In-Depth Study Notes for REBT and DBT Concepts

How does REBT view humans?

-we are fallible humans beings (not perfect,make mistakes), who have the potential of rational and irrational thinking  

-anti determinstic

What does REBT stand for?

Rational Emotive Behavioral Therapy

Rational thinking

leads to healthy ways of living, unconditional acceptance of others and self acceptance

irrational thinking

 leads to self-defeating emotions and dysfunctional behaviors 

Is REBT deterministic or anti-deterministic?

anti-deterministic (you can change as a person)

What is a constructivism?

We create our own reality/meaning making system

What is social constructivism?

We create our own reality by our interactions with other people

What phobias did Ellis have?

He had a fear of women

development of rational or irrational thinking is based on

early child-rearing practices: how did your parents raise you

societal influxes:

family dynamics

innate biology

What role does “unconditional acceptance” play in REBT?

Allows clients to freely discuss their thoughts, feelings or behaviors; recognizes client as fallible human who may have behaviors toxic to themselves and others

What is the role of cognitive distortions in REBT and Cognitive Therapy?

Used to indoctrinate ourselves into thinking irrationally

• I can’t stand its

• awfulising

• demands

• people-rating (damning oneself and others)

• absolutistic musts and shoulds

Core Irrational Beliefs

1. I must always be approved of and liked/loved by everyone

2. You should always treat me well and act the way I think you should

3. Life should always be fair and just

What is “A” in the ABCDES of REBT?

A: Activating event as “A”

What is “B” in the ABCDES of REBT?

•Belief about the Activating event as

–iB (irrational belief), or

–rB (rational belief)

What is “C” in the ABCDES of REBT?

Consequential feeling or behavior as “C”

What is “D” in the ABCDES of REBT?

Dispute the irrational belief

What is “E” in the ABCDES of REBT?

Develop new Effective responses

How do the ABCDE’s relate to each other?

Albert Ellis argued that it is not the event that causes us to feel poorly, it is how the event filtered through our cognitive distortions that impact the development of beliefs

What is Socratic Dialogue?

Gently challenging clients to think differently and rationally about their situation to illuminate alternative ways of understanding predicaments

• challenges client to show evidence that irrational belief is true

How do REBT therapists teach the client about REBT philosophy?

Tell client about it

Encourage clients to read books, etc.

Suggesting websites that describe the approach

Promoting the use of audio and visual aids

What do disputations do?

Help client challenge existing unhealthy cognitions, behaviors, or emotions and replace them with healthy ones

What is cognitive disputation?

Encourage clients to Dispute the Irrational Beliefs (DIBS) by ask disputing questions

• Where is the evidence for this belief?

• Is that really true?

• Why must it be so?

• Is there another way to think about this?

• What’s the worst thing that could happen? Would that really be awful?

• What’s this way of thinking about things going to get me?

What does DIBS stand for?

Dispute the Irrational Beliefs

What are behavioral disputations?

practice behaviors that challenge the irrational beliefs

• Risk-taking behaviors: given to encourage new ways of acting (homework)

• Shame-attacking exercise: approval from others is not necessary for self acceptance (homework)

What are emotive disputations?

practice new emotions that challenge the irrational beliefs

•Rational-emotive imagery

–Focus on the situation causing emotional distress

–Then, therapist asks client to change the self-defeating emotion

What is homework used for?

Dispute irrational thoughts at home

• behavioral conditioning

• bibliotherapy aimed at reinforcing new ways of being

• expression of feelings

• assertiveness training

• role-playing new behaviors

What are the ultimate goals of REBT?

To replace irrational thinking with rational thinking

Solution Focused Behavioral Therapy View of Human Nature

Pragmatic, anti-deterministic, future oriented and optimistic

In SFBT, who is the expert? How is this communicated to the client?

The client is the expert; counselor allows client to take lead in coming upon with their own solutions to questions while counselors take a “not-knowing posture”

What are the three terms used in SFBT to differentiate people who come seeking treatment?

Customers, complainants, visitors

Complainants can become customers and visitors can become complainants

Customers

clients ready to work on defining preferred outcomes and on problem-solving

Complainants

clients that can come to consensus with counselor about what’s needs to be addressed but has trouble coming up with solutions

visitors

clients that are testing the water to see if they want to try out therapy

What is reframing?

Changing client’s thinking of self from deficit model to positive focus

What is scaling?

Clients rate themselves between 0 and a 10 on imaginary scale that assesses experiences, feelings, or behaviors from the past, currently, or in future

How is the therapeutic alliance constructed?

In SFBT: counselors show curiosity, respect and acceptance; counselors are listeners and empathetic; they are tentative

Why is DBT considered a third wave cognitive behavioral approach?

