Positive CBT: The Flip Side of the Coin

Positive cognitive behavioral therapy

Positive Cognitive-behavioral therapy (PCBT) can be defined as a “strength-based approach” with its roots in positive psychology. Its philosophy is based on the idea that we are capable beings and that we possess abilities within ourselves that influence behavior and our interpretation of experiences (Bannink, 2013).

 

Before you start reading this article, I recommend you to download these 3 Positive CBT exercises for free. With these exercises, you will not just be able to understand positive CBT on a theoretical level, but you’ll also have the tools to apply it in your work with clients or students.

You can download the PDF for free on this page: https://bit.ly/2VmfP5r

 

Positive CBT versus CBT

Cognitive-behavioral therapy (CBT)’s main assumption is that our thoughts affect our emotion, which affect our behavior, which then has a direct result on our interpretation of that event. It evolved to address a broad range of issues with an impressive body of evidence to support their resources, but their outcomes, specifically their long-term outcomes, is less successful than one would hope (The Journal of Happiness and Well-being, 2013).

Positive CBT (Bannink, 2012; 2013) is a recent combination, which has emerged because practitioners are looking for a way to move CBT forward in finding more long-term results. Positive psychology practitioners and coaches believe that it is the client’s abilities, strengths, and resources that are most important in helping them change as opposed to focusing on their limitations and deficiencies.

It draws on research and applications taken from positive psychology and solution-focused brief therapy (SFBT), which can be simply described as finding the best route to take in knowing what works for the client (The Journal of Happiness and Well-being, 2013). It emphasizes the construction of solutions as opposed to the more traditional emphasis on analyzing problems.

CBT and Positive CBT (PCBT) also differ in their theoretical views.

CBT uses a logical positivist view and views the foundations of science as being the most important kind of observations since it is objective and quantifiable. Positive CBT and SFBT use a social constructionist view, where it is the individual’s belief of what is real, such as his abilities and problems, that is constructed in communication with others (The Journal of Happiness and Well-being, 2013).

Positive CBT in Practice

The focus of Positive CBT is not on pathology, but like positive psychology itself, building on clients’ strengths and what works for them. It can be seen as the other side of the CBT coin.

Kuyken, Padesky, & Dudley (2009) state that CBT literature has a tendency to place greater emphasis on identifying precipitating, predisposing, and perpetuating factors for problems other than strengths; they argue that we should always be including strengths building resources for every case (The Journal of Happiness and Well-being, 2013).

This focus adds to the well-being of the clients, as you ask them to describe their preferred future and find solutions to reach their goals.

Positive CBT practitioners listen respectfully if a client wants to talk about problems, but they would not ask for details. In order to shift the attention, they may ask a question such as, “How is this a problem for you?” in order to change the client’s focus into talking about how they can meet their goals.

Another way to shift the attention is to gather all symptoms, problems, and complaints and then translate them into goals by asking the client, “What would you like to see next?” or “If these problems were not there, how would your life/relationship be different?”

Kuyken et al. (2009) proposes that positive CBT practitioners should notice strategies that clients employ in coping with problems in order to start finding ways to build resilience. Settings goals is a great way to accomplish that because you help the client understand the process and it keeps them motivated to reach their goal.

The Positive CBT Therapist

Positive cognitive behavioral therapistRather than being the only expert in the room that analyzes and advises, the positive CBT therapist’s role is seen as a co-expert where both practitioner and client work together to answer solution-focused questions.

The practitioner focuses his or her attention on positive reinforcement of strengths and solutions-talk, i.e. paying close attention to a person’s goal setting, possibilities, and strengths, as well as negative punishment of problem-talk, ie. not paying attention to conversations about problems, weaknesses, and causes.

The alliance between the practitioner and client is obviously important, not only to build trust but for creating an active and collaborative engagement to help the client. Positive CBT therapists should create a positive alliance by asking questions that extract useful information about strengths and solutions that are already present in the client’s life. For example questions such as:

Suppose tonight a miracle happens and your problems are all solved. But because you are asleep, you don’t know that this miracle happens. What will be the first thing you notice tomorrow morning that will tell you that this miracle has happened? What will be the first thing you notice yourself doing differently that will let you know that this miracle occurred?

and

When things are going somewhat better, what have you noticed that you or others do differently? What other consequences have you noticed?

Set the tone for a more light-hearted conversation for the client and it activates their engagement in the conversation.

Upward Arrow Technique

Unlike the traditional downward arrow technique used in CBT, this technique is focused on positive reaction to a given situation.

The downward arrow technique follows questions, such as “What is the worst case scenario?” “What was bad about that experience”, while the upward arrow technique questions are, “How would you like to behave differently?” “What is the best outcome of this situation?”

Truthfully, it is quite difficult to find many therapists and practitioners who take on the role of Positive CBT. It is still very new, but its techniques look promising and effective. 

You can also watch Aaron Beck, a pioneer of CBT, discuss the marriage between positive psychology and CBT.

Would Positive CBT fit in your practice? Let us know below!

Bannink, F. (2012). Practicing positive CBT: From reducing distress to building success. Chichester, West Sussex: Wiley-Blackwell.

The Journal of Happiness and Well-Being. (2013). Are you ready for positive cognitive behavioral therapy? Retrieved from http://www.journalofhappiness.net/article.php?volume=1&issue=2&article=125&vid=30

About the Author

Reham Al Taher is an aspiring Clinical Psychologist with a deep love for all living things. A self-proclaimed “chronic helper” she seeks to only add positivity in people’s lives rather than strip it away, a skill she works on all the time. Get to know our whole team!

