Cognitive Therapy

1. Cognitive Therapy • Rational Emotive Behavior Therapy • Albert Ellis • Cognitive Therapy • Aaron Beck

2. Cognitive Processing Situation/ Event Response: Behavioral Emotional Cognitive

3. Rational Emotive Behavior Therapy

4. Rational Emotive Behavior Therapy (REBT) • Originally known as Rational Emotive Therapy (RET). • Changed its name when its founder, Albert Ellis, decided it needed to be more reflective of focusing on behavior as well as cognitions. • Ellis, a Columbia trained clinical psychologist, formulated this treatment after deciding that psychoanalysis was inefficient.

5. View of Human Nature/Personality • Assumes that people are both rational and irrational, sensible and crazy. • This duality is biological and is perpetuated unless a new way of thinking is learned.

6. View of Human Nature • Although Ellis does not deal with developmental stages, he does think that children are more vulnerable to outside influences and irrational thinking than adults. • Believes that human beings are gullible and highly suggestible and are easily disturbed. • People have within themselves the ability to control thoughts, feelings and behavior; but they must first become aware of their self-talk.

7. Irrational Beliefs and Emotional Disturbance Ellis places irrational beliefs into three categories correlated with emotional disturbance. • “I absolutely must perform important tasks well and be approved by significant others or else I am an inadequate, pretty worthless person” • RESULT: Severe feelings of anxiety, depression, and demoralization often leading to severe inhibition.

8. Irrational Beliefs and Emotional Disturbance • “Other people, especially my friends and relatives, truly must treat me kindly and fairly, or else they are rotten, damnable people” • RESULT: Severe feelings of anger, rage, fury, often leading to fights, child abuse, assault, rape, murder and genocide.

9. Irrational Beliefs and Emotional Disturbance “The condition under which I live absolutely must be comfortable , unhassled, and enjoyable, or else it’s awful, I can’t stand it, and my life is hardly worth living!” RESULT: Severe feelings of low frustration tolerance, often leading to compulsion, addiction, avoidance, inhibition, and public reaction.

10. REBT’s Theory of Therapeutic Processes • Consciousness raising (aware of irrational thinking patterns) • Counterconditioning (replace irrational thinking with rational thinking) • Contingency management (rearrange reinforcements to support behavior changes) Copyright © 2007 Brooks/Cole, a division of Thomson Learning, Inc.

11. Roles of the Counselor/Therapist • Active and direct interaction. • Instructors who teach and correct client cognitions. • Main assessment instrument is evaluation of a client’s thinking. • Do not rely heavily on DSM diagnostic categories.

12. Therapeutic Goals • Primary goal is to help people realize they can live more rational and productive lives. • Avoid having more of an emotional response to an event than is warranted. • Help people change self-defeating habits of thoughts or behavior. • Encourage clients to be more tolerant of themselves rather than dwell on mistakes or miscues.

13. Therapeutic Content Intrapersonal Conflicts • Anxieties and defenses • Self-esteem • Responsibility Interpersonal Conflicts • Intimacy and sexuality • Communication • Hostility • Control Copyright © 2007 Brooks/Cole, a division of Thomson Learning, Inc.

14. Therapeutic Content (cont.) Indivduo-Social Conflicts • Adjustment versus transcendence • Impulse control Beyond Conflict to Fulfillment • Meaning of life • Ideal individual Copyright © 2007 Brooks/Cole, a division of Thomson Learning, Inc.

15. Techniques • Before changes can be made, clients must learn the basic ideas of REBT and understand how thoughts are linked with emotions and behaviors. • Highly didactive and very directive. • Counselors teach their clients the anatomy of an emotion – feelings are a result of thoughts, not events, and self-talk influences emotion. • This is known as Rational Emotive Education (REE). • Critical for clients to be able to dispute irrational thoughts.

16. Disputing Thoughts or Beliefs • Cognitive Disputation - the use of direct questions, logical reasoning, and persuasion. • May challenge clients to prove their responses are logical. • May incorporate the use of “Why?” questions.

17. Disputing Thoughts or Beliefs • Imaginal Disputation - relies on the client’s ability to imagine. • Employs a technique called rational emotive imagery (REI). • Client imagines a situation likely to be upsetting and examines his/her self-talk.

18. Disputing Thoughts or Beliefs • Behavioral Disputation - involves behaving in a way that is the opposite of the client’s usual way of thinking. • If successful, a new Effective Philosophy will emerge. This process is most effective when all three methods of disputation are used in conjunction.