Complex interaction among behavior, biology, and context (environment)

DBT is one approach that embraces third wave

Embraces “mindfulness, emotions, acceptance, the relationships, values, goals, and meta-cognition”

Helps people move toward less rigid ways of thinking and more adaptive behaviors

What is the focus of DBT?

Grounded in cognitive behavioral traditions, but integrates existential-humanistic skills, mindfulness, Eastern philosophy, and more to foster deeper meaningfulness in clients’ lives.

What are the symptoms of borderline personality disorder (BPD)?

•Five or More of the Following Symptoms:

•“Frantic efforts to avoid imagined abandonment

•Instability in interpersonal relationships

•Identity disturbance

•Impulsivity

•Suicidal behaviors

•Emotional instability

•Chronic feelings of emptiness

•Inappropriate or intense anger

•Stress related paranoid ideation or dissociation

Seven Basic Assumptions of DBT

1. People are doing the best they can

2. People want to improve

3. Although people are doing the best they can, if they’re suffering, they need to try harder and be more motivated to change

4. People may not have caused all of their own problem, but they have to solve them anyway

5. New behavior has to be learned in relevant contexts

6. All behaviors (actions, thoughts, emotions) are caused

7. Figuring out and changing the causes of behavior is a more effective way to change than judging and blaming

First stage of individual therapy in DBT

A focus on safety and stabilization, in the following order: behaviors that are life threatening, behaviors that interfere with therapy, and behaviors that decrease the quality of life.

What are the four stages of individual therapy in DBT?

Stage 1: behavior dysregulation

Stage 2: quiet desperation

Stage 3: ordinary problems in living

Stage 4: freedom of choice

Second stage of individual therapy in DBT

A focus on behaviors that cause misery and “quiet desperation,” often due to past trauma and invalidation.

Third stage of individual therapy in DBT

A focus on behaviors that cause problems in everyday living so that clients can live a life of relative contentment with its ups and downs.

Fourth stage of individual therapy in DBT

A focus on finding deeper meaning, spiritual fulfillment, and ongoing capacity for success and joy.

Diary card

Assess strong feelings or behaviors during the week (e.g., depression, anxiety, anger, self-injury, suicidal ideation, medications used, sleep, energy level, substance use, etc.

Chain Analysis

•Detailed analysis of problematic behavior

–The problem behavior (often identified in the diary card)

–How the environment is linked to the prompting event

–Links in the chain of events between the prompting event and the problem behavior

–Negative and positive consequences of the problem behavior

–Ways to decrease one’s vulnerability to the problem behavior

–Ways to prevent the prompting event from occurring again

–Ways to decrease the chain of events that led to the problem

–Ways to correct or repair the harm, or make amends, related to the problem behavior

structuring therapy

methods of maintaining consistency in routine of therapy sessions, may include greeting client warmly, addressing the affective state of client, conducting mindfulness to ground client and counselor

Dialectical Communication Skills: Radical acceptance

empathy and unconditional positive regard

Dialectical Communication Skills: Reciprocal communication

a give and take egalitarian, empathic, and respectful conversation

Dialectical Communication Skills:

Irreverent communication

provocative, confrontational, and direct

Dialectical Communication Skills:

Playing the devil’s advocate

suggesting different perspective

Dialectical Communication Skills: Making lemonade out of lemons

finding ways to turn a negative situation into a positive one

Dialectical Communication Skills: exception rule

examining times when problem did not exist to develop fresh ways of coping

Dialectical Communication Skills: role reversal

asking the client to take on the role of a person with whom there are ongoing problems so that the client can see a different perspective on the problems.

Dialectical Communication Skills: wise mind

place between the logical mind and emotional mind obtained during meditative or aware state that allows one to recognize feelings and respond to them rationally

Dialectical Communication Skills: understanding the three dialectics

through psychoeducation and encouragement, therapists can help clients understand the polarity they are struggling with: active passivity/apparent competence, emotional vulnerability/self-invalidation, and/or unrelenting crisis/inhibited grieving

Functional Behavior Analysis

identify contingencies involved when a behavior is reinforced (a chain analysis discussed earlier is a type of functional behavior analysis)

What does Linehan suggest as some of the causes of DBT?

Clients learn new behaviors, develop more flexible ways of thinking and apply a variety of acceptance and change techniques that help moderate their emotional regulations to have a more emotionally moderate and joyful life

What are the fundamental dialectical issues that Linehan sees inherent in her therapy?

Biological based vs social based

Active passivity vs apparent competence

emotional vulnerability vs self-invalidation

unrelenting crisis vs inhibited grieving

Why did Linehan call her theory “Dialectical”?

DBT was created with the philosophy that reality is interrelated and connected, made of opposing forces, always changing

What are the different parts of treatment in DBT?

