CBT/ CBFT Approach

IN A NUTSHELL- What is CBT/CBFT trying to do?

Change dysfunctional thoughts and behaviors that maintain problems

CBFT therapist role?

Directive educator and expert

CBFT therapist relationship style?

Empathetic but teaching/directive

CBFT main focus?

Thoughts + behaviors + mutually reinforcing family patterns

CBFT sees symptoms as?

Maintained by interactions and reinforcement patterns

Therapist trying to do?

Identify and replace dysfunctional thoughts and behaviors

🔴 CONCEPTUALIZATION

Functional analysis

Examines antecedents, behavior, and consequences maintaining symptoms

🔴 CONCEPTUALIZATION

Functional analysis formula

Antecedent → Behavior → Consequence

🔴 CONCEPTUALIZATION

Baseline assessment

Measure frequency, duration, and severity of symptoms. Identify antecedentsvand consequences affecting behavior.

Ideal with children’s behavior

🔴 CONCEPTUALIZATION

Mutually reinforcing behaviors

Family members accidentally reinforce behaviors that maintain symptoms.

ex: tantrum occurs, parents reinforce by giving attention.

ex: when child misbehaves, sibling laughter encourages repetition.

🔴 CONCEPTUALIZATION

Schema

Cognitive framework that organizes thoughts, feelings, and behaviors

🔴 CONCEPTUALIZATION

Core beliefs

Deep beliefs about self and others

🔴 CONCEPTUALIZATION

CBT says psychological problems come from?

Dysfunctional thoughts and beliefs

A-B-C THEORY (ELLIS)

A in ABC theory

Activating event

A-B-C THEORY (ELLIS)

B in ABC theory

Belief about event

A-B-C THEORY (ELLIS)

C in ABC theory

Emotional/behavioral consequence

A-B-C THEORY (ELLIS)

What causes distress in CBT?

Beliefs about events, not events themselves

A-B-C THEORY (ELLIS)

D in ABCDEF

Disputing irrational beliefs

A-B-C THEORY (ELLIS)

E in ABCDEF

New effect

A-B-C THEORY (ELLIS)

F in ABCDEF

New feelings

A-B-C THEORY (ELLIS)

Exam trap: clients think

A → C

A-B-C THEORY (ELLIS)

Actual CBT model

A → B → C

COGNITIVE DISTORTIONS

Arbitrary inference

Belief with little evidence

COGNITIVE DISTORTIONS

Selective abstraction

Focus on one detail and ignore the rest

COGNITIVE DISTORTIONS

Overgeneralization

Broad conclusion from few incidents

COGNITIVE DISTORTIONS

Magnification

Exaggerating importance

COGNITIVE DISTORTIONS

Minimization

Downplaying importance

COGNITIVE DISTORTIONS

Personalization

Taking external events personally

COGNITIVE DISTORTIONS

Dichotomous thinking

All-or-nothing thinking

COGNITIVE DISTORTIONS

Mislabeling

Assigning global traits from few events

COGNITIVE DISTORTIONS

Mind-reading

Assuming you know another person's thoughts

Exam clue for cognitive distortions?

always / never / should / everyone / no one

IRRATIONAL BELIEFS

Ellis irrational beliefs often contain?

Must, should, ought

IRRATIONAL BELIEFS

Three basic musts

Perfection-based worth, justice for me, effortless perfection

IRRATIONAL BELIEFS

Perfection-based worth

"I must always succeed or I am worthless"

🟢 INTERVENTIONS

Classical conditioning

Pairing a stimulus with a response

🟢 INTERVENTIONS

Operant conditioning

Behavior changes through reinforcement and punishment

🟢 INTERVENTIONS

Shaping

Rewarding small steps toward desired behavior

🟢 INTERVENTIONS

Positive reinforcement

Add something desirable to increase behavior

🟢 INTERVENTIONS

Negative reinforcement

Remove something unpleasant to increase behavior

🟢 INTERVENTIONS

Positive punishment

Add something unpleasant to decrease behavior

🟢 INTERVENTIONS

Negative punishment

Remove something desirable to decrease behavior

🟢 INTERVENTIONS

Intermittent reinforcement

Random reinforcement sustains established behavior

🟢 INTERVENTIONS

Contingency contracting

Behavior must occur to earn reward

🟢 INTERVENTIONS

Token economy

Earn points/tokens for desired behaviors

🟢 INTERVENTIONS
Behavior exchange

Quid pro quo ("this for that")

🟢 INTERVENTIONS

Psychoeducation

Teaching clients about problems and coping

🟢 INTERVENTIONS

Socratic dialogue

Open-ended questions that help clients challenge beliefs

🟢 INTERVENTIONS

Thought record

Structured journal examining thoughts and responses

🟢 INTERVENTIONS

Communication/Problem Solving Training

• Begin with the positive
• Single subject
• Specific, behavioral problems

• Describe impact
• Take responsibility
• Paraphrase
• Avoid mind reading
• Disallow verbal abuse

🟢 INTERVENTIONS

Behavior Exchange and Quid Pro Quo

Mutual Behavior Exchanges
-Help partners negotiate relational rules
“If you make dinner, I will do the dishes”

Used Judiciously with Couples
-Balance with more affective techniques to to avoid framing

marriage as a business deal

Giving vs. Receiving
-Have each partner select a behavior to “give” rather than have

each “ask” for what he/she wants

Therapist teaches skills + assigns homework

CBT/CBFT

Therapist tracks behavior frequency and duration

CBT/CBFT

Therapist asks client to identify distorted thoughts

CBT

Parents use points for good behavior

Token economy

"If you finish homework, then you get screen time"

Contingency contract

Challenging Irrational Beliefs

Direct Confrontation

• Client is explicitly told that the belief is irrational

Indirect Confrontation

• Therapist uses series of questions to help client see how the belief is irrational and/or contributing to the problem

"If you cook dinner, I do dishes"

Behavior exchange / quid pro quo

Client says "Everyone hates me"

Overgeneralization

Client says "He didn't text me back because he hates me"

Mind-reading

CBFT

"Measure it → teach it → change it → reinforce it."