Positive CBT Introduction
Positive CBT Introduction
https://PositivePsychologyProgram.com
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table of contents
Chapter 5 - References 21
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1
TRADITIONAL
CBT
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n cbt explained
Fig 1.1 The cognitive model depicting the interrelationships between thoughts, feelings,
and behavior.
BEHAVIOR
THOUGHTS FEELINGS
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emotional and behavioral change (Beck, 2011). The thought “no one here wants
to talk to me” is an example of an automatic thought, an idea that spontaneously
comes to mind in a given moment. Helping clients become aware of the automatic
thoughts that influence their feelings and behaviors is a key component of CBT,
and often the first level of cognition addressed in treatment. CBT therapists also
work at a deeper level of cognition by addressed clients’ basic beliefs about
themselves, their world, and other people. Such beliefs are known as core beliefs,
and according to CBT, addressing a clients’ core beliefs leads to lasting emotional
and behavioral change (Beck, 2011). For example, the socially anxious person
may hold the core belief, “I am boring.” CBT therapists work to modify underlying
dysfunctional beliefs (e.g., by helping this client see himself in a more realistic light
as having both strengths and weaknesses) in order to produce enduring change.
n treatment
While treatment for each client will be individual and unique, there are certain
principles that underlie CBT for all clients (Beck, 2011). First, treatment is
based on an ever-evolving formulation of clients’ problems and an individual
conceptualization of each client in cognitive terms. Second, a sound therapeutic
alliance must be established and maintained throughout treatment. Also, treatment
is viewed as teamwork by both therapist and client, who collaborate and decide
together on things like what to work on each session, how often sessions should
occur, and what the client can do in between sessions as homework. Further,
treatment is goal oriented and problem focused. As well, treatment emphasizes
the present moment initially; examination of current problems and on specific
situations that are distressing to the client is paramount. Furthermore, treatment
should be informative, aiming to teach the client to be his or her own therapist;
psychoeducation and relapse prevention are key. Moreover, treatment is time-
limited, and sessions follow a certain structure in each session to maximize
efficiency and effectiveness. And, treatment involves teaching clients to identify,
evaluate, and respond to their dysfunctional thoughts and beliefs, and a variety of
engaging techniques to change mood and behavior. These basic principles apply
to all CBT clients.
n research
As mentioned above, CBT has been studied rigorously since its conception, with
the first outcome study published in 1977 (Rush, Beck, Kovas, & Hollon, 1977). The
efficacy of CBT has been demonstrated across a wide range of psychopathology,
including major depressive disorder, generalized anxiety disorder, social anxiety
disorder, obsessive-compulsive disorder, substance abuse, eating disorders,
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and personality disorders (Beck, 2011; Hofmann et al., 2012). Further, CBT has
been shown to be effective in the treatment of couple problems, pathological
gambling, and complicated grief (Sylvain, Ladouceur & Boisvert, 1997; Beck, 2011).
Furthermore, empirical support for CBT has been established for medical problems
with psychological components, including obesity, insomnia, and chronic pain
(Beck, 2011; Ehde, Dillworth & Turner, 2014).
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2
A WEAKNESS
FOCUS
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Traditional CBT treatment involves a strong focus on the client’s current problems
and on specific situations that are distressing to the client. The question “What is
wrong with the client?” is at the heart of traditional CBT. It is hard to deny that it
is an important question. Focusing on what is wrong with an individual is what
we call a weakness focus. We place direct attention on the negative aspects of
an individual. In the context of work and performance, a weakness focus means
that we are primarily concerned with behavior that is causing suboptimal or low
performance. For example, during a performance evaluation, the employer focuses
only on why an employee is not reaching his sales targets, or why she is not able to
communicate well with customers. In a clinical context, a weakness focus means
that the emphasis is on behavioral or cognitive patterns that cause suffering and
reduce well-being. For instance, a psychologist focuses only on the problems that
the client is experiencing. From this perspective, the psychologist may discover
that the client thinks negatively about the past and these thoughts cause negative
consequences in dealing with the present. The idea behind the weakness focus
may seem intuitive—by fixing what is wrong, we aim to make things right. As we
will see, this view is far from complete and includes fundamental misconceptions
about well-being.
After World War II, psychology became a science largely devoted to curing illness.
