references/foundation.md
# CBT — Background and Theory
> Foundation reference for Cognitive Behavioral Therapy. Loaded on demand.
## Origins
CBT is the most extensively researched form of psychotherapy, developed by Aaron T. Beck in the 1960s. It is based on the cognitive model: our interpretations of situations (not the situations themselves) influence our emotional, behavioral, and physiological responses.
## The Cognitive Model
```
THOUGHTS (Cognitions)
/ \
/ \
/ \
FEELINGS ———————— BEHAVIORS
(Emotions) (Actions)
```
Each vertex influences the other two. Changing any one vertex can shift the entire triangle.
### Three Levels of Cognition
1. **Automatic Thoughts** — spontaneous, surface-level, situation-specific ("She didn't reply; she hates me")
2. **Intermediate Beliefs** — rules, attitudes, assumptions ("If people don't respond quickly, it means they don't care")
3. **Core Beliefs** — deep, global, rigid beliefs about self/others/world ("I am unlovable," "The world is dangerous")
## Session Structure (Beck's Standard)
1. **Agenda Setting** (2-3 min) — collaboratively set 1-2 topics
2. **Mood Check** (2-3 min) — rate 0-10, compare with last session
3. **Bridge from Previous** (2-3 min) — main takeaway, anything that came up
4. **Review Homework** (5-10 min) — celebrate effort, problem-solve barriers
5. **Work on Topic** (20-30 min) — Socratic questioning, identify distortions, restructure
6. **Assign New Homework** (3-5 min) — specific, achievable, relevant
7. **Summary and Feedback** (2-3 min) — person summarizes, provides feedback
## 15 Cognitive Distortions
| # | Distortion | Example |
|---|-----------|---------|
| 1 | All-or-Nothing Thinking | "If I'm not perfect, I'm a total failure" |
| 2 | Overgeneralization | "I got rejected. I'll always be alone" |
| 3 | Mental Filter | Fixating on 1 criticism, ignoring 20 compliments |
| 4 | Disqualifying the Positive | "They only said that to be nice" |
| 5 | Jumping to Conclusions | Making negative interpretations without evidence |
| 6 | Mind Reading | "She thinks I'm incompetent" |
| 7 | Fortune Telling | "The presentation will be a disaster" |
| 8 | Magnification / Minimization | Exaggerating negatives, shrinking positives |
| 9 | Emotional Reasoning | "I feel anxious, so something bad must happen" |
| 10 | Should Statements | "I should never make mistakes" |
| 11 | Labeling | "I'm a loser" |
| 12 | Personalization | "The team failed because of me" |
| 13 | Catastrophizing | "If I fail this exam, my career is over" |
| 14 | Blaming | "It's all their fault" |
| 15 | Control Fallacy | "Nothing I do matters" / "Everything depends on me" |
## Downward Arrow Technique
Used to uncover core beliefs:
```
"My boss didn't say hello."
↓ What does that mean to you?
"He's upset with me."
↓ If true, what would that mean?
"I'm going to get fired."
↓ What would that mean about you?
"I'm incompetent and can't hold a job." ← CORE BELIEF
```
## References
- Beck, J.S. (2020). *Cognitive Behavior Therapy: Basics and Beyond* (3rd ed.). Guilford Press.
- Beck, A.T. (1976). *Cognitive Therapy and the Emotional Disorders*. Penguin.
- Burns, D. (1980). *Feeling Good*. Harper.
- Greenberger, D. & Padesky, C. (2015). *Mind Over Mood* (2nd ed.). Guilford Press.
