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Cognitive Behavior Therapy
A brief/time sensitive, structured, agenda and present oriented therapy that involves teaching and learning with the goal to change both dysfunctional thinking and maladaptive behavior; a therapy that integrates cognitive and behavior therapies.
In the future
With CBT you can work directly with the problem the clients face today, while also changing how they might perceive and act ______________.
Socratic Questioning
Thoughtful dialogue create by focusing on discovering answers by asking questions.
Albert Ellis
Created Rational Emotive Behavior Therapy, Had a difficult family life (Father often away, absorbed bipolar mother, 2 siblings), diagnosed with a kidney ailment at age 5. Wanted to be a writer but switched to psych. He thought the traditional psychoanalytic practice was ineffective so he learned/discovered how to improve it. Switched to more active-directive, cognitive included therapy. He credited Epictetus for his “rational psychotherapy”. He influenced many, randomly broke into song, and swore a lot.
Rational Emotive Behavior Therapy
A philosophical, behavioral, and cognitive approach; the goal is to help clients develop 3 types of acceptance: unconditional self-acceptance, unconditional other-acceptance, and unconditional life-acceptance
Aaron Beck
Youngest of 5, 2 died before he was born → very depressed mother. He viewed himself as a replacement for his siblings and after he injured his arm and missed lots of school, he began believing he wasn’t smart. He overcame these negative beliefs and obtained a medical degree from Yale. He focused on and developed a new theory of depression. Switched from psychoanalysis to developing cognitive (focused on the “other streams of consciousness”)
Collaborative Empiricism
Therapists working together with clients to explain/make clear the maladaptive nature of client’s automatic thoughts and come or primal beliefs.
Eradication of irrational thoughts
Ellis emphasized the forceful __________________________________.
Collaborative modification of maladaptive thoughts
Beck emphasized that ____________________.
Donald Meichenbaum
Started practicing behavior therapy. Then shifted to cognitive then became a constructivist.
People Watching
Meichenbaum learned a lot from ___________. His early research focused on Schizophrenia and impulsive school children. Discovered that all 3 of these types of people improve their functioning after being taught to talk to themselves.
Self-Instructional Training (SIT)
Client talks to themselves and give themselves instructions to slow down and guide themselves through problems and other situations.
Stress Inoculation Training (SIT)
A specific approach for helping clients manage difficult stressors; teaches skills to react differently to stressful situations (and manage PTSD symptoms). It has 3 phases: Conceptualization, Skill Acquisition and rehearsal, and Application and follow through
Theoretical Principles of CBT
Classical conditioning, operant conditioning, social learning, and cognitive appraisal theory
Social Learning Theory
Developed by Bandura, includes stimulus-influenced components (classical conditioning) and consequence-influence components (operant conditioning) but also cognitive meditational components. This includes observational learning and person-stimulus reciprocity.
Observational/Vicarious Learning
When individuals learn indirectly from watching or listening to the experiences of others. It can invoke the increase or decrease of behavior and.or new skill development (modeling)
Reciprocal Interactions
Occurs between an individual’s behavior and the environment. Individuals can have thoughts about the future, behavioral consequences, and goals. These thoughts focus on feedback loop and influence current behavior.
Self-directed behavior change
Observational learning and reciprocal interactions make individuals capable of ______________________.
Free will and self-determination
Bandura sees _________ and ______________ as possible.
Self-efficacy
The conviction that one can successfully execute the behavior required to produce an outcome (Bandura’s definition)
High self-efficacy
______________- is associated with more persistence, greater effort, and willingness to face obstacles.
Factors to improve self-efficacy
Incentives, knowledge and skills, positive feedback, successful performance accomplishment
Efficacy
A primary CBT goal is to help clients develop and strengthen their self-_______.
Cognitive Appraisal Theories
Psychopathology is the result of how they view themselves and the situation; behavior is the function of what the organism thinks about its consequences.
