Cognitive Behavior Therapy

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Cognitive Behavior Therapy
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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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Overview

• Developed by Albert Ellis in 1955. General REBT
  is virtually synonymous with cognitive behavior
  therapy. Preferential or elegant REBT seeks a
  deeper philosophic change in the client.

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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
• 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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Psychotherapy - Chapter 10 (3)
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Major philosophies and nature of humans

• REBT is a comprehensive approach to treatment and
  education that employs cognitive, emotive, and
  behavioral approaches. It advocates a
  humanistic, educative model of treatment as
  opposed to a medical model.
• Human problems stem not from external events or
  situations but from peoples views or beliefs
  about them. Peoples emotions stem from their
  beliefs, evaluations, interpretations, and
  philosophies about what happens to them, not from
  the events themselves. (Gilliland James, p.
  232)

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Irrational Ideas

• Irrational ideas lead to self-defeating behavior
• Some examples
• The idea that you must have love or approval from
  all people you find significant.
• The idea that you must prove thoroughly
  competent, adequate, and achieving.

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Irrational Beliefs

• The idea that when people act obnoxiously and
  unfairly, you should blame and damn them and see
  them as bad, wicked or rotten.
• The idea that you have to view things as horrible
  and catastrophic when you get seriously
  frustrated, treated unfairly or rejected.
• The idea that emotional misery comes from
  external pressures and that you have little
  ability to control or change your feelings.

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Irrational Beliefs

• The idea that if something seems dangerous or
  fearsome, you must preoccupy yourself with it and
  make yourself anxious about it.
• The idea that you can more easily avoid facing
  many life difficulties and self-responsibilities
  than undertake more rewarding forms of
  self-discipline.
• The idea that your past remains all-important and
  that because something once strongly influenced
  your life, it has to keep determining your
  feelings today.

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Irrational Beliefs

• The idea that people and things should turn out
  better than they do and that you must view life
  as awful if you dont find good solutions to its
  realities.
• The idea that you can achieve maximum human
  happiness by inertia or inaction or by passively
  or uncommittedly enjoying yourself. (Gilliland
  James, p. 245)

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Major personality constructs

• REBT suggests that there is a biological basis
  for human behavior.
• Virtually all humans show evidence of major
  irrationalities.
• No social or cultural group is devoid of
  irrational behavior.
• Many irrationalities run counter to teaching by
  significant others and society at large.
• Irrationality is not exclusive to the stupid or
  retarded bright and gifted humans can act
  irrationally.
• Those who may oppose irrational activity and be
  most aware of it may also fall prey to it.
• People often adopt new irrationalities after
  giving up old ones or go back to an irrational
  activity after working hard to overcome it.
  (Gilliland James, p. 233)

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Major personality constructs

• There is also a social basis for personality.
  However, it is only because people teach
  themselves as they aspire to succeed socially and
  live comfortably within society. (Gilliland
  James, p. 234)

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Nature of maladaptivity

• Maladaptivity stems from the way people think
  about things. It is ones belief system that
  leads to inappropriate emotional consequences
  such as rage, depression, and extreme anxiety.
  (Gilliland James, p. 237)

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Major goals of counseling

• The overall goal of REBT involves minimizing the
  clients central self-defeating outlook and
  acquiring a more realistic, tolerant philosophy
  of life. Two other central goals are reducing
  the clients anxiety (self-blame) and hostility
  (blaming others and the world) and teaching
  clients a method of self-observation and
  self-assessment that will ensure that this
  improvement continues.
• Thus, a primary goal for counseling is to teach
  clients to detect and dispute irrational beliefs.
• Another long-term goal is to assist clients in
  becoming involved in activities that are vitally
  absorbing to them. (Gilliland James, pp.
  241-242)

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Major techniques/strategies

• Major strategies for detecting irrational beliefs
  include education, problem exploration,
  ferreting out B. (Gilliland James, p. 246)
• Strategies for disputing irrational beliefs
  include debating, discriminating and defining.
  (Gilliland James, p. 248)

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Major techniques/strategies

• Cognitive (rational) techniques include
  interpretation of defenses, presentation of
  alternative choices and actions, analogies,
  parables and metaphors, paralinguistics,
  therapeutic markers, reduction to absurdity,
  visual aids, bibliotherapy, contradiction with a
  cherished value, pragmatic disputes, paradoxical
  intention, humor and semantic precision.
  (Gilliland James, pp. 249-252)

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Major techniques/strategies

• Emotive techniques include negative imagery,
  stepping out of character, future imaging,
  labeling, role playing, and using emotionally
  charged language. (Gilliland James, pp.
  252-254)
• Behavioral techniques include homework
  assignments, flooding, penalization, skill
  training, and practicing and reinforcing positive
  cognitions. (Gilliland James, pp. 255-256)

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Major roles of counselor

• The role of the counselor is to help the client
  discover how they block themselves from pursuing
  happiness and health and how they can remove
  those blocks. (Gilliland James, p. 242)
• The counselor is active, directive and
  confrontive in approaching the clients needs.
  (Gilliland James, p. 244)

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Major roles of the client

• The clients role is to learn to identify their
  beliefs and seek ways to eliminate the ways they
  block themselves from becoming happy and healthy.
• Clients may be asked to perform risk-taking
  activities in which they may intentionally set
  themselves up to fail to see that the results are
  not as fearsome as they imagined. They may be
  given hard tasks so that they can engage in tough
  activities and learn not to be upset or scared by
  them. (Gilliland James, p. 245)

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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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The A-B-C theory
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Psychotherapy - Chapter 10 (4)
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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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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 Distortions

• Arbitrary inferences
• Selective abstraction
• Overgeneralization
• Magnification and minimization
• Personalization
• Labeling and mislabeling
• Polarized thinking

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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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Psychotherapy - Chapter 10 (12)