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Cognitive-Behavioral Therapy

Relación entre el pensamiento, emoción y conducta

Cognitive-behavioral therapy is the clinical application of the science of psychology that is based on principles and procedures validated empirically. It is based on the reciprocal relationship between thoughts, emotions and behaviors. Changing one component, others change. Besides, the situation in which we are, can be interpreted differently by each person and provoke very different thoughts leading, in turn, to different emotions and behavior. Its main objective is to identify and modify dysfunctional nuclear thoughts and behavior patterns and beliefs that may be negatively affecting a person’s life.  Not all, but some thoughts we have during the day, are dysfunctional and maladaptive that cause discomfort and lead to certain biases and cognitive distortions. They are erroneous interpretations of reality that lead the person to perceive the world from a very subjective, unrealistic and dysfunctional perspective. A good part of these thoughts are irrational, automatic, rumiative, obsessive and/or intrusive. Some people face them more successfully and manage to turn them into other, more rational thoughts. Nuclear beliefs can also cause a lot of discomfort and maintain a disorder for a while. It is not always easy to identify them because they are within us. However, it is the first step necessary to modify them. Below, first I leave you the most practical part: some examples of irrational beliefs and cognitive distortions so you can make the first step, identify them. Then I leave you general information about Cognitive-Behavioral Therapy

Irrational beliefs

All people of all cultures have irrational thoughts and beliefs.  These thoughts cause us discomfort and often come from absolutist and dogmatic beliefs. If you detect your irrational thoughts, you can change them but this does not guarantee that in the future you will not fall into them again. We tend more to self-destruct behaviors than to self-improvement behaviors.  However, some people are more effective at detecting and confronting these beliefs and others fail to do so.

Within Cognitive-Behavioral Therapy a special place occupies the Behavioral Emotional Rational Therapy that identifies more than 200 irrational beliefs. These beliefs have an important influence on different psychological disorders. Among these beliefs 11 main stand out (you can find them in the book "Reason and emotion in psychotherapy" by Albert Ellis from 1962.. Desclée de Brouwer):

1., I need the love and approval of all the important people around me.

2. In order to be considered valuable/a I must be competent and be able to achieve everything I set out to achieve.

3. There are persons who must be regarded as wicked, infamous or immoral and must be blamed and punished for it.

4. It really is terrible, catastrophic and horrible that things do not go my way.

5. We can do almost nothing to avoid them because they are caused by external causes that we do not control

6. When something dangerous or threatening happens, I must worry a lot and think about the worst

7. It is much easier to avoid than to face the difficulties of life.

8. You have to depend on others and have a stronger person to trust.

9. Past events determine my current and future conduct because they will always influence me.

10. The problems of others must be a constant concern.

11. There is a precise and perfect solution to every problem and it is horrible not to find it.

Сognitive distortions

1. Personalisation (false attribution) - makes you assume personal causality or responsibility for external situations, reactions or events that are beyond your control, You think that everything that happens around you is related to you and that others are always aware of what you do or don’t do. The actions of others happen for and by you. It leads you to compare yourself with others and take responsibility for the mistakes of others. 

"Jon and Olga laugh, sure it’s at me" VS "Olga tells Jon something funny, so they laugh"
"My neighbor has not greeted me, I’m sure he doesn’t like me" VS "My neighbor doesn’t greet anyone, it’s his way of being"
"My boss ignores me at the meeting, he is angry with me". VS "I have nothing to add to this meeting"

2. Dichotomous thinking (polarized, black or white, all or nothing) - you place experiences or behavior of yourself or others in opposite categories, like good-bad. You perceive reality in an extreme or radical way. Usually you oscillate between 2 extremes, "everything is either very beautiful or everything is horrible". You think in absolute terms and do not take into account nuances, degrees or intermediates. Sometimes you use certain absolutist words such as "All", "Nothing/Nobody", "Always", "Never".

"I have answered correctly only 19 questions out of 20. Everything has gone wrong. I would not have tried". VS "I have done almost everything very well".
"I either pass all the exams or I’m useless" VS "I try to pass the exams but nothing catastrophic happens if I don’t, I can retake it later".
"My husband is a good person because he doesn’t lie. Once he lies to me he will be a bad person" VS "Anyone can lie at some point and that does not define your personality".
"This project has not been perfect. It is a total failure" VS "Who said that projects have to go perfect?"