Stimulus Organism Response (SOR) Theory
The organism (person) appraises stimulus and response. There is conscious thought between an external event and a particular emotional response.
REBT Philosophies
Unconditional self-acceptance, unconditional other-acceptance, and unconditional life-acceptance
Unconditional Self-acceptance
Don’t / stop “beating yourself” up when failures or rejections or other adverse experiences occur. (REBT)
Unconditional Other-acceptance
Accepting others as they are, without preconditions. Accept that people are capable of making mistakes. (REBT)
Unconditional life-acceptance
Fully accepting your life and ongoing existence regardless of whether you get what you want (REBT)
Effort
The REBT philosophies require _______ while irrational beliefs are easy and natural, often leading to more profound problems including (a) low frustration tolerance, (b) self-denigration, and (c) awfulizing or spoiling personal experiences
Irrational Thinking
In Ellis’s RBT model, _______________ is the primary source of human suffering
Ellis’s ABCDEF Model
A-acting event
B-belief about the event
C-consequent emotion linked to said belief
D-disputation (dispute irrational beliefs and replace them)
E-emotional effect (feels better with the rational belief)
F- new feeling
Rational Beliefs
REBT Goal; take the irrational beliefs and substitute them with ____________ to result in a more positive and comfortable new feeling.
Bedrock Components of REBT
People dogmatically adhere to irrational ideas and personal philosophies
These irrational ideas cause people great distress and misery
These ideas can be boiled down to a few a few basic categories
Therapists can find those irrational categories rather easily in their client’s reasoning
Therapists can teach clients to give up their misery causing irrational beliefs.
Maladaptive
Beck criticized Ellis’s use of “irrational” to describe the rules by which people regulate their lives. Beck uses ____________.
Cognitively perfect
Beck believes that no one is _______________. Psychopathology is an exaggeration of normal cognitive biases.
Self
Beck believes that all individuals develop deep beliefs about the ________.
Negative or inaccurate beliefs
Due to biogenetic predisposition, modeling by early caregivers and/or adverse life events, individual’s schemas include _______________ about the self (Beck)
Activated
These negative beliefs aren’t necessarily problematic until __________ by stressful life events or negative mood states, especially events and mood states that match or are consistent with the underlying belief of schema. (Beck)
Automatic Thoughts
When negative beliefs are activated, fully info processing increase and negative or positive biases spread to several cognitive domains like (a) selective attention, (b) memory, and (c) interpretation of events/experiences. these biases often emerge in the form of _____________ and that in turn contributes to increasing emotional dysfunction. (Beck)
Automatic and Reflective Processing
Info processing has two interacting subsystems: ______________ (Beck)
Automatic Subsystem Processing
Processes info rapidly, but categorizes incoming data into broad categories and produces errors.
Reflective Subsystem Processing
Process info slowly, requires more cognitive resources, and is more nuanced and accurate.
Repeated Information Processing
Especially the rapid, automatic processing- tends to be repetitive and confirmatory; there is repeated activation and confirmation of underlying negative beliefs, some of which have cognitive content consistent with specific mental disorders. (Beck)
Reflective Subsystem
When therapists engage the ________________, automatic thoughts, intermediate beliefs, core (primal) beliefs, and their associated emotional and behavior disturbances can be modified (Beck)
Collaborative Empiricism
Client and therapist work together in partnership. the therapist employs socratic questioning to uncover the client’s idiosyncratic and maladaptive thinking patterns. The therapist uses socratic questioning and other techniques to help clients test the validity or usefulness of their automatic thoughts and core beliefs.
The client’s eyes
While engaging in collaborative empiricism, the therapist must try to see the world through _____________.
Worst Case Scenarios
While doing collaborative empiricism, Ellis would present clients with the _____________ and then directly dispute the terribleness of the scenario. This provides clients with a way to cope with these in case they ever occur.
Meichenbaum’s Self-Instructional Theory
A reciprocal model that emphasizes an interactive relationship between the individual and the environment. He takes inner speech and brings it out to develop more adaptive speech. Then helps clients internalize the new speech.
