1 cbt An Introduction to CBT

© Peter Creagh, Trainer, Supervisor , UKCP Independent and BACP Registered Counsellor
email : - peadar@satsang.freeserve.co.uk
COGNITIVE BEHAVIOURAL THERAPY (CBT)
A Brief Introduction
INTRODUCTION
There are many ideas, theories and strategies in counselling. There are those who
contend that it is a skilled process, those who feel it has a mainly theoretical base, those
who consider it is all about relationship and being and those who feel it combines all or
elements of the first three. However, there is considerable agreement that broadly
speaking therapeutic approaches can be divided into four main schools. These are:-
• Psychodynamic Approaches - concerned with the mind , psyche ,instincts and drives.
This is often referred to as ‘working with the presenting past’ .
• Cognitive –Behavioral Approaches — concerned with the mind ,its thoughts feelings
and behaviors and mainly how to assist clients to live in the present and look for a
preferred future.
• Humanistic and Existential Approaches - concerned with relationship and being.
• There is the development of the 4th
wave. This includes approaches such as
Solution Focused Brief Therapy and a variety of eclectic (e.g. Egan’s Skilled Helper
Model) and integrative approaches (e.g. Culley’s Integrative Helping Model) . The
Eclectic and integrative models combine aspects of some or all of the first three.
This development in integration and eclecticism is particularly relevant to models of
helping for those who use counseling skills and for those who wish to combine several
theoretical approaches e.g. CBT with aspects of Humanistic Therapy ( see Nelson-Jones
2002). McLeod (1998) suggests that ‘eclecticism’ is a model where the counsellor selects
or chooses the best or appropriate concepts and techniques from a broad range of
theories. Whereas integration usually uses no more than 3 models He further suggests
that some of the main differences between an eclectic and integrative approach are:
ECLECTIC INTEGRATIVE
Technical Theoretical
Focus on differences Focus on commonalities
Choosing from many theories Combining many (normally 3 max)
Applying what is Creating new approaches
Table 1 : Adapted & Summarised from McLeod(1998)
These notes are designed mainly to provide a backdrop to a presentation and experiential
exercises on CBT. They will look at its background, roots and some of the main concepts
which underpin this approach to helping and outline several exercises designed to
facilitate a greater understanding of this popular and effective approach to therapy.

Cognitive Behavior Therapy (CBT)
Cognitive Behavioural Therapy (CBT) is a combination of cognitive therapy, (whose major
exponent was Aaron Beck) -, behaviour modification therapy (of which Joseph Wolpe was
a well known expert) and Rational Emotive Behaviour Therapy (REBT) (whose main
exponent and founder was Arthur Ellis). Ellis, in particular, formed his theory as a direct
alternative to psychoanalysis, the then dominant force in therapy. This seemed to
emphasise the irrational aspect of people, caught in a struggle between the irrational ID
and the over-moralising, controlling, parental super-ego. Like many others, he felt that an
approach that acknowledged the connection between thinking and feeling, and the ability
of people to change patterns in the present, was important. Thus the cognitive and
behavioural approach to therapy was born and this eventually led to CBT. Each of these
terms is now briefly defined.
Cognitive is a process such as mental thinking. It refers to everything in the mind, such
as thoughts, dreams, memories, images etc.
Behaviour is everything we do. What we say, do, act or avoid and do not say, do,
act or avoid.
Therapy, comes from the Greek word ‘to heal’ and it is how the concepts and strategies
of CBT are used in a helping relationship.
This (very short history) is important because it describes the antecedents and basic
premise of this important and widely accepted form of therapy. It is a therapy that can be
readily ‘adapted’ or ‘integrated’ within other approaches
More About CBT. CBT is based on the assumption that most unwanted thinking patterns
and emotional and behavioural reactions are learned over a long period of time. The aim is
to identify the thinking that is causing unwanted feelings and behaviours and to learn to
replace this thinking with positive thoughts. This can result in behaviours that are more
positive. The therapy does not focus on the events from the past (such as childhood) but
focuses on current difficulties in the here and now. CBT aims to teach new skills and new
ways of reacting.
Strategies. It uses cognitive techniques (such as challenging negative thoughts) allied
with behavioural techniques (such as exposure therapy that gradually desensitises a
person to ,say, phobia and also techniques such as relaxation, breath awareness etc.
This combination is designed to help challenge negative thoughts, beliefs and behaviour.
Research Research indicates that CBT is particularly useful in the treatment of a wide
variety of presenting problems and particularly, anxiety, panic attacks, depression, OCDs
and phobias. It is designed to combine elements of cognitive therapy that assist clients to
modify or eliminate unwanted thoughts and beliefs-, and behavioural therapy, which can
help to change behaviour in response to those thoughts.
So in short CBT could be said to rest on the following seemingly simplistic saying; ‘You
feel the way you think and/or you think the way you feel’ It offers an approach that is
designed to work with unhelpful thoughts and thus change how we feel. In this way it sets
out to assist people; to avoid and/or eliminate unhelpful behaviours. Like other approaches
it proposes that we are ultimately responsible for our choices and our ABC’s

