COGNITIVE BEHAVIOR THERAPY

believes that beliefs, behaviors, emotions, and physical reactions are all reciprocally linked

Attitudes of CBT

  1. A collaborative relationship between therapist and client

  2. The premise that psychological distress is often maintained by cognitive processes

  3. A focus on changing cognitions to produce desired changes in affect and behavior

  4. A present-centered, time-limited focus

  5. An active and directive stance by the therapist

  6. An educational treatment focusing on specific and structured targeted problems

Albert Ellis’s REBT (Rational Emotive Behavior Therapy)

"People disturb themselves as a result of the rigid and extreme beliefs they hold about events more than the events themselves."

  • People contribute to their own psychological problems and specific symptoms by the rigid and extreme beliefs they hold about events and situations.

  • People contribute to their own psychological problems because of what they believe about the situation; beliefs create emotions → influence evaluations and interpretations about the event

  • CBT is an educational process. Therapists are teachers who collaborate with clients, who learn skills and tools to identify and dispute irrational beliefs.

  • Developed from a philosophical standpoint

View of Emotional Disturbance

  • Irrational (i.e., self-defeating) beliefs become reinforced and learned through “shoulds, musts, oughts, demands, and commands.” - karen horney tyranny of the shoulds

  • Our beliefs about the past influence us in the present because it is what we keep telling ourselves

  • When we are disturbed, we must look at our hidden dogmatic "musts" and "shoulds", stop blaming ourselves and learn unconditional self and other acceptance.

THREE BASIC MUSTS THAT LEAD TO SELF-DEFEAT:

"I must do well and be loved and approved by others."

"Other people must treat me fairly, kindly, and well."

"The world and my living conditions must be comfortable, gratifying, and just, providing me with all I want in life."

The A-B-C Framework

A [ANTECEDENT] - An activating event or an inference about an event by the individual

B [BELIEF] - The person's belief about A, which creates C; humans are largely responsible for creating their own emotional reactions and disturbances because they create their own behavior

C [CONSEQUENCE] - The emotional and behavioral consequence or reaction of the individual, either healthy or unhealthy

Therapy aims to show how people can change their irrational beliefs that cause their emotional consequences by disputing (D) methods

  • Discriminating between self-defeating and self-helping beliefs

  • Detecting own irrational beliefs

  • Debating the irrational beliefs

    • why must this happen? why should something be like [your belief]?

After disputing, clients are encouraged to develop their effective philosophy (E) or belief system that replaces unhealthy irrational thoughts with rational ones.

Relationship between the counselor and the client is very persuasive, directive, didactic

Therapeutic Goal

  • Acquiring a more realistic, workable, and compassionate philosophy of life

    • towards yourself

    • distinguish between realistic and unrealistic goals, should not reinforce their dogma

  • Achieve unconditional self-acceptance (USA), which leads to unconditional other acceptance (UOA) and unconditional life acceptance (ULA)

Therapist Function and Role

  1. Show clients how they have incorporated many irrational absolute "shoulds," "oughts," and "musts" into their thinking

  2. Demonstrate how clients maintain their emotional disturbance by maintaining their irrational thoughts

  3. Help clients change their thinking and minimizing/reducing the frequency of their irrational ideas; identify and dispute core irrational beliefs

  4. Strongly encourage clients to develop a rational philosophy of life so they avoid hurting themselves with other irrational beliefs in the future

Client’s Experience in Therapy

An active student

  • The client does homework and learns effective ways of disputing self-defeating thinking.

  • Towards the end of therapy, clients review their progress, make plans, and identify strategies to prevent or cope with new challenges as they arise.

  • Little focus on client’s history

Relationship Between Therapist and Client

A respectful teacher-student relationship

  • REBT therapists strive to have at least a respectful relationship with the client.

  • Not need to be warm and friendly but respectful

  • The therapist teach clients about how their beliefs affect them and what they can do about it; insight is not required, but action is

Application

Multi-modal and Integrative

  • REBT uses cognitive, emotional, behavioral, and interpersonal modalities to dispel self-defeating thoughts and teach people how to acquire a rational approach to living

Cognitive Methods

  • Disputing irrational beliefs - challenging thoughts (e.g., "Why must they treatment fairly?" "How do I become a total flop if I don't succeed at important tasks I try?" "If I don't et the job I want, it may be disappointing, but I can certainly stand it."

  • Doing cognitive homework - Clients fill-up the REBT Self-Help Form; clients record their absolutist beliefs, dispute them, and work at uprooting them

  • Bibliotherapy - an adjunctive form of treatment

  • Changing one's language - "shoulds" "musts" and "oughts" can be replaced by preferences

  • Psychoeducational methods - introducing clients to educational materials (books, DVDs, articles) so they can educate themselves on the nature of their problems and how treatment will proceed.

