CBT

Albert Ellis REBT, Aaron and Judith Beck cog ther, Christine Padesky’s strength-based CBT, Donald Meichenbaum CBT.

-Aaron Beck father of cog therapy. -All share following attributes: a. collab rela b/w cli and counb. Premise that psych distress maint by cog processes

c. focus on changing cognitions to produce desired changes in affect and behave

d. present-centered, time-limited focus

e. active stance by coun d. educa treat focus on specific tech to target problems.

-CBT and cog therapy based on psychoedu model, use of homework, place respon on cli to be active in and out of ther, strong ther alliance, draw from diff strat.

-Both coun help cli examine understanding of self and world and sugges experiment w/new ways of behaving.

Ellis’s Rational Emotive Behavior Therapy 271

-First of CBT, assumes people contribute to their own psych problems, as well as symptoms by rigid/extreme beliefs they hold.

-Emph cog, emo, and behaviors how they interact signif and have cause/effect rela.

-We are not influenced by the events themselves but rather by our interpretation of them.

-Emotions are created from our beliefs which influence evaluations and interpretation we make and fuel reactions to situations.

-Educational process: large part of ther, coun function is to be like a teacher, collab w/cli on homework and assignments, and intro effective thinking strategies. Cli is a learner who prac new skills.

View of Emotional Disturbance 272

-REBT premise is that we learn irrat’l beliefs from others during childhood and re-create those beliefs throughout life. -Self-defeating behave are reinforced and go unchallenged.

-To Ellis, blame is core of many emot’l disturb.

*We should stop blaming and accept ourselves.

-3 Basic Musts (Irrational beliefs) we internalize that lead to self-defeat: a. I must do well/be loved and approved by others. b. Other ppl must treat me fairly, kindly, well.

c. The world and my living conditions must be comfortable, gratifying, just, provide all that I want.

A-B-C Framework 273

-Central to REBT theory and prac

A exis of activat event/adversity

B belief about a creates c

C emo and behave conseq/reaction of individual.

D encompasses methods to help challenge irrational beliefs.

E effective, healthier practices to implement everyday

-Detect irrational beliefs, question them, minimize irrational beliefs while emph process of disputing beliefs.

The Therapeutic Process 274

-Collab effort from both to choose realistic, life enhancing goals.

-Ther task is to help cli differentiate realistic from unrealistic goals and challenge dysfunctional habits.

-Help cli achieve unconditional self-accept, unconditional other-accep and unconditional life-accept.

Ther function and role

-Show cli how they have incorp unrealistic or irrational beliefs.

-Ther disputes irrational beliefs and encourages cli engage in countering activities.

-Demon how cli are keep emo disturb active by contin to think illogically.

-Help cli change and minimize irrational ideas.

-Ther process is to encourage cli develop rat’l beliefs.

Cli Exper in Ther

-Here and now exper and cli present abil to change

-REBT doesn’t place much value on free assoc, dreams, deal w/transference phenomena.

-Homework designed to get cli carry out more productive actions that change beliefs.

Rela b/w Cli and Coun -Respectful rela is recommended, REBT strive to unconditionally accept cli and teach them to unconditionally accept others.

-Coun takes mystery out of ther, teach cli understand how contin sabotage self and what can do to change.

-REBT prac accept cli as imperfect beings.

Applica: Ther Tech and Procedures 276

REBT

-Diff modalities to dispel self-defeat cog and teach people to acquire rat’l approach to living.

-Ther encourage to be flexible and creative with methods.

Cognitive Methods

-Persuasive cog meths in ther process.

-Demonstrate quick manner what it is cli are telling themselves.

-Disputing irrational beliefs: Most common method, challenge irrational beliefs until no longer hold that belief.

-Doing cog homework: Cli make lists of problems, look for absolutist beliefs, dispute the beliefs.

*Cli record beliefs and think about how they contrib to problems.

*Sessions, evaluate disputing beliefs that aren’t healthy.

-Bibliotherapy

-Changing One’s Language: Cli learn must, oughts, should and replace with healthier, more empowering self-statements.

-Psychoeducational methods: Materials used to educa cli about nature of prob and treatment.

Emotive Techniques

-Imagery: Intense mental prac designed estab new patterns in place of disruptive ones by think healthier ways.

-Rat’l Emotive Imagery: cli are asked to vividly imagine worst things happen and describe disturb feel.

*Devel healthy emo and feelings about self, change.

*Prac in sessions a week for a few weeks reach a point of no longer being disturbed.

-Humor: Don’t take self too seriously.

-Role playing: show cli who they’re telling self to create disturb and do to change unhealthy feelings.

*Play through situate that caus discomfort, anx, etc

-Shame attacking exercises: reduce, minimize feelings of shame, guilt, anx, depression through exercises around self-acceptance and reality.