Learning Your ABCs
A major aid in cognitive therapy is what Albert Ellis called the ABC Technique or system
of Irrational Beliefs. This ‘system’ attempts to bring together the feeling-thinking link and
the meaning you attach to this with the resulting consequences and behaviours. These
behaviours are normally acted out and this ‘acting out’ comes in three main forms:
Self- Destructive Behaviours - addictions & self harm
Isolating and moody Behaviours - depression
Avoidance Behaviours – leading to phobias and Obsessive Compulsive
Disorders (OCDs)
Before examining the thinking-feeling link in greater detail, each of the components of the
ABC concept will be outlined.
A - Activating Event or objective situation. We live in an ‘environment’ or world is
eventful. An outline of this, including some typical events is shown below.:
A = Activating Event
Our Eventful
World
The Activating Event – often
referred to as a ‘Trigger’ is
caused by one of these :
• A real external event
• An anticipated event
• An internal event in the
mind – thoughts, image ,
memory dream
EVENTS
The World
Other people- relationships
Personal Experiences
Personal History
Future ( thoughts & feelings)
Self
Note
This activating event is an ‘objective ‘ situation that ultimately leads either to some sort
of emotional response and/or possible irrational thinking.

B – BELIEFS. We live in this eventful world with a set of beliefs . These include rules,
demands and thoughts that we connect to events. In problematic and negative issues
these can be irrational and lead to negative consequences.
B = BELIEFS
Beliefs
These include the :
thoughts, rules,
demands , meanings
that we attach to events & the
world :
**** THOUGHTS lead to
Attitudes
Rules
Demands
Beliefs
Images
Meanings
Note
These beliefs, which lead to negative thoughts and feelings and behaviours, are the link or
bridge between the Activating Event and the Consequences.
*** Very often people find it difficult to identify the thoughts linked to the belief
( More on this later when we explore how to complete an ABC Table)
C – The CONSEQUENCES So we live in this eventful world with a set of beliefs which
effect our thoughts and lead to consequences for us, others and our ‘world’
C = the CONSEQUENCES
Consequences include
emotions,
behaviours
and physical sensations
caused by A and B
EMOTIONS
Healthy feelings
Unhealthy feelings
Physical Sensations
BEHAVIOURS
Constructive Action
Destructive Action
Note
The thoughts caused by the ‘belief’ leads to the emotions and resulting behaviour. These
emotions could be anger, anxiety, distress etc .
These are often referred to as the Mad, Sad, Bad, Glad range of emotions. Before
moving on, it can be useful to look at the ‘volcano of felt experiences’

THE VOLCANO OF FELT EXPERIENCES
We are all aware of the term ‘emotion’ but it is important to understand where these ‘rise
up’ from. The following diagram shows the Volcano of Felt Experiences
FOUR LEVELS OF FELT EXPERIENCE
All feelings and emotions (of which we are more aware) rise up through us like lava in a
volcano. They rise up from a Raw or Primitive Basic Life Energy. This ‘courses up’
through the Felt Senses (see Gendlin and Existential Therapy) and up to the Feelings
& Emotions levels.
Feelings are more easily recognised than the Felt Sense. Emotions are more intense
than feelings . e.g. irritation and rage. Emotions totally DOMINATE our attention,
whereas feelings are more subtle and fluid than emotions
Understanding the levels of felt experience helps us to decide how we can use the
therapeutic relationship to assist clients to control , explore and manage these
experiences.
In general the deeper the level of felt experience the more existential is the issue .
Therefore CBT can help at the feelings/emotions level, but if these are rooted in
existential questions, then approaches that are more humanistic/existential , and can
deal with the ‘spiritual’ are more appropriate. This can assist in deciding how and when
to integrate aspects of CBT into our practice.
As feelings are thoughts can be linked, we now move on to errors in thinking that can
give rise to inappropriate and often unhealthy feelings
Raw or Basic Life Energy
Felt Senses
Feelings
Emotions
Rise of Emotions.
Note the Intensity
increases as the
‘Cone’ width
decreases

