Cognitive Behavioral Therapy


Cognitive Behavioral Therapy is a counseling technique used widely for the treatment of many disorders, namely depression and the anxiety disorders.  The basic premise is this.  Let’s say I have plans tonight to go to a local pub to have a beer and hear a local acoustic band.  Three other friends are planning to go, but one had to back out a few days ago because she must travel to her parents’ home due to a sick grandparent.  I totally understand and wished her well.  Today at 6:30PM, an hour before the meet time, another friend sent me a text saying “sorry, can’t go, catch u later”.  This really upset me.  The other one also backed out as of this morning because his girlfriend is jealous and did not like him hanging out with us.  This is so inconsiderate, and I cannot find anyone to go with.  I spend the next hour cursing at the walls, hating my friends, cracking open a couple of beers at home, starting to cry a little, and thinking of blocking all of them on my phone.  Lots of people would say I am upset because of the text I got – that last cancellation.  A cognitive behavioral therapist would say that it is not the event (text) that is responsible for me being upset, but it is my belief about the event.  I took it personally, decided that my whole evening is ruined, began thinking that my friends do not like me, etc.  Those distorted thoughts are what is causing me to be upset, not the event.  I can challenge those distorted thoughts (these cancellations are not connected to each other, I may not like it but it is not a catastrophe, I can still go and hear the band and maybe find some other people there I know, etc.).  The cognitive behavioral worksheet is what my therapist would have me use.  As for me, Bill, I have had clients print and carry blank worksheets with them, some of them completing up to 40 per day – each one for a very specific situation.  People who are depressed, for example, do three things with their thinking that worsens their low mood.  They assume that bad outcomes are their fault and that good outcomes are just luck or chance, that when bad things happen, they will keep happening forever rather than being temporary, and, they often believe that if one part of their life is “bad” that all other parts are “bad”, too.  The worksheets help them challenge this thinking.  Instructions:1. Begin to identify situations in the recent past in which you became upset because you may have misinterpreted what was going on, took things too personally, or made the wrong assumptions.  If you do not believe this has happened, keep thinking.  Every person does this from time to time.2. Read the “Breakup with Boyfriend” sample worksheet.3. Read the list of thought distortions and become familiar with them.4. Begin filling out the cognitive behavioral worksheet, after saving a version of it to your computer, using your last and first name in the title, followed by “CBT Worksheet.”5. Take time, do not complete it in one sitting.  Be detailed, be sure to refer to the above documents for guidance.6. Upload your completed worksheet in this folder as an assignment upload.Cognitive Behavioral Worksheet (Page 1 offers instructions and examples – Page 2 is blank for you to use)Event or Situation Be specific and brief; do not write “had a bad day” or “lots of stress at school” – describe a specific event, something like “Mom called me and was very critical about my new boyfriend” – or – “My boss talked to me this afternoon and said there could be layoffs in two months” – and in that one – it is not the layoff that is the event (it may not happen) – but it is the conversation with the boss that is the event; also, do not use the death of a loved one as an event or situation.Unhealthy Negative Feelings List here any extreme emotions (not thoughts, not behaviors) – “I was very anxious and mentally froze up for hours” or “I was really, really angry!” – “I felt really extreme despair”Unhealthy Behaviors List here any extreme behaviors that may be destructive to your functioning – like “I just stayed in all day and skipped classes” or “I called in sick to work but was not sick” – or – “I just blew everything off and went out and got drunk.”
Pessimistic, irrational or distorted belief – what are you saying to yourself in your head that is leading to the unhealthy negative feelings?  List at least 3. What cognitive distortion is being used to create this belief?  Look at the list of cognitive distortions to get this (awfulizing, overgeneralizing, etc.) What would you say to yourself to dispute this belief?  What evidence exists that the distorted belief is not true? Now, write an optimistic, rational or realistic belief to replace the pessimistic, irrational or distorted belief.1  “This absolutely sucks, and that idiot cashier was really trying to screw with my head by not letting me have my discount” 1 Awfulizing – I made this out in my head to be the worst thing that could ever happen; I was also Personalizing – making it totally about me and not the situation the cashier was in – maybe I was wrong.Students – remember, there is a long list of possible distortions – check them all out 1. Other people also did not get their discounts today because, like me, they read the coupon wrong; it is highly unlikely that a casher I have never met before actually hated me and wanted to mess with my mind 1. “If I don’t get the discount then I must have read the coupon wrong.  I have options.  I can ask the manager to verify and if I do not get the discount I can either not buy the product or accept that I will pay the normal price – it’s not the end of the world.”