*Cli learn they can’t control others and learn to not allow others’ reactions to influence them.

Behavioral Techniques 279: -Most standard procedures, operant conditioning, self-management principles, desensitza, relaxation, modeling.

Applica of REBT as Brief Ther: More efficient than others, quickly teaches cli to tackle present and future.

Applica to Group Coun -CBT groups most pop treatments in clinics and community settings.

-Employ active role in encourg members commit selves to practice what learning in everyday life.

a. learn beliefs influ what feel what they do

b. explore ways to change self-defeat thoughts

c. learn minimize symp through profound change.

Aaron Beck’s Cognitive Therapy 281

Intro

-Devel same time as Ellis’s REBT.

-Emph edu and prevention.

-Evidence-based ther approaches devel for many disorders.

-Ellis take on depression: neg bias in interp of certain life events

-Beck: thinking, genetics, neurobiological, or enviro change.

*Negative cognitive triad: Neg views of self (self-criticism), world (pessimism), and future (hopelessness).

-CBT, REBT and BT are all directive, time limited, present, problem-oriented, collab effort.

*CBT also poses people influenced by perceptions/meanings of exper.

-3 assump of CT:

a. thought processes accessible to introspection

b. beliefs have meanings

c. people can discover meaning rather than being taught.

Generic Cognitive Model

-Describe principles pertain to all CT applica from dep and anx treatments and other problems.

-Framework for understanding distress and major principles.

-Distress is an exagg of normal adap human functioning.

-Psych disorder begins when emo/bheav become disproportionate to reality.

-Faulty info processing prime cause of exagg in adaptive emo behave reac

-Several common cog distortions: a. Arbitrary inferences: Conclusions drawn without supporting evidence.

b. Selective abstraction: forming conclu based on isolated detail of an event while ignoring other info.

c. Overgen: holding extreme beliefs and apply inappropriately.

d. Magnification and minimization: perceive greater/lesser than it truly deserves.

e. Personalization: Tendency to relate to events when there’s no basis for making connection.

f. labeling and mislabeling: portray identity on basis of past mistakes and imperfections.

g. Dichotomous thinking: category exper in either or extremes

-Our beliefs play major role in determ what type of psych distress we will exper.

-Central to cognitive therapy is the empirically supported observation that “changes in beliefs

lead to changes in behaviors and emotions”

-Clinical conditions are likely to reoccur if beliefs aren’t modified

Basic Principles of Cognitive Therapy 284

-Emphasizes recognizing and changing unrealistic thoughts and maladaptive beliefs.

-Id dysfunc thoughts, learn practical skills that they can use to make changes in

their thoughts, behaviors, and emotions.

-Focused on pres problems, past used to make connections w/devel of thoughts of thinking.

Some Diff B/W CT and REBT -REBT highly direction, persuasive, confrontational, teaching role of ther.

*Ther help cli id and dispute irrat’l beliefs.

-CT uses socratic dialogue, open-ended questions to cli w/aim get cli reflect on personal issues and arrive at own conclusions.

*CT more epmh on help cli id misconcep for self rather than being taught.

*Collaborative empiricism: Test validity of cognitions.

Diff in How Ellis and Beck view faulty thinking:

-Ellis works persuade cli of certain beliefs are irrational and nonfunctional. -Beck views cli distorted beliefs as result of cog errors rather than driven solely by irrational beliefs.

*cli conduct exper to test accuracy of beliefs.

*people live by rules (underlying assumptions), get into trouble when label, interpret, evaluate set of rules that are unrealistic or when use rules inappropriately or excessively.

*asks cli to examine evidence for and against belief system.

The Client-Therapist Relationship 286

-Basic applica of CT is ther rela

-Effective ther must use empathy and sensitivity w/tech compet

-Rogers person-centered ther conditions necessary but not sufficient.

-Coun delib interactive, help cli frame conclusions and test hypotheses.

-Emph role in self-discovery of cli.

-Id goals and move directly to what’s caus most issues for cli

-Homework continuation of addressing issues

Applications of Cog Ther 287 Most popularly studied/researched

Applying Cog Tech:

-Mainly interested in applying procedures that will assist individuals in making alternative interpretations of events in their daily living and behaving in ways that move them closer to their goals and values

-Help cli make alt interp of events in life and behaving in ways that move closer to goals.

Treatment Approaches: -Thought records: help cli id neg automatic thoughts and to test them.

-Action plan: Coun and cli create plan to solve prob rather than ruminate

-16-20 sesh for depression, 6-12 for panic disorder.

Application to Family Therapy

-CBT approach focus on cognitions, emotions, behavior mutually influenced within fam that can cause dysfunction.

