Intro to Counseling Exam: CBT

five common cognitive distortions and examples

1) dichotomous/ polarized thinking: wonderful or awful.

2) labeling/ mislabeling: considering oneself bad at art.

3) magnification and minimization: bigger or lesser of situation.

4) mind reading: “he thinks I’m a loser”

5) personalization: things that happen are my fault

ABCDEF and examples

A: activating event - forgot purse

B: belief about activating event - I am losing my mind

C: consequent emotion - fear of going crazy

D: disputation - why belief is irrational

E: emotional effect - understands why irrational

F: new feeling - not afraid

REBT

Rational Emotive Behavior Therapy - Albert Ellis

CT/ CBT

cognitive behavioral therapy - Aaron Beck

SIT

self-instructional training - Donald Meichenbaum

model/ main components of REBT

ABCDEF model

3 philosophies:

1. unconditional self-acceptance

2. unconditional other acceptance

3. unconditional life acceptance

model/ main components of CBT

thoughts, behaviors, feelings

• psychopathology is an exaggeration of normal cognitive biases

• self-schema includes negative beliefs

• negative beliefs are activated by stressful life events

• biases spread to cognitive domains

• modification through cognitive therapy

model/ main components of SIT

• conceptualization

• skill acquisition

• application/ follow through

Historical context for REBT, CBT, SIT

• Wundt used introspection for studying cognition

• introspection dates back to socrates “socratic questioning”

• cognition is a slipper phenomenon

• Albert Ellis, Aaron Beck, Donald Meichenbaum

history of REBT and Ellis

• developed approach in ‘40s and ‘50s

• used self-awareness as a source of learning/ discovery

• rational psychotherapy → rational-emotive therapy → rational emotive behavior therapy

history of CBT and Beck

• suffered physically → thought not smart but then went to Yale

• psychoanalytically trained and interested in Freud

• rejected Freud’s theory and came up with: collaborative modification of maladaptive thoughts: cognitive therapy

history of SIT and Meichenbaum

• M. practiced behavior therapy → cognitive therapy → constructivism

• noticed people talking to themselves

• kids and schizophrenics could improve by “self-instruction”

• also stress inoculation training

Bandura: social learning theory and self-efficacy

• CBT based on learning theory

• social learning theory:

  • observational learning

  • person-stimulus reciprocity

• self-efficacy: conviction that one can be successful - can influence client behavior

cognitive appraisal theories

Epictetus and glass half full - perspective determines response

REBT ABCDEF Cognitive model

through REBT a rational belief is substituted for an irrational belief

similarities and differences btwn Beck’s cognitive theory and Ellis’s REBT

similarities:

• cognition is at the core of human suffering

• therapist’s job is to help modify distress-producing thoughts

differences:

• irrational vs. maladaptive

collaboration vs. confrontation

therapist is working with client instead of attacking/ confronting

M’s self-instructional theory and training

SIT focuses on patterns of clients’ response to stressful life events, and is addressed in a sequence focused on inner speech:

1) preparation: inner speech before stressful situation

2) coping: during situation

3) aftermath: after situation

helpful self-instruction helps in stressful situations

theories of psychopathology

Ellis: a function of irrational beliefs - absolutist

Beck: cognitive distortions

M: dysfunctional inner speech

cognitive distortions

Beck defined - faulty assumptions

the practice of CBT

1) access clients maladaptive thoughts

2) instruct clients in more adaptive thinking; educate

3) support clients as they apply these new developing skills

assessment issues and procedures

1) collaborative interviewing: after establish rapport and therapeutic alliance

2) setting an agenda: collaborate

3) the problem list: client concerns in concrete terms

4) self-rating scales: inventories etc.

5) cognitive self-monitoring: client homework

6) thought record

7) case formulation: helps in developing treatment plan

8) psychoeducation

psychoeducation

educational process that focuses on client diagnosis, treatment process, prognosis, and intervention strategies:

1) therapist uses stories, demonstrations, and life examples to illustrate CBT rationale

2) therapist senses a need to provide psychoeducation about client problems slowly and clearly - normalizing

3) skilled CBT therapist can simultaneously provide psychoeducation about CBT rationale, client problems, and procedure

methods to explore and identify automatic thoughts and core beliefs

1) guessing the thought:

2) vertical descent:

3) chasing cognitive distortions:

4) evaluation using cost-benefit analysis:

5) applying double standard technique:

Ellis and more techniques

1) vigorous/ forceful disputing: offers rational counterattack

2) shame attacking exercises: tolerate discomfort

Beck and more techniques

1) graduated thinking/ shades of grey: measurable scale instead of black and white

M. and more techniques

1) stress inoculation training:

• conceptualization

• skills acquisition and rehearsal

• application and follow through

• each includes “self-statements”

other techniques

1) generating alternative interpretations:

2) thinking in shades of grey:

3) exploring the consequences of giving up the “should” rule

the problem list and case formulation

• list: client concerns in concrete terms

• formulation: helps in developing treatment plan

more interventions

1) psychoeducation

2) cognitive self-monitoring

3) socratic questioning

4) distinguishing thoughts from facts technique

5) generating alternative interpretations technique

outcomes measurement

best way to measure treatment success is measuring symptoms before, during, after, and at 6 - months using same scales

evidence based status

effective across a wide range of clients with studies but two caveats:

1) many efficacy studies focus on immediate effects

2) CBT outcomes research usually conducted by CBT researchers

cultural and diversity considerations for CBT

• focuses on symptoms w/in individuals so context not always important

• clients may feel blamed: microaggressions and conscious aggressions

self-efficacy

conviction that one can be successful - can influence client behavior

higher self-efficacy means more persistence, greater effort, and willingness to face obstacles

• incentives

• knowledge and skills

• positive feedback

• successful performance accomplishment