PRACTICING POSITIVE CBT
CHAPTER 1: WHAT IS CBT?
INTRODUCTION
CBT is a psychotherapeutic talking therapy that developed from the combination of
behavioural therapy (1920s–1970s) and cognitive therapy (1960s), influenced by
behaviourist learning theories.
1. Cognitive therapy focuses on the idea that maladaptive emotions and behaviours
result from distorted or irrational thinking patterns (automatic thoughts).
a. And aims to identify and change these through cognitive restructuring.
2. Behavioural therapy focuses on modifying observable behaviour by replacing
maladaptive behaviours with healthier ones, without focusing on unconscious
motivations.
CBT integrates both approaches, aiming to identify and change dysfunctional thoughts,
assumptions, and beliefs, and replace them with more realistic and helpful alternatives,
while also addressing underlying core beliefs (schemas).
- Through this process, clients learn to challenge irrational beliefs and develop more
adaptive ways of thinking and behaving, which can reduce emotional distress.
CBT is collaborative and action-oriented, with the client playing an active role, and
treatment is typically short-term (around 16 weeks).
A strong therapeutic alliance and the use of empirically supported methods both
contribute to better treatment outcomes and reinforce each other.
CBT TECHNIQUES
CBT uses a range of techniques to help clients become aware of their thoughts, emotions,
and behaviours, and to change maladaptive patterns.
1. Keeping a diary helps clients monitor situations, thoughts, feelings, and
behaviours, increasing awareness of maladaptive patterns and later reinforcing
positive changes.
2. Cognitive rehearsal involves mentally practicing how to handle difficult situations
step by step, so that clients can apply these responses in real life.
3. Testing automatic thoughts and schemas helps clients evaluate their validity; by
examining evidence, dysfunctional beliefs can be challenged and modified.
4. Modelling and role-play allow clients to learn appropriate behaviours by observing
and practicing them with the therapist.
5. Conditioning uses reinforcement to increase desired behaviours or reduce
unwanted ones by linking behaviour to positive or negative consequences.
6. Systematic desensitization gradually exposes clients to feared situations while
using relaxation techniques, reducing anxiety and building coping, sometimes
progressing to real-life exposure.
7. Relaxation, mindfulness, and distraction techniques are used to help manage
emotional and physiological responses.
8. CBT can also be combined with medication, particularly for disorders such as
depression and bipolar disorder.
, 9. Homework assignments are an essential part of CBT, encouraging clients to apply
strategies and test new behaviours in real-life situations between sessions.
EMPIRICAL EVIDENCE
There is strong empirical evidence that CBT is effective for a wide range of disorders,
including mood, anxiety, personality, eating, substance use, and psychotic disorders,
often delivered as structured, time-limited, and manualized treatments.
CBT can be applied in individual and group settings, as well as in self-help formats, with
approaches ranging from more cognitive to more behavioural or integrated methods,
depending on the focus of the intervention.
Many CBT programs have been empirically evaluated, and the emphasis on evidence-
based treatment has contributed to its preference over other approaches, such as
psychodynamic therapy.
CBT can be viewed as a class of treatments that share core features:
1. Problem-focused
2. Structured
3. Collaborative
>>> Requiring openness from the client, while the therapist guides the process using
expert knowledge to support change.
,CHAPTER 2: WHAT IS POSITIVE CBT?
INTRODUCTION
Example: a purely problem-focused approach—asking many questions and delaying
action—can leave a person feeling unsatisfied, highlighting limitations of traditional
assessment-heavy models.
The traditional cause–effect (medical) model assumes that accurate diagnosis must
precede treatment, which works well for clear, physical problems but is less suited to
complex psychological issues.
- This model in psychotherapy is highly problem-focused, emphasizing diagnosis
and symptom reduction, which can lead to an overemphasis on problems and their
causes.
- Focusing extensively on problems may create a vicious circle in which problems
seem to grow, solutions become less visible, and hope for improvement
diminishes.
- Analyzing causes of problems does not automatically lead to improvement;
psychotherapy is fundamentally relational rather than purely diagnostic or
medical.
Criticism of the medical model highlights concerns about over-pathologizing normal
human experiences and framing distress as illness rather than natural variation.
There is also evidence that professionals working within a strictly problem-focused model
may experience higher levels of stress, burnout, and related difficulties, pointing to
limitations of this approach.
SHORTCOMINGS OF THE PROBLEM-SOLVING PARADIGM
The problem-solving paradigm is widely used across domains such as business,
government, coaching, psychotherapy, and conflict management, where the focus is
typically on diagnosing pathology and identifying causes using the medical (cause–effect)
model.
- Problems are viewed as deviations from normal functioning, with the assumption
that identifying and removing the cause will restore normality.
Although this approach is simple, logical, and action-oriented, it has several important
limitations:
1. In complex situations, it is often not possible to isolate a single cause, as multiple
interacting factors are involved.
2. There is a risk of focusing too narrowly on one easily identifiable cause while
ignoring the broader context.