Errors in Thinking Before exploring both how the ABC ‘model’ could be applied
and at some examples of its use, it is useful to look at how ‘beliefs’ can lead to faulty
thinking. Now, CBT is based on the proposition that feelings and emotions are directly
linked to thinking. Therefore, we can develop ‘thinking errors’ and these lead to unhealthy
emotions with subsequent destructive action. Consequently, it is important to begin to
recognise and then challenge faulty or irrational thinking. These irrational thoughts are
often rooted in what can be termed the ‘Three Bad Witches’ or the ‘3 Dunnerby Sisters!
I SHOULDA
Done or Be
I AUGHTA
Done or Be
I MUSTA
Done or Be
These ‘witches’ are often at the root of many of the following typical irrational/faulty
thinking errors.
‘With ME It’s ALL or NOTHING Very often our beliefs lead to extremes of ‘either : or’ i.e.
love: hate: ; right: wrong etc. This ‘all or nothing’ type of thinking can then lead to extremes
in emotions. In short we either take full responsibility or blame for an event or else take
none. Very often it is better to have a more balanced view and to be open to ‘both: and’
type of thinking.
‘ Gonna Build a Mountain’ Awfulising This form of thinking error turns a relatively
minor event into a major catastrophe . Everything is ‘awfulised’ and a minor ‘crisis’ is
turned into a major drama. An example could be that somebody turns down your invitation
to have a coffee and you assume ‘ They hate me’ or ‘ I’ll never speak to them again’ !
‘It can never be or it always will be ’ Thinking Very often we can over-predict the
future. We can in a sense be ‘prophets of doom’ and decide that bad experiences from
the past will. certainly happen in the future. In this way we can often cause unhealthy
emotions and actions.
Another form of this thinking is that we ‘guess’ the future and predict that all our guesses
must be right. This nearly always extends into ‘mind reading’ others and deciding you
know what they are thinking and feeling. These ‘guesses are virtually always negative and
very often incorrect. We can so easily ignore the facts, get in touch with the negative
feelings and their link with our ‘it can never be or always will be’ forms of thinking.’!
‘Feelings are facts’ Thinking Being totally ruled by your feelings and subsequent
thoughts; in other words, taking your feelings at their face value. Whilst feelings are
authentic and deserve to be ‘heard’ they are also part of a complex emotional system, with
deepening layers that often reach back into our past. This is often referred to as the
‘Volcano of Emotions’ with at least 4 layers of consciousness. Thus feelings are not only
complex but they form only one part of the true meaning of incidents and events.

Other Possible Errors Some other possible ways of faulty thinking are based on the
following :
The ‘Perfect’ World Remember, seeking perfectionism is a lost cause. There
is difference and diversity and not ‘perfection’ Attempting to find the ‘perfect’ in life
leads to disappointment and mental stress.
Over-generalising – Remember, one swallow does not necessarily make a
Summer. Beware of any tendency to form general ‘rules’ for particular events
Over-Personalising whilst taking responsibility and personalising events can be
helpful, we need to remember that we are not the centre of the world and thus
everything does not ‘rotate’ or ‘relate’ to myself.
Labelling Needlessly labelling yourself or others, This is often connected with
all or nothing thinking
Only seeing the negative Failing to see ,or filtering out , positives, this is often
Connected with ‘awfulising’
There are many other possible faults in thinking that can lead to unhealthy emotions and
destructive actions. Individuals can benefit from identifying their faulty thoughts and then
developing strategies to challenge and change these.
PAUSE FOR EXERCISE
Exploring irrational / faulty thinking
Putting the ABC’s Together Returning to the simple ABC model . It can be seen that
an Activating event can trigger a Belief with consequential thoughts and these can give
rise to Consequences. This can this can lead either to Unhealthy/Destructive or Healthy
/Constructive Action. An example of each of these is shown in the following two ABC
Tables.
EXAMPLE 1 – Unhealthy / Destructive Action ‘ Vicious Cycle’
A – The Event B : - The Beliefs C : - The Consequences
You get a C Grade in your
Assignment on a course
You expect an A. You
think “ I’m useless, I
should have done better” ‘
This means I’m going to
fail the Course ’
You experience feeling of panic
and anxiety (emotions)
feel sick ( physical sensation)
and stay in bed next day and
don’t attend the School/
University ( behaviour)

