11

Chapter 10: Cognitive Behavioral Therapy

Ellis’s Rational Emotive Behavior Therapy (REBT)

• Assumes that cognitions, emotions, and behaviors interact in a reciprocal cause-and-effect relationship.

• Emphasizes that emotions primarily stem from beliefs, evaluations, interpretations, and reactions to life situations.

REBT Key Concepts: Irrational Beliefs

• Irrational beliefs are learned from significant others during childhood.

• Such beliefs are recreated and perpetuated throughout life.

REBT Key Concepts: The A-B-C Framework

• A: Activating Event or Adversity

• B: Beliefs about the Event

• C: Consequences or Emotional Response

• D: Disputations to challenge irrational beliefs.

• E: Effective new beliefs replace irrational ones.

REBT Therapeutic Goals

• Collaborative effort between therapist and client.

• Aim to transform dysfunctional emotions and behaviors into healthy responses.

• Assist in achieving:

  1. Unconditional Self-Acceptance (USA)

  2. Unconditional Other-Acceptance (UOA)

  3. Unconditional Life-Acceptance (ULA)

The Role and Function of the Therapist

• Help clients identify and address irrational, absolute thoughts.

• Show how clients maintain emotional disturbances through illogical thinking.

• Facilitate a change in thinking to minimize irrational beliefs.

• Encourage development of a rational life philosophy to prevent future irrational beliefs.

REBT Client Experiences

• Focus on clients' present experiences, with minimal emphasis on free association or dream analysis.

• Encourage active client participation outside therapy sessions.

• Design and agree on homework that reinforces therapeutic concepts.

REBT Therapeutic Relationship

• While a warm relationship is not essential, it may assist certain clients.

• Therapist provides unconditional acceptance as a model for clients' self-acceptance.

• Frequent acknowledgment of client progress is crucial.

REBT Therapeutic Techniques

Cognitive Methods

• Dispute irrational beliefs.

• Engage in cognitive homework.

• Use self-help forms and bibliotherapy.

• Change language and incorporate psychoeducational methods.

Emotive Methods

• Rational emotive imagery.

• Employ humor and role-playing.

• Conduct shame-attacking exercises.

Behavioral Methods

• Incorporate standard behavior therapy procedures:

  • Operant Conditioning Principles.

  • Self-management techniques.

  • Systematic desensitization and relaxation techniques.

  • Modeling and behavioral homework.

Cognitive Therapy (CT)

• Developed by Aaron Beck, focused on clients' cognitive errors.

• Primarily addresses present problems.

Negative Cognitive Triad

• Clients hold negative views about:

  • Self: "I'm worthless."

  • The World: "Everyone is against me."

  • The Future: "I'll never succeed."

The Generic Cognitive Model

• Principles applicable to all CT applications include:

  1. Psychological distress is an exaggeration of normal functioning.

  2. Faulty information processing leads to exaggerated emotional and behavioral reactions.

  3. Beliefs significantly influence the type of psychological distress experienced.

  4. Changes in beliefs lead to changes in behavior and emotions.

  5. Unmodified beliefs risk recurrence of clinical conditions.

CT’s Cognitive Distortions

• Arbitrary Inferences: Conclusions drawn without evidence.

• Selective Abstraction: Focusing on isolated details and ignoring other relevant information.

• Overgeneralization: Applying extreme beliefs based on a single incident.

• Magnification/Minimization: Distorting perception of situations.

• Personalization: Relating external events directly to oneself.

• Labeling/Mislabelling: Defining identity based on past imperfections.

• Dichotomous Thinking: Categorizing experiences in black-and-white terms.

The Therapeutic Relationship in CT

• Essential therapeutic conditions from Rogers's Person-Centered Approach are necessary but not sufficient:

  • Congruence

  • Unconditional positive regard

  • Accurate empathic understanding

• Cognitive therapists are interactive and creative with emphasis on client self-discovery.

CT Applications

• Length and course of CT vary and depend on protocol for specific diagnoses.

• Proven to be more effective than medications for depression and anxiety in children.

• Effects are more enduring and relapse is less common compared to medications.

Strengths-Based Cognitive Behavioral Therapy (SB-CBT)

• Developed by Christine Padesky and Kathleen Mooney.

• Integrates Beck’s CT with a focus on client strengths at each phase of therapy.

• Therapists maintain a collaborative and client-centered approach.

SB-CBT Applications

1. Acts as an add-on to classic CBT.

2. Builds resilience and positive qualities through a four-step model.

3. Helps clients conceptualize their old systems of operating, construct new systems, and manage relapse.

Cognitive Behavior Modification (CBM)

• Developed by Meichenbaum, it emphasizes changing self-talk.

• Clients must observe their thoughts, feelings, reactions, and their impact on others.

• Assumes distressing emotions arise from maladaptive thoughts.

Behavior Change in CBM

• Three phases:

  1. Self-observation.

  2. Initiating a new internal dialogue.

  3. Learning new skills.

CBM’s Stress Inoculation Training (SIT)

• Combines information giving, cognitive restructuring, problem-solving, relaxation training, and behavioral rehearsals.

• Three phases:

  1. Conceptual-educational phase.

  2. Skills acquisition and consolidation.

  3. Application and follow-through.

CBT Limitations

• Requires extensive training for practice.

• Risk of power misuse by imposing therapists' rational thoughts.

• Ellis’s confrontational style may overwhelm some clients.

• Some clinicians believe CBT overlooks past experiences.

CBT Contributions

• Both Ellis’s REBT and Beck’s CT are systematic, brief, and structured therapies, known for their cost-effectiveness.

• They have demystified therapy processes and the model's credibility stems from empirical testing.

• Emphasizes practicing new skills both in therapy and in daily life alongside homework.