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