Chapter 12: Cognitive Behaviour Therapy: Behaviour Restructuring

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Chapter 12Cognitive Behaviour
TherapyBehaviour Restructuring
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Thinking and Doing

• Our behaviour is largely based on cognitions
  about ourselves and the world around us
• A cognition is a thought coupled to an emotion
• Weight/valence that compels behaviour in a
  particular direction
• Illusion of veracity and constancy

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How are cognitions changed?

• Directly by identifying maladaptive behaviours
• Substituting with adaptive behaviours
• Cognitive Restructuring

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How are cognitions changed?

• 2. Indirectly by changing behaviours first
• Supporting cognitions (beliefs) are unnecessary
• Fake it till you make it
• Coping Skills

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Operationalizing Cognitions

• Heavy reliance on language Self Talk
• Explicit statement by the client on what theyre
  thinking
• Often unaware of self talk, so the first step is
  bringing this to awareness
• Easiest approach to doing this is to use
  Think-aloud

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A. Thought Stopping!

• Conditioning of maladaptive cognition
• Shouting Stop! following cognition
• Differential reinforcement with adaptive
  cognition
• Imagery Rescripting transforming maladaptive
  cognition into a tolerable or pleasant one

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B. Rational Emotive Behaviour Therapy (Ellis,
1962)

• Psychological problems are maintained by peoples
  interpretations of events
• Most people believe things (objective
  reality??) cause emotions
• i.e. the parking spot phenomenon
• Beliefs, not objects, are what affect us
• All life situations are neutral

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Rational Emotive Behaviour Therapy (Ellis, 1962)
Some Event Occurs Car enters parking spot we thought we could take
Irrational belief is activated Seeing implies ownership Other driver is being malicious
Negative consequences Anger Giving the finger Swearing
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Obsessive MusterbationIrrational beliefs

• Common irrational beliefs
• Absolute thinking world is black and white
• Overgeneralization from specific instances
• Catastrophizing exaggerating the impact of
  negative situations
• Two general themes
• Personal worthlessness
• Sense of duty

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Process of REBT

• Identification of irrational thoughts
• Challenging irrational beliefs
• Replacing irrational with rational beliefs
• An argument with the therapist, where client is
  required to justify the logic of beliefs

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REBT Pros

• Rationality makes sense
• Takes advantage of authority role of therapist
• Wide application
• Phobias, depression, anxiety, obesity, anger
  management
• Can be used with peoples varying belief systems

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REBT Cons

• Not appropriate for some disorders that involve
  rebelliousness
• personality disorders, substance abuse, eating
  disorders, OCD
• Direct confrontational style is unappealing to
  some people
• Confrontation may not be necessary for successful
  treatment

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C. Cognitive Therapy (A. Beck, 1963)

• Involves hypothesis testing of clients beliefs
• Search for supporting evidence
• Less confrontational, more collaborative
• Assertive, Socratic dialogue

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Cognitive Therapy (A. Beck, 1963)

• Irrational cognitions are automatic thoughts
• Reflexive reactions that appear reasonable and
  valid to the client
• No questioning of automatic thoughts
• Corrective functions, such as reality testing
  and refined global conceptualizations, are weak
• Instead there are selective, egocentric, rigid
  (lazy) cognitions

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Cognitive Therapy (A. Beck, 1963)

• Cognitive Distortions
• Arbitrary inference
• Overgeneralization
• Selective abstraction
• Personalization (misattribution)
• Polarized (black and white) thinking
• Magnification or minimization

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Process of CT

• Collaboration between therapist and client
• Establishing a good relationship
• Socratic dialogue
• Collaborative criticism
• Determining conclusions, choosing interventions

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CT in Perspective

1. Cognitive distortions are common in many
   psychological disorders.
2. CT is particularly effective in the treatment of
   depression, even in severe cases.
3. Intuitively pleasing, less confrontational, and
   emphasizes a self control approach.