Comments

  1. Purvi V. Chottai

    Hi. These seems to be a pretty interesting subject and since I am working in the field of Mental Health I can quite relate to the need of this module.
    In this purview, I was wondering if you had any online course on this topic.

    Reply
  2. Christy

    This has been very informative! I am a 2nd year student pursuing my Masters Degree in Clinical Mental Health Counseling. I have been having a hard time finding my “soulmate” theory that I can grab a hold of and feel comfortable with. I love Rogers’ Person Centered Theory but I believe that most clients need “more”. I also see the benefit of CBT but it doesn’t always feel like a good fit for how I approach life. Positive Psychology has a lot of views that I can hold onto and match my general optimistic outlook on life. Approaching CBT from a Strengths base and using PCBT sounds very exiting to me and I look forward to learning more! Thank you for this article!

    Reply
  3. Carol Mutzel

    Hi All,
    I would agree that this is extremely similar to the coaching process I have learned through Wellcoaches both in their Health & Wellness Coach certification program and their advanced Professional Health & Wellness Coach certification program. As a coach I develop a collaborative relationship and view the client as knowing inside what will work best for them to develop an upward spiral of wellbeing. This includes many of the factors you have presented such as using Appreciative Inquiry, Motivational Interviewing, Visioning, finding and leveraging strengths and resources, finding the positive, looking at “problems” as “opportunities for growth and learning”, reframing/refocusing from what they don’t want to what they want, goal setting, developing emotional intelligence, developing communication skills, mindfulness practices, self-compassion, positivity, Positive Psychology and PERMA as developed by Martin Seligman, and many more that are grounded in current neuroscience. I appreciate where traditional psychology has taken us however I believe using a positive and strengths based approach helps individuals become more aware and use that awareness of the past and problems to craft a better now and future.

    Reply
  4. Bianca Mcleish

    Thanks for this article. As I currently study a Masters of Applied Leadership in Positive Education I am inspired by how I could use positive CBT with children. I can see how setting goals, focusing on strengths and distracting from negative thoughts will immensely help children who suffer with anxiety, low self-esteem, depression or behavioural issues.

    Reply
    • Reham Al Taher

      Hi Bianca,

      You have inspired to write an article on Positive CBT with children! Thank you! I think I’ll post it next week on the website.

      Reply
  5. Carlos Nunes

    Hello Natascha,

    Your article is very important for behavioral practitioners. It adds positive approaches to traditinal CBT, in order to tranlate its application into long-term results. Moreover, its positive aspects, being redirected, upward instead of downward makes it uniquely uplifiting in distancing the client from pathology to healing, even while undergoing the therapeutic process. Great work and thanks.

    Reply
  6. Natascha Lavery

    I think I’ve been using positive CBT since before I’d ever heard about CBT. In coaching entrepreneurs to increase their sustainable sufficient income streams I found the barriers were always mirrored in their patterns of behaviour, thinking and emotion. It was a cardiologist client who introduced me to CBT saying “Did you know you were doing this?”

    Reply
    • Reham Al Taher

      Hi Natascha,

      You raise an interesting point because I don’t think these kinds of models of therapy are created and then put in practice, it’s the other way around most of the time. So, I’m sure what you were aware of (mind-body-emotion connection) came naturally to you and then you found a therapy that was the perfect fit for you.

      For example, from before I ever heard of positive psychology I was a positive psychology enthusiast. Once I was introduced to its theory and application it felt like home because it was something I always believed to be true.

      Reply
  7. Keren Chen

    PCBT sounds exactly like life coaching. As a coach I mainly look at the customer strengths and always ask the questions from a positive stand point. Always looking on how to make things better and what can we learn and do differently to make things better for the customer. Also, in this practice the customer is the expert and bring up the answers and the coach is only asking the questions and supply the tools for the customer to apply.
    Great article!

    Reply
    • Reham Al Taher

      Hi Keren– you are right that PCBT is pretty similar to life coaching. If I had to point out a difference, I would say that PCBT focuses on treating mental illnesses and pathology. The approach to clients is to work to reduce their dysfunctional symptoms by finding the best way to trigger biological, psychological, and emotional states of wellbeing. The way they do that is by working on the client’s strengths.

      Reply
  8. Asif Dhanani

    Hi Reham,

    Thank you for this informative article. I cannot believe that I did not know that this existed until now.

    As PCBT seems to have been around for a few years now, is there any research about the efficacy of it in comparison to traditional CBT? I am intrigued as to whether PCBT is more effective in any, all, or certain specific situations. For example, I have heard that CBT can work extremely well in certain contexts such as working with social anxiety and I wonder whether PCBT works even better or if there are specific contexts in which using PCBT would be provide a distinct advantage.

    I’m excited to learn more about this new method!

    Reply
    • Reham Al Taher

      Hey Asif,

      PCBT is still fairly new, so I think most people who use it draw research from Solution-Focused Brief Therapy, PP, as well as CBT. I haven’t heard much research about PCBT itself, most likely because researchers are still trying to find the right techniques to integrate in a PCBT model.

      You raise an interesting point about anxiety vs CBT vs PCBT. From my personal experience, I used CBT to deal with my anxiety 6 years ago and I remember clearly thinking, “Okay, the anxiety is gone but it killed my spirit. I think I’ve forgotten to enjoy things.” I think PCBT could have filled that void for me because I had to work extra hard to get the old me back. Time will tell how effective PCBT is.

      Reply

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