Emotive Techniques

  • Rational emotive imagery - clients teach themselves to react with a different emotion when faced with adversity (i.e., the worst things that can happen to them)

  • Humor - Humor shows the absurdity of certain ideas clients maintain, and it teaches clients to laugh — not at themselves, but at their self-defeating ways of thinking.

  • Role playing - clients rehearse certain roles, note their anxieties and specific beliefs about them, and think of ways to change unhealthy feelings to healthy ones

  • Shame-attacking exercise - exercises to reduce shame and anxiety, and other negative feelings by acting them out in reality

Behavioral Techniques

  • Techniques used can include operant conditioning, self-management principles, systematic desensitization, relaxation techniques, modeling, behavioral homework, and in vivo desensitization

Application

REBT as a Brief Therapy

  • Well-suited for teaching clients to quickly teach clients skills to handle present and future problems.

REBT in Group Counseling

  • In groups, members are taught to apply REBT principles to one another and affords many opportunities to practice assertiveness skills to take risks by practicing different behaviors, to challenge self-defeating thinking, to learn from others' experiences, and to interact therapeutically and socially with each other in after-group sessions.

Aaron Beck’s CT (Cognitive Therapy)

  • Regardless of the origin/cause, once people become depressed, their negative thinking reflects the negative cognitive triad: negative view of self (self-criticism), the world (pessimism), and the future (hopelessness) → maintain the depression

  • developed from an empirical basis; conducted research on depression

  • will not teach the client but rather guide them to make their own realizations

CT has three specific theoretical assumptions:

  1. People's thought processes are accessible through introspection

    • can reflect about their own thoughts, can evaluate which are helpful and not

  2. People's beliefs have highly personal meanings

  3. People discover these meanings themselves rather than being taught or having them interpreted by the therapist

The Generic Cognitive Model

  • A disorder begins when these normal emotions and behaviors become disproportionate to life events in degree or frequency.

  • Faulty information processing is a prime cause of exaggerations in adaptive emotional and behavioral reactions.

ARBITRARY INFERENCES - conclusions that people draw without any evidence

SELECTIVE ABSTRACTION - selecting one detail of an event and make conclusions based on that detail

OVER GENERALIZATION - holding extreme beliefs because of a single incident

MAGNIFICATION AND MINIMIZATION - magnify bad events, minimizing good ones

PERSONALIZATION - it’s me hi I’m the problem it’s me

LABELING AND MISLABELING - labeling/mislabeling yourself

DICHOTOMOUS THINKING - black and white thought process

If beliefs are not modified, clinical conditions are likely to reoccur

Basic Principles of CT

  • Clients are taught the connection between their thoughts, behaviors, emotions, physical responses, and situations through specific learning experiences.

  • The goal is to help clients learn practical skills to identify dysfunctional thinking, weigh evidence for or against them

    • not a counselor’s job to label a thought irrational

Relationship Between Therapist and Client

More than the core conditions

  • A working alliance is a necessary first step, but therapists must also have skills aimed at guiding clients in significant self-discoveries that will lead to change.

Catalyst and guide

  • Therapists serve as catalyst and guide for clients to understand how their beliefs and attitudes influence the way they feel and act. Therapists identify goals directed towards the client's most pressing problem.

Application

Beyond Depression

  • Cognitive therapists apply procedures that help individuals make alternative interpretations of events and in behaving in ways that move them closer to their goals and values.

    • Begins with behavioral activation to lift depression

    • Testing negative automatic thoughts thru Socratic questioning like asking for the client to look pieces of evidence and support for their maladaptive thought

  • Treatment of depression but has extended to other types of disorders (e.g., anxiety, drug dependence, BDD, eating disorders, etc.) with good evidence for efficacy over other treatments (except BT).

More Developments

  • Padesky & Mooney's Strengths-Based CBT

    • Incorporates all of Beck's ideas with the additional emphasis on the identification and integration of client strengths at each phase of therapy

  • Meichenbaum's Cognitive Behavior Modification

    • Focuses on changing clients' self-talk; focuses more on helping clients become aware of self-talk and stories they tell themselves (changing behavior rather than thinking, as it is easier)

Strengths

  • emphasis on cognition, emotions

  • structure

  • evidence-based techniques

Shortcomings

  • a little more confrontative than some people may be comfortable with

  • danger of values imposition (REBT)

  • emphasis on independent, autonomous individuals, limited application on collective cultures

Techniques can be integrated to other approaches :>