WHAT IS
COGNITIVE
BEHAVIORAL
THERAPY?
A brief introduction to
CBT for everyone!
BY DR TARIQUE SANI
INTRODUCTION
Men are
''
disturbed not
by things, but
by the view
which they
take of them.
- Epictetus
""So Laura, how was your first session of cognitive behavioral therapy?" I asked
as a way to take feedback from my client.
"Oh! It was so very different from what I had expected. It felt very 'normal'; I
mean, I was expecting to be told I am doing everything in my life wrong.
Instead, several of my emotions felt validated. I understood how I can take
better control of myself and that, in fact, I am in charge of my feelings."
Other than the name change, this is an excerpt from a real life CBT session
that I had with a very anxious young woman who was having some difficulties
at her workplace.
Page 01
Definition
Cognitive behavioral therapy (CBT) is a common type of talk therapy
(psychotherapy). You work with a mental health practitioner in a structured
way, attending a limited number of sessions. CBT helps you become aware of
inaccurate or negative thinking so you can view challenging situations more
clearly and respond to them in a more effective way.
CBT has been shown to be effective in over 1,000 research studies. It is a time-
sensitive, structured, present-oriented psychotherapy that helps individuals
identify goals that are most important to them and overcome obstacles that
get in the way. CBT helps people get better and stay better.
CBT is based on the cognitive model: the way that individuals perceive a
situation is more closely connected to their reaction than the situation itself.
Precursors of certain fundamental aspects of CBT have been identified in
various ancient philosophical traditions, particularly Stoicism. Stoic
philosophers, specifically Epictetus, believed logic could be used to identify
and discard false beliefs that lead to destructive emotions, which has
influenced the way modern cognitive-behavioral therapists identify cognitive
distortions that contribute to
Page 02
Definition
CBT emerged during the 1960s and originated in the work of psychiatrist Aaron Beck,
who noted that certain types of thinking contributed to emotional problems. Beck
labeled these "automatic negative thoughts" and developed the process of cognitive
therapy. Where earlier behavior therapies had focused almost exclusively on
associations, reinforcements, and punishments to modify behavior, the cognitive
approach addressed how thoughts and feelings affect behaviors. Since then, CBT has
emerged as an effective first-line treatment for a wide range of disorders and
conditions.
Where earlier behavior therapies had focused almost exclusively on associations,
reinforcements, and punishments to modify behavior, the cognitive approach
addressed how thoughts and feelings affect behaviors. Since then, CBT has emerged
as an effective first-line treatment for a wide range of disorders and conditions.
Cognitive behavioral therapy focuses on changing the automatic negative thoughts
that can contribute to and worsen emotional difficulties, depression, and anxiety.
These spontaneous negative thoughts have a detrimental influence on mood.
Through CBT, these thoughts are identified, challenged, and replaced with more
objective, realistic thoughts.
CBT is one of the most researched types of therapy, in part
because treatment is focused on highly specific goals and
results can be measured relatively easily.
One of the greatest benefits of cognitive behavioral therapy
is that it helps clients develop coping skills that can be useful
both now and in the future.
Ebook Name Page
Page 03
04
Applications of CBT
CBT is most widely applied to mood disorders (such as depression) and anxiety
disorders. It is also used to help people with substance use problems, personality
disorders, eating disorders, sexual problems and psychosis. It is successfully delivered
in individual, group and couples formats.
CBT can help with a range of things, including the following mental health conditions:
depression
eating disorders
post-traumatic stress disorder (PTSD)
anxiety disorders, including panic and phobia
obsessive-compulsive disorder (OCD)
schizophrenia
bipolar disorder
substance misuse
But you don’t need to have a specific mental health condition to benefit from CBT. It
can also help with:
relationship difficulties
breakup or divorce
a serious health diagnosis, such as cancer
grief or loss
chronic pain
low self-esteem
insomnia
general life stress
Page 04
Cognitive model
The diagram depicts how feelings, thoughts, and behaviors all influence each other.
The triangle in the middle represents CBT's tenet that all humans' core beliefs can be
summed up in three categories: self, others, future.