As a consequence, a disproportionate amount of studies in psychology focused on
psychopathology and factors that make life dysfunctional. Little research focused
on the factors that promote psychological well-being. For instance, an analysis
of the ratio of positive to negative subjects in the psychology publications from
the end of the 19th century to 2000 revealed a ratio greater than 2:1 in favor of the
negative topics (Linley, 2006). This disproportionate focus on psychopathology
and markers of psychological disease has been referred to as the disease model of
human functioning. The disease model can be easily explained by the picture in
fig. 2.1.
-5 0 +5
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In this picture, -5, represents suffering from problems, 0 represents not suffering
from these problems anymore and +5 represents a flourishing, fulfilled life. The
disease model is focused on the -5 to 0 part. Interventions that are grounded in
this model have the goal of helping people move from -5 to 0. In a clinical context,
this could mean that a therapist aims to reduce symptoms and to prevent relapse.
The end goal (0-point) is achieved when the client is no longer experiencing
diagnosable symptoms of psychopathology as described in the Diagnostic and
Statistical Manual of Mental Disorders (DSM).
Although the disease model has been the dominant view for many researchers
and practitioners, there are some important misconceptions that have often been
neglected or overlooked. The awareness of these misconceptions has contributed
to the development of positive psychology as we know it today. In this section, we
discuss some essential misconceptions that are based on the focus of the disease
model.
Underlying the weakness focus of the disease model is the belief that fixing what
is wrong will automatically establish well-being. However, as counterintuitive
as it may sound, happiness and unhappiness are not on the same continuum.
Positive affect is not the opposite of negative affect (Cacioppo & Berntson 1999).
Getting rid of anger, fear, and depression will not automatically cause peace, love,
and joy. In a similar way, strategies to reduce fear, anger, or depression are not
identical to strategies to maximize peace, joy, or meaning. Indeed, many scholars
have argued that health is not merely the absence of illness or something negative,
but instead is the presence of something positive. This view is illustrated in the
definition of mental health by the World Health Organization (2005): “a state of
well being in which the individual realizes his or her own abilities, can cope with
the normal stresses of life, can work productively and fruitfully, and is able to
make a contribution to his or her community,” (p. 18).
In support of this view, a growing body of research shows that the absence of
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mental illness does not imply the presence of mental health. In a similar vein, the
absence of mental health does not imply the presence of mental illness. Keyes
(2005) found that although a higher score on subjective well-being correlates with
less psychological complaints and vice versa, this relationship is far from perfect.
In other words, there are people who suffer from a disorder, but still experience
a relatively high level of subjective well-being, and there are people who report
low levels of subjective well-being, but experience little psychopathological
symptoms. This finding has been replicated in other studies using different
measures and populations, for instance, in American adolescents between 12 and
18 years (Keyes, 2006), South African adults (Keyes et al., 2008), and Ducth adults
(Lamers et al., 2011).
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Further support for the idea that it is not merely a reduction in negative states
that reflects effective coping comes from the literature on post-traumatic growth.
Post-traumatic growth is the development of a positive outlook following trauma
(Tedeschi & Calhoun, 1996, 2004). Positive changes may include a different way of
relating to others, awareness of personal strengths, spiritual changes, and increased
appreciation for life (Tedeschi & Calhoun, 2004). Post-traumatic growth can be
perceived as an effective way of coping with adversity. It can emerge following
a diversity of traumatic events, including war and terror (Helgeson, Reynolds, &
Tomich, 2006). Growth following adversity, however, is not the absence of post-
traumatic stress reactions, but the presence of positive states.
According to Clifton and Nelson (1996), the behavior and mindset of many
teachers, employers, parents, and leaders is guided by the implicit belief that
optimal performance results from fixing weaknesses. Indeed, in order to promote
professional development, employees are typically exposed to training programs
that focus on correcting their weakness. In a similar vein, evaluation interviews
often focus on areas that need improvement and aspects of work that employees
are typically struggling with. A similar pattern can be found at many schools.
Typically, the number of mistakes/errors are highlighted when student work is
corrected and when report cards are taken home, the lower grades often attracting
more attention. According to Clifton and Nelson (1996), fixing or correcting
weakness will not result in an optimally functioning person or organization. In
their view, fixing weakness will at best help the individual or organization to
become normal or average.
