Cognitive Behavior Therapy

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Cognitive Behavior Therapy

• C6436 Individual Counseling Theory and Practice
• James J. Messina, Ph.D.

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Rational Emotive Behavior Therapy

• Started by Albert Ellis in 1955-Grandfather of
  Cognitive Behavior Therapy
• Combination of Humanistic Behavioral Therapy to
  help deal with issues from past
• Ellis had chronic renal problems since 9 and
  diabetes by 40
• Exaggerated fear of public speaking
• Shy around women

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Rational Emotive Behavioral Therapy (REBT)

• Stresses thinking, judging, deciding, analyzing,
  and doing
• Assumes that cognitions, emotions, and behaviors
  interact and have a reciprocal cause-and-effect
  relationship
• Is highly didactic, very directive, and concerned
  as much with thinking as with feeling
• Teaches that our emotions stem mainly from our
  beliefs, evaluations, interpretations, and
  reactions to life situations

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Assumptions of REBT

• People contribute to their own psychological
  problems symptoms by way they interpret events
  situations
• Reorganization of ones self-statements will
  result in reorganization of ones behaviors
• Operant conditioning, modeling behavioral
  rehearsal applied to thinking internal dialogue

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Commonalities between all Cognitive Behavior
Approaches

• Collaborative relationship between therapist
  client
• Premise psychological distress is largely
  function of disturbance in cognitive processes
• Focus on changing cognitions to produce desired
  changes in affect behavior
• Generally time-limited educational treatment
  focusing on specific structured target problems

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Roots of REBT

• Epictetus-Greek Stoic Philosopher-1st century
  A.D.-People are disturbed not by things, by the
  view which they take of them.
• Horneys (1950) Tyranny of the shoulds
• Adler-our emotional reactions lifestyle are
  associated with our basic beliefs therefore
  cognitively created
• role of social interest in determining
  psychological health
• Importance of goals, purposes, values meaning
  in human existence
• Focus on active teaching
• Use of persuasive methods
• Giving of live demonstrations in audiences

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The Therapeutic Process

• Therapy is seen as an educational process
• Clients learn
• To identify and dispute irrational beliefs that
  are maintained by self-indoctrination
• To replace ineffective ways of thinking with
  effective and rational cognitions
• To stop absolutistic thinking, blaming, and
  repeating false beliefs

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View of Human Nature

• We are born with a potential for both rational
  and irrational thinking
• We have the biological and cultural tendency to
  think crookedly and to needlessly disturb
  ourselves
• Humans are self-talking, self-evaluating
  self-sustaining
• We develop emotional behavioral problems when
  we mistake simple preferences (love, approval,
  success) for dire needs
• We learn and invent disturbing beliefs and keep
  ourselves disturbed through our self-talk
• We have the capacity to change our cognitive,
  emotive, and behavioral processes

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Emotional Disturbance

• Through autosuggestion self-repetition we
  install maintain self-defeating
  beliefs-irrational dogmas superstitions
  self-created plus irrational beliefs from
  significant others
• Blame is core of emotional disturbance-so to
  recover stop blaming self others
• We escalate desires preferences into dogmatic
  absolutist shoulds, musts, oughts, demands,
  commands-which are irrational beliefs which need
  to be changed

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Irrational Ideas

• Irrational ideas lead to self-defeating behavior
• Some examples
• I must have love or approval from all the
  significant people in my life.
• I must perform important tasks competently and
  perfectly.
• If I dont get what I want, its terrible, and I
  cant stand it.

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A-B-C Theory of Personality

• A existence of fact, event, behavior, attitude
  of individual
• B persons belief
• C emotional behavioral consequence or
  reaction of individual
• D disputing intervention-challenge beliefs
• E effective philosophy after disputing
• F new set of feelings
• Human beings are largely responsible for creating
  their own emotional reactions disturbances
• Goal show people how to change irrational
  beliefs that directly cause disturbed emotional
  consequences

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The A-B-C theory
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D disputing intervention