The cognitive model describes how people’s thoughts and perceptions influence their
lives. Often, distress can distort people’s perceptions, and that, in turn, can lead to
unhealthy emotions and behaviors. CBT helps individuals learn to identify and
evaluate their “automatic thoughts” and shift their thinking to be healthier. The
cognitive model is at the core of CBT, and it plays a critical role in helping therapists
use gentle Socratic questioning to develop treatments.
Page 05
The ABC of CBT
Imagine a situation. Jack and Jill's boss reprimands them over a report they made as a
part of their assignment. As a consequence Jack feels depressed, where as Jill feels
angry. Read that again! Do you think that the reaction that Jack and Jill had was a
direct consequence of being reprimanded? In other words, there is a direct A to C
connection? Most people will answer "Yes" but the ABC model of CBT says otherwise!
According to the ABC model, it is the beliefs which people hold about an adversity or
activating event that gives rises to the consequences and not the adversity itself. Thus,
there is a B to C connection rather than than an A to C connection. In CBT sessions
this model is used to challenge irrational thoughts, cognitive distortions and beliefs.
This allows you to restructure these beliefs and adapt a healthier response.
Page 06
Cognitive Distortions
Dr. Aaron Beck identified a number of illogical thinking processes (i.e. distortions of
thought processes). These illogical thought patterns are self-defeating, and can cause
great anxiety or depression for the individual. These are collectively called as Cognitive
distortions. Some of these are:
Arbitrary interference: Drawing conclusions on the basis of sufficient or irrelevant
evidence: for example, thinking you are worthless because an open air concert you
were going to see has been rained off.
Selective abstraction: Focusing on a single aspect of a situation and ignoring others:
E.g., you feel responsible for your team losing a football match even though you are
just one of the players on the field.
Magnification: Exaggerating the importance of undesirable events. E.g., if you scrape a
bit of paint work on your car and, therefore, see yourself as a totally awful driver.
Minimisation: Underplaying the significance of an event. E.g., you get praised by your
teachers for an excellent term’s work, but you see this as trivial.
Overgeneralization: Drawing broad negative conclusions on the basis of a single
insignificant event. E.g., you get a D for an exam when you normally get straight As
and you, therefore, think you are stupid.
Personalisation: Attributing the negative feelings of others to yourself. E.g., your
teacher looks really cross when he comes into the room, so he must be cross with you.
During the course of CBT sessions these distortions are identified and reframed using
various techniques. Thus the client gets a healthier thinking pattern which in turn
results in more helpful and functional behaviours
Page 07
TECHNIQUES USED
To find yourself,
''
think for
yourself.
- Socrates
During Cognitive Behavioral Therapy the client and therapist collaborate
through an open dialogue to develop a problem definition and goal. Goals can
be behavioral, cognitive, or physical in nature and can be defined by problem
or process.
Cognitive Behavioral Therapy uses a range of therapeutic techniques to
achieve these goals.
Ultimately, however, despite the vast toolbox of techniques, client change is
related to his/her investment in the process of CBT.
Page 08
5 common techniques
1. Socratic Questioning: Questioning allows the therapist to stimulate the client’s self-
awareness, focus in on the problem definition, expose the client’s belief system, and
challenge irrational beliefs while revealing the clients cognitive processes.
2. Action Plans: To assist with cognitive restructuring, clients are often assigned action
plans also known as homework. Typical CBT homework assignments may include
activities in behavioral activation, monitoring automatic thoughts, reviewing the
previous therapy session, and preparing for the next therapy session.
3. Self-Monitoring: Also called diary work, self-monitoring is used to record the
amount and degree of thoughts and behaviors. This provides the client and therapist
information regarding the degree of a client’s negative affirmations.
4. Behavioral Experiments: The experiment process includes experiencing, observing,
reflecting, and planning. These steps are conducted through thought testing,
discovery, activity, and/or observation.
5. Systematic Desensitization: Systematic Desensitization pairs relaxation with
exposure to something stressful. Clients are taught to relax in anxiety producing
situations.