Research findings show that the opportunity to do what one does best each day—
that is, using strengths—is a core predictor of workplace engagement (Harter,
Schmidt, & Keyes, 2002), and an important predictor of performance (see, for
instance, Bakker & Matthijs, 2010; Salanova et al, 2005). These findings indirectly
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support Clifton and Nelson’s (1996) claim that boosting strength use, rather than
improving weaknesses, will contribute to optimal performance.
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3
POSITIVE
CBT
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In 1998, Martin Seligman strongly encouraged the field of psychology to widen its
scope and move beyond human problems and pathology to human flourishing.
Seligman introduced the field of positive psychology. According to Seligman
(2002), positive psychology aims to move people not from -5 to 0 but from 0 to +5
(see fig. 2), and to do this, a different focus is needed. Rather than merely focusing
on what is wrong with people and fixing their problems, the focus should also be
on what is right with people and boosting their strengths.
The questions that positive psychology aims to answer are: What
characteristics do people with high levels of happiness possess? And, what
qualities do people who manage their troubles effectively have? In other words,
what strengths do these people possess? These questions do not fit the disease
model. These questions force us to consider the bigger question of “What is right
with people?” If we learn what differentiates happy and resilient people from
unhappy and unresilient people, then we can use this knowledge to increase
happiness and boost the resilience of others.
An important mission of positive psychology research is, therefore, to
investigate human behavior using a strengths approach. This focus on human
flourishing and markers of psychological well-being has been referred to as the
health model of human functioning (see fig. 2.2).
-5 0 +5
n critical notes
At first sight, the previously discussed misconceptions about a deficit focus may
give rise to the idea that one should predominantly focus on human strengths,
rather than weaknesses. While it may be true that correcting weakness will not
create optimal performance or well-being, it is also true that only focusing on
human strengths while ignoring weaknesses will not automatically lead to
optimal performance or well-being. Especially when weaknesses cause problems
or hinder optimal strength use, they need to be addressed and managed. While
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many traditional psychologists may falsely believe that taking away negatives
will automatically create positives, positive psychologists and practitioners must
avoid the trap of believing that creating positives will automatically take away
the negatives. As discussed above, the positive and negative are on two separate
continua. Attention must be paid to processes for building the positive and to
processes for coping with the negative. For this reason, positive psychology can
best be considered as an addition to existing psychology, not a replacement. It can
best be considered as an enrichment of the field, rather than a rejection of it. Or,
to use Seligman’s words: “Positive psychology is not just happyology” and “is not
meant to replace psychology as usual,” (Seligman, 2001).
n positive cbt
Positive CBT is a term coined by Fredrike Bannink (2012) and rooted in positive
psychology. According to Bannink, “In Positive CBT there is a different focus from
that of traditional CBT. The focus is on clients’ adaptive, operant behavior, rather
than on passive, respondent behavior” (Bannink, 2012, p. 16). In other words, just
like positive psychology, the main focus of Positive CBT is no longer solely on
pathology, on what is wrong with the client and on repairing what is not working,
but on strengths, what is right with him and on promoting flourishing. The focus
is no longer on merely reducing problems, but also on building competencies.
Basically, positive CBT is traditional CBT applied through the lens of positive
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psychology. The most important difference between traditional CBT and positive
CBT are summarized in table 3.1.
Avoidance goals: away from what clients Approach goals: towards what clients
do not want (problems or complaints) do want (preferred future, what clients
want to have instead of their problems
or complaints)
Past or present oriented; cause and effect Present and future oriented; letting go
medical model of cause- effect medical model
helps to clarify the current position of the helps the client increase awareness
boat of his current values, goals, strengths,
weaknesses, etc.
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4
THIS PRODUCT
17 POSITIVE CBT TOOLS
This product contains 17 different positive CBT tools. Each tool is structured in the
same way, consisting of a background section, a goal description, advice for using
the exercise and suggested readings.
On the first page of every tool, a legend is shown, consisting of several icons:
▪ The first icon displays the main category the tool belongs to.
▪ The second icon shows the type of tool. The following options are available:
» Exercise (a tool that describes an activity that is done once, during a session)
» Assessment (a tool that aims to assess a trait or characteristic of a person)
» Overview (a tool that provides an overview or list of something; research
findings, facts, etc.)