EXAMPLE 2:- Healthy/Constructive Action ‘ Virtuous Cycle’
A – The Event B : - The Beliefs C : - The Consequences
Peter ( 17) fails his driving
test
Peter thinks ‘Too bad I
failed the test. Practice
makes perfect. I’ll have to
take more lessons’
Peter feels regret and
irritation.( emotion)
A slight ‘sinking feeling’
( physical)
Decides to take more lessons
and re-take the test as soon
as possible.( behaviour)
Initially, therapists often use a simple ABC Table to assist clients to ‘map out’ the whole of
their ABC process. Once this has been done, a more complex Table is used to further the
process. The latter will be looked at in greater detail later on in this note.
If we were to look at the simple examples of the ABC Table shown above, it is reasonable
to suppose that clients are often readily aware of the Consequences and then can move
on to identify the Activating event. The bridge or link between these (the A and the C ) is
the Belief that lead to Unhealthy/Destructive or Healthy /Constructive Action. However,
many clients find it difficult to readily identify these and the ensuing faulty thoughts.
Therefore, when working to explore and identify an ABC ‘pattern’ it is important to reach a
point where the ‘thinking’ rooted in the Belief is identified. Then, if it leads to
Unhealthy/Destructive Action ( C ) strategies can be devised to counter-act the
faulty/irrational thoughts thus leading to a more healthy/constructive cycle.
Most people can more readily access the Consequences and this is probably the best
starting point in identifying an ABC pattern. Some points on this are to be found in the next
section.
Format for a simple ABC Table There are many formats for an ABC table. But a
simplified version is shown below. The five steps are an indication of the order that can
be used to complete the Table for a given event.
A – The Event
The ‘Trigger’
B : - The Beliefs C : - The Consequences
3.
Record ‘trigger’- what
started emotions
4
Record thoughts & beliefs
that occurred
5.
Try to identify ‘fault or
error in thinking
1.
Record Emotions
2.
Record Behaviour/Action

Step 1. Record the emotions that have arisen (concerning the event)’
Step 2 Record the resulting behaviour and action (also any physical sensations)
Step 3 Record and explore the ‘trigger’ event that gave rise to Steps 1 and 2.
Step 4. Record the thoughts and beliefs (and explore) that occurred with Steps 1 to
3. These are the link or bridge between the Consequences and the Activating event.
The Helper/Therapist can either do this during the session with the client and/or encourage
the client to maintain their own ABC log or set of tables.
Before moving on to explore how to adapt the simple ABC Table and begin to challenge
and change the faulty or irrational thinking, we need to pause for an experiential exercise
that uses the simple ABC Table.
PAUSE FOR EXERCISE
Establishing the ABC link Part 1
Taking it Forward – Challenge and Change
Once the simplified ABC Table has been explored and the irrational thought(s) identified,
then it is possible to begin to deepen the exploration, understanding and action towards
challenging and changing unhealthy/destructive patterns.
This requires two extra components to be added to the basic ABC scheme. These are
often referred to as Disputing irrational thoughts and the Effect of alternative
action/changes. This leads to an A B C D E Table,
Both of these extra components ( D and E ) will be briefly explored, sub-steps for each
proposed and then the complete ABCDE Table will be outlined

Disputing Irrational Thoughts The obvious first step is to begin to challenge the
irrational thoughts which are based on a ‘faulty’ understanding that is fed by unhealthy
beliefs. This requires two new steps, steps 6 and 7 , that follow Steps 1 to 5..
Step 6 Identify and Challenge Identify the ‘thinking error’ and also record a
challenge to this. This can best be achieved by a much closer examination of the negative
thought(s). Some ways of doing this are to explore the following areas and questions.
a. Is the thinking ‘rigid’ or ‘flexible’? Very often, ‘rigid’ thinking leads to
negativity.
b. Are these thoughts logical, sensible and can they be checked out with
friends and others?
c. Are emotions ‘flooding’ and swamping the thoughts?.
Step 7 Generate Alternatives Once errors have been identified, it is important
to begin to generate alternative thoughts for the Beliefs. This can be helped by asking the
following questions;
a. What do I do differently when I’m either not feeling so bad or feeling OK?
b. What ‘coping strategies’ have I adopted in the past either for this or similar
situations ?
c. How can I think in a more flexible and balanced way?
d. If I were to advice my best friend about this situation, what one thing might I
recommend that could improve the situation?
These are many other strategies and questions that could be asked in order to assist in
Steps 6 and 7. Now to move on the E where alternative thoughts, beliefs, emotions and
behaviours are explored and implemented as an Experiment and Evaluated.
Effects on Emotions and Behaviour of Alternative Thoughts and proposed Action
Once Steps 1 to 5 ( initial ABC Table) and Steps 6 and 7 ( challenging negative thoughts
and proposing alternatives) has been achieved, it is now time to reflect on this and to try
something different. This will require a further step which has two main parts
Step 8 : - Effect of Alternative Having decided how you ( wish or think) will feel and
behave differently :
a. Assess any (predicted) healthy emotions on a scale of either 0 to 10 or 0 to
100, with the higher number being the best
b. Outline your ‘new’ or ‘modified’ behaviour or action
The final stage is to implement and act on Step 8b and assess its effects.