Page 09
5 common techniques
With the help of above techniques the clients learn to
Set realistic goals and learn how to solve problems (e.g., engaging in more social
activities; learning how to be assertive)
Learn how to manage stress and anxiety (e.g., learning relaxation techniques
such as deep breathing, coping self-talk such as “I’ve done this before, just take
deep breaths,” and distraction)
Identify situations that are often avoided and gradually approaching feared
situations
Identify and engage in enjoyable activities such as hobbies, social activities and
exercise
Identify and challenge negative thoughts (e.g., “Things never work out for me”)
Keep track of feelings, thoughts and behaviours to become aware of symptoms
and to make it easier to change thoughts and behaviours
Cognitive behaviour therapy is all about the relationship
between emotions, thoughts (cognitions) and behaviour.
CBT helps you to understand whether you might be stuck in
vicious cycles that are getting in the way of living the life you
want to live, and to discover ways to help yourself break
those patterns.
Page 10
FAQ
How many sessions will I need?
This is probably the most frequently asked question about CBT. The short answer is
anywhere between 1 to 20 or more.
The longer answer is an honest “at this stage, I don’t know”. I will need to meet you for
an assessment, and gain a better understanding of your difficulties before I can say
how many sessions you will need. CBT is not a “one size fits all” approach and I will
therefore want to find out more about your difficulties. CBT is time-limited; typically, it
lasts between 3-20 sessions. However, if a problem is long-standing (has been around
for many years) or you have multiple problems, therapy can last longer than 20
sessions. Duration of therapy depends on the nature of your problems and on your
progress.
How long is a CBT appointment?
All sessions are 50 minutes unless otherwise specified. It's called the therapy hour.
How often do I need to attend therapy?
We will meet weekly at the start of treatment. Once you start to feel better we will
discuss reducing the frequency of our sessions to every fortnight, etc. When you feel
ready to end therapy, we can plan some follow-up appointments to help you maintain
the progress you have made, usually at 3 and 6 month intervals.
What happens at the first appointment?
Your first appointment is an opportunity to:
Discuss your difficulties and goals
Work out together whether CBT is likely to be able to help
See whether you feel comfortable with me as your coach
Discuss whether now is a good time for the emotional, financial and time
investment of CBT
Page 11
FAQ
How soon can I expect to feel better?
As soon as after the first session. Some individuals find it helpful to just come and talk
to somebody about their difficulties, especially if this is the first time they are opening
up, however, and contrary to popular belief, CBT is not a “quick-fix” therapy; therapy is
a process, and it can take a few sessions for you to start to benefit from the
therapeutic techniques that your therapist will teach you.
In my experience most of my clients start feeling significantly better after 3 to 4
sessions
What will I need to do between CBT sessions?
CBT is like learning a new language - attending appointments is a starting off point
and you will build on this if you put things into practice in between sessions. It's also
important to me that the hard work you put in during sessions actually leads to
changes in your life. At each session we will design a challenge for you to work on
during the week.
If the circumstances in your life make it difficult to try things out in the "real world",
then we might talk about whether this is the best time for you to be investing in
therapy. You don't have to do anything you don't want to do, but I'm also not going to
keep taking your money if it's not leading to something being different in your life.
What are some examples of CBT homework?
The options for "homework" are as varied as the people who come for CBT. It's a
creative process: we will work together to come up with the best techniques to make
the most of what we are working on in the sessions. This might include observations,
like monitoring your mood, watching how other people react in situations, or paying
attention to your physical symptoms. I'm a scientist and techie at heart, and I will help
you design experiments to test out new ways of doing things. It might go against your
instincts, but by putting yourself in situations that make you feel uncomfortable, you
can gradually train your body to cope with what it takes to achieve your long-term
goals. I sometimes do my own CBT homework to help me better understand and
appreciate what it is I am asking you to do.
Page 12
FAQ
Will I need medication? Do you prescribe medication?
I will not prescribe you medication even though as a doctor I am licensed to (most
therapists are not) . Most of the time medications are not needed. However, if you are
already taking medications please continue with them and do not alter without
consulting the prescribing doctor first.