» Advice (a tool that is directed at the helping professional providing advice on
how to carry out a certain activity)
» Meditation (a tool that describes a form of meditation)
» Intervention (a tool that describes an activity that needs to be done more
than once during a certain period)
▪ The third icon provides an estimation of the duration of the tool. In other
words, how long it takes to complete the exercise. This is always an estimation
of the total time it takes. Note that for some tool types, like overview, advice,
protocol and intervention it is difficult if not impossible to provide an
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Please note that the tool in this product are not a substitute for a clinical or coaching
certification program, which we recommend you take before you call yourself an
official “therapist” or “coach” and before you see clients or patients.
Note that you are advised to use these tools within the boundaries of your
professional expertise. For instance, if you are a certified clinician, you are advised
to use the exercises within your field of expertise (e.g. clinical psychology).
Likewise, a school teacher may use the exercises in the classroom, but is not
advised to use the exercises for clinical populations. Positive Psychology Program
B.V. is not responsible for unauthorized usage of these tools.
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REFERENCES
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▪ Alberts, H. J., Schneider, F., & Martijn, C. (2012). Dealing efficiently with emotions:
Acceptance-based coping with negative emotions requires fewer resources than
suppression. Cognition and Emotion, 26(5), 863-870.
▪ Alberts, H.J.E.M, Muschalik, C., Tugsbatar & Niemec, R. (2017). Mindfulness in Action:
A Cross Cultural Study on the Relationship between Mindfulness and Strength Use.
Unpublished data.
▪ Antonovsky, A. (1979). Health, stress, and coping. San Francisco, London: Jossey-Bass.
▪ Bakker, A. B., & Bal, M. P. (2010). Weekly work engagement and performance: A study
among starting teachers. Journal of Occupational and Organizational Psychology, 83, 189-
206.
▪ Bakker, A. B., & Bal, M. P. (2010). Weekly work engagement and performance: A study
among starting teachers. Journal of Occupational and Organizational Psychology, 83(1),
189-206.
▪ Bannink, F. (2012). Practicing positive CBT: From reducing distress to building success.
Chichester, UK: John Wiley & Sons
▪ Beck, J. S. (2011). Cognitive behavior therapy: Basics and beyond. Guilford press.
▪ Berg, I. K. (1994). Family-based services: A solution-focused approach. WW Norton & Co.
▪ Berg, I. K., & De Jong, P. (1996). Solution-building conversations: Co-constructing a
sense of competence with clients. Families in Society: The Journal of Contemporary Social
Services, 77(6), 376-391.
▪ Berg, I. K., & Miller, S. D. (1992). Working with the problem drinker: A solution-focused
approach. WW Norton & Co.
▪ Borghans, L., Duckworth, A. L., Heckman, J. J., & Ter Weel, B. (2008). The economics
and psychology of personality traits. Journal of human Resources, 43, 972-1059.
▪ Boyd, N. M., & Bright, D. S. (2007). Appreciative inquiry as a mode of action research for
community psychology. Journal of Community Psychology, 35(8), 1019-1036.
▪ Cacioppo, J. T., & Berntson, G. G. (1999). The affect system architecture and operating
characteristics. Current directions in psychological science, 8, 133-137.
▪ Cade, B., & O’Hanlon, W. H. (1993). A brief guide to brief therapy. WW Norton & Co.
▪ Clifton, D. O., & Nelson, P. (1996). Soar with your strengths. New York: Dell Publishing.
▪ Cooperrider, D. L., & Whitney, D. (2001). A positive revolution in change: Appreciative
inquiry. Public Administration and Public Policy, 87, 611-630.
▪ Dahlsgaard, K., Peterson, C., & Seligman, M. E. (2005). Shared virtue: The convergence
of valued human strengths across culture and history. Review of General Psychology, 9(3),
203.
▪ De Jong, P., & Berg, I. K. (2001). Co-constructing cooperation with mandated clients.
Social Work, 46(4), 361-374.
▪ Diener, E., Wirtz, D., Biswas-Diener, R., Tov, W., Kim-Prieto, C., Choi, D. W., & Oishi, S.
(2009). New Measures of Well-being (pp. 247-266). Springer Netherlands.
▪ Ehde, D. M., Dillworth, T. M., & Turner, J. A. (2014). Cognitive-behavioral therapy
for individuals with chronic pain: efficacy, innovations, and directions for research.
American Psychologist, 69, 153.
▪ Edwards, J. R., & Cooper, C. L. (1988). Research in stress, coping, and health: Theoretical
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