What Is Cognitive Therapy? 10 Types & Research Findings

The links connecting our thoughts together define our attitudes, emotions, and behaviors.

Examining and understanding these links provides an extremely promising target for therapeutic intervention.

In this article, you’ll learn about Cognitive Therapy, one of the most foundational and widely used approaches for achieving this.

Before you continue, we thought you might like to download our three Mindfulness Exercises for free. These science-based, comprehensive exercises will not only help you cultivate a sense of inner peace throughout your daily life, but also give you the tools to enhance the mindfulness of your clients, students, or employees.

What Is Cognitive Therapy?

Cognitive Therapy emerged in the late 1960s amid a surge in popularity of cognition-focused approaches to mental health, as empirical techniques for investigating cognitive processes such as learning and memory opened up new areas of study and triggered a shift away from more traditional behavior-focused approaches.

Dr. Aaron Beck developed the foundational theory of Cognitive Therapy while testing the assumptions of Freudian psychoanalysis on patients with clinical depression. He found that data from discourse with patients and descriptions of their dreams suggested that their depression was associated with deep-rooted beliefs regarding failure and defeat.

These beliefs caused patients to automatically make negative assumptions about their internal and external lives, which precipitated and maintained their depression. Importantly, Beck realized these beliefs could be identified and ‘captured’ directly by examining the patient’s automatic responses and tracing them back to their source.

Once this cognitive source of negative and distorted beliefs had been found, it could be challenged and corrected, ending the self-maintaining depressive cycle driven by automatic assumptions linked to the beliefs. As the therapeutic targets and outcomes involved in this process are cognitive in nature, he called this technique “Cognitive Therapy” (Beck, 2019; Beck & Fleming, 2021).

Cognitive Therapy vs Cognitive-Behavioral Therapy

While Cognitive Therapy and Cognitive-Behavioral Therapy (CBT) are very similar and largely share the same core theory, they should not be considered synonymous or used interchangeably.

Cognitive Therapy is a therapeutic technique that focuses on identifying and mending negative beliefs and automatic assumptions that are contributing to a poor (or clinically unwell) state of mental health.

In contrast, CBT is a broad range of techniques that encompass Cognitive Therapy. CBT refers to any technique that focuses on achieving behavioral change through changing dysfunctional thought processes and using the relationship between thoughts and behaviors as a therapeutic tool.

CBT techniques may be more or less focused on either the cognitive or behavioral elements, depending on the specific theoretical assumptions of the technique and nature of the client.

In short, CBT refers to a variety of techniques in which the goal is to change behavior in order to change thoughts, and vice versa. Cognitive Therapy is a specific technique in which the goal is to change thoughts for the sake of changing thoughts.

Psychotherapy vs Cognitive Therapy

Similarly, psychotherapy and Cognitive Therapy may seem to have similar connotations, as ‘psyche’ (as the root of psychotherapy) and ‘cognition’ are largely synonymous.

However, while Cognitive Therapy refers to a specific technique, psychotherapy is a very general term referring to a variety of methods encompassing both CBT and Cognitive Therapy.

Importantly, while some psychotherapeutic techniques are less concerned with empirical methods and content to take a more fluid humanistic or psychoanalytical approach, Cognitive Therapy assumes an empirical framework that is concerned only with cognitive phenomena that can be observed (indirectly) using scientific techniques, such as beliefs that manifest transparently as automatic thought processes.

Aaron Beck’s Theory & Cognitive Model

There are several elements that make up the theoretical foundation of Cognitive Therapy.

Automatic thoughts are fast, reactive assumptions and conclusions that are made by the individual in response to internal and external events.

The most important and dangerous detail of these automatic thoughts is that without intervention, they often go unexamined and unnoticed, and as a result are considered true (or at least plausible) de facto. This makes it very easy for these automatic thoughts to become deeply rooted in everyday cognition.

Negative beliefs or ‘schemas’ are the cognitive structures underlying automatic thoughts that encode negative and dysfunctional assumptions about the world.

Beck (2019) categorized these beliefs as concerning the self (e.g., prone to failure), the world (e.g., adverse and critical), or the future (e.g., containing failure) and described them as existing in a self-reinforcing ‘triad,’ where negative beliefs in one category maintain negative beliefs and block positive change in another category.

In the context of Cognitive Therapy, a defining feature of negative beliefs and the automatic thought processes they produce is that they are not logical.

For example, they might involve overextending the consequences of an event, overemphasizing its significance, taking a feeling or emotion as fact, drawing unevidenced assumptions about an event, or unwittingly cherry-picking evidence that confirms negative beliefs.

How Does Cognitive Therapy Work?

The most basic mechanism of Cognitive Therapy in practice is that automatic thoughts can be identified and captured. The negative beliefs that produced them can be challenged and changed (Beck, 1976).

Principles & goals of Cognitive Therapy

1. Targets

The client and therapist must have a clear sense of what is being targeted by their therapy. The goal is cognitive change, and the first step to realizing this cognitive change is identifying where the change must take place. As a result, the most obvious target is exploring the thought processes relating to the client’s issues. However, the type of dysfunctional thought process involved may vary.