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Healthy Negative Feelings List here any feelings, while negative, that may actually be a normal reaction to the situation – like “I was disappointed” – “I was upset for a few minutes but was able to calm down” – or- “I was sad about it”New Constructive Behaviors “I called a friend and talked about it” – I searched the Internet for how others have dealt with this” or “I went for a long walk to help myself feel more at ease” – “I got busy with my day and decided I would deal with the event or situation later and not let it consume my whole day”


Cognitive Behavioral WorksheetEvent or Situation

Unhealthy Negative Feelings

Unhealthy Behaviors


Pessimistic, irrational or distorted belief – what are you saying to yourself in your head that is leading to the unhealthy negative feelings? What cognitive distortion is being used to create this belief?  Look at the list of cognitive distortions to get this (awfulizing, overgeneralizing, etc.) What would you say to yourself to dispute this belief?  What evidence exists that the distorted belief is not true? Now, write an optimistic, rational or realistic belief to replace the pessimistic, irrational or distorted belief.1


1 1 1



2 2 2



3 3 3

Healthy Negative Feelings

New Constructive Behaviors


1. Filtering. We take the negative details and magnify them while filtering out all positive aspects of a situation. For instance, a person may pick out a single, unpleasant detail and dwell on it exclusively so that their vision of reality becomes darkened or distorted.2. Polarized Thinking (or “Black and White” Thinking). In polarized thinking, things are either “black-or-white.” We have to be perfect or we’re a failure — there is no middle ground. You place people or situations in “either/or” categories, with no shades of gray or allowing for the complexity of most people and situations. If your performance falls short of perfect, you see yourself as a total failure.3. Overgeneralization.In this cognitive distortion, we come to a general conclusion based on a single incident or a single piece of evidence. If something bad happens only once, we expect it to happen over and over again. A person may see a single, unpleasant event as part of a never-ending pattern of defeat.4. Jumping to Conclusions. Without individuals saying so, we know what they are feeling and why they act the way they do. In particular, we are able to determine how people are feeling toward us.For example, a person may conclude that someone is reacting negatively toward them but doesn’t actually bother to find out if they are correct. Another example is a person may anticipate that things will turn out badly, and will feel convinced that their prediction is already an established fact.5. Catastrophizing. We expect disaster to strike, no matter what. This is also referred to as “magnifying or minimizing.” We hear about a problem and use what if questions (e.g., “What if tragedy strikes?” “What if it happens to me?”).For example, a person might exaggerate the importance of insignificant events (such as their mistake, or someone else’s achievement). Or they may inappropriately shrink the magnitude of significant events until they appear tiny (for example, a person’s own desirable qualities or someone else’s imperfections).With practice, you can learn to answer each of these cognitive distortions.6. Personalization. Personalization is a distortion where a person believes that everything others do or say is some kind of direct, personal reaction to the person. We also compare ourselves to others trying to determine who smarter, better looking, etc is.A person engaging in personalization may also see themselves as the cause of some unhealthy external event that they were not responsible for. For example, “We were late to the dinner party and caused the hostess to overcook the meal. If I had only pushed my husband to leave on time, this wouldn’t have happened.”7. Control Fallacies.If we feel externally controlled, we see ourselves as helpless a victim of fate. For example, “I can’t help it if the quality of the work is poor, my boss demanded I work overtime on it.” The fallacy of internal control has us assuming responsibility for the pain and happiness of everyone around us. For example, “Why aren’t you happy? Is it because of something I did?”8. Fallacy of Fairness.We feel resentful because we think we know what is fair, but other people won’t agree with us. As our parents tell us when we’re growing up and something doesn’t go our way, “Life isn’t always fair.” People who go through life applying a measuring ruler against every situation judging its “fairness” will often feel badly and negative because of it. Because life isn’t “fair” — things will not always work out in your favor, even when you think they should.9. Blaming.We hold other people responsible for our pain, or take the other track and blame ourselves for every problem. For example, “Stop making me feel bad about myself!” Nobody can “make” us feel any particular way — only we have control over our own emotions and emotional reactions.10. Shoulds.We have a list of ironclad rules about how others and we should behave. People who break the rules make us angry, and we feel guilty when we violate these rules. A person may often believe they are trying to motivate themselves with shoulds and shouldn’ts, as if they have to be punished before they can do anything.For example, “I really should exercise. I shouldn’t be so lazy.” Musts and oughts are also offenders. The emotional consequence is guilt. When a person directs should statements toward others, they often feel anger, frustration and resentment.11. Emotional Reasoning. We believe that what we feel must be true automatically. If we feel stupid and boring, then we must be stupid and boring. You assume that your unhealthy emotions reflect the way things really are — “I feel it, therefore it must be true.”12. Fallacy of Change. We expect that other people will change to suit us if we just pressure or cajole them enough. We need to change people because our hopes for happiness seem to depend entirely on them.13. Global Labeling. We generalize one or two qualities into a negative global judgment. These are extreme forms of generalizing, and are also referred to as “labeling” and “mislabeling.” Instead of describing an error in context of a specific situation, a person will attach an unhealthy label to themselves.For example, they may say, “I’m a loser” in a situation where they failed at a specific task. When someone else’s behavior rubs a person the wrong way, they may attach an unhealthy label to him, such as “He’s a real jerk.” Mislabeling involves describing an event with language that is highly colored and emotionally loaded. For example, instead of saying someone drops her children off at daycare every day, a person who is mislabeling might say that “she abandons her children to strangers.”14. Always Being Right.We are continually on trial to prove that our opinions and actions are correct. Being wrong is unthinkable and we will go to any length to demonstrate our rightness. For example, “I don’t care how badly arguing with me makes you feel, I’m going to win this argument no matter what because I’m right.” Being right often is more important than the feelings of others around a person who engages in this cognitive distortion, even loved ones.15. Heaven’s Reward Fallacy. We expect our sacrifice and self-denial to pay off, as if someone is keeping score. We feel bitter when the reward doesn’t come.

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