Aaron Beck and Cognitive Therapy

Behaviorism and psychoanalysis were the dominant forces in the psychological therapies until the second
half of the 20th century when some behaviorists began to investigate how thinking affects a person’s
feelings and behavior. The cognitive theories began to break away from Skinnerian and Pavlovian
theories (based on behavior) and several cognitive-behavioral therapies became popular. Beck (born
1921) was originally a psychoanalyst who became disillusioned with its orthodox methods. His research
led him to believe that depression was a form of thought disorder and he developed his cognitive therapy
which became very popular in America, and later on in Europe.
The Image of the Person
1. Humans are active and interact with the world.
2. This interaction is based on interpretations, inferences and evaluations about the environment.
3. The results of these ‘cognitive’ processes can be expressed in terms of thoughts and images and so can
be changed.
Emotions and behavior are connected by thinking and are therefore conscious processes (here cognitive
therapy differs from behavioral therapies and psychoanalysis). The behavior of the person is determined
by his interpretation of events.
The personal domain is all the things that are important to us (family, possessions, health, status, values,
and goals) and the more an event impinges on our personal domain then the greater will be our emotional
response to it. The meaning we give to a situation depends on our interpretation of it. Beck states that
life is too short to interpret every single event so we make our own rules and patterns and fit events (and
so consequences) into these patterns or schemata (singular is schema). Schemata allow us to filter out
‘unnecessary’ information. Familiar situations have well developed schemata and new situations have less
developed schemata.

Concepts of psychological disturbance and health

Psychological disturbance results in a malfunction in interpreting and evaluating experience.
Interpretations bias to negative meanings and the person makes global, absolute
judgements.
Psychological health comes from schemata that are consistent and give good predictions of
outcomes, AND are flexible enough to incorporate new information. Interpretations of
events bias to positive meanings and the person can learn from situations that go wrong.
1. Faulty and adaptive information-processin
Concepts of Psychological Disturbance and Health
Psychological disturbance results in a malfunction in interpreting and evaluating experience.
Interpretations bias to negative meanings and the person makes global, absolute judgements.
Psychological health comes from schemata that are consistent and give good predictions of outcomes,
AND are flexible enough to incorporate new information. Interpretations of events bias to positive
meanings and the person can learn from situations that go wrong.
1. Faulty and adaptive information-processing: Errors in logical thinking are made when
processing information and experiences. The tendency is to distort information repeatedly
leading to psychological disturbance. In psychological health the person has the ability to make
relatively accurate interpretations and evaluations but this does not mean that the person always
thinks and acts rationally. Mental health is therefore difficult to define absolutely but:
Depression: is a negative view of the self, the world and the future.
Anxiety: the perceptions of threat are greater that the perception of the ability to cope (anxious people
selectively focus on cues that represent threat).
Examples of cognitive distortions are:
a) Arbitrary inference – drawing conclusions when there is no evidence or when the
evidence is to the contrary.
b) Selective abstraction – taking something out of context and drawing conclusions,
ignoring other information.
c) Over-generalisation – general conclusions are made from single incidents.
d) Magnification and minimisation – distorting information and drawing conclusions.
e) Personalisation – relating external events to the self when it is not appropriate to do
so.
f) Absolutistic, dichotomous thinking – all experiences are in one of two opposing
categories, e.g. perfect/flawed, immaculate/filthy, there are no in-betweens. When
describing the self the person uses only extreme negatives.
a) Arbitrary inference – drawing conclusions when there is no evidence or when the evidence is to the
contrary.
b) Selective abstraction – taking something out of context and drawing conclusions, ignoring other
information.
c) Over-generalization – general conclusions are made from single incidents.
d) Magnification and minimization – distorting information and drawing conclusions.
e) Personalization – relating external events to the self when it is not appropriate to do so.
f) Absolutistic, dichotomous thinking – all experiences are in one of two opposing categories, e.g.,
perfect/flawed, immaculate/filthy, there are no in-betweens. When describing the self, the person uses
only extreme negatives.

2. Negative Automatic Thoughts (NATs)

People with psychological disturbance think about different things as well as thinking negatively. They
have negative automatic thoughts which seem plausible but are unrealistic. For example, in:
Depression: “I’m useless, never do anything right, I’m a fraud.”
Anxiety: “I can’t cope, I can’t do anything to stop something awful happening. What if I’m going mad?”
We all experience these thoughts sometimes but they are more frequent and distressing in psychological
disturbance.