Thoughts may involve distortions to reality that may be either tangible or more abstract. For example, a tangible distortion may be a belief that the client can no longer complete a routine task despite evidence to the contrary or a belief that their health is rapidly declining despite a clean bill of health from a physician.

Abstract distortions may involve the belief that the client is disliked by their family and friends or that they have lost some core aspect of their identity or personality.

Dysfunctional thought processes also involve different types of illogical thinking.

These may be:

• Catastrophizing (exaggerating the impact of an event)
• Emotional reasoning (reasoning based on feelings rather than facts)
• Polarization (all-or-nothing thinking)
• Selective attention (biased information filtering)
• Mind reading (assuming others’ thoughts and beliefs)
• Labeling (blanket categorizing people and events)
• Minimizing and maximizing (ignoring positive events and emphasizing negative ones)
• Imperative reasoning (focusing on what should have happened rather than what did happen)

2. Collaboration

The therapist should recognize that they are not a surgeon picking apart the client’s thoughts in an isolated cognitive operating theater; they are part of the client’s social environment, and their attitudes and actions can interact with the client’s negative beliefs in a way that may be harmful if not navigated carefully.

Instead, the therapist should assume a collaborative attitude with the client, encouraging the client to work together with them to solve the client’s problem and engage in a discourse about treatment.

Collaboration avoids reinforcing the belief that there is something fundamentally wrong with the client that needs to be fixed and instead reframes therapy as a way to address a problem associated with but external to them.

3. Credibility

As the primary aim of Cognitive Therapy is changing illogical or distorted negative beliefs, it is essential for the therapist to establish their credibility as someone with a trustworthy and accurate perspective, or else their assessment of a thought will not be considered legitimate by the client.

In order to facilitate a sense of credibility, the therapist should not assume the position of arbiter, but rather encourage the client to engage in an examination of their own thoughts, empowering the client as the agent responsible for challenging and changing the illogical or distorted nature of their beliefs.

With the client taking the lead, the therapist adopts a more neutral position, offers points for consideration, and, where appropriate, suggests evidence that might contradict the client’s negative beliefs, relying less on a more authoritative and assertive form of credibility.

4 Types of Cognitive Therapies

Let’s take a quick look at four of the different types of Cognitive Therapies.

Hypothesis testing

The client can be positioned as a scientist in charge of testing the ‘hypothesis’ of their negative belief in a way that does not violate the scientific method.

In the simplest terms, this means reaching a conclusion that is not arbitrary, based on evidence, and made with the intention of trying to disprove rather than confirm the belief.

Recognizing negative thoughts

A form of mindfulness can be encouraged, where the client focuses on becoming better at spotting automatic thoughts when they occur.

This is difficult at first, as automatic thoughts are just that – automatic – and they can be accepted without examination or awareness. But over time, the client can hone this into a practice and gradually become better able to spot automatic thoughts without the aid of the therapist.

Filling gaps

Recognizing automatic thoughts alone is not necessarily sufficient, as it is also necessary to understand that these automatic thoughts are illogical or distorted. Often, the illogical nature of these thoughts is not obvious, as they are accepted with no justification. As a result, a method for identifying their illogical nature is to deliberately try to construct a justification by ‘filling in the gaps’ between an event and the negative conclusion.

For example, the client may notice someone looking at them and conclude they are attracting the unwanted attention of everyone around them. However, when the client tries to fill in the steps between the event and the conclusion, they find there is no logical way to link them.

Distancing

Identifying automatic thoughts and understanding the illogical or distorted nature of their underlying negative beliefs are invaluable skills, but they can be said to constitute the ‘intellectual’ methods of Cognitive Therapy.

That is to say, it is possible that the client may be fully able to identify and understand a negative thought, but may still experience distress, regardless. This is where distancing becomes useful as a technique for disconnecting the experience of having these thoughts from their immediate negative emotional consequences.

Distancing is another mindfulness exercise in which the individual fosters a sense of separation between themselves and their negative thoughts, viewing them as something disconnected and originating from a place external to or otherwise separate from the client’s mind. This is a challenging therapeutic task, but over time, it helps to sever the connections linking negative cognition and negative affect.

3 Real-Life Examples of Cognitive Therapy

A great way to get a better understanding of this topic, is to see how it is applied in real-life.

Hypothesis testing in practice

A client has performance anxiety that is disrupting their academic performance. They have an upcoming exam and express the fear that if they fail, it will be a fatal blow to their chances of future success and they will become alienated from their peer groups.

Their therapist encourages them to consider alternate hypotheses, that there may be little or no serious negative impact even in the worst-case scenario, and uses the upcoming exam as an opportunity for the client to put hypothesis testing into practice.

Somewhat as they expected, their anxiety harmed their performance a little on the exam, and they did not perform as well as they had wanted. However, after a few days, they observe that they no longer feel as bad as they expected, and that there are no serious consequences to their ongoing prospects or peer group.

This shows that their initial hypothesis was incorrect, and the credibility of the belief supporting this hypothesis is weakened.