-Schema: key spect of ther, distorted beliefs that influence fam dynamics.

Christine Padesky and Kathleen Mooney’s Strengths-Based Cognitive Behavioral Therapy

-Emphasis on identification and integration of client strengths at each phase of therapy

-Incorporate strengths to encourage cli be more active in therapy and in change.

Basic Principles of Strengths-Based CBT 290

-Empirically based

a. Coun knowledgeable about evidence-based approaches pert to issues disc in ther

b. Cli asked make observant/describe life exper that influ thoughts

c. Coun and cli collab test beliefs and exper w/new behave to achieve goals

-Pos/strengths help integrate into treatment and understanding cli.

-Help cli develop and construct new ways of interacting w/world.

The Cli-Ther Rela 291

-Collab, active, present role of coun, be genuine, caring, willing engage w/cli as full humans.

-Coun don’t take expert stance but serve as curious assistants or guides to cli.

-Shows cli how destructive behaviors are done for self-protective reasons and as attempts to cope.

Applications of Strengths-Based CBT

3 applica:

a. Add on for classic CBT

b. 4 step model build resilience and positive qual

c. New paradigm for chronic diff and personality disorders

-SBCBT add on to classic CBT w/goals to reduce problematic moods, behaviors and difficulties.

-4 step model to build resiliency:

1. search: for strengths

2. construct: discover what obstacles cli encounter while doing activities and how they manage challenges.

3. apply: make plan to use strat to help move towards goals

4. practice: maintain focus on resilience, set goals but maintain motivated while building resiliency.

SB-CBT New Paradigm:

(1) Conceptualize the OLD System of operating and help clients understand they do things “for good reasons,”

(2) construct NEW systems of how clients would like to be,

(3) strengthen the NEW using behavioral experiments to try on NEW ways of being and edit them as needed,

(4) relapse management.

Meichenbaum’s CB Modification 293

-Focuses on changing cli self-talk. ST impacts a cli as much as hearing it from other people.

-Premise: Must notice how think, feel, behave to change behavior.

-Self-Instructional Training: focus more on help cli become aware of self talk.

-Teach cli self-statements and train cli modify instruct they give themselves so can cope more effectively w/prob.

Meich: How Behavior Changes 294

Phase 1: Self-observa: Through ther, cli learn to observe own behave, monitor internal dialogues, self-statements, imagery.

*Imp for depressed cli to realize they aren’t vic of neg thoughts/feelings and can change those.

Phase 2: Starting a new internal dialogue: Learn notice maladaptive behave, begin see opport for alter. Must initiate new behaviors.

*Distress is a funct of dep on faulty cog, emo, behave.

Phase 3: Learn new skills: Cli learn to interrupt neg spiral of thinking, feeling, behave, and coun teaches cli more adaptive ways of coping.

Stress Inoculation Training 295: Motivate to change and deal w/resis or relapse.

-Cli given opport to deal w/relative mild stress stimuli in successful ways and grad develop better tolerance for stronger stimuli.

-We can effectively cope w/stress by modif our beliefs and self-statements.

a. Expose clients to anxiety-provoking situations by means of role playing and imagery

b. Cli to evaluate their anxiety level

c. Teach cli to become aware of the anxiety-provoking cognitions they experience in stressful situations

d. Help cli examine these thoughts by reevaluating their self-statements

e. Have cli note the level of anxiety following this reevaluation

Phases of Stress Inoculation Training

1. Conceptual Edu Phase: Create alliance w/cli, help cli gain better understand of stress, reconcep social-interactive terms. Cli learn role cog and emo play in create/maintain stress in guided self-discov.

2. Skills acquisition: Give cli cope skills to apply to stress. Direct actions, gather info about fears/stressors, learn methods of relaxa/coping and skills training, taught how behaviors linked to inner dialogue. Rehearse a new set of self-statements.

3. Applica and follow-through phase: Arrange transfer and maint change from ther to real life. Homework and work on relapse prevention.

*View relapse as growing opportunities.

Cog Narrative Approach to Cog Behavior Ther 297

-Meich focus on plots, characters, themes in cli stories they tell themselves.

-Coun assumes multiple realities

Behavior Ther from Multicult Perspec 298

Strengths from Diversity Perspec

-Incorporate cult beliefs and values, work together to modify beliefs and practices that don’t serve cli.

-A strength of CBT is integrating assessment of client beliefs, emotional responses, and behavioral choices throughout therapy, which communicates respect for clients’ viewpoints regarding their progress.

Shortcoming from Diversity Perspective 299

-Cli may not respond well to forceful methods of persuasion towards certain things like independence, where dependence is highly valued.

-Avoid directly challenging core cult beliefs.