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-1 ”People are disturbed not by things, by the view which they take of them.” st century A.D. 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

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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

Steps in REBT Therapeutic Process

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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

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.

 2.

 3.

The conceptual phase Skills acquisition and rehearsal phase 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