19. Additional REBT Techniques Two additional effective REBT techniques are confrontation and encouragement.

20. Strengths and Contributions • Clear, easily learned and effective. • Can be easily combined with other behavioral techniques to help clients more fully experience what they are learning. • Relatively short-term. • Has generated a great deal of research and literature. • Has continued to evolve over the years as its processes and techniques have been refined.

21. Limitations and Criticisms • Not effective for individuals with mental problems or limitations such as schizophrenics and those with severe thought disorders. • May be too closely associated with its founder Albert Ellis. • Limited usefulness if not combined with behavioral or emotive techniques. • REBT’s direct and confrontive way of working with clients is a limitation for some. • May not be the simplest way of helping clients change behaviors or emotions.

22. Cognitive Therapy Aaron Beck

23. Aaron Beck • A Philadelphia psychiatrist who was originally trained as a psychoanalyst. • His approach to mental disorders emphasizes the importance of cognitive thinking, especially dysfunctional thoughts. • Found that cognitive therapy is effective as a short-term treatment for depression and general anxiety.

24. Beck’s Theory of Psychopathology • Maladaptive cognitions & dysfunctional attitudes cause psychopathology • Negative Automatic Thoughts • Maladaptive Schemas • Cognitive distortions are not irrational per se, but too absolute or broad • Underlying cognitions vary specifically with behavioral disorder (cognitive specificity) • These individuals often engage is self-statements that affect their behavior • The outcome is negative emotion and maladaptive behavior that reinforces faulty cognitions

25. Cognitive Distortions • “All or Nothing” Thinking • Selective Abstraction • Overgeneralization • Magnification • Minimization • Personalization • Labeling (Mislabeling) • Catastrophizing • Mind-reading • Negative Predictions

26. Role of the Therapist • Collaborative empiricism • Shared mission to determine dysfunctional thoughts and pursue better ones • Function as experts on cognitions, behaviors, and emotions. Client is expert on self • Therapist engenders responsible dependency in client • Therapist provides support and direction; however, empathy is not necessary or sufficient for success

27. Goals • Primary goal is to teach clients ways to monitor their negative or automatic thoughts. • Recognize the relationship between thoughts and emotions or behavior. • Compile evidence for and against the distorted automatic thoughts.

28. Process and Techniques • Specific and goal-directed. • Emphasizes modification of thoughts in order to bring about therapeutic changes. • Thought organization • Cold cognition – descriptive and non-evaluative • Warm cognition – preferences and non-preferences • Hot cognition – heavily-laden emotional-demand statements

29. Prevalent Cognitive Techniques • In session work & homework • Specifying automatic thoughts. • Cognitive interventions. • Challenging absolutes. • Reattribution. • Labeling of distortions. • Challenging “All or Nothing” thinking. • Cognitive Restructuring/Rehearsals.

30. Basic Questions of Cognitive Restructuring • What’s the evidence? • What’s another way of looking at it? • So what if it happens? Copyright © 2007 Brooks/Cole, a division of Thomson Learning, Inc.

31. Therapeutic Processes • After symptoms begin to subside, tx shifts to underlying cognitions • Identification of problematic schemas and their remediation • Successful clients pass through stages • Become aware of thinking • Recognize what thoughts are awry • Substitute accurate for inaccurate judgments • Receive feedback on effectiveness of change

32. 4 Step Procedure of Implementing Cognitive Strategies • Use standardized guidelines for understanding in a concrete manner the events in people’s lives. • Set up a way of recording or reflecting people’s thoughts about those events in order to understand their cognitions in a clear, precise way. (Thought Record) • Counselors and clients work to find a means to identify and challenge distorted thoughts. • Implement new ways of thinking that are realistic and productive.

33. Strengths and Contributions • Focused on teaching how to identify and monitor thoughts and behaviors and how to change or modify them. • Proactive in nature. • Demystify the process and techniques that are associated with choice and change. • Generally empowering. • Applicable to a wide range of disorders.

34. Limitations and Criticisms • Hypothesized mechanism of change doesn’t always change even though the client is approved • Might the active ingredient be behavioral activation • For maximum benefit, clients need to have average or above-average intelligence. • Clients must be willing and able to complete systematic homework assignments. • Do not explore past influences including the unconscious or underlying conflicts.