CT Myths: Three of the Most Common Misunderstandings about Cognitive Therapy

Myth: Cognitive Therapy (CT) is all about changing your thinking, and does not involve behavioral change.

Fact: Actually, Cognitive Therapy (developed by Aaron T. Beck, M.D. in the 1960s) addresses your thinking, emotions, behaviors, and physiological symptoms (if applicable). Cognitive Therapy (CT) is called Cognitive Therapy because it is based on the premise that your underlying beliefs about yourself, others and the world influence the way you perceive situations, and prompt you to have certain thoughts, emotions, behavioral responses and physical symptoms. CT treatment actually starts by addressing present problems and helping patients to have a better week — patients often begin evaluating their own thoughts and doing some behavioral experimentation very early on.

Myth: Cognitive Therapy only deals with surface layer problems, and it doesn’t do much to change the root of people’s problems.

Fact: Cognitive Therapy treatment starts by addressing present problems as a way to help patients gradually change their underlying problems. Cognitive Therapists work to understand patients’ ‘core beliefs’ — how they view themselves, others and the world. These beliefs are often formed in childhood and are deep-seated. And these beliefs pop up in every day situations in the form of anxious or depressed thoughts that lead to negative feelings and behavioral reactions to situations. Cognitive Therapists work with patients to analyze what’s happening in a given situation, come up with alternative responses, experiment with implementing new ways of thinking and acting, and gradually begin to change their responses to situations. When patients see how their reactions, mood and other symptoms can improve once they begin viewing situations in a more realistic light, they gradually begin to chip away at their ‘deep-seated’ core beliefs. In other words, Cognitive Therapists recognize that the best way to help patients alter their deep-seated beliefs and their current distress is to take action now, in the present, so that patients can see the effects of changing their thinking and behavior, and start to develop more positive and realistic outlooks after seeing the results in action their own lives.

Myth: All Cognitive Therapists do the same kind of therapy. So if I already tried a Cognitive Therapist and it didn’t help, that means that the treatment itself doesn’t help.

Fact: Not all therapists who call themselves Cognitive Therapists, or Cognitive Behavior Therapists are really trained and qualified to practice Cognitive Therapy (CT). As CT becomes more and more well known, due to the many studies that have shown it to be effective, more and more therapists are including CT ‘techniques’ in their practices, and some may call themselves Cognitive Therapists even if they do not have much training in Cognitive Therapy. Just because someone uses some part of CT in their practice, does not mean that he or she is actually delivering overall CT treatment (which is an integrative form of therapy that requires mastery of many different therapeutic techniques, and understanding of individualized treatment approaches for different disorders). We recommend that patients who are interested in CT treatment search for an ACT-Certified Cognitive Therapist. The Academy of Cognitive Therapy is the only Cognitive Therapist certifying organization that reviews therapists’ knowledge and ability before granting certification.

15 replies
  1. Sam
    Sam says:

    Thanks for posting this. Really helps us to understand CBT better.
    The eclecticism of CBT should definitely be highlighted more. For example, I personally have been often confused with these (myths?):

    1. Using CT means intuitions shouldn’t be trusted and acted upon without analyzing them. (Afterall, if you ‘sense something is wrong’ it could be because of a distorted thought too).

    2. ‘Excessive’ use of CT can turn you into an unemotional robot like human.

    3. Without cognitive restructuring, your behaviours can’t be changed. So work on thoughts first, behaviour later.

    4. CT is only good for depression and anxiety; not good for treating personality disorders; not good for anxiety personality disorders because of its emphasis on cognition analysis.

    The emphasis on cognition perhaps causes all this confusion, so it makes me curious as to why this newsletter uses the term CT rather than CBT?

    Reply
  2. CT Today
    CT Today says:

    Sam, thanks for your comments — you ask some good questions. In response to the “CT Myths” you brought up:

    1. CT doesn’t try to teach people to analyze every thought and not even every negative thought. Most of our thoughts, when we don’t have a psychiatric disorder, are accurate,though we all experience inaccurate thoughts and emotional overreactions from time to time. Cognitive Therapy helps people evaluate their thoughts when they have a pattern of excessive emotional reactions, unhelpful behaviors, or avoidance. When people have a psychiatric disorder, much of their thinking (but not all of it) is distorted or dysfunctional in some way. Distorted thinking means that there’s an error in thinking, such as “No one likes me,” (when in fact, there is plenty of evidence to suggest the contrary). Dysfunctional thinking means that the thoughts may or may not be true, but they are certainly unhelpful and contributing to the problem. A person may have the dysfunctional thought “I don’t want to get out of bed.” While this may be true, it leads to unhelpful behavior that contributes to the person’s depression. CT teaches people to examine and respond to distorted and dysfunctional thoughts with regard to a particular problem or problems that they are experiencing.