3. Overgeneralization - you draw seemingly valid conclusions from one or a few experiences or events and apply them to other situations that may be unrelated. Things are going to happen the same way because they always happened before. You think if someone fails at something, he/she is not going to succeed in the future. You often use the words "All", "Nothing/Nobody", "Always", "Never", "None"

"I didn’t pass the history exam. I won’t pass any other exam". VS "I didn’t pass the history exam but I can pass other exam".
"You’ve turned the wrong street. Don't you know how to drive? You can’t do anything right". VS "You just took a wrong street but it can happen to anyone. Before you chose the path well many times".
"A gypsy stole from me yesterday. All gypsies are thieves". VS "It is unlikely that all gypsies are thieves"
"This girl didn’t give me her phone number. I’ll never get a partner", VS "Everyone can't like you"
"Nobody loves me". VS "It's impossible and unnecessary to get love from everyone, it’s okay if some people don’t like me"

4. Labeling -you put a pejorative label. You draw a global conclusion about a person or yourself based on conduct, failure, attitude or trait. It leads to an absolutist, inflexible or stereotypical view, far from objectivity. This distortion is related to the previous one.
"I’m a fool and useless, I cooked bad food" VS "I got a little distracted while I was cooking, it can happen to everyone"
"It’s a bad person" VS "He’s angry because he had a fight with his partner".
"They are very shy and fearful, they cannot claim a refund" VS "They find it uncomfortable to enter into a conflict"
"The problem is you" VS "We have a communication problem"

5. Selective abstraction (filtering) - you focus only on one negative aspect or detail. and you are unable to see other aspects of a situation. You don’t get to see anything positive or good in the situation. This distortion is related to the next group of distortions.
"I lost the keys. I’m a mess"  VS "I got distracted but I can make a copy of the keys"
"I have won shares in only 80% of the companies in which I invested money. I lost a lot of money. It is terrible". VS "I have made good use of my investments"
"Today my boss has given me the guidelines to improve performance. I do a bad job. I feel miserable", . VS "I know I do a good job as my boss always told me and I take my boss’s advices to improve performance"

6. Magnification and minimization  - you tend to exaggerate the negative of a situation, event, person or trait or downplay the positive. These distortions include others, quite frequent, which I indicate below.
"I have not passed the interview, it is horrible, I can not stand it". VS "It is unpleasant but I will have more interviews in the future"
"My daughter called me only 2 times today. She could have called more often" VS "My daughter remembers me, she called me 2 times today"
"My brother passed only 4 exams out of 5. It’s horrible. I don’t understand why he’s still studying". VS. "My brother passed almost all the exams"

6A. Negativism (disqualification of the positive) - you tend to ignore the positive and to look for the negative in events or situations.. The result of this distortion is the total nullification of all the time and efforts of you and others. You can become self-righteous. It’s a kind of selective abstraction. 
"When I go to meet her, I’m sure she’ll dislike me". VS "I have many positive qualities"
"I don’t see any reason for the interview to go well". VS "I think I fit well in this position"
"The food has gone well but it is by pure chance". VS "Today I got the food especially well"

6B. Catastrophism (catastrophic vision) - you evaluate the worst outcome of what happened or will happen.  Often these hypothetical scenarios are unrealistic. You don’t see the low probability of the catastrophic outcome. You see the result as an unbearable situation. It is related to intolerance to uncertainty, increased anxiety, worries and fears.
"I prefer not to start it because I am sure that I will fail and I can not bear it". VS "I do everything possible but nothing happens if I do not get"
"My son is too late. I’m sure an accident happened on the way and he’s in the hospital". VS "Most likely, my son is delayed because he caught a jam"
"My mother hasn’t answered the phone for 1 hour. Something very serious has happened to her".  VS "My mother is busy or doesn’t hear the phone"

"If I don’t get this job, I will die." VS. "If I don’t get this job, I’ll do more interviews."
"If you go by plane, it will be terrible because the plane may fall". VS "The plane is the safest type of transport"

6C. Denial -  you tend to deny or downplay errors, problems or weaknesses.
"Nothing's wrong with me, I’m always fine". VS. "It’s okay to be anxious, it’s an emotion that anyone has"
"My boyfriend is angry but I don’t care about everything, we have no problems" VS "It seems we have a problem. Let’s see how we solve it"

7. Perfectionism ("should", "I have to", "I must", demands) - you strive to complete some internal or external representations of perfection. You don’t evaluate the reasonable part of these standards. If you don’t meet some of these subjective standards, you feel like a failure. These rules are indisputable, inflexible and unalterable. It is one of the most powerful and difficult distortions to change because the roots are in education, inculcated values, feelings of inferiority or defense mechanisms.. Mistakes serve to change and learn but perfectionism turns them into sins. It can provoke anger towards others or towards yourself or self-criticism and self-destruction when demands are not met. You use words such as "I have to/I must", "I should not", "Perfect", "Ideal", etc.