Analyzing automatic thoughts

A client is undergoing therapy for persistent anger issues. Specifically, they find themselves frequently irritated by the people around them for no apparent reason and continually feel as though they are in a state of conflict with their family and friends.

Through working with the therapist, the client learns to spot automatic negative thoughts and finds that they routinely make hostile assumptions about the behavior and attitudes of others.

By trying to fill in the gaps between their assumptions and the facts of their experience, they find that they are not rooted in evidence. Instead, their automatic thoughts result from an illogical negative belief that other people have inherently hostile motives.

Creating distance

A client works as a high-functioning business executive and becomes extremely stressed when confronted with a situation they have not rehearsed or experienced previously, despite recognizing that this response is an unnecessary overreaction.

Together, the client and the therapist identify that this difficulty with stress management can be reduced to an archetypal panic response that the client automatically assumes in novel situations, rooted in a distorted negative belief that the client is incompetent despite their extensive experience.

The client learns to distance themselves from this response and reframes their stress as an ultimately normal and meaningless physiological response initiated by the body when surprised by a new situation that does not hold any deeper personal significance as suggested by their distorted negative belief.

Is It Effective? 6 Research Findings

Multiple review papers have reported the efficacy of Cognitive Therapy, finding it at least as effective as other psychotherapeutic techniques and potentially more effective than pharmacological interventions.

Dobson (1989) and Gloaguen, Cottraux, Cucherat, and Blackburn (1998) initially found Cognitive Therapy to be more effective than a variety of other therapeutic approaches. Wampold, Minami, Baskin, and Tierney (2002) later suggested these findings may be exaggerated, but nevertheless concluded that Cognitive Therapy was at least as effective as its alternatives.

Chiesa and Serretti (2011) reviewed the evidence of a more contemporary approach to Cognitive Therapy and found it was superior or at least as effective as drug-based therapies for treating depression, some anxiety disorders, and bipolar disorder.

Cognitive-Behavioral Therapy more generally has had similar support from research, with the literature suggesting it is effective for treating a wide variety of psychological conditions.

For example, Butler, Chapman, Forman, and Beck (2006) reviewed 16 meta-analysis studies and concluded that CBT was superior to antidepressants in the treatment of clinical depression and showed promising effectiveness for bulimia, obsessive-compulsive disorder, and even schizophrenia.

However, emerging neuroscientific evidence suggests that some individuals may be more naturally responsive to CBT than others because of variations in their brain activity. La Buissonniere-Ariza et al. (2020) reviewed several preliminary neuroimaging studies investigating this effect and reported that enhanced brain activity in regions associated with emotional regulation and cognitive control may predict therapeutic effectiveness.

Advantages & Disadvantages of Cognitive Therapy

Cognitive Therapy, like CBT, is an empowering technique that places the client at the center of the therapeutic process, while also providing a highly structured framework where the therapeutic targets are clearly identified and tackled directly.

Furthermore, the emphasis of Cognitive Therapy is on helping the client help themselves, allowing a gradual and natural conclusion of the therapeutic process as the client becomes more independent and avoiding the need for the therapist to be more strongly prescriptive.

However, as suggested by the techniques used in Cognitive Therapy, it can be a long process that requires a lot of discipline and practice from the client and therapist as they work to hone the necessary therapeutic skills. This may not be suited to the needs or preferences of the client or therapist.

Similarly, while the highly structured or client-empowering nature of Cognitive Therapy may be beneficial for some, it may not suit others, especially clients who have trouble managing responsibility or engaging with a program, or therapists who prefer to work within a looser theoretical framework.

More specifically, this may be the case when the client has either a serious clinical issue that requires a more intense intervention or is dealing with complex trauma that defies a direct proximal link with superficial, automatic thought patterns.

Resources From PositivePsychology.com

Throughout our blog, you’ll find many valuable resources to help your clients gain skills at recognizing and challenging automatic negative thoughts.

To help, check out the following free worksheets.

• Identifying ANTS: Challenging Different Types of Automatic Thoughts
  This worksheet details ten different types of automatic negative thoughts and presents five powerful questions clients can ask to challenge them when they arise.
• Getting Rid of ANTS: Automatic Negative Thoughts
  This worksheet helps clients recognize triggers that spur negative thoughts and consider adaptive alternatives to these automatic thinking patterns.
• Behavioral Experiments to Test Beliefs Worksheet
  This worksheet guides clients through a series of six steps to help them test and re-evaluate the beliefs underlying negative automatic thoughts.
• 17 Mindfulness & Meditation Exercises
  If you’re looking for more science-based ways to help others enjoy the benefits of mindfulness, check out this collection of 17 validated mindfulness tools for practitioners. Use them to help others reduce stress and create positive shifts in their mental, physical, and emotional health.

A Take-Home Message

Cognitive Therapy provides a structured, clear, and empowering approach to identifying and understanding the links between negative beliefs and the often covert and automatically accepted thoughts they produce.

During therapy, these thoughts can be traced to their source and ultimately corrected through practicing several simple techniques. It has been proven to be an effective therapy and advantageous to the right clients.

We hope you enjoyed reading this article. Don’t forget to download our three Mindfulness Exercises for free.