    2. CT doesn’t aim to stop people from having emotions — emotions are a normal part of life. But if you’re experiencing excessive, debilitating emotions, CT can help you to examine why this is happening and address it. The goal is not to stop people from having emotions, but to help people decrease their distorted, dysfunctional responses to situations. (People who have had CT treatment, or who use it in an ongoing way to prevent relapse, do not stop having emotions.)

    3. Actually, cognitive restructuring and behavioral activation often go hand in hand. CT helps people work on both thoughts and behavior, usually simultaneously. For instance, a depressed patient may need to respond to dysfunctional thoughts before, during, and after behavioral activation. He may need to respond to a thought like, “It won’t help if I get out of bed, there’s nothing I can do to feel better,” in order to get himself to go for a short walk. He may also have dysfunctional thoughts during his walk, such as “I used to be able to walk a mile; now I’m too tired to walk even two blocks — I’m such a basket case” and/or after his walk: “The walk didn’t make me feel completely better. It’s not worth trying to fight my depression.” He would learn to address these thoughts with more realistic responses, such as “At least I did something. Maybe I don’t feel totally better, but it’s a start.” In other words, cognitive restructuring and behavioral activation reinforce one another, and are often used simultaneously in CT.

    4. CT has been demonstrated in over 400 clinical trials to be effective for many disorders, including personality disorders. It has been demonstrated in randomized, controlled trials to be effective for Borderline Personality Disorder, and in initial clinical studies, to be effective for Schizophrenia, in combination with medication. For a list of disorders and sources, please see the http://www.academyofct.org.

    5. Great question about why we use the term “CT” for Cognitive Therapy instead of “CBT” for Cognitive Behavior Therapy. We’re actually going to be posting about this difference soon, but the short answer is that Cognitive Behavior Therapy is technically an umbrella term for many different therapies that share some common elements — CBT is not one exact therapy. CT, on the other hand, refers to a particular therapy developed by Aaron T. Beck, M.D. in the 1960s, that understands people’s problems as related to their thinking and that uses cognitive, behavioral, and a variety of other techniques to help people change their thinking, behavior, mood, and sometimes physiological response. However, many people refer to CT (Aaron Beck’s therapy) as CBT… many news articles about him and the therapy he developed use the terms interchangeably. So some people who use the term “CBT” may actually mean “CT.” More on this later.

    Hope this helps, and thanks again for your questions,
    Judith S. Beck, Ph.D.

    Reply
  3. Sam
    Sam says:

    Thank you so much, Dr. Beck. Really appreciate your thoughtful and detailed answers. I especially found your explanation of dysfunctional thoughts very insightful, as most self-help literature on CT tend to only mention distorted thoughts.

    One clarification on the second Q&A would be helpful –
    Most self-help literature on CT explain the basic premise of CT, explain the common cognitive distortions and often ask you to maintain a mood log. Thus a (common?) side effect when we start learning and practicing CT for self-improvement is to train ourselves to look at every emotion and ‘apply’ CT (what was the thought behind the feeling, is there any distortion) to it, sometimes unconciously. This can at times dampen the ‘joy’ of positive emotions or inhibit its expression; thus the statement – ‘excessive use of CT can make you unemotional’.

    (Something similar to what happens during assertive training – the patients initially tend to be more aggressive than assertive before they start realizing the appropriate behavior). Is this common during CT? Perhaps a better question would have been – Is CT safe as self-help without guidance from a therapist?

    Reply
  4. Alvaro
    Alvaro says:

    Dear Judith,

    “cognitive restructuring and behavioral activation reinforce one another”. From a cognitive neuroscience perspective, couldn’t agree more. You may enjoy this interview on learning with neurobiologist James Zull.

    I just found your blog, and enjoyed reading several of the posts. I wanted to let you know of the brain fitness blog carnival we just launched, http://blogcarnival.com/bc/cprof_880.html, with title “How the Mind shapes the Brain. And vice versa.” and whose goal is to “facilitate a dialogue about this emerging field across multiple perspectives, from scientists and health professionals, to education and training ones, to basically everyone who has conducted an experiment on his on her brain and mind, and has news to report.”