- Beck Institute: https://beckinstitute.org
SKILL.md
---
name: cbt
version: "1.1.0"
description: "Cognitive Behavioral Therapy (Aaron Beck) - Identify and restructure unhelpful thinking patterns through the thoughts-feelings-behaviors triangle"
user-invocable: false
tools:
- Read
- Write
- Skill
---
# Cognitive Behavioral Therapy (CBT) Skill
> "The way you think about a situation determines how you feel about it." — Aaron T. Beck
> Background and theory: Read references/foundation.md
## Sub-commands
| Command | Description |
|---------|-------------|
| `/cbt` | Full CBT session on a given situation |
| `/cbt:thought-record` | Guided 7-column thought record |
| `/cbt:distortions` | Identify cognitive distortions in a statement |
| `/cbt:experiment` | Design a behavioral experiment to test a belief |
---
## The 7-Column Thought Record
```
1. Date/Time — When?
2. Situation — What happened? (objective facts)
3. Automatic — What went through your mind? (rate belief 0-100%)
Thoughts
4. Emotions — What did you feel? (rate intensity 0-100%)
5. Distortions — Which cognitive distortions apply?
6. Alternative — More balanced/realistic thought? (rate belief 0-100%)
Thought
7. Outcome — Re-rate emotions. What will you do now?
```
---
## Key Techniques
### Socratic Questioning
Do NOT tell what to think. Ask guided questions:
1. **Evidence for:** "What supports this thought?"
2. **Evidence against:** "What contradicts it?"
3. **Alternative explanations:** "Another way to see this?"
4. **Worst/best/most likely:** "What's the worst? The best? Most realistic?"
5. **Effect of believing:** "How does this belief affect you?"
6. **Friend test:** "What would you say to a friend with this thought?"
### Behavioral Experiments
1. **Identify prediction:** "If I speak up, people will think I'm stupid"
2. **Design experiment:** Speak up once in next meeting
3. **Predict outcome:** Expected probability (0-100%)
4. **Conduct and observe**
5. **Record results**
6. **Evaluate:** Was prediction accurate?
### Activity Scheduling (for depression)
1. Rate activities for **Mastery** (0-10) and **Pleasure** (0-10)
2. Schedule high-scoring activities
3. Start small — minimum viable action
4. Track mood before and after
---
## Example Guided Session
**User:** "I made a mistake at work. I'm sure my manager thinks I'm incompetent."
**AI Guide:**
> **Situation:** You made a mistake at work.
> **Automatic Thought:** "My manager thinks I'm incompetent." Belief: __%?
> **Emotion:** Anxious? Ashamed? Intensity: __%?
>
> **Evidence for:** What specifically makes you think this?
> **Evidence against:** Has your manager given positive feedback before? Do competent people make mistakes?
> **Alternative:** Could this be a learning moment?
> **Friend test:** What would you tell a colleague who made one mistake?
>
> **Distortions:** Mind Reading, Labeling, All-or-Nothing Thinking
>
> **Balanced thought:** "I made a mistake, which is normal. One error doesn't define my competence."
>
> **Action:** Ask your manager for feedback on preventing this.
---
## Anti-patterns
1. **Thought suppression** — Not about stopping thoughts, but evaluating them
2. **Forced positive thinking** — Goal is realistic, not blindly optimistic
3. **Intellectualizing without feeling** — Connect to emotional experience
4. **Skipping behavioral experiments** — Cognitive restructuring alone is insufficient
5. **Therapist as expert** — CBT is collaborative discovery
6. **Ignoring the relationship** — Warmth and empathy are prerequisites
7. **Cookie-cutter application** — Some situations genuinely are bad; validate first
8. **Rushing to restructure** — Understand the thought before challenging it
---
## Output Format
```
## CBT Analysis
**Situation:** [brief factual description]
### Automatic Thoughts
- [thought] (belief: __%)
### Emotions
- [emotion] (intensity: __%)
### Cognitive Distortions
- [distortion]: [how it applies]
### Socratic Examination
- Evidence for: ...
- Evidence against: ...
- Alternative: ...
- Friend test: ...
### Balanced Thought
"[realistic thought]" (belief: __%)
### Re-rated Emotions
- [emotion] (new intensity: __%)
### Behavioral Experiment (if applicable)
- Prediction: ...
- Experiment: ...
```