"If things don’t go perfect, it’s better not to try to do them". VS "Things don’t have to go perfect"
"I have to be a perfect father". VS "I will try to be a good father but anyone can make mistakes"
"I should/I can’t make mistakes in my job" VS "Everyone has the right to make mistakes"
"My room always has to be clean and tidy". VS "I can sort my room whenever I want"

8. Arbitrary inference - you jump to a negative conclusion without having evidence or empirical support. Some authors indicate 2 subtypes of this distortion (8A and 8B).

"I can’t get a job because I’m useless and I'm a disaster". VS "My profile doesn’t fit well in this job"
"Marta has done this project wrong, biology is not hers" VS "This project has not gone well for Marta"

8A. Reading the mind (reading the thought) - you think you know what others think or say without having any evidence of it. You draw a totally arbitrary conclusion that someone is speaking or thinking bad about you. It can lead to misunderstandings and poor communication.

"I know my father actually thinks I’m a failure" VS "I can’t know what my father thinks of me if I don’t ask him"
"Surely my client considers me an incompetent professional" VS "There are no reasons to think so. Even if there are, I can’t know what he’s thinking"
"I know she doesn’t like me at all". VS "She has never said you doesn't like me"
"He’s not answering my messages or calling me today. He’s definitely mad at me" VS "He is probably busy"

8B. Prediction of the future - You predict the negative outcome of future emotions, behaviors or events and you believe that this is totally true. Pessimistic people often present this distortion. It can increase anxiety, undermine your personal growth and lead to avoiding certain situations.

"Why will I try to do it if it will not serve for anything and I have no hope for the future" VS "You can not know the future, therefore, I lose nothing by trying"
"I know that even if I party with my friends, I’m not going to have fun" VS "I can’t know if I’m going to have a bad time, I’m going to find out"
"Sara doesn’t respond to my messages, she doesn’t care much anymore. We'll never meet again" VS "I don’t know why Sara doesn’t respond. Maybe she’s busy. We'll talk later"
"I won’t pass this test" VS "I can’t know if I’ll pass the test if I don’t try"

9. Emotional reasoning - you come to the conclusion about yourself/others or a situation based only on emotions. You think your emotions and feelings represent reality as it is. You think something is true because you just feel it’s true.
"If I feel like a failure, then I am a failure" VS "A feeling does not define my personality"
"I am very afraid to fly, planes are dangerous". VS "Statistics say it is one of the safest means of transport"
"I have a lot of jealousy and anger, so my husband cheats on me". VS. "My feelings are just sensations. They say nothing about reality"
"I feel that I cannot perform this task, therefore I cannot perform it" VS "It’s just a feeling"

10. Confirmatory bias - you tend to skew reality to confirm your preconceptions. For example, if a doctor tells you a possible diagnosis, you focus only on the symptoms that confirm it but leave out the rest of the symptoms. If you have a prejudice about a nationality or group of people, you tend to confirm your ideas when something punctually happens that confirms them (theft, lie, recklessness) but you ignore the fact when the opposite happens (no theft, no lie, no recklessness). Among the news you choose only those that fit you in your perception of the fact, situation or world.
"I was robbed by a gypsy. I always thought they were thieves". VS. "I have met some gypsies who have not stolen anything"
"You’ve had an accident. I always tell you that having a car is dangerous" VS "It was the only accident in the last 30 years"

11. Culpability (guiltiness) - you place blame or responsibility for your actions on others or, on the contrary, you blame yourself for others' problems. Another form of this distortion would be to be trapped in the past and keep blaming yourself.
"Because of me Alex will not go to the cinema: I do not want to go and he does not want to go without me" VS "I have the right not to go to the cinema if I do not want. Alex can decide what he wants to do"
"Because of foreigners who come to our country, I can not find work" VS "Foreigners are not guilty if they are taken for certain workplaces. They fit better. There’s others foreigners who don't have a job".
"It would have been perfect if I had done it differently, but I didn’t and because of me everything was ruined" VS "I did everything I could"

