Cognitive Behavioral Therapy

Common Tenets of CBT

Many therapy packages fall under the umbrella of CBT, all of which incorporate elements of both cognitive and behavioral theory to varying degrees. Further, all of the various CBT treatment packages share common tenets. First, psychological distress or difficulties are believed to be caused by maladaptive thoughts and behaviors. These difficulties are remedied through helping the patient identify and change these thoughts and behaviors, leading to a reduction in distress. In this modality, cognitions are believed to play a role such that (a) the individual is exposed to a stimulus, (b) the individual makes a cognitive appraisal of the stimulus, and (c) the cognitive appraisal then affects the resulting emotional response. Thus, it is not the situation, per se, that gives rise to emotional responses, but the individual's appraisal of that situation that leads to the emotional experience. Appraisals are thought to occur near instantaneously and often outside conscious awareness. A key aspect of treatment, therefore, is teaching patients to be cognizant of these automatic thoughts in an attempt to have opportunities to decrease the automaticity of these appraisal processes and alter maladaptive cognitions.

The second shared tenet of CBT treatments is that behaviors are learned through operant or classical conditioning and therefore, are able to be altered. Specifically, CBT therapists assume that (a) any behavior that is followed by a positive outcome will be more likely to be repeated and (b) any behavior that is followed by a negative outcome will be less likely to be repeated. Teaching patients to alter their maladaptive cognitions will lead to more pleasant emotional states, which will be rewarding to the patient, therefore reinforcing this new behavioral pattern. In regard to classical conditioning, CBT therapists share an awareness that stimuli that were previously neutral may be paired with an unconditioned stimulus to give rise to behaviors. Therefore, acute attention to the environments of patients is needed to accurately conceptualize their behavior and to effectively assist patients in altering their behavior. Finally, the third shared tenet is that CBT is a collaborative treatment process, with patients playing an active role in defining the problem to be targeted for intervention, utilizing new skills learned, and practicing these skills between therapy sessions. During each session, goals or homework are collaboratively decided on and are to be completed during the proceeding intersession days. At treatment onset, therapeutic rationale is clearly explained, and the patient is taught skills to help facilitate changes in thought patterns and behaviors. The onus of change resides with the patients and their willingness to practice and incorporate these new skills outside of sessions.

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