Theory and Practice of Counseling and Psychotherapy

Psych422

Chapter10: Cognitive Behavior Therapy

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

View of Human Nature We are born with a potential for both rational and

irrational thinking We are self-talking, self-evaluating, and self-

sustaining. We have an inborn tendency toward growth and

actualization 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

View of Emotional Disturbance We learn irrational belief from significant other during

childhood Teach clients to feel undepressed even when they are

unaccepted and unloved by significant others. Blame is at the core of most emotional disturbances Irrational idea (e.g., I must be loved by everyone)

internalize self-defeating We have a tendency to make ourselves emotionally

disturbed by internalizing self-defeating beliefs

The A-B-C theory of personality

Case discussion 1 Tom, a college sophomore, want to overcomes

his shyness around women. He doe not date and even des his best to keep away from women because he is afraid they will reject him. But he want to change this pattern. Using A-B-C-D-E-F to analyze and help Tom

Case discussion 2 Mary would like to take a course in

creative writing, but she fears that she has no talent. She is afraid of failing, afraid of being told that she is dumb, and afraid of follow through with taking the course. Using A-B-C-D-E-F to analyze and help

Mary

Case discussion 3 Each week John comes to his sessions with a new excuse

for why he has not succeeded in following through with his homework assignments. Either he forgets, gets too busy, gets scared. Or puts it off—anything but actually doing something to change what he says he wants to change. Instead of really doing much of anything, he whines each week about how rotten he feels and how he so much would like to change but just doesn’t know how. What are the possible irrational beliefs, which keep

John from taking actions What homework assignment might you suggest?

Case discussion 4 Brent feels that he must win everyone’s approval.

He has become a “super nice guy” who goes out of his way to please everyone. Rarely does he assert himself, for fear that he might displease someone who then would not like him. What are the possible irrational beliefs? How do you help Brent? If Brent is Asian American, what cultural

components you might take into account?

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.”

The Therapeutic Process Therapy is seen as an educational process Clients learn

To identify and dispute irrational beliefs To replace ineffective ways of thinking with

effective and rational cognitions To stop absolutistic thinking, blaming, and

repeating false beliefs

Therapeutic Goals A basic goal is to teach clients how to change

their dysfunctional emotions and behaviors into health ones.

Two main goals of REBT are to assist clients to achieving unconditional self-acceptance and unconditional other acceptance. As clients become more able to accept themselves,

they are more likely to unconditionally accept others.

Therapist’s function and Role 1. Encouraging clients to discover their irrational

beliefs and ideas 2. Making connection of how these irrational

beliefs lead to emotional disturbances 3. Challenging clients to modify or abandon their

irrational beliefs. 4. Dispute the irrational beliefs and substitute

rational beliefs and behaviors.

Client’s Experience in Therapy A learner---learn how to apply logical thoughts,

experiential exercises, and behavioral homework to problem solving and emotional change.

Focus on here-and-now experiences Not spend much time to exploring clients’ early

history and connecting present and past Expect to actively work outside the therapy

sessions.

Relationship Between Therapist and Client Intensive therapeutic relationship is not required. But,

REBT unconditionally accept all clients and teach them to unconditionally accept others and themselves. (accept them as persons but confront their faulty thinking and self-destructive behaviors)

Ellis believes that too much warmth and understanding can be counter-productive, fostering dependence for approval.

Therapists shows great faith in their clients’ ability to change themselves.

Open and direct in disclosing their own beliefs and values Transference is not encouraged, when it occur, the therapist

is likely to confront it (e.g., clients believe that they must be liked and loved by their therapists.)

