Cognitive Behavior Therapy
Jan 21, 2016
Cognitive Behavior Therapy
Rational Emotive Behavior Therapy
Started by Albert Ellis in 1955-Grandfather of Cognitive Behavior Therapy
Combination of Humanistic & Behavioral Therapy to help deal with issues from past Ellis had chronic renal problems since 9 and
diabetes by 40 Exaggerated fear of public speaking Shy around women
Rational Emotive Behavioral Therapy (REBT) Stresses thinking, judging, deciding, analyzing,
and doing Assumes that cognitions, emotions, and
behaviors interact and have a reciprocal cause-and-effect relationship
Is highly didactic, very directive, and concerned as much with thinking as with feeling
Teaches that our emotions stem mainly from our beliefs, evaluations, interpretations, and reactions to life situations
Assumptions of REBT
People contribute to their own psychological problems & symptoms by way they interpret events & situations
Reorganization of one’s self-statements will result in reorganization of one’s behaviors
Operant conditioning, modeling & behavioral rehearsal applied to thinking & internal dialogue
Commonalities between all Cognitive Behavior Approaches
Collaborative relationship between therapist & client
Premise psychological distress is largely function of disturbance in cognitive processes
Focus on changing cognitions to produce desired changes in affect & behavior
Generally time-limited & educational treatment focusing on specific & structured target problems
Roots of REBT
Epictetus-Greek Stoic Philosopher-1st century A.D.-”People are disturbed not by things, by the view which they take of them.”
Horney’s (1950) “Tyranny of the shoulds” Adler-our emotional reactions & lifestyle are associated
with our basic beliefs & therefore cognitively created role of social interest in determining psychological health Importance of goals, purposes, values & meaning in human
existence Focus on active teaching Use of persuasive methods Giving of live demonstrations in audiences
The Therapeutic Process
Therapy is seen as an educational process
Clients learn: To identify and dispute irrational beliefs that
are maintained by self-indoctrination To replace ineffective ways of thinking with
effective and rational cognitions To stop absolutistic thinking, blaming, and
repeating false beliefs
View of Human Nature We are born with a potential for both rational and
irrational thinking We have the biological and cultural tendency to think
crookedly and to needlessly disturb ourselves Humans are self-talking, self-evaluating & self-sustaining We develop emotional & behavioral problems when we
mistake simple preferences (love, approval, success) for dire needs
We learn and invent disturbing beliefs and keep ourselves disturbed through our self-talk
We have the capacity to change our cognitive, emotive, and behavioral processes
Emotional Disturbance
Through autosuggestion & self-repetition we install & maintain self-defeating beliefs-irrational dogmas & superstitions self-created plus irrational beliefs from significant others
Blame is core of emotional disturbance-so to recover stop blaming self & others
We escalate desires & preferences into dogmatic & absolutist “shoulds, musts, oughts, demands, commands-which are irrational beliefs which need to be changed
Irrational Ideas
Irrational ideas lead to self-defeating behavior
Some examples: “I must have love or approval from all the
significant people in my life.” “I must perform important tasks competently
and perfectly.” “If I don’t get what I want, it’s terrible, and I
can’t stand it.”
A-B-C Theory of Personality A = existence of fact, event, behavior, attitude of
individual B = person’s belief C = emotional & behavioral consequence or reaction
of individual D = disputing intervention-challenge beliefs E = effective philosophy after disputing F = new set of feelings Human beings are largely responsible for creating
their own emotional reactions & disturbances Goal: show people how to change irrational beliefs
that directly “cause” disturbed emotional consequences
The A-B-C theory
D = disputing intervention
Challenges irrational beliefs Use principles of logic-destroy unrealistic,
unverifiable hypotheses Detect~detect the “shoulds”, “I musts”
“awfulizing” “self-downing” Debate~learn to logically & empirically
question beliefs-to argue self out of them Discriminate~irrational-self-defeating
from rational-self-helping beliefs
Steps to Change Dysfunctional Living1. Acknowledge we are responsible for creating own
emotional problems2. Accepting we have ability to change disturbances
significantly3. Recognize emotional problems stem from irrational beliefs4. Clearly perceive these beliefs5. Seeing value of disputing self-defeating beliefs6. Accepting fact to change we must work hard in emotive &
behavioral ways to counteract irrational beliefs & dysfunctional feelings and behaviors
7. Use the REBT methods rest of our lives
Steps in REBT Therapeutic Process
1. Show client incorporated irrational beliefs-teach how to separate irrational from the rational beliefs-engage in activities which are not self-defeating
2. Demonstrate to client keeping emotional disturbance active by illogical thinking
3. Help client to modify thinking-recognize vicious cycle of self-blaming
4. Challenge clients to develop rational philosophy of life-dispute core irrational thinking-teach how to replace with rational beliefs
Methods used in REBT Disputing irrational beliefs Doing cognitive homework Changing one’s language Using humor Rational emotive imagery Role playing Shame-attacking exercices Use of force & vigor Desensitization Skills training Assertiveness training
Aaron Beck’s Cognitive Therapy (CT) Insight-focused therapy Emphasizes changing negative thoughts and
maladaptive beliefs Theoretical Assumptions
People’s internal communication is accessible to introspection
Clients’ beliefs have highly personal meanings These meanings can be discovered by the client
rather than being taught or interpreted by the therapist
Cognitive Distortions identified in CT
Arbitrary references-catastrophizing Selective abstraction-total context missed Overgeneralization-extreme belief based on
single episode Magnification & minimization Personalization-relate external event to self Labeling & mislabeling-identity based on
imperfections or mistakes in the past Polarized thinking-all or nothing at all thinking
Theory, Goals & Principles of CT Basic theory:
To understand the nature of an emotional episode or disturbance it is essential to focus on the cognitive content of an individual’s reaction to the upsetting event or stream of thoughts
Goals: To change the way clients think by using their automatic
thoughts to reach the core schemata and begin to introduce the idea of schema restructuring
Principles: Automatic thoughts: personalized notions that are triggered
by particular stimuli that lead to emotional responses
CT’s Cognitive Triad
Pattern that triggers depression: 1. Client holds negative view of themselves 2. Selective abstraction: Client has tendency
to interpret experiences in a negative manner 3. Client has a gloomy vision and projections
about the future
Donald Meichenbaum’s Cognitive Behavior Modification (CBM)
Focus: Client’s self-verbalizations or self-statements
Premise: As a prerequisite to behavior change, clients
must notice how they think, feel, and behave, and what impact they
have on others Basic assumption:
Distressing emotions are typically the result of maladaptive thoughts
Meichenbaum’s CBM
Self-instructional therapy focus: Trains clients to modify the instructions they give to
themselves so that they can cope Emphasis is on acquiring practical coping skills
Cognitive structure: The organizing aspect of thinking, which seems to
monitor and direct the choice of thoughts The “executive processor,” which “holds the
blueprints of thinking” that determine when to continue, interrupt, or change thinking
Behavior Change & Coping (CBM)
3 Phases of Behavior Change 1. Self-observation 2. Starting a new internal dialogue 3. Learning new skills
Coping skills programs – Stress inoculation training (3 phase model) 1. The conceptual phase 2. Skills acquisition and rehearsal phase 3. Application and follow-through phase
Constructivist Narrative Perspective (CNP)
Focuses on the stories people tell about themselves and others about significant events in their lives
Therapeutic task: Help clients appreciate how they construct
their realities and how they author their own stories