Section 6: Techniques Based on Cognitive-Behavioral Approaches

What is the basis of CBT?

Focuses on the role of thoughts in changing behavior

Who are the pioneers of CBT?

Albert Ellis, William Glasser, Donald Meichenbaum

What influenced CBT’s rise?

Managed-care programs emphasizing brief, effective treatment

What is self-talk?

Monitoring and challenging internal dialogue to replace irrational beliefs

Common negative self-talk patterns?

Negativizing, Awfulizing, Catastrophizing, Overgeneralizing, Minimizing, Blaming, Perfectionism, Musterbation, Personalizing, Judging Human Worth, Control Fallacy, Polarized Thinking, Being Right, Fallacy of Fairness, Shoulding, Magnifying

Purpose of self-talk?

To change absolutist thinking and gain control of thought patterns

Steps to implement?

1. Build awareness of self-talk.

2. Record and examine negative thoughts.

3. Identify purpose/themes of negative self-talk.

4. Create realistic, positive counters.

5. Practice and review progress (use SUDS scale).

Variations of self-talk technique?

P & Q method, instant replay, thought bubbles (for children)

Uses?

Perfectionism, worry, anger, stress, motivation, self-esteem, performance

What is reframing?

Changing perception of a problem to view it more positively or productively

Origin?

Adlerian therapy; also used in CBT, family systems, and solution-focused work

Core belief?

Problems stem from how we view events, not the events themselves

How to implement?

• Listen nonjudgmentally to understand client’s perspective.

• Build a bridge to new interpretation.

• Reinforce new perspective (homework may help).

Variations?

Relabeling, removing diagnostic labels, positive connotation

Uses?

Depression, family/couples counseling, disability rehab, changing attitudes

What is thought stopping?

Interrupting unwanted or repetitive thoughts and replacing them with positive ones

Why does it work?

Acts as a distraction and teaches thought substitution

Steps to implement?

• Identify target thoughts.

• Visualize thought and say “STOP.”

• Replace with positive thought.

• Practice repetition (overt to covert).

Variations?

Rubber band snap, buzzer, movement interruption (no shocks)

Uses?

Obsessions, phobias, brooding, self-critical thoughts, depression, sex offenders

What is cognitive restructuring?

Changing distorted thinking into rational, realistic thought patterns

Key figures?

Albert Ellis, Aaron Beck, Donald Meichenbaum

How to implement?

• Identify thought patterns and triggers.

• Explore alternative interpretations.

• Examine logic and impact of thoughts.

• Replace irrational thoughts with rational ones.

• Reinforce new beliefs through practice and homework.

Tool used?

Schema diary (records triggers, emotions, thoughts, behaviors, coping, etc.)

Uses?

Depression, anxiety, self-esteem, problem-solving

Who developed REBT?

Albert Ellis

Main idea?

Thoughts—not events—cause feelings; change thinking to change emotions

REBT goals?

Unconditional self-acceptance (USA), other-acceptance (UOA), life-acceptance (ULA)

What is the ABCDEF model?

A – Activating event
B – Beliefs (rational or irrational)
C – Consequences (emotions/behaviors)
D – Dispute irrational beliefs
E – Evaluate effects
F – (Corey) New feelings

Common irrational beliefs?

Must be loved by everyone, perfectionism, catastrophizing, avoiding problems, past determines present, need for dependency, punishment for evil, unhappiness is uncontrollable, should be upset by other’s problem, pefection solution for every problem

How to implement REBT (13-step process)?

• Ask what brought client to counseling.

• Agree on presenting problem and goals.

• Identify activating event (A).

• Assess consequence (C).

• Identify secondary emotions.

• Teach the link between A and C.

• Assess beliefs (B) – rational vs. irrational.

• Connect B and C.

• Dispute irrational beliefs (D) using logical, empirical, pragmatic questions.

• Deepen client’s understanding of new belief.

• Assign homework.

• Check progress.

• Work through difficulties and reinforce change.

How to implement REBT-REI (7-step process)?

• Access client’s self-talk.

• Identify underlying belief.

• Agree on a more rational belief.

• Perform REI (Rational Emotive Imagery).

• Assign homework.

• Reinforce positive daily consequences.

• Discuss negative consequences for noncompliance.

What is Rational Emotive Imagery (REI)?

Visualization exercise where clients imagine distressing events, experience emotions, and then practice shifting to healthier emotions through repetition and reinforcement

Variations and uses and limitations

• Variations: Written belief logs, philosophical counseling.

• Useful for: addiction, anxiety, BPD, OCD, PTSD, jealousy, and relationships.

• Limitations: May be too fast-paced for severe disorders or low motivation.

What is systematic desensitization?

Gradual exposure to anxiety-provoking situations while using relaxation techniques to reduce fear responses.

How to implement systematic desensitization?

• Build rapport and gather history.

• Teach relaxation (e.g., PMRT, deep breathing).

• Create anxiety hierarchy (10–15 stimuli).

• Use relaxation while visualizing or experiencing stimuli.

• Move up the hierarchy until fear reduces.

• Practice at home; follow up with progress check

Variations and uses of systematic desensitization?

• Variations: In vivo, self-administered, or virtual.

• Useful for: phobias, anxiety, medical/dental fears, stress.

• Uses SUDS (Subjective Units of Distress Scale) to rate anxiety.

Who developed Stress Inoculation Training and what is its goal?

Developed by Donald Meichenbaum; helps clients build tolerance to stress through coping skill development

What are the stages of Stress Inoculation Training?

• Conceptualization:

  • Teach nature of stress.

  • Identify problems and coping attempts.

  • Set short-, mid-, and long-term goals.

  • Self-monitor internal dialogue and behaviors.

• Skill Acquisition and Rehearsal:

  • Learn coping skills (relaxation, restructuring, problem-solving, etc.).

  • Practice social skills and time management.

• Application and Follow-Through:

  • Apply skills to real situations via role play, simulations, and homework.

  • Plan relapse prevention and follow-up sessions.

Variations and uses of Stress Inoculation Training?

• Variation: 5-step model for children (Archibald Hart).

• Useful for: anxiety, depression, phobias, PTSD, stress, anger, medical and military populations.

What are the multicultural implications of CBT?

• Emphasizes collaboration and respect for client beliefs.

• Works well across demographics when counselors maintain empathy, flexibility, and a strong therapeutic alliance.