3. Cognitive schemata
Healthy schemata are flexible, unhealthy ones are rigid, for example:
“I must always be nice to everyone” – inflexible, irrational, unhealthy.
“It is generally better to be pleasant to people, but sometimes it is ok to be unpleasant” – flexible and
healthy.
People with rigid schemata tend to be hard on themselves when they fall short of their high standards. In
psychological disturbance the negative schemata are more predominant and the person is less able to
challenge them, for example: “If I am not successful, I am worthless”, is more believable when depressed.
Acquisition of Psychological Disturbance
Many things bring about emotional disturbance (i.e. depression and anxiety), some are long-term
(predisposing) and some are short-term (precipitating).
1. Predisposing factors
a) Genetic makeup.
b) Physical disease (e.g., hypothyroidism leads to depression, hyperthyroidism leads to anxiety).
c) Developmental traumas (e.g., loss of a parent in childhood can lead to depression).
d) Poor role-models in childhood can lead to a lack of coping mechanisms.
e) Counter-productive cognitive processes can lead to unrealistic goals and unreasonable assumptions.
2. Precipitating factors
a) Physical disease.
b) Severe external stress (physical danger can lead to anxiety and grief can lead to depression).
c) Chronic insidious external stress (i.e., long-term subtle disapproval).
d) Specific external stress (working on psychological vulnerability).

Underlying Assumptions
Early experiences (traumas and stresses) lead to beliefs and attitudes that make a person vulnerable to
psychological disturbance. For example, a child who has been ill a lot and over-protected may believe
that he is frail and needs to be looked after by others in order to survive; someone who is criticized for
each thing she gets wrong may then believe she has to get everything right; someone who is constantly
told not to argue when she expresses her own opinion may think it is wrong to speak her mind.
We make sense of our experiencing by developing rules for how the world should/does work. The more
rigid, judgmental and absolute these beliefs are the more likely we are to have psychological problems.
Beliefs that may lead to anxiety include:
“Any strange situation is dangerous”
“I am safe only if I am prepared for possible danger”
“I must be in control of myself at all times”
Beliefs that may lead to depression include:
“I can only be happy if I am totally successful”
“I need to be loved in order to be happy”
“I must never make a mistake”
Early childhood experiences can create maladaptive schemata which remain but need not cause us a
problem until they are tested. For example, a woman might believe she has to be loved in order to
survive. While she is happily married there is no problem, but if her husband leaves her then her
reasoning might well be:
1. “I need to be loved to survive”
2. “X has left me”
3. “Therefore I cannot survive”
Once the depression goes (either with time or because she is in another relationship, for example) the
thinking becomes dormant again but remains a vulnerability. Cognitive therapy would work to correct
faulty thinking and also modify the assumptions (i.e., working on the statement 1 and 3 above) and so
reduce the vulnerability.

Perpetuation of Psychological Disturbance

1. Information is manipulated or ignored in order to fit the belief system, for example:
In depression: “I’m no good at anything” – past successes are dismissed as luck.
2. Behaving in a way consistent with wrong beliefs, for example:
In phobias: avoiding the trigger, so do not learn that dogs don’t bite/spiders can’t harm etc.
In panic attacks: avoid the situation, or hold onto something to avoid collapsing, so do not learn
that they will not collapse/pass out.
Personality disorders: for example, abandonment schema: the person will be expecting to be
abandoned so reads every little thing as “it’s happening again”, or will act in ways that bring
abandonment about, or will avoid relationships altogether.
3. External factors: for example:
 Unemployment, bereavement make it hard for depressed people to believe in a future, or that
they are of value.
Long term stress/rejection cause continuing anxiety.
Close relationships: if an important person continually puts the person down, then depression
continues.
The more negative the environment is, the harder it is to challenge negative thinking.

Goals of Therapy
1. To relieve symptoms and resolve problems
2. To help the client acquire coping strategies
3. To help the client modify underlying thinking and assumptions to prevent relapses.
Therapy is problem orientated. Whether the problem is psychological (anxiety, depression), behavioral
(addictions, bulimia), or interpersonal (social anxiety), the emphasis is always on the problem. The
therapist targets symptoms that are important to the client and can be changed, he then teaches new
coping skills. Therapy relieves symptoms but does not change the personality. It changes only the
thinking that is causing problems for the client; by helping the client develop more flexible thinking there
is less vulnerability to psychological disturbance.
the person is less able to challenge them, bot example: “If I am not successful I am
worthless”, is more believable when depressed.
Acquisition of psychological disturbance
Many things bring about emotional disturbance (i.e. depression and anxiety), some are long-
term (predisposing) and some are short-term (precipitating).
1. Predisposing factors
a) Genetic makeup.
b) Physical disease (e.g. hypothyroidism leads to depression, hyperthyroidism leads to
anxiety).
c) Developmental traumas (e.g. loss of a parent in childhood can lead to depression).
d) Poor role-models in childhood can lead to a lack of coping mechanisms.
e) Counter-productive cognitive processes can lead to unrealistic goals and
unreasonable assumptiothe person is less able to challenge them, bot example: “If I am not successful I
am worthless”, is more believable when depressed.Acquisition of psychological disturbanceMany things
bring about emotional disturbance (i.e. depression and anxiety), some are long-term (predisposing) and
some are short-term (precipitating).1. Predisposing factorsa) Genetic makeup.b) Physical disease (e.g.
hypothyroidism leads to depression, hyperthyroidism leads to anxiety).c) Developmental traumas (e.g.
loss of a parent in childhood can lead to depression).d) Poor role-models in childhood can lead to a lack
of coping mechanisms.e) Counter-productive cognitive processes can lead to unrealistic goals and
unreasonable assumptions.