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Cognitive Therapy Myia T. Bennett Background information regarding the origin of Dr. Aaron Beck’s cognitive therapy and a rationale for alignment with this theory




Theoretical Orientation: Cognitive Therapy Cognitive Therapy is an approach used to treat various psychiatric disorders. This approach was developed during the study and treatment of depression. It is an active and directive approach where clinicians assertively partner with clients to identify specific problems and therapeutic goals. It is time limited and structured; therapy typically spans 15-25 sessions, and sessions are structured with specific questions and the implementation of subjective interventions timed and designed to engage the client’s collaboration and participation (Beck, Rush, Shaw, & Emery, 1979). Standard presentations of depression and anxiety are typically treated with even fewer sessions averaging between 6-14 visits (J. Beck, 2011b). Aaron Beck is attributed as the founder of Cognitive Therapy. He received his bachelor’s degree from Brown University and his doctor of medicine degree from Yale University. He completed residencies in pathology, neurology and psychiatry and was initially aligned with Freud’s Psychoanalytic Theory. Beck admits that the early origins of his theory formation are unclear to him and limited by his memory, but postulates that sometime in the mid 1950’s he noticed and decided to do something about two things: the lack of empirical evidence supporting psychoanalytic theory which obstructed it’s acceptance by the psychiatry community, and to find out more about the courses of depression so that he could develop a brief and effective psychotherapy treatment (A. Beck, 1991); Beck, Rush, Shaw, & Emery, 1979; Sharf, 2012). There is speculation surrounding what the cognitive therapy community accepts and teaches as the circumstances behind Beck’s break from psychoanalytic theory. It is worthy to note that Beck’s separation from his original theory of alignment came after submitting his application to the American Psychoanalytic Association twice, and being rejected twice. Beck is on record admitting that he was not a fan of the psychiatry community. Other noteworthy



reports indicate that Beck not only drew largely on the psychoanalytic concepts of primary and secondary processing in the formulation of cognitive therapy, but that he also continued to support, if not practice psychoanalysis after the construction of his new approach (Roser, 2012; J. Beck, 2011a). Despite speculation, it is widely accepted that Beck developed his theory of cognitive therapy and started publishing on the topic in the 1960’s. There are similarities between aspects of Beck’s Cognitive Therapy and Alfred Adler’s Adlerian therapy; an example of this is a comparison of Beck’s schemas with Adler’s lifestyles. There are also similarities between Beck’s emphasis on core beliefs in cognitive therapy and Albert Ellis’ irrational beliefs as part of his ABC model. Beck also drew on psychoanalytic principles as he formulated a theory that psychological distress could be caused by a variety of combinations of environmental, social, and biological factors; he attributed some cognitive distortions to early childhood events much like Freud emphasized the psychosexual stages of development in childhood. Regardless of the distress or the cause, dysfunctional thinking was theorized as a crucial component of the perceived distress (Sharf, 2012). Structure of the Personality The cognitive model is an underlying theory of cognitive therapy. The cognitive model asserts that people’s perceptions and thoughts affect their feelings and their behaviors. For example, if an individual has a thought spontaneously pop into their head without much choice or reflection—something Beck called an automatic thought—and that thought was “I’ll never lose weight.” They might then feel lowly or sad and subsequently eat junk food to comfort themselves. The cognition (automatic thought) directly impacted their feeling (sadness) and influenced their behavior (eating) (J. Beck, 2011b).



Individuals are not born with perceptions, but rather with a distinctive uniqueness and the ability to think and perceive both negatively and positively. Alongside this individualism and ability are physiological reflexes, all present at birth. The ability to think extends beyond just automatic thoughts to encompass schemas and assumptions/rules (Sharf, 2012). Schemas are underlying cognitive processing, and belief systems that serve as a lens through which individuals perceive experiences. These systems are mechanisms of processing and responding to stimuli related to the triad of an individual’s environment, self, and future; these processing mechanisms affect an additional cognitive triad consisting of emotions, behaviors and thoughts. Schemas are categorized into five different types: physiological, motivational, behavioral, affective, and cognitive-conceptual. A closer look at the cognitiveconceptual schema type reveals what clinicians call core beliefs. Core beliefs depict how an individual feels about their world and his or her self, for example, “I am ugly;” this can be a core belief one has about oneself. They are typically formulated by interactions experienced during early childhood and can also be shaped by significant or traumatic events that occur in early or later stages of development; an example of a traumatic event at a later stage would be experiencing a sexual assault as a young adult. This also serves as evidence that new schemas can be formulated later in life (James, Todd, & Reichelt, 2009; Rosner, 2012; Sharf, 2012). Schemas can be both positive and negative; they also vary in their level of rigidity. An example of a positive schema would be “I am capable of learning,” while an opposing negative schema could be, “I am not smart.” Here is an illustration using this negative schema in a specific situation: A student who believes that they are not smart receives a low score (D-) on a math test. This event triggers the activation of their negative schema, which includes a compensatory assumption/rule – “As long as you get a C you won’t be stupid; you’ll be okay.”