12. Fallacies - They are arguments or reasoning that seem to be valid and correct but they are not:
12A. Fallacy of change - you avoid changing your behavior by removing responsibility for your actions or your own life. When you have a problem with a person or situation, you expect that person or situation to change. You can pressure someone else to change. You think your happiness depends on other people’s behaviors or external circumstances.
"If Ivan gave me more flowers, I would be happier and give him more affection". VS. "I would like to receive more flowers"

"If at the supermarket the sweets were not at the entrance, I would eat less sugar and could lose weight". VS "I like sweets"
"I’m not going to do the homework that my psychologist sends me. I’m sure the problem will be solved in a short time". VS "Little will change as to receive a different result you have to change solution"

12B. Control fallacy - you think you must have total control over what is going on around you or, on the contrary, you think you are driven by others or by vital circumstances and feel powerless. 
"I have to control everything that happens in my family" VS "It is impossible to control everything. It is neither necessary nor useful"
"I must have to control more my emotions" VS "We all have emotions and we have the right to express them"


12C. Fallacy of divine reward - you expect problems or situations to change and improve on their own or to receive a reward without doing anything. You don’t usually look for solutions to problems in the present. 
"Sure the situation will change tomorrow" VS "If nothing changes, everything will remain the same"
"Soon I will have my reward" VS "I will do something to get my reward"

12D. Fallacy of justice - if something does not match your beliefs, expectations or desires, you consider it unfair. You justify your own shortcomings. You usually have strict criteria and rule out alternatives that don’t suit you.
"It is unfair that she was taken for this position and not me". VS "She may fit in this position more"
"This test has been very difficult. It is unfair that the teacher has suspended me". VS "Next time I will spend more time in preparing"


12E. Fallacy of reason - you do your best not to make mistakes, obviate opinions of other people, you think you are right, you impose your own criteria and you believe that only your actions are valid and correct.
"I know I’m right. I can’t go wrong". VS "Anyone can go wrong"

 Información general sobre la Terapia Cognitivo-Conductual

Principios Fundamentales de la Terapia Cognitivo-Conductual:

  1. Conciencia de los Pensamientos: Como se ha dicho antes, la Terapia Cognitivo-Conductual se basa en el principio de que nuestros pensamientos influyen en nuestras emociones y comportamientos. A menudo, las personas pueden caer en patrones de pensamiento negativos y distorsionados que desencadenan respuestas emocionales poco saludables.

  2. Modificación de Patrones de Pensamiento y Reestructuración cognitiva: Mediante la Terapia Cognitivo-Conductual, los terapeutas ayudan a los pacientes a identificar y cuestionar pensamientos negativos o irracionales, reemplazándolos gradualmente por pensamientos más realistas y positivos. Esto permite a las personas desarrollar resiliencia y respuestas más saludables a los factores estresantes.

  3. Experimentos Conductuales y Exposición Gradual: La Terapia Cognitivo-Conductual utiliza la exposición gradual y experimentos conductuales para enfrentar miedos y ansiedad que llevan a la persona a evitar ciertas situaciones y estímulos. Este hecho, a su vez, no permite comprobar la viabilidad de las consecuencias temidas. A través de estas técnicas, las personas aprenden a tolerar y manejar mejor situaciones estresantes y comprobar que las consecuencias temidas nunca ocurren, lo que conduce a una reducción de la ansiedad y del miedo asociados.

  4. Refuerzo Positivo: Los terapeutas utilizan el refuerzo positivo para recompensar comportamientos saludables y positivos, lo que ayuda a fomentar cambios duraderos en el comportamiento del paciente. Es más, una persona puede aprender a administrarse el autorreforzamiento para aumentar la probabilidad de realizar ciertas acciones y comportamientos.

  5. Resolución de problemas orientada a objetivos: La Terapia Cognitivo-Conductual alienta a establecer metas específicas y alcanzables y caminar sistemáticamente hacia ellas. Este enfoque estructurado ayuda a desglosar los problemas abrumadores en pasos manejables, fomentando un sentido de logro y empoderamiento.