    We would love you to submit a couple of posts-this one being a good candidate-, to introduce the principles of cognitive therapy to a wider audience than is usually exposed to it (we call it “brain fitness”, not “mental health” to reach healthy individuals from a fitness and wellness perspective).

    Regards

    Reply
  5. CT Today
    CT Today says:

    Thanks Alvaro, we liked your blog, and the idea of dialogue across different science/health fields. We’re interested in sending something in — going to think about CT angles that might be relevant for your framework, and we’ll see what posts we come up with… I got your email too, will be in touch soon. Thanks again for the heads up!

    Reply
  6. CT Today
    CT Today says:

    Sam, about your last question — it sounds like the mood logs you’re referring to are instructing users to monitor EVERY mood (?). For Cognitive Therapy, we only recommend using a mood log WHEN YOUR MOOD IS WORSE.

    We use something called a Dysfunctional Thought Record (DTR). The directions on the DTR state that: When you notice your mood getting worse, ask yourself, “What’s going through my mind right now?” and as soon as possible jot down the thought or mental image in the Automatic Thought Column.

    We don’t tell patients to fill out DTRs all the time, nor do we tell them to fill out DTRs for every emotion. The idea is to fill out a mood log when your emotions are distressing, and you want to see what’s happening to cause this.

    As for self-help versus guidance from a therapist, there is some research that suggests that self-help can be beneficial when people have mild cases of depression. If people have more accute symptoms, however, they my want to consult a mental health professional.

    Reply
  7. Joe
    Joe says:

    Judith, your a blessing. and so is your Dad. I cannot tell how much I love the two of you.

    and everybody else working here.

    Thank you.

    Reply
  8. CBT fan
    CBT fan says:

    I can say that from personally doing CBT (CT) for many years, it in no way makes a personal unemotional, of course.
    There is also nothing I have seen about overly-monitoring your emotions. Of course, some obsessive folks might start graphing their feelings all day or something, but that is extremely excessive.

    But there is nothing wrong with Identifying your Emotions when you choose to, and rating their intensity, and learning to manage them.

    CBT works extremely well for me. I can go from feeling quite crappy or worse, and after doing a FULL written Thought Record, can usually feel a lot better right after it. That to me is amazing.

    I have done hundreds of Thought Records over the years, and they have literally saved my bacon.
    So thank you, to all the people who designed the ABCDEF Thought Record, similar to the one in Mind Over Mood.

    (I have added to it though…G-H)
    G: Goal: at the end of the Thought Record, I set a clear Behavioral Goal, and do it right then.
    H: How’d it go? Which I sometimes use to monitor the result.

    So its adding another CT technique in at the end. It covers almost the entire process.
    ABCDEFGH

    Reply
  9. cathy
    cathy says:

    Could you please tell me if CT would be a useful type of therapy for someone who has a dual diagnosis; specifically, bipolar disorder and addiction to caffeine pills and DXM, the active ingredient in cough suppressants. Thank you!

    Reply
  10. CT Today
    CT Today says:

    Clinically we have seen that CT is effective for dual diagnoses such as these but we don’t know of any research that has studied this particular dual diagnosis.

    Reply
  11. Edgar R Rivera
    Edgar R Rivera says:

    CT is helpful in a very wide variety of symptoms or disorders. It has an eclectic approach to treatment according to symptoms. My question is; is the training a specialized one according to the different disorders that the therapist want to work or it is general and then the therapist selects the form of treatment within CT that he wants to apply in certain situations? My confusion arises because I have seen different books on psychological disorders and a particular treatment for that specific disorder, Like: for example, Cognitive Therapy of Personality Disorders, Cognitive Therapy of Depression, Cognitive Therapy of Substance Abuse, Cognitive Therapy and the Emotional Disorders, etc. By the way, I found out that, according to your records, and my search, there is only one certified therapist in Puerto Rico, Is that right?
    Thank you,
    Edgar Rivera

    Reply

Trackbacks & Pingbacks

  1. […] A term that is sometimes used to refer directly to Cognitive Therapy (CT), especially in countries outside the U.S. (for instance, CT and CBT are used interchangeably in Why Distinguish Between Cognitive Therapy and Cognitive Behavior Therapy, or this post to find out more about behavioral change in Cognitive Therapy.   […]

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