Cognitive Behavioral Therapy

1
Cognitive Behavioral Therapy

• Rational vs Irrational Thinking

2
Essential Concepts

• Thinking ? Feeling ? Behavior
• This is an Automatic Process
• Merges Cognitive Principles with Behavioral
  Approaches
• Psychological distress is due to disturbances in
  the cognitive process

3
ABCs of CBT and RET

• A activating event
• B belief about event
• C emotional and behavioral consequence

4
Ellis Rational Emotive Therapy and Interventions

• A (event) -? B (beliefs ) ? C (consequence)
• D (disputing intervention) ? E (effect)
• 
  
• F (New Feeling)

5
Examples of Becks Biases in Thinking

• Depression negative view of self, experience,
  and future
• Hypomania- Inflated view of self and future
• Anxiety- Sense of physical or psychological
  danger
• Phobia- Sense of danger in specific, avoidable
  situations
• Paranoia- Attribution of bias onto others

6
Elliss Eleven Irrational Beliefs

• It is essential that a person be loved or
  approved of by virtually everyone in the
  community
• Some people are bad/wicked and therefore should
  be blamed and punished
• A person must be perfectly competent, adequate
  and achieving to be considered worthwhile
• It is a terrible catastrophe when things are not
  as we want them to be
• Unhappiness is caused by outside circumstances,
  and a person has no control over it
• Dangerous or fearsome things are a great cause
  for concern and their possibilities must be dwelt
  opon

7
cont

• It is easier to avoid certain difficulties and
  self-responsibility than to face them
• A person should be dependent on others and should
  have someone stronger on whom to rely
• Past events are determinants of present behavior
  the influence of the past can not be eradicated
• A person should be quite upset over other
  peoples problems
• There is always a right or perfect solution to
  every problem, and it must be found or the
  results will be catastrophobic

8
Becks Cognitive Therapy and Errors in
Information Processing

• Arbitrary Inference- drawing conclusions without
  enough evidence
• Selective Abstraction-Focusing on details out of
  context
• Overgeneralizing- Drawing a conclusion about all
  events based on only a few
• Magnification and minimization- Errors in
  evaluating the significance or magnitude of an
  event
• Personalization- Relating external events to
  yourself with no rational basis for doing so
• Absolutist dichotomous thinking- splitting

9
Becks Core Schemas

• Systems of beliefs in which we consistently view
  situations.
• Developed from past experiences, upbringing and
  trauma (Beck was trained psychodynamically and
  holds more from this theory than Ellis does-thus
  these schemas can lie dormant and be triggered
  by events)

10
Becks Cognitive Triad

• How you see self, experience and future
• Example of a depressed person
• Sees self as defective, inadequate, deprived and
  diseased
• Interprets experience as negative, even when
  evidence exists for a neutral or positive
  interpretation.
• See future as continuing in this grim fashion and
  expect failures

11
Process of Therapy

• Identify problem and dysfunctional thought
  patterns
• Challenge thought patterns
• Change thought patterns

12
CT and REBT differences

• Cognitive Therapy-Beck
• Therapist uses Socratic Dialog to elicit
  exceptions and counter arguments to challenge
  thoughts
• Client does not take on philosophical system

• REBT- Ellis
• Structured Induction to Philosophical system
• Therapist is more directive and confrontational
• Specific Worksheet Techniques

13
Glassers Reality Therapy

• The tough, smart drill sergeant approach
• Excuse making, assigning blame to external
  events, upbringing or bad environment is
  discouraged
• Emphasizes Natural Consequences
• Individual choice and responsibility is
  emphasized
• Meeting needs for survival, belonging, power,
  freedom, independence and fun leads to vision of
  what we want
• Choice theory- Maladaptive behavior arises from
  flaws in matching desired outcomes to our actions
  due to 1) lack of knowledge, 2) previous failure
  and giving up or 3) faulty beliefs about what
  will work

14
Glassers Realty Theory InterentionsWDEP

• Wants- Cl. Identifies and understands wants from
  life in all arenas.
• Direction and Doing- Is the clients behavior
  taking them closer or further away from their
  wants
• Evaluating- Look at behavior and its impact on
  others and their own wants. Evaluation of wants
  is also conducted for realism and worthwhilness
  to client
• Planning- Clients evaluation leads to
  formulation of action plan

15
Attributes of a Reality Therapist beyond empathy,
congruence and positive regard

• High energy
• Actively able to confront with a caring attitude
• Positive, but not naïve view of human behavior
• High hope and ability to reframe lazy, resistant,
  and manipulative behaviors into creative
  expressions
• Culturally sensitive in realizing reality is not
  the same for all clients

16
Lazaruss Multimodal TherapyBASIC-ID

• Patients are troubled by seen problems and all
  seven realms should be explored as possible
• Behavior, affect, sensations, imagery, cognition,
  interpersonal relationships, and biological
  functions
• Very Intergrative

17
Linehans Dialectical Behavioral Therapy DBT

• Designed for use with Borderline Clients
• Looks at interrelatedness of clients behaviors,
  thoughts, and emotions
• Focuses on Dialects of clients need to accept
  self and change getting what she needs and
  loosing it in order to grow, and client
  maintaining the validity of her experience while
  learning to interpret it differently
• Focus on emotional regulation and mindfulness

18
Shapiros Eye Movement Desensitization
Reprocessing

• EMDR

19
Other Techniques

• RET BOOK
• DTR Daily Thought Record
• Self-talk
• Relaxation techniques
• Visualizations
• Meditation
• 1-10 symptom report and log