Self-Instructional Training Stages
Preparation → Coping → Aftermath
Preparation
Inner speech that occurs before the stressful situation (Self-Instructional Training Stages)
Coping
Inner speech that occurs during the stressful situation (Self-Instructional Training Stages)
Aftermath
Inner speech that occurs after the stressful situation
REBT Psychopathology
A function of irrational beliefs
Musterbation
All the “musts” in life
Cognitive Psychopathology
Cognitive distortions or faulty assumptions and misconceptions that produce automatic thoughts which are linked to core beliefs or schemas. There are 7 distortions and specific thoughts and core beliefs are indicative or a particular disorder.
Beck’s' Negative Cognitive Triad
Negative evaluation of the self, negative evaluation of the world, and negative evaluation of future
Meichenbaum’s Self-Instructional Psychopathology
Dysfunctional inner speech. Individuals engage in disturbing inner speech to prepare/they self-criticize instead of cope. After an event, they talk to themselves about their failures.
Therapeutic Relationship
CBT begins with the initial contact between therapist and client. The focus is on developing a positive _____________________ while educating the client on CBT
Primary Goals for CBT Assessment
Arrive at a diagnosis that best describes the client’s symptoms
Develop a tentative CBT formulation that can be used as a treatment plan
Assessment Strategies
Collaborative interviewing, setting an agenda, developing an initial problem list, self-rating scales, cognitive behavioral self-monitoring, and case formulation
Collaborative Interviewing
The client and the therapist join together to identity and move toward treatment goals (this is used by practitioners using the Beck or Meichenbaum model)
Setting the Agenda
In the first few minutes the client and therapist collaborate to determine what to do in the current session. This could include a formal structured clinical interview or an informal interview.
Problem List
A list that includes the client’s concerns described in simple, descriptive, concrete terms (generally have 5-8 things).
Interest in and compassion for
The problem list gives the therapist a chance to show ______________ clients, the ABCs can be identified as the client describes their problems/develop hypotheses, and as the therapist uses Socratic questions clients become enacted in the CBT process.
Self-rating scales
Have clients fill out ____________ before/at the beginning of every session.
Cognitive Behavioral Self-Monitoring
A method for helping clients to develop awareness of automatic thoughts, automatic behaviors, and associated emotions. This can occur at the beginning of sessions but also often involves homework.
Thought Record
A system for clients to record the data and time of the emotional response, the situation that evoked the emotional response, the behaviors the client engaged in, the emotions that were elicited, the associated thoughts that occurred during the situation, and other related responses immediately after experiencing a strong emotional response
CBT Case Formation
Identifies an underlying psychological (cognitive and behavioral) mechanism and describes how they are maintaining client problems. These help with developing treatment plans.
Case Formation Components
Creating a problem list, identifying mechanisms, identifying precipitants activating current client problems, and consideration of the origins of the client’s current problems.
Past
CBT therapists focus on the ___________ when (a) clients want to, (b) clients are stuck in dysfunctional thinking, or (c) cases are especially complex. Talking about this can build rapport and give therapists insight into thoughts and behavior maintaining the problem in the present.
Psychoeducation
An educational process that focuses on info about client diagnosis, treatment process, prognosis, and intervention strategies. CBT therapist educate their clients about their treatment rationale, problems, and procedures.
Life examples
Psychoeducation is not lecturing. Many therapist use stories, demonstrations, and ____________ to illustrate CBT rationale.
Guessing the thought
When clients have difficulty identifying the thoughts that underlie their emotions and behaviors, the therapist use their knowledge and experience to make an educated guess at the content of the client’s underlying thought
Vertical Descent
Asking a series of socratic questioning to uncover underlying core beliefs.