If we decide that your mood is so low that it is making it difficult for you to
concentrate on the therapy, and if your low mood is also making it difficult for you to
attend work, or attend to your day to day tasks at home, we can discuss the role of
medication. If I think you would benefit from starting an antidepressant, or other
medication, I would recommend that you visit your GP, or a psychiatrist.
How can CBT help me with the past?
CBT is a here-and-now therapy. One of the main principles of CBT is that we cannot
change the past; we can only change how we think about, and understand the past
and that is done in the present.
The first stage of CBT is the assessment stage, where you and your therapist will
develop a good understanding of how your problems developed, and what is
maintaining them.
The main focus of your CBT sessions will be on changing current behaviours, that
serve to maintain your problems, in order to help you act in ways consistent with your
values and goals.
In your CBT sessions, you will also learn how to pay more attention to your thoughts,
and turn the more negative, unhelpful thoughts into more helpful thoughts. This will
enable you to move forward in life, instead of being held back by your past
experiences.
Page 13
FAQ
How does CBT differ from other modalities?
One of the main differences between the various psychotherapies and counselling is
in how active an approach the therapy is, and therefore how active a role you will be
expected to play.
In CBT your role is as an active participant, where you and your therapist collaborate
and work together to come to a shared understanding of your problems and develop
strategies together for overcoming them. CBT is empowering in that you will learn
how to help yourself so that if the same problems crop up in future, you will be better
prepared to deal with them.
Is CBT effective in treating anxiety?
CBT has been found to be effective in treating panic disorder, phobias and other types
of anxiety. It has also been found to help when patients may have a comorbid
condition, such as depression, substance abuse or additional anxiety disorders.
What types of professionals perform CBT?
Several different types of mental health professionals are able to perform CBT:
Psychologists
Clinical Social Workers
Psychiatrists
Professional Counselors
Coaches
Can CBT be self administered?
Yes, CBT can be self administered in several situations. As stated above it is the aim of
CBT to make you self reliant, which is in effect teaching you to self administer CBT.
However, for better effectiveness of CBT it is recommended you take help of a
professional for learning the techniques.
Page 14
FAQ
How much does CBT cost?
I charge US$90 per hour for CBT sessions unless specified otherwise. There are people
who charge more and those who charge less.
I'm still not sure if CBT is for me. What should I do next?
You wouldn't be the first person to be unsure or nervous about having counselling or
CBT. Yes, it can be hard to open up to a stranger, especially if you tend to keep your
emotions private or wouldn't normally ask for help.
Take some time to think about whether you think CBT is right for you, and whether
you think I am the right therapist for you. Check out the rest of my website, but also
have a look at what - and who - else is out there. If you'd like to speak to me before
deciding we can have a virtual coffee over Zoom, 20 minutes, 1 to 1, free.
Select a time for coffee!
Feel free to forward this eBook to your friends, family,
colleagues or clients who can benefit from the knowledge
about Cognitive Behavioural Therapy
Page 15
ABOUT THE
AUTHOR
Hello!
I AM DR TARIQUE SANI
Let me help you overcome!
I help IT CXO and IT executives overcome anxiety,
overwhelm, procrastination, perfectionism, imposter
syndrome, depression. I use the power of Cognitive
Behavioural Therapy (CBT) to help them become unstuck
and unleash their highest potential.
I have in-depth knowledge of CBT and have been practicing
''
since the past 7 years. I studied to be a medical doctor,
practiced as a Pediatrician and Forensic expert for 10 years
before starting my software company SANIsoft. I
successfully nurtured SANIsoft as the CTO for 20+ years. We
built high-performance web applications. We also
contributed a lot to FOSS. Currently, apart from doing one
to one coaching, I also offer group workshops and have
online courses on topics like assertiveness, procrastination,
perfectionism and more. All these are based on the
principles of CBT
CONTACT INFORMATION ON NEXT PAGE
Page 16
CONTACT ME
[email protected]
https://rationalredo.com/
https://www.facebook.com/rationalredo
https://www.linkedin.com/in/tariquesani/
Online Assertiveness
Training
Get Started Now
Join me for a virtual
coffee over Zoom. 1:1,
20 minutes, free
Select a time
Page 17