3. Even when a cause is identified, it may not be possible to remove or change it.
4. The assumption that removing the cause will resolve the problem and return
things to normal is often incorrect.
5. Defining clear goals within this model can be difficult, raising questions about how
precisely outcomes should be specified.
A key limitation is that defining a problem too quickly also predetermines the type of
solution, potentially restricting more creative or effective alternatives.
, Positive CBT shifts the focus from problem-solving to outcome or goal design,
emphasizing the creation of something new rather than merely eliminating a problem.
- Design thinking is future-oriented, open-ended, and purposeful, focusing on what
can be achieved rather than what has gone wrong.
There is growing dissatisfaction with problem-focused therapy models, as extensive
problem analysis can reduce hope and lead to dropout when change is not experienced.
Although psychotherapy is generally effective—improving symptoms, functioning, and
coping—there are also significant concerns.
- Outcomes have not substantially improved over decades, dropout rates remain
high, and confidence in therapy outcomes is limited.
- There is also little evidence that specific techniques or models are uniquely
responsible for therapeutic change, despite ongoing claims of superiority.
- These limitations highlight the need to move beyond purely problem-focused
approaches and explore alternative, more constructive frameworks.
EXERCISE
This exercise invites reflection on the questions people ask themselves or others when
facing a problem.
- The key point is to examine whether these questions actually help create
movement and improvement, or whether they only explain why the person feels
stuck.
o If the questions do not help, the task is to replace them with more
constructive questions.
How to not be unhappy
The story contrasts two ancient Greek approaches to life. The Stoics focused on enduring
discomfort and aimed mainly not to be unhappy, while Epicurus and the Epicureans
aimed to create a happy and tranquil life.
- This distinction is used to show that clients can choose between avoidance goals,
such as not being unhappy, and approach goals, such as becoming happy.
- Positive CBT is more interested in helping clients move toward desired outcomes,
rather than only away from problems.
TOWARDS A STRENGTHS AND SOLUTIONS PARADIGM
Traditional therapy approaches tend to focus on problems, limitations, and deficits, often
overlooking the client’s abilities and resources, even though these are crucial for
facilitating change.
- A strengths-based approach, rooted in Positive Psychology, views individuals as
capable and resourceful.
o With strengths that can be activated to reduce suffering, resolve problems,
and improve well-being and functioning.
- Change is promoted through empowering, respectful, and collaborative processes
that help clients use their strengths in meaningful ways.
- The strengths perspective assumes that all individuals possess strengths, that
focusing on these enhances motivation.
CHAPTER 1: WHAT IS CBT?
INTRODUCTION
CBT is a psychotherapeutic talking therapy that developed from the combination of
behavioural therapy (1920s–1970s) and cognitive therapy (1960s), influenced by
behaviourist learning theories.
1. Cognitive therapy focuses on the idea that maladaptive emotions and behaviours
result from distorted or irrational thinking patterns (automatic thoughts).
a. And aims to identify and change these through cognitive restructuring.
2. Behavioural therapy focuses on modifying observable behaviour by replacing
maladaptive behaviours with healthier ones, without focusing on unconscious
motivations.
CBT integrates both approaches, aiming to identify and change dysfunctional thoughts,
assumptions, and beliefs, and replace them with more realistic and helpful alternatives,
while also addressing underlying core beliefs (schemas).
- Through this process, clients learn to challenge irrational beliefs and develop more
adaptive ways of thinking and behaving, which can reduce emotional distress.
CBT is collaborative and action-oriented, with the client playing an active role, and
treatment is typically short-term (around 16 weeks).
A strong therapeutic alliance and the use of empirically supported methods both
contribute to better treatment outcomes and reinforce each other.
CBT TECHNIQUES
CBT uses a range of techniques to help clients become aware of their thoughts, emotions,
and behaviours, and to change maladaptive patterns.
1. Keeping a diary helps clients monitor situations, thoughts, feelings, and
behaviours, increasing awareness of maladaptive patterns and later reinforcing
positive changes.
2. Cognitive rehearsal involves mentally practicing how to handle difficult situations
step by step, so that clients can apply these responses in real life.
3. Testing automatic thoughts and schemas helps clients evaluate their validity; by
examining evidence, dysfunctional beliefs can be challenged and modified.
4. Modelling and role-play allow clients to learn appropriate behaviours by observing
and practicing them with the therapist.
5. Conditioning uses reinforcement to increase desired behaviours or reduce
unwanted ones by linking behaviour to positive or negative consequences.
6. Systematic desensitization gradually exposes clients to feared situations while
using relaxation techniques, reducing anxiety and building coping, sometimes
progressing to real-life exposure.
7. Relaxation, mindfulness, and distraction techniques are used to help manage
emotional and physiological responses.
8. CBT can also be combined with medication, particularly for disorders such as
depression and bipolar disorder.
, 9. Homework assignments are an essential part of CBT, encouraging clients to apply
strategies and test new behaviours in real-life situations between sessions.
