2nd/10_Wiki/Topics/AI_and_ML/Cognitive-Therapy-in-CBT.md

---
id: wiki-2026-0508-cognitive-therapy-cbt
title: Cognitive Therapy in CBT
category: 10_Wiki/Topics
status: verified
canonical_id: self
aliases: [CBT, cognitive behavioral therapy, cognitive distortion, automatic thoughts, ABC model, Aaron Beck, third wave]
duplicate_of: none
source_trust_level: A
confidence_score: 0.9
verification_status: applied
tags: [psychology, cbt, cognitive-therapy, mental-health, cognitive-distortion, mindfulness, ai-mental-health]
raw_sources: []
last_reinforced: 2026-05-10
github_commit: pending
tech_stack:
  language: psychology
  applicable_to: [Mental Health Apps, Self-Help, Cognitive Worker Wellness]
---

# Cognitive Therapy in CBT

## 매 한 줄
> **"매 situation X — 매 thought 의 변화 의 emotion + behavior"**. Aaron Beck (1960s) 의 founding. 매 가장 evidence-based therapy. 매 modern: 매 AI mental health (Woebot, Wysa) 의 base. 매 cognitive worker 의 self-care 의 leverage.

## 매 핵심

### Beck's Cognitive Triad
1. **Self**: "I am worthless".
2. **World**: "World is unfair".
3. **Future**: "Things will never improve".

→ 매 depression 의 typical.

### ABC Model (Ellis)
- **A**: Activating event.
- **B**: Belief (interpretation).
- **C**: Consequence (emotion + behavior).
- 매 B 의 매 modify 의 C 의 변화.

### Cognitive Distortions (Beck / Burns)
1. **All-or-Nothing**: 매 흑백.
2. **Overgeneralization**: 매 single 의 always.
3. **Mental Filter**: 매 negative 만.
4. **Disqualifying Positive**: 매 positive 의 dismiss.
5. **Jumping to Conclusions** (mind-reading / fortune-telling).
6. **Magnification / Minimization**: 매 catastrophize / dismiss.
7. **Emotional Reasoning**: 매 feel = real.
8. **Should statements**: 매 imperative.
9. **Labeling**: 매 self / others 의 stigmatize.
10. **Personalization**: 매 self-blame.

### CBT 의 process
1. **Identify automatic thought**.
2. **Identify distortion**.
3. **Examine evidence**.
4. **Generate alternative thought**.
5. **Test in behavior** (behavioral experiment).
6. **Address core belief** (deeper).

### Third-wave CBT
- **DBT** (Dialectical Behavior Therapy): 매 emotion regulation, 매 acceptance + change.
- **ACT** (Acceptance & Commitment Therapy): 매 value-driven action.
- **MBCT** (Mindfulness-Based Cognitive Therapy): 매 meditation 결합.
- **CFT** (Compassion-Focused Therapy).
- **Schema Therapy**.

### 매 효과
- **Depression**: 매 strong evidence.
- **Anxiety**: 매 strong.
- **PTSD**: 매 effective (CBT-T, CPT).
- **Insomnia**: 매 CBT-I (gold standard).
- **Chronic pain**: 매 CBT for pain.
- **OCD**: 매 ERP.
- **Eating disorders**.

### 매 modern AI 의 응용
- **Woebot**: 매 first chatbot CBT.
- **Wysa**: 매 chatbot.
- **Replika**: 매 companion (caution).
- **Mind tools / journaling apps**.

#### Limit
- 매 nuance / empathy 의 limit.
- 매 crisis (suicide ideation) 의 X.
- 매 adjunct, 매 substitute X.
- 매 EU AI Act 의 high-risk.

### 매 cognitive worker 의 응용
- **Imposter syndrome**: 매 distortion 의 challenge.
- **Catastrophizing on PR review**.
- **Burnout prevention**.
- **Negotiation / interview anxiety**.

## 💻 패턴

### Thought record (CBT 표준)
```python
class ThoughtRecord:
    def log(self, situation, automatic_thought, emotion, intensity_0_100,
             evidence_for, evidence_against, alternative_thought, new_intensity):
        return {
            'situation': situation,
            'automatic_thought': automatic_thought,
            'distortion': self.identify_distortion(automatic_thought),
            'emotion': emotion,
            'before_intensity': intensity_0_100,
            'evidence_for': evidence_for,
            'evidence_against': evidence_against,
            'alternative_thought': alternative_thought,
            'after_intensity': new_intensity,
        }
    
    def identify_distortion(self, thought):
        patterns = {
            'all_or_nothing': ['always', 'never', 'completely', 'totally'],
            'overgeneralization': ['everyone', 'no one', 'every time'],
            'catastrophize': ['disaster', 'awful', 'terrible', 'ruined'],
            'should': ['should', 'must', 'have to'],
            'labeling': ['I am stupid', 'I am loser', 'I am fail'],
        }
        found = []
        for distortion, keywords in patterns.items():
            if any(kw in thought.lower() for kw in keywords):
                found.append(distortion)
        return found
```

### Cognitive restructuring (LLM-assisted)
```python
def cbt_restructure(automatic_thought, situation):
    prompt = f"""You are a CBT-informed cognitive coach (NOT a therapist).
    
Situation: {situation}
User's automatic thought: "{automatic_thought}"

Help by:
1. Identify the cognitive distortion (Beck/Burns categories).
2. Ask 3 evidence-examining questions.
3. Suggest 1 balanced alternative thought (NOT toxic positivity).

Important:
- NOT a substitute for professional therapy.
- If suicidal ideation or crisis is mentioned, suggest immediate professional help / crisis line.

Format: JSON."""
    return llm.generate(prompt)
```

