Cognitive Behavior Therapy

1. Cognitive Behavior Therapy

2. Rational Emotive Behavioral Therapy (REBT) • Stresses thinking,judging, deciding, analyzing, and doing • Assumesthat 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 • Teachesthat our emotions stem mainly from our beliefs, evaluations, interpretations, and reactions to life situations

3. Overview • Developed by Albert Ellis in 1955. General REBT is virtually synonymous with cognitive behavior therapy. Preferential or elegant REBT seeks a deeper philosophic change in the client.

4. 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 • 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 Theory and Practice of Counseling and Psychotherapy - Chapter 10 (3)

5. Major philosophies and nature of humans • REBT is a comprehensive approach to treatment and education that employs cognitive, emotive, and behavioral approaches. It advocates a humanistic, educative model of treatment as opposed to a medical model. • Human problems stem not from external events or situations but from people’s views or beliefs about them. People’s emotions stem from their beliefs, evaluations, interpretations, and philosophies about what happens to them, not from the events themselves. (Gilliland & James, p. 232)

6. Irrational Ideas • Irrational ideas lead to self-defeating behavior • Some examples: • The idea that you must have love or approval from all people you find significant. • The idea that you must prove thoroughly competent, adequate, and achieving. Theory and Practice of Counseling and Psychotherapy - Chapter 10 (5)

7. Irrational Beliefs • The idea that when people act obnoxiously and unfairly, you should blame and damn them and see them as bad, wicked or rotten. • The idea that you have to view things as horrible and catastrophic when you get seriously frustrated, treated unfairly or rejected. • The idea that emotional misery comes from external pressures and that you have little ability to control or change your feelings.

8. Irrational Beliefs • The idea that if something seems dangerous or fearsome, you must preoccupy yourself with it and make yourself anxious about it. • The idea that you can more easily avoid facing many life difficulties and self-responsibilities than undertake more rewarding forms of self-discipline. • The idea that your past remains all-important and that because something once strongly influenced your life, it has to keep determining your feelings today.

9. Irrational Beliefs • The idea that people and things should turn out better than they do and that you must view life as awful if you don’t find good solutions to its realities. • The idea that you can achieve maximum human happiness by inertia or inaction or by passively or uncommittedly “enjoying yourself.” (Gilliland & James, p. 245)

10. Major personality constructs • REBT suggests that there is a biological basis for human behavior. • Virtually all humans show evidence of major irrationalities. • No social or cultural group is devoid of irrational behavior. • Many irrationalities run counter to teaching by significant others and society at large. • Irrationality is not exclusive to the mentally challenged,; bright and gifted humans can act irrationally. • Those who may oppose irrational activity and be most aware of it may also fall prey to it. • People often adopt new irrationalities after giving up old ones or go back to an irrational activity after working hard to overcome it. (Gilliland & James, p. 233)

11. Major personality constructs • There is also a social basis for personality. However, it is only because people teach themselves as they aspire to succeed socially and live comfortably within society. (Gilliland & James, p. 234)

12. Nature of “maladaptivity” • Maladaptivity stems from the way people think about things. It is one’s belief system that leads to inappropriate emotional consequences such as rage, depression, and extreme anxiety. (Gilliland & James, p. 237)

13. Major goals of counseling • The overall goal of REBT involves minimizing the client’s central self-defeating outlook and acquiring a more realistic, tolerant philosophy of life. Two other central goals are reducing the client’s anxiety (self-blame) and hostility (blaming others and the world) and teaching clients a method of self-observation and self-assessment that will ensure that this improvement continues. • Thus, a primary goal for counseling is to teach clients to detect and dispute irrational beliefs. • Another long-term goal is to assist clients in becoming involved in activities that are vitally absorbing to them. (Gilliland & James, pp. 241-242)

14. Major techniques/strategies • Major strategies for detecting irrational beliefs include: education, problem exploration, “ferreting out B.” (Gilliland & James, p. 246) • Strategies for disputing irrational beliefs include: debating, discriminating and defining. (Gilliland & James, p. 248)

15. Major techniques/strategies • Cognitive (rational) techniques include: interpretation of defenses, presentation of alternative choices and actions, analogies, parables and metaphors, paralinguistics, therapeutic markers, reduction to absurdity, visual aids, bibliotherapy, contradiction with a cherished value, pragmatic disputes, paradoxical intention, humor and semantic precision. (Gilliland & James, pp. 249-252)

16. Major techniques/strategies • Emotive techniques include: negative imagery, stepping out of character, future imaging, labeling, role playing, and using emotionally charged language. (Gilliland & James, pp. 252-254) • Behavioral techniques include: homework assignments, flooding, penalization, skill training, and practicing and reinforcing positive cognitions. (Gilliland & James, pp. 255-256)

17. Major roles of counselor • The role of the counselor is to help the client discover how they block themselves from pursuing happiness and health and how they can remove those blocks. (Gilliland & James, p. 242) • The counselor is active, directive and confrontive in approaching the client’s needs. (Gilliland & James, p. 244)

18. Major roles of the client • The client’s role is to learn to identify their beliefs and seek ways to eliminate the ways they block themselves from becoming happy and healthy. • Clients may be asked to perform risk-taking activities in which they may intentionally set themselves up to fail to see that the results are not as fearsome as they imagined. They may be given hard tasks so that they can engage in tough activities and learn not to be upset or scared by them. (Gilliland & James, p. 245)

19. 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 Theory and Practice of Counseling and Psychotherapy - Chapter 10 (2)

20. The A-B-C theory Theory and Practice of Counseling and Psychotherapy - Chapter 10 (4)

21. 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 Theory and Practice of Counseling and Psychotherapy - Chapter 10 (6)

22. 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 Theory and Practice of Counseling and Psychotherapy - Chapter 10 (7)

23. CT’s Cognitive Distortions • Arbitrary inferences • Selective abstraction • Overgeneralization • Magnification and minimization • Personalization • Labeling and mislabeling • Polarized thinking Theory and Practice of Counseling and Psychotherapy - Chapter 10 (8)

24. 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 Theory and Practice of Counseling and Psychotherapy - Chapter 10 (9)

25. 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 Theory and Practice of Counseling and Psychotherapy - Chapter 10 (10)

26. 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 Theory and Practice of Counseling and Psychotherapy - Chapter 10 (11)

27. 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 Theory and Practice of Counseling and Psychotherapy - Chapter 10 (12)