EMPIRICAL EVIDENCE
There is strong empirical evidence that CBT is effective for a wide range of disorders,
including mood, anxiety, personality, eating, substance use, and psychotic disorders,
often delivered as structured, time-limited, and manualized treatments.
CBT can be applied in individual and group settings, as well as in self-help formats, with
approaches ranging from more cognitive to more behavioural or integrated methods,
depending on the focus of the intervention.
Many CBT programs have been empirically evaluated, and the emphasis on evidence-
based treatment has contributed to its preference over other approaches, such as
psychodynamic therapy.
CBT can be viewed as a class of treatments that share core features:
1. Problem-focused
2. Structured
3. Collaborative
>>> Requiring openness from the client, while the therapist guides the process using
expert knowledge to support change.
,CHAPTER 2: WHAT IS POSITIVE CBT?
INTRODUCTION
Example: a purely problem-focused approach—asking many questions and delaying
action—can leave a person feeling unsatisfied, highlighting limitations of traditional
assessment-heavy models.
The traditional cause–effect (medical) model assumes that accurate diagnosis must
precede treatment, which works well for clear, physical problems but is less suited to
complex psychological issues.
- This model in psychotherapy is highly problem-focused, emphasizing diagnosis
and symptom reduction, which can lead to an overemphasis on problems and their
causes.
- Focusing extensively on problems may create a vicious circle in which problems
seem to grow, solutions become less visible, and hope for improvement
diminishes.
- Analyzing causes of problems does not automatically lead to improvement;
psychotherapy is fundamentally relational rather than purely diagnostic or
medical.
Criticism of the medical model highlights concerns about over-pathologizing normal
human experiences and framing distress as illness rather than natural variation.
There is also evidence that professionals working within a strictly problem-focused model
may experience higher levels of stress, burnout, and related difficulties, pointing to
limitations of this approach.
SHORTCOMINGS OF THE PROBLEM-SOLVING PARADIGM
The problem-solving paradigm is widely used across domains such as business,
government, coaching, psychotherapy, and conflict management, where the focus is
typically on diagnosing pathology and identifying causes using the medical (cause–effect)
model.
- Problems are viewed as deviations from normal functioning, with the assumption
that identifying and removing the cause will restore normality.
Although this approach is simple, logical, and action-oriented, it has several important
limitations:
1. In complex situations, it is often not possible to isolate a single cause, as multiple
interacting factors are involved.
2. There is a risk of focusing too narrowly on one easily identifiable cause while
ignoring the broader context.
3. Even when a cause is identified, it may not be possible to remove or change it.
4. The assumption that removing the cause will resolve the problem and return
things to normal is often incorrect.
5. Defining clear goals within this model can be difficult, raising questions about how
precisely outcomes should be specified.
A key limitation is that defining a problem too quickly also predetermines the type of
solution, potentially restricting more creative or effective alternatives.
, Positive CBT shifts the focus from problem-solving to outcome or goal design,
emphasizing the creation of something new rather than merely eliminating a problem.
- Design thinking is future-oriented, open-ended, and purposeful, focusing on what
can be achieved rather than what has gone wrong.
There is growing dissatisfaction with problem-focused therapy models, as extensive
problem analysis can reduce hope and lead to dropout when change is not experienced.
Although psychotherapy is generally effective—improving symptoms, functioning, and
coping—there are also significant concerns.
- Outcomes have not substantially improved over decades, dropout rates remain
high, and confidence in therapy outcomes is limited.
- There is also little evidence that specific techniques or models are uniquely
responsible for therapeutic change, despite ongoing claims of superiority.
- These limitations highlight the need to move beyond purely problem-focused
approaches and explore alternative, more constructive frameworks.
EXERCISE
This exercise invites reflection on the questions people ask themselves or others when
facing a problem.
- The key point is to examine whether these questions actually help create
movement and improvement, or whether they only explain why the person feels
stuck.
o If the questions do not help, the task is to replace them with more
constructive questions.
How to not be unhappy
The story contrasts two ancient Greek approaches to life. The Stoics focused on enduring
discomfort and aimed mainly not to be unhappy, while Epicurus and the Epicureans
aimed to create a happy and tranquil life.
- This distinction is used to show that clients can choose between avoidance goals,
such as not being unhappy, and approach goals, such as becoming happy.
- Positive CBT is more interested in helping clients move toward desired outcomes,
rather than only away from problems.
TOWARDS A STRENGTHS AND SOLUTIONS PARADIGM
Traditional therapy approaches tend to focus on problems, limitations, and deficits, often
overlooking the client’s abilities and resources, even though these are crucial for
facilitating change.
- A strengths-based approach, rooted in Positive Psychology, views individuals as
capable and resourceful.
o With strengths that can be activated to reduce suffering, resolve problems,
and improve well-being and functioning.
- Change is promoted through empowering, respectful, and collaborative processes
that help clients use their strengths in meaningful ways.
- The strengths perspective assumes that all individuals possess strengths, that
focusing on these enhances motivation.