### Behavioral activation
```python
def behavioral_activation_plan(low_mood_period):
    """매 depression 의 evidence-based intervention."""
    return {
        'pleasure_activities': [  # 매 매일 1+
            ('walk in nature', 'value: connection'),
            ('cook a meal', 'value: nourishment'),
            ('call friend', 'value: relationship'),
        ],
        'mastery_activities': [  # 매 매일 1+
            ('complete small task', 'value: accomplishment'),
            ('learn 10 min skill', 'value: growth'),
        ],
        'rule': 'Do BEFORE feeling motivated. Action precedes motivation.',
    }
```

### Imposter syndrome (cognitive worker)
```python
def imposter_check(thought):
    distortions = {
        'discount_positive': ["I just got lucky", "anyone could do it"],
        'overgeneralize_negative': ["I always mess up", "I'm always behind"],
        'mind_reading': ["they think I'm a fraud", "they'll find out"],
        'labeling': ["I'm an imposter", "I'm not real engineer"],
    }
    
    flags = []
    for d, examples in distortions.items():
        if any(e.lower() in thought.lower() for e in examples):
            flags.append(d)
    
    if flags:
        return {
            'flags': flags,
            'questions': [
                'What evidence (concrete projects, code shipped) supports your competence?',
                'Would you say this to a peer in the same situation?',
                'What is the difference between "feeling like" and "being"?',
            ],
        }
    return None
```

### Behavioral experiment
```python
class BehavioralExperiment:
    def design(self, prediction):
        return {
            'prediction': prediction,  # 매 e.g., "If I speak up, they'll laugh"
            'experiment': '...',  # 매 actually do it
            'expected_outcome': prediction,
            'observed_outcome': None,
            'learning': None,
        }
    
    def review(self, exp_id, observed):
        # 매 prediction vs reality
        ...
```

### CBT-I (insomnia)
```python
def cbt_i_protocol():
    return {
        'stimulus_control': [
            'Bed = sleep + sex only.',
            'If awake > 20 min, leave bed.',
            'Wake same time every day (even weekends).',
        ],
        'sleep_restriction': 'Restrict time-in-bed to actual sleep time + 30 min.',
        'cognitive_restructure': 'Challenge "I MUST sleep 8h or tomorrow is ruined" thought.',
        'sleep_hygiene': [
            'No caffeine after 2 PM.',
            'No screen 60 min before.',
            'Cool, dark, quiet room.',
        ],
        'paradoxical_intention': 'Try to STAY awake (reduces performance anxiety).',
    }
```

### Mindfulness moment (MBCT)
```python
def three_minute_breathing_space():
    return [
        ('1 min', 'Awareness — what is here? Thoughts, feelings, body.'),
        ('1 min', 'Gathering — focus on breath as anchor.'),
        ('1 min', 'Expanding — awareness to whole body, posture.'),
    ]
```

## 🤔 결정 기준
| 상황 | Approach |
|---|---|
| Daily stress | Thought record + behavioral activation |
| Insomnia | CBT-I |
| Anxiety | CBT + exposure |
| Depression | CBT + behavioral activation + meds (severe) |
| Imposter syndrome | Distortion check + evidence |
| Burnout | DBT + boundary + recovery |
| Mild | Self-help (Burns "Feeling Good") |
| Moderate-severe | Therapist + adjunct |

**기본값**: 매 self-help 의 mild + 매 therapist 의 moderate+. 매 AI 의 adjunct only.

## 🔗 Graph
- 부모: [[Psychology]]
- 변형: [[DBT]]
- 응용: [[Cognitive-Distortion]] · [[ERP]]
- 사상가: [[Aaron-Beck]]
- Adjacent: [[Cognitive Biases]] · [[Beliefs]] · [[Chronic-Pain-Management-Protocols]] · [[Brain-Derived Neurotrophic Factor (BDNF)]]

## 🤖 LLM 활용
**언제**: 매 self-help guidance. 매 product mental wellness feature. 매 cognitive worker self-care.
**언제 X**: 매 therapy substitute. 매 crisis (suicide / self-harm) 의 LLM 의 단독 의 X — 매 redirect to crisis line.

## ❌ 안티패턴
- **AI 의 sole therapy**: 매 EU AI Act 의 high-risk.
- **Toxic positivity**: 매 "just think positive" 의 invalidate.
- **No professional referral**: 매 crisis 의 miss.
- **One-shot fix**: 매 process 의 weeks.
- **Cognitive only (no behavior)**: 매 behavioral activation 의 critical.
- **Self-diagnosis**: 매 specific disorder 의 일반 의 X.

## 🧪 검증 / 중복
- Verified (Beck, Ellis, Burns, Linehan, NICE guidelines).
- 신뢰도 A.
- Related: [[Cognitive Biases]] · [[Mindfulness]] · [[Brain-Derived Neurotrophic Factor (BDNF)]] · [[Chronic-Pain-Management-Protocols]] · [[Beliefs]].

## 🕓 Changelog
| 날짜 | 변경 |
|---|---|
| 2026-05-08 | Phase 1 |
| 2026-05-10 | Manual cleanup — distortion catalog + ABC + 매 thought record / behavioral experiment / CBT-I code |