Format for a Complete ABC Table The final Table is outlined below with all 8 Steps
Steps 1 to 5
A – The Event
The ‘Trigger’
B : - The Beliefs C : - The Consequences
3.
Record ‘trigger’- what
started emotions
4
Record thoughts & beliefs
that occurred
5.
Try to identify ‘fault or
error in thinking
1
Record Emotions
2
Record Behaviour/Action
Steps 6 to 8
D = Dispute / Challenge E = Effect of Alternative Thought
6.
Identify and challenge faulty thoughts and
beliefs
7
Find alternatives to those that are
challenged
8
Rate the effects of 7 on your emotions
Outline your new or modified behaviour /
action
The Helper/Therapist can initially do the simple ABC Table with clients. Once that has
been done , then the ABCDE Table can be explored and completed either during the
session with the client and/or the client can be encouraged and asked to maintain their
own ABC/ ABCDE log or set of tables. This may take more than one session.
PAUSE FOR EXERCISE
Establishing the ABC link Part 2
The aim of the CBT therapy is to assist clients to create more Healthy/ Constructive
Consequences, like example 2. of the ABC Model shown earlier.

Conclusions
This short introduction to CBT outlined the background and some of the main concepts of
this approach. It defined the terms of CBT and the underlying concept of the link between
thoughts, feelings and behaviours. It looked at the ABC Table of activating event or trigger,
the consequences for feelings and behaviours of this trigger and the underlying beliefs that
underpin the thoughts that generate these emotions and behaviours.
IT outlined how this ABC link could result in either healthy/Constructive or Unhealthy/
Destructive emotions or actions. The latter were fuelled by irrational or faulty thinking.
Some of the more common types of thinking errors were outlined. Finally, it looked at how
these thinking errors could be challenged and alternatives found and put into action.
All of the above were brought together in a complete ABCDE Table and three exercises
facilitated an experiential understanding of these important but introductory concepts of
CBT. There is much more to this approach to therapy and change. It is highly effective in
treating the triad of neurosis (depression, aggression and addiction) and has a range of
advanced concepts and strategies. These are not the subject of this brief note.
However, the basics of CBT have been covered. These involve exploring and
understanding the Thinking – Feeling – Behaviour cycle. Only when understanding is
gained can people decide to and plan goals and actions that change vicious negative
cycles into virtuous positive cycles.
BIBLIOGRAPHY
Burns, D (1999) Feeling Good – The New Mood Therapy Avon Books, New York
Carkhuff, R (2000) The Art of Helping Human Resources Press Massachusetts
Culley,S ( 1999) Integrative Counselling Skills in Action SAGE London
Egan, G ( 1998) The Skilled Helper Brooks/Cole Pacific Grove Ca,USA
Frankl,V ( 1984) Man’s Search for Meaning Washington Square Press
Gendlin, E (
Greenberger, D & Padesky, C (1995) Mind Over mood Guilford Press New York
Hough, M ( 2002) A Practical Approach to Counselling Longman
May,R (1978 ) Art of Counselling Abingdon Press
McLeod,J ( 1998) An Introduction to Counselling OU Press
Nelson-Jones ,R (2002) Essential Therapy & Counselling Skills SAGE London
Rogers,C ( 1951) Client Centered Therapy Constable, London
Rogers,C ( 1961) On Becoming a Person Constable, London
Sanders,P (1994) First Steps in Counselling PCCS Ross on Wye

1 cbt An Introduction to CBT

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