What Is Cognitive Therapy and How Does It Work?

Cognitive therapy is a psychological treatment that focuses on modifying cognitions, including automatic thoughts, dysfunctional beliefs, schemas, and cognitive distortions:

• Automatic thoughts are spontaneous interpretations of events.  An example is having the spontaneous thought “This is a disaster!” after spilling your coffee at a meeting.
• Dysfunctional beliefs are usually in the form of if-then statements, as in: “If you get too close, then you will discover how incompetent I am.”
• Schemas refer to core beliefs about oneself and the world, as in: “People cannot be trusted.”
• Cognitive distortions are logical errors that lead to mistaken judgments (see the next section).

Cognitive distortions

Common cognitive distortions include:

1. Over-generalizing. Drawing sweeping conclusions based on limited evidence.
2. Dichotomous thinking. Categorizing experiences in one of two opposing and mutually exclusive categories.
3. Labeling. Labeling oneself (e.g., “I’m a loser”), instead of describing what actually happened (e.g., “I got rejected”).
4. Jumping to conclusions. Trying to understand a situation by focusing only on a single aspect of it.
5. Mind reading. Assuming to know what another person is thinking or feeling.
6. Fortune telling. Making negative predictions without evidence.
7. Minimizing/magnifying. Minimizing the positive and emphasizing the negative.
8. Emotional reasoning. Believing that one’s intuitions or feelings always reflect reality.
9. Making should-statements. Having unreasonable standards for oneself and/or others.
10. Disqualifying the positive. Disregarding positive experiences or events (e.g., “I got an A only because I got lucky”).
11. Inappropriate blaming. Blaming oneself (or others), despite mitigating factors.

The workings of cognitive therapy

Cognitive therapy teaches patients how to examine their thoughts using logic and evidence. The goal of treatment is to create distance between cognitions and one’s sense of self.  When people no longer identify with their thoughts, they can analyze the thoughts objectively.  Doing so will not only help reduce distress and unpleasant symptoms but will also lower the risk of relapse. The treatment also requires identifying and changing maladaptive beliefs and schemas.  One way to identify schemas involves the use of the “downward-arrow” technique. For instance, suppose a patient says his coworkers dislike him because he is not as smart as they are.  Instead of asking about the validity of this automatic thought, the therapist asks, “What if this were true?” With further questioning, eventually, the underlying schema is revealed (e.g., “I am worthy and likable only if I’m perfect”). Identifying maladaptive schemas facilitate loosening their hold and replacing them with more adaptive beliefs.

The daily record of thoughts

Another useful tool for analyzing beliefs in cognitive therapy is the daily thought record. To complete the thought record, a patient needs to:

• Examine the evidence for their automatic thought.
• Consider alternative ways of looking at the situation.
• Ponder the implications (i.e. What would it mean if the automatic thought is/not true?).

The daily record often includes several columns—the situation, emotional reactions, automatic thoughts, adaptive responses, and outcome. Here is an example—concerning a father angry at his daughter:

• Situation (Janet did not do the dishes, despite promising me.)
• Emotional reactions (Enraged and powerless)
• Automatic thoughts and degree of belief in them (I’m 99% sure she didn’t do the dishes because she hates me.)
• Adaptive responses (Maybe she forgot or was too tired.  I need to speak to her.)
• Outcome (Reduced anger)

Conclusion

Cognitive therapy is a psychological treatment that teaches patients how to identify and change unhelpful beliefs. Cognitive therapy has been shown to be effective for many mental health conditions, particularly depression.  Indeed, research shows cognitive therapy may be even more effective than antidepressants.