Pre-treatment, Individual therapy, group skills counseling, consultation team meeting, between-sessions coaching

Pre-treatment DBT

Evaluating client’s living situation, orientation to therapeutic process, explain purpose of each process

Individual therapy

One on one sessions to apply DBT skills to real life situations and manage processes

Group Skills Training

Clients learn and practice midnfulness, distress tolerance, emotion regulation, interpersonal effectiveness

Consultation team meetings

professionals involved with case meet about the treatment plan to make sure they’re all on the same page

Between sessions coaching

focused on reinforcing new skills

What were Beck’s phobias?

Suffocation and related tunnel phobia, heights, public speaking, blood, self-defeating beliefs like he was incapable of achieving

Cognitive Behavioral Therapy View of Human Nature

Anti-deterministic, active, educative, time sensitive, and empirical

Continuity hypothesis

Emotional responses adapted thousands of years ago continue into modern world and are dysfunctional now

Diathesis-stress model

“a combination of genetic predispositions, biological factors, and experiences combine to produce specific cognitive schemas and core beliefs, some of which may lie dormant and then suddenly appear as the result of stress and other conditions impinging on the person.”

Core beliefs

Fundamental beliefs that underlie how we think, feel and behave

Intermediate Beliefs

set the attitudes, rules and expectations, and assumptions we live by

Automatic thoughts

result in our behaviors, feelings, and physiological responses and are the outgrowth of the attitudes, rules and expectations, and assumptions

Beck’s negative core beliefs

-helpless core beliefs

-unlovable core beliefs

-worthless core beliefs

Cognitive schema

cognitive structures (similar to core beliefs)

How are core beliefs and schema different?

Core belief: single, strong help conviction about oneself or the world

schema: broader cognitive structure that encompasses a network of core beliefs

How do core beliefs, intermediate beliefs, automatic thoughts, and schema interact?

Schema—> core beliefs —> intermediate beliefs—> automatic thoughts

Core beliefs gives rise to intermediate beliefs which gives rise to automatic thoughts

What is the order that these are addressed in therapy?

1st- automatic thoughts

2nd-intermediate

then core beliefs

Where do automatic thoughts and automatic images come from?

Thoughts and images that come throughout the day are products of intermediate beliefs

How do we acquire coping strategies?

We develop early in life to avoid dealing with strong negative feelings that are a result of their negative core beliefs

What is Beck’s view of Human Nature?

People were born with a genetic and evolutionary predisposition toward certain attitudes and temperament

What model does Aaron Beck use to discuss mental disorders?

Diathesis-stress model of mental disorders

What is automatic thought-stopping?

Client realizes and finds new ways to prevent automatic thoughts related to negative feelings and/or dysfunctional behaviors

What is the diathesis-stress model and why is it important?

The diathesis stress model is important because it allows the identification of factors that may result in stress and other conditions

What is automatic thought-stopping?

Client realizes and finds new ways to prevent automatic thoughts related to negative feelings and/or dysfunctional behaviors

What is the focus of cognitive therapy?

The initial focus is automatic thoughts in the present

CBT show clients how current thinking affects their attitudes, feelings, and behaviors and have them learn how to change their cognitions so they can live a more fully functioning and meaningful life

What is the major dialectic in DBT?

Radical acceptance of a person and the need to change

What happens when a person grows up with invalidation?

They are increasingly at risk of developing Borderline Personality Disorder (BPD) or other mental disorders

Biosocial Theory

Based somewhat on biosocial theory which says that children are born with constitutional factors such as physical ability, intellectual capacity, drive, energy, and temperament that shapes their view of the world

However, expression of their constitutional factors is expressed differently as a function of childhood experiences such as parenting, peer relationships, and other environmental factors

Amplification

Amplify client successes by encouraging them to have expanded discussions about solutions that have worked for them

Complimenting

Reinforcing client resources and strengths to encourage clients in their continued efforts at solution building

Presuppositional Questions

therapists ask questions in a manner that assumes change will occur. Used to examine 5 areas of client’s life

Presuppositional Questions: Coping question

Asking how the client has coped in the past with his or her problem

Presuppositional Questions: exception-seeking questions

Asking when exceptions to the problems have occurred

Presuppositional Questions: preferred-outcome question

What the client is hoping his or her future will look like

Presuppositional Questions: evaluative questions

What the client is doing and whether it is working for him or her

Presuppositional Questions: solution oriented question

how the clients life would be if the problem did not exist

In solution focused therapy, the therapist takes a not-knowing posture. Why?

stresses collaboration, not authoritarianism

Uses questions that show tentativeness

Could it be that…?

Am I correct in assuming that…?

Correct me if I wrong that…

In REBT, the therapist challenges the client to approach living in what way?

Live in a mindset based on rational thinking, self-acceptance, and emotional responsibility