• Challenges irrational beliefs
• Use principles of logic-destroy unrealistic,
  unverifiable hypotheses
• Detectdetect the shoulds, I musts
  awfulizing self-downing
• Debatelearn to logically empirically question
  beliefs-to argue self out of them
• Discriminateirrational-self-defeating from
  rational-self-helping beliefs

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Steps to Change Dysfunctional Living

• Acknowledge we are responsible for creating own
  emotional problems
• Accepting we have ability to change disturbances
  significantly
• Recognize emotional problems stem from irrational
  beliefs
• Clearly perceive these beliefs
• Seeing value of disputing self-defeating beliefs
• Accepting fact to change we must work hard in
  emotive behavioral ways to counteract
  irrational beliefs dysfunctional feelings and
  behaviors
• Use the REBT methods rest of our lives

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Steps in REBT Therapeutic Process

• Show client incorporated irrational beliefs-teach
  how to separate irrational from the rational
  beliefs-engage in activities which are not
  self-defeating
• Demonstrate to client keeping emotional
  disturbance active by illogical thinking
• Help client to modify thinking-recognize vicious
  cycle of self-blaming
• Challenge clients to develop rational philosophy
  of life-dispute core irrational thinking-teach
  how to replace with rational beliefs

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Methods used in REBT

• Disputing irrational beliefs
• Doing cognitive homework
• Changing ones language
• Using humor
• Rational emotive imagery
• Role playing
• Shame-attacking exercices
• Use of force vigor
• Desensitization
• Skills training
• Assertiveness training

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Aaron Becks Cognitive Therapy (CT)

• Insight-focused therapy
• Emphasizes changing negative thoughts and
  maladaptive beliefs
• Theoretical Assumptions
• Peoples internal communication is accessible to
  introspection
• Clients beliefs have highly personal meanings
• These meanings can be discovered by the client
  rather than being taught or interpreted by the
  therapist

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Cognitive Distortions identified in CT

• Arbitrary references-catastrophizing
• Selective abstraction-total context missed
• Overgeneralization-extreme belief based on single
  episode
• Magnification minimization
• Personalization-relate external event to self
• Labeling mislabeling-identity based on
  imperfections or mistakes in the past
• Polarized thinking-all or nothing at all thinking

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Theory, Goals Principles of CT

• Basic theory
• To understand the nature of an emotional episode
  or disturbance it is essential to focus on the
  cognitive content of an individuals reaction to
  the upsetting event or stream of thoughts
• Goals
• To change the way clients think by using their
  automatic thoughts to reach the core schemata and
  begin to introduce the idea of schema
  restructuring
• Principles
• Automatic thoughts personalized notions that are
  triggered by particular stimuli that lead to
  emotional responses

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CTs Cognitive Triad

• Pattern that triggers depression
• 1. Client holds negative view of themselves
• 2. Selective abstraction Client has tendency to
  interpret experiences in a negative manner
• 3. Client has a gloomy vision and projections
  about the future

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Donald Meichenbaums Cognitive Behavior
Modification (CBM)

• Focus
• Clients self-verbalizations or self-statements
• Premise
• As a prerequisite to behavior change, clients
  must notice how they think,
• feel, and behave, and what impact they have on
  others
• Basic assumption
• Distressing emotions are typically the result of
  maladaptive thoughts

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Meichenbaums CBM

• Self-instructional therapy focus
• Trains clients to modify the instructions they
  give to themselves so that they can cope
• Emphasis is on acquiring practical coping skills
• Cognitive structure
• The organizing aspect of thinking, which seems to
  monitor and direct the choice of thoughts
• The executive processor, which holds the
  blueprints of thinking that determine when to
  continue, interrupt, or change thinking

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Behavior Change Coping (CBM)

• 3 Phases of Behavior Change
• 1. Self-observation
• 2. Starting a new internal dialogue
• 3. Learning new skills
• Coping skills programs Stress inoculation
  training (3 phase model)
• 1. The conceptual phase
• 2. Skills acquisition and rehearsal phase
• 3. Application and follow-through phase

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Constructivist Narrative Perspective (CNP)

• Focuses on the stories people tell about
  themselves and others about significant events in
  their lives
• Therapeutic task
• Help clients appreciate how they construct their
  realities and how they author their own stories