Therapeutic techniques and procedures Cognitive methods

Disputing irrational beliefs If I don’t get what I want, it is not at the end of the world

Doing cognitive homework Applying ABC theory in daily life’s problems Put themselves in risk-taking situations to challenge their self-

limiting beliefs. Replace negative self-statement to positive message

Changing one’s language It would be absolutely awful..It would be inconvenient

Using humor Humorous songs

Therapeutic techniques and procedures Emotional Techniques

Rational-emotional imagery Imagine the worst things that could happen to them

Role playing Shame-attacking exercises

Take a risk to do something that they are afraid to do because of what others might think…until they realize that their feelings of shame are self-created.

Use of force and vigor From intellectual to emotional insight Reverse role playing

Therapeutic techniques and procedures

Behavioral Techniques Use most of the standard behavioral therapy

approaches. Research Efforts

Most studies focus only on cognitive methods and do not consider emotive and behavioral methods.

Applications of REBT REBT has been widely applied to several

areas: anxiety, depression, psychotic disorders, problems of sex, love, and marriage, crisis, couple and family therapy…

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, 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: Observe automatic thoughts, identify cognitive distortions, and

ask for evidences for reality testing the cognitive distortions

CT’s Cognitive Distortions Arbitrary inferences

Making conclusions without supporting and relevant evidence

Selective abstraction Forming conclusions based on an isolated detail of an

event

Overgeneralization Based on one single incident and applying them to

dissimilar events

CT’s Cognitive Distortions Magnification and minimization

Perceiving a case or situation in a greater or lesser light than it truly deserves

Personalization Relate external events to themselves even when there is

no basis for the connection. Labeling and mislabeling

Portraying one’s identity on the basis of imperfections or mistakes made in the past

Polarized thinking Thinking in all-or-nothing terms

The Client-Therapist Relationship Therapeutic relationship is necessary, but not

sufficient, to produce therapeutic effect. Encourage clients to take an active role in self-

discovery. Aim to teach client how to be their own therapist,

educate clients about the nature of their problem, about the process of cognitive therapy, and how thoughts influence their emotions and behaviors.\

Use homework to test their beliefs in daily-life situations

CT’s Cognitive Triad Pattern that triggers depression:

1. Client holds negative view of themselves and blames 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

Application of CT Treatment of depression and anxiety Managing stress, in parent training,

and in treating various clinical disorders

Donald Meichenbaum’s Cognitive Behavior Modification (CBM) Focus:

Changing 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

How Behavior Changes? 3 Phases of Behavior Change

1. Self-observation Listen to themselves, realize they contribute to

their depression through how they think, and develop new cognitive structures

2. Starting a new internal dialogue See adaptive behavioral alternatives

3. Learning new skills Teaching more effective coping skills

Coping Skills Programs Coping skills programs – Stress inoculation

training (3 phase model) 1. The conceptual phase

Creating a working relationship with clients

2. Skills acquisition and rehearsal phase Giving coping skills to apply to stressful situations

3. Application and follow-through phase Transfer change to real world

From a multicultural perspective Contributions

Diverse populationsappreciate the emphasis on cognition and actions

Challenge rigid thinking (e.g., “should”) instead of questioning the values

Stress the relationship of individuals to the family, community, and systems

From a multicultural perspective Limitations

Exploring core beliefs is important in CBT-needs to sensitive to cultural background and context Value “working hard”feel ashamed for not living up to

the expectations; divorcebring shame to her family

Diverse clients may be hesitant to question their basic cultural values

Diverse clients may value interdependence and may feel difficult to be independent

Summary and Evaluation Contributions

REBT: focus on how we interpret and react to the events; put insight into action; teach clients ways to carry out their own therapy without depending on therapists

CT: research support that CT is as empirically validated treatment; focus on a detailed case conceptualization to understand clients; is an eclectic psychotherapy

Summary and Evaluation Limitations

Ellis: being too confrontational; ignoring “past”; power imbalance

CT: focusing too much on positive thinking, being too simplistic, denying past, being too technique-oriented, failing to use the therapeutic relationship, working only to reduce symptoms, failing to explore the underlying causes of difficulties, ignoring unconscious factors and emotions.