The core belief and rule can be found beneath the triggered automatic thought, “You’re so stupid.” Once the activating event has passed, a schema can return to a dormant state (James, Todd, & Reichelt, 2009; Rosner, 2012; Sharf, 2012). Function of the Personality Individual dispositions, acquired schemas and compensatory assumptions/rules, and cognitions all function as a way for individuals to process, perceive, respond to, and cope with their environment. The cognitive model supports the idea that components of the personality— particularly cognitions—function to interpret stimuli and drive/influence other components of the personality such as feelings or behaviors. According to Beck, individual participants in his study of depression, which served as the foundation for cognitive therapy, did not have a need to experience distress or suffering; these participants actually presented the opposite and sought out behaviors to avoid suffering, which supports the idea the people’s personality makeup functions to perpetuate a survival free of distress (Beck, Rush, Shaw, & Emery, 1979). Role of the Environment There are arguments that cognitive therapy is too structured, not humanistic, doesn’t consider the role of the family, or place emphasis on relationships and their historical context. J. Beck (2011b) explains that one of the basic principles of cognitive therapy is the therapeutic alliance. Warmth, empathy, caring, and genuine regard is required of the therapist and serves as a foundation upon which the therapeutic relationship is built. There is emphasis and placed on building this type of relationship and social interaction; the benefits of this type of social exchange is not overlooked. Another basic principle of cognitive therapy is the initial emphasis on the present without much in depth examination of social context, family background and crucial events in early development—with exceptions. If the client expresses a wish to explore



context in more depth, or if a failure to do so would jeopardize the therapeutic relationship, exploration of background and context is encouraged. It is also encouraged if the clinician determines that doing so would aid the client in understanding and modifying or restructuring existing schemas or developing new core beliefs. Cognitive therapy recognizes that schemas are formed in early development as a result of individual interactions with others and one’s environment, critical events that took place during this stage, and as a result of the use of one’s innate ability to learn and process new information, consequently formulating perceptions (J. Beck, 2011b; Sharf, 2012). Healthy vs. Unhealthy Functioning The hierarchy of cognitive conceptualization supports the idea that schematic core beliefs are much like the roots of a tree; they underlay assumptions/rules, and automatic thoughts. It is natural to examine schemas when ascertaining the health of individual functioning. Healthy schemas possess validity and aren’t rigid but rather adaptive; they perpetuate healthy behaviors. An example of a motivational, adaptive, healthy core belief could be, “I work to provide for myself and to make use of a skill that I have.” Healthy functioning is also displayed when the individual is able to identify automatic thoughts and/or faulty beliefs, test the validity, and replace with more realistic thinking. An example of this could be seeing a client make use of the Socratic method, self questioning as they process an automatic thought they were able to identify. Unhealthy functioning is supported by a foundation of maladaptive schemas. Cognitive distortions might take on various forms such as negative prediction, all or nothing thinking, mind reading, catastrophizing, selective abstraction, labeling and mislabeling, personalization, overgeneralization, and magnification or minimization. Conditional,



compensatory assumptions and rules will be present in the individual’s thinking, often followed by unpleasant emotions (Sharf, 2012). Alignment Rationale Individuals who were subjected to negative childhood experiences could formulate unhealthy core beliefs and schemas. If these negative childhood experiences are coupled with traumatic events, maladaptive schemas are likely to be reinforced and/or new ones could also be learned. An example of this [omitted for online publishing]. The individual developed maladaptive schemas such as mistrust/abuse, emotional deprivation and defectiveness/shame. Rules such as, “People can never know what has happened,” were formulated (Glaser, Campbell, Calhoun, Bates, & Petrocelli, 2002). The subject also experienced trauma [omitted for online publishing]. The subject developed additional maladaptive schemas such as abandonment/instability and unrelenting standards. Automatic thoughts that plagued the adolescent included, “That’s not good enough,” “You’re your only family,” and “People don’t care about you.” Through cognitive therapeutic interventions that highlighted the origin of schemas and and learning about the importance of individual schemas, cognitions and perceptions, combined with the establishment of practical goals to foster explicitly desired outcomes, the subject was able experience relief and, more normal (Glaser, Campbell, Calhoun, Bates, & Petrocelli, 2002).



References Beck, A. T. (1991). Cognitive therapy: A 30-year retrospective. American Psychologist, 46(4), 368-375. doi:10.1037/0003-066X.46.4.368 Beck, A. T., Rush, J. A., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression. New York, NY: Guilford Press. Beck, J. S. (Interviewer) & Beck, A. T. (Interviewee). (2011a). A Conversation with Aaron T. Beck [Interview transcript]. Retrieved from Annual Reviews Conversations Web site: ranscript.pdf Beck, J. S. (2011b). Cognitive behavior therapy basics and beyond (2nd ed.). New York, NY: The Guilford Press. Glaser, B. A., Campbell, L. F., Calhoun, G. B., Bates, J. M., & Petrocelli, J. V. (2002). The Early Maladaptive Schema Questionnaire-Short Form: A construct validity study. Measurement And Evaluation In Counseling And Development, 35(1), 2-13. James, I., Todd, H., & Reichelt, F. (2009). Schemas defined. Cognitive Behaviour Therapist, 2(1), 1-9. doi:10.1017/S1754470X08000135 Rosner, R. (2012). Aaron T. Beck's drawings and the psychoanalytic origin story of cognitive therapy. History Of Psychology, 15(1), 1-18. Sharf, R. S. (2012). Theories of psychotherapy and counseling: Concepts and cases (5th ed.). Belmont, CA: Linda Schreiber-Ganster.

Cognitive Therapy: A Theoretical Orientation