Cognitive Behavior Therapy

1. Cognitive Behavior Therapy

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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.”

11. 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

12. The A-B-C theory

13. 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

14. Steps to Change Dysfunctional Living • Acknowledge we are responsible for creating own emotional problems • Accepting we have ability to change disturbances significantly • Recognize emotional problems stem from irrational beliefs • Clearly perceive these beliefs • Seeing value of disputing self-defeating beliefs • Accepting fact to change we must work hard in emotive & behavioral ways to counteract irrational beliefs & dysfunctional feelings and behaviors • Use the REBT methods rest of our lives

15. Steps in REBT Therapeutic Process • Show client incorporated irrational beliefs-teach how to separate irrational from the rational beliefs-engage in activities which are not self-defeating • Demonstrate to client keeping emotional disturbance active by illogical thinking • Help client to modify thinking-recognize vicious cycle of self-blaming • Challenge clients to develop rational philosophy of life-dispute core irrational thinking-teach how to replace with rational beliefs

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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