Dichotomous/Polarized Thinking
People and situations are evaluated as black and white, good or bad, These client come to either hate or love their therapist. (A cognitive distortion)
Labeling and Mislabeling
Labels are used inaccurately, with emotional cost. i.e a client consistently labels themself as a loser which has negative effects. Overly positive labels can have maladaptive features too i.e a narcissistic women calling herself Queen (A cognitive distortion)
Magnification and Minimizing
When clients exaggerate the likelihood of something happening or when clients downplay themselves. i.e minimizing the extent of their hard work. This is also known as catastrophizing. (A cognitive distortion)
Mind Reading
Clients think they know what other people think. Although these thoughts may or may not be accurate, clients who use this are fairly certain their assumptions are correct. (A cognitive distortion)
Personalization
Clients tend to take everything personally. This often results in automatic negative thoughts.
Validity or utility
Therapist used different techniques to have clients question the ______________ of their cognitive distortions.
Cost-Benefit Analysis
Do you think [your distortion type] gives you valuable information? How would your thoughts, feelings, and behavior if you did less of this distortion? What are the pros and cons of this distortion? This is good for mind reading.
Double Standard Technique
Would everyone see it this way? Why not? How might someone else describe the situation? This is good for dichotomous thinking.
Vigorous and Forceful Disputing
Involves clients offering a forceful and rational counterattack against their irrational beliefs. They record it and listen to it multiple times. Over time they record it again with more force and repeat the listening process.
Shame Attacking Exercises
Situations where clients intentionally act in ways that are socially inappropriate in public settings. The purpose is for clients to learn to accept themselves while tolerating discomfort. (Ellis technique)
Graduated Thinking
A technique for dichotomous thinking; involves taking automatic thoughts, assumptions, or conclusions about a specific event or performance and placing them on a concrete measurable scale. This starts with a verbal inquiry and client response. The next step involves expressing empathy and building a continuum.
Conceptualization
First step of Stress Inoculation Training; this phase includes developing a collaborative relationship and using socratic questioning to educate clients about stress and how to view stressful situations as “problems to be solved”. When stress is viewed as a challenge, the therapist begins assisting clients in formulating methods for preparing for, confronting, and reflecting on stressful events.
Skills Acquisition and Rehearsal
Second step of Stress Inoculation Training; this phase specifically teaching coping skills and practicing them in the office and eventually in vivo. Skills taught are related to the individual’s problems.
Application and Follow Through
Third and final step of Stress Inoculation Training; clients apply their new coping skills to increasingly challenging stressors. Personal opponents are used to help inoculate clients from later stressful situations. Relapse prevention strategies, attribution procedures, and booster sessions are built in this phase.
Preparation Self-Statements
Internal self-instructions that prepare clients for a challenging situation
Coping Self-Statements
Internal instructions that focus on how to deal effectively in the moment
Reinforcement Self-Statements
Internal statements that focus on positive outcomes and look to a positive future
Generating Alternative Interpretations
A technique that teaches clients to immediately counter the first, often the worst-most negative situation with at least 4 reasonable alternatives
Misattribution of Hostility
When a person quickly and incorrectly interprets the behavior of other youths as hostile.
Accepted
CBT is the most widely ________ and respected approach.
Potential Bias
Most CBT efficacy evidence focuses on immediate effects and is mostly done by CBT Users and supporters so there is _______________.
Used
CBT can be used for phobias, social anxiety disorder, eating disorders, sleep disorders, chronic fatigue syndrome, anger and aggression, psychosis, somatic symptoms disorders, and borderline personality disorder
Medical Model
CBT is consistent with the ____________________.
Disregards
CBT ___________- important culture, gender, and sexual diversity issues. They focus on the client’s well-being. However, this could lead to them leading the client to blame themselves. Counselors need to consider the possibility of microaggressions and prevent from doing them too.
Spirituality CBT Options
Ignore client religion and spirituality
Freely challenge religious beliefs whenever they cause emotional distress
Integrate religious/spiritual knowledge into practice in a way that supporters nuanced of religion and spirituality
Unhelpful or irrational thoughts might be questioned as needed but not central religious values
Note
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