Transcript Clinical and Counseling Psychology

Cognitive Behavior Therapy
Rational Emotive Behavior
Therapy
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Started by Albert Ellis in 1955-Grandfather
of Cognitive Behavior Therapy
Combination of Humanistic & Behavioral
Therapy to help deal with issues from past
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Ellis had chronic renal problems since 9 and
diabetes by 40
Exaggerated fear of public speaking
Shy around women
Rational Emotive Behavioral
Therapy (REBT)
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Stresses thinking, judging, deciding, analyzing,
and doing
Assumes that cognitions, emotions, and
behaviors interact and have a reciprocal causeand-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
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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
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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
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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
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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
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Therapy is seen as an educational
process
Clients learn:
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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
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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 & selfsustaining
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
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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
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Irrational ideas lead to self-defeating
behavior
Some examples:
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“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
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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
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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 Living
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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
Steps in REBT Therapeutic Process
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Show client incorporated irrational beliefsteach 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
Methods used in REBT
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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)
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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
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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
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Basic theory:
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Goals:
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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
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:
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Automatic thoughts: personalized notions that are
triggered by particular stimuli that lead to emotional
responses
CT’s Cognitive Triad
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Pattern that triggers depression:
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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)
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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
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Self-instructional therapy focus:
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Trains clients to modify the instructions they give to
themselves so that they can cope
Emphasis is on acquiring practical coping skills
Cognitive structure:
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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)
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3 Phases of Behavior Change
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Self-observation
Starting a new internal dialogue
Learning new skills
Coping skills programs – Stress inoculation
training (3 phase model)
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The conceptual phase
Skills acquisition and rehearsal phase
Application and follow-through phase
Constructivist Narrative
Perspective (CNP)
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Focuses on the stories people tell about
themselves and others about significant
events in their lives
Therapeutic task:
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Help clients appreciate how they construct
their realities and how they author their own
stories