognitions (thoughts and beliefs) that maintain distress

  • the behaviors (avoidance, compulsions, social withdrawal) that reinforce the distress

• CBT is typically short-term (8–20 sessions), structured, and goal-oriented

• Clients are often given homework assignments to practice skills between sessions

Rational emotive behavior therapy (REBT)

• REBT is based on the idea that when people encounter situations, they recite irrational statements to themselves that generate maladaptive emotional and behavioral responses

  • E.g. a person with social anxiety might think "Other people's opinions are crucial to my happiness" or "I always have to be perfect in everything I do"

• The therapist confronts these irrational beliefs directly, explaining why they are incorrect and helping the client replace them with more rational, flexible alternatives

  • Unlike standard CBT, the client is not guided to discover the irrationality themselves; the therapist states it explicitly

Dialectical behavior therapy (DBT)

• DBT combines standard CBT techniques with distress tolerance and emotional regulation strategies

  • Unlike standard CBT, DBT focuses on emotions and interpersonal relationships rather than thought patterns alone

  • DBT is built around dialectical tension

    • This is where the therapist helps the client accept two opposing truths simultaneously: "I am doing the best I can" and "I need to do better"

Group therapy

• Group therapy involves clients meeting together with a therapist in an interactive group, rather than in a one-to-one session

  • Group therapy can incorporate any of the therapeutic orientations covered in this unit, i.e. psychodynamic, humanistic, or may be eclectic in approach

• A therapist facilitates the group but the group dynamics themselves are considered part of the therapeutic process

How group therapy differs from individual therapy

• Cost and accessibility: group therapy is less expensive than individual therapy and allows a therapist to treat more clients simultaneously

  • This makes mental health treatment more accessible

• Social learning and peer support: group members benefit from hearing the experiences and coping strategies of peers, not just from the therapist's input

  • Hearing that others have found ways to cope can normalize the client's own experience and provide practical strategies

• Universality: clients realize they are not alone in their struggles

  • This can reduce shame and isolation, which is a benefit unique to group settings

• Interpersonal learning: the group setting provides a live context for practicing social and interpersonal skills

  • Individual therapy cannot replicate this

• However, there are limitations as:

  • clients may be less willing to disclose sensitive material in a group setting

  • individual needs may receive less attention than in one-to-one therapy

Types of group therapy

• Family therapy is a form of group therapy in which the therapist works with the couple or family unit rather than the individual

  • Family therapy recognizes that a client's problems rarely occur in isolation

    • patterns of interaction among family members often maintain or exacerbate individual difficulties

  • The goal is to alter the behavior of the whole family system rather than just the identified individual

  • Family members are encouraged to:

    • express feelings to one another and to the therapist

    • listen to one another in ways that may not occur in other settings

• Twelve-step programs (e.g., Alcoholics Anonymous) are a widely used form of group therapy

  • They are modeled on a combination of spirituality and group support

• Twelve-step groups are typically not facilitated by professional psychotherapists

  • Instead, peers who have experienced the same difficulties share their experience and strength with each other

  • These groups have gained popularity in the treatment of substance use disorders

• Peer support groups involve people sharing experience and mutual support around a particular condition or life challenge, without a professional therapist present