 

La Terapia Cognitivo-Conductual se basa en 4 pilares:

  1. Condicionamiento clásico o aprendizaje clásico que viene de los experimentos de Ivan Pavlov. Un estímulo neutro, el que no tiene mucha relevancia para nosotros, puede provocar una respuesta condicionada de igual fuerza que un estímulo incondicionado. Es decir, una campana es un estímulo neutro para un perro. La comida es un estímulo incondicionado que provoca una respuesta incondicionada como la salivación. Sin embargo, si cada vez antes de dar comida al perro hago sonar la campana, tras unas repeticiones el perro empezará a salivar solo al escuchar la campana.

  2. Condicionamiento operante o aprendizaje instrumental que fue desarrollado por Skinner y otros psicólogos. Las consecuencias que tenemos al realizar cierta acción o comportamiento influyen en la probabilidad de emitir esta misma conducta en el futuro. Por ejemplo, si intento comprar una lata de refresco en una máquina y se atasca, es poco probable que meta más dinero en esta máquina ya que no he conseguido lo que quería. Si la madre de un niño que siempre interrumpe a los adultos mientras hablan le presta atención diciendo que pare, el niño seguirá haciéndolo ya que consigue lo que quiere. Si al recibir una buena nota en la escuela me halagan varias personas, me esforzaré más para obtener más buenas notas.

  3. Aprendizaje vicario o por observación que viene de la "Teoría del aprendizaje social" de Albert Bandura. La información que recibimos por medio de símbolos visuales y verbales durante nuestra vida y por medio de observación de otras personas nos ayuda en el proceso de aprendizaje. Por ejemplo, si veo como una persona se quema la mano en el fuego y llora del dolor, no hace falta que yo meta mi mano en el fuego para comprobar si me va a doler o no. Si yo veo cómo una persona abre un candado con ayuda de una llave, ya puedo saber que una llave sirve para abrir un candado y no me hace falta realizar experimentos tipo "ensayo y error" para aprender abrir un candado por mi mismo.

  4. Aprendizaje cognitivo que fue desarrollado por unos de los psicólogos más prominentes Albert Ellis y Aaron Beck. El aprendizaje se considera una actividad mental no observable que consiste en ciertos procesos de pensamiento los cuales determinan la conducta de una persona. Gracias a este aprendizaje podemos identificar, percibir, interpretar y procesar la información que recibimos a través de nuestra experiencia, percepción y cerebro.

La Terapia Cognitivo-Conductual es una forma de terapia altamente versátil que se ha utilizado con éxito para tratar una amplia gama de condiciones y trastornos psicológicos, por ejemplo:

 

Beneficios de la Terapia Cognitivo-Conductual:

  1. Resultados a Corto Plazo: La Terapia Cognitivo-Conductual se centra en objetivos específicos y tangibles, lo que la convierte en una terapia de resultados rápidos. Los pacientes suelen experimentar mejoras significativas en un corto período de tiempo.

  2. Resultados a Largo Plazo: La Terapia Cognitivo-Conductual equipa a las personas con habilidades prácticas y estrategias que se pueden usar después de la terapia. Esto permite a las personas hacer frente con éxito a futuras dificultades, ganando nueva confianza y autoeficacia.

  3. Enfoque Práctico y Activo: A diferencia de algunas formas de terapia más tradicionales, la Terapia Cognitivo-Conductual es una terapia activa que implica el trabajo conjunto entre el terapeuta y el paciente. Se proporcionan técnicas y herramientas prácticas que pueden aplicarse en la vida cotidiana.

  4. Prevención de Recaídas: La Terapia Cognitivo-Conductual no solo ayuda a abordar problemas actuales, sino que también proporciona habilidades para prevenir recaídas futuras al enseñar a los pacientes a manejar situaciones desafiantes de manera más efectiva.

  5. Enfoque en el presente: Mientras se reconocen experiencias pasadas, la Terapia Cognitivo-Conductual se concentra principalmente en el presente y el futuro, ayudando a las personas a concentrarse en lo que pueden cambiar y controlar en sus vidas.

 

En conclusión, la Terapia Cognitivo-Conductual ha demostrado ser una herramienta poderosa para abordar una amplia gama de problemas psicológicos y emocionales. Su enfoque práctico y efectivo ha ayudado a innumerables personas a superar obstáculos y mejorar su bienestar mental. Si sientes que estás luchando con desafíos emocionales o patrones de pensamiento negativos, considera la Terapia Cognitivo-Conductual como una opción para comenzar tu camino hacia el bienestar mental.

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