CHAPTER 10

LUCY HESTER & CLAIRE NAWOJCHIK

Cognitive Behavior Therapy

Key People

Albert Ellis (1913-2007) Rational Emotive Behavior Therapy (REBT)

Aaron Temkin Beck (1921-) Cognitive Therapy (CT) Founded Beck Institute

Judith S. Beck (1954-) Daughter of Aaron Beck; Co-Founder/President Beck

Institute Donald Meichenbaum (1940-)

Cognitive Behavior Therapy (CBT) Constructivist Narrative Therapy

All Cognitive Behavior Therapies Share:

Collaboration between therapist and clientIdea that psychological distress is caused by

disturbances in cognitive processesFocus on changing cognitions to produce

desired changes in affect and behaviorPresent-centered, time-limited focusAn active and directive stance by the

therapistEducational treatment focusing on target

problems

Ellis’s Rational Emotive Behavior Therapy

First of the cognitive behavior therapies (1955)

Peoples beliefs about events shape their emotions and irrational beliefs contribute to problems

Cognitions, emotions, and behaviors have a cause-and-effect relationship

Therapy is educational: therapist is teaching healthy thinking skills, client is practicing in homework/life

Focus on thoughts and actions rather than emotion

Key Concepts

View of Human Nature People born with potential for rational and irrational

thinking Have positive and negative predispositions People are encouraged to accept their imperfections

View of Emotional Disturbance People blame themselves when they do not fulfill the

irrational beliefs internalized in childhood. “Shoulds” and “musts” --three basic musts Learn to be less emotionally reactive—sad but not

depressed

A-B-C Framework

A person’s beliefs about an event rather than an event itself shapes their emotional reaction

Detect, debate, discriminateCognitive restructuring: replace irrational beliefs with

rational beliefsDisputing irrational beliefs leads to a new, effect

philosophy

A (activating event) B (belief) C (emotional and behavioral consequence) D (Disputing intervention) E (effect) F (new feeling)

The Therapeutic Process

Therapeutic Goals Separating evaluation of behaviors from evaluation of

self Unconditional Acceptance of Self and Others (USA/UOA)

Therapist’s Function and Role Therapist teaches client to modify irrational thinking and

develop a sustainable rational philosophy and skills for future

Client’s Experience in Therapy Focus on present ability to change irrational patterns Homework

Relationship Between Client and Therapist Self-disclosure, acceptance, egalitarianism

Application

Cognitive Methods: dispute irrational beliefs, do cognitive homework, bibliotherapy, change one’s language, psychoeducational methods

Take risks to challenge self-limiting beliefsEmotive Techniques: Rational emotive

therapy, humor, role playing, shame-attacking exercises

Behavioral Techniques: homework—client desensitizes themselves through real-world practice

Beck’s Cognitive Therapy

Came out of research on depressionSimilarities with REBT and Behavior TherapyProblems come from: faulty thinking, failure

to distinguish between fantasy and reality, making false assumptions

Schema restructuring based on cognitive content of stream of thoughts surrounding upsetting events

Theoretical underpinnings: Introspection, beliefs with personal meanings, discovery and interpretation of meaning by client

CBT and Learning Disabilities… Beck in Action

Key Concepts

Automatic thoughtsCognitive distortions—arbitrary inferences,

selective abstraction, overgeneralization, magnification and minimization, personalization, labeling and mislabeling, dichotomous thinking

What is the evidence for _____?Therapist teaches client to identify

dysfunctional thinking, evaluate and replace with rational thought

Focus on present problems Collaborative empiricism

Compare to REBT

Similar emphasis on reality-testingTeacher/student (REBT) vs. Socratic dialogue

(CT) REBT is directive, persuasive, confrontational CT helps clients self-reflect and make their own

conclusionsIrrational, non-functional thoughts (REBT) vs.

Inaccurate thoughts (CT) REBT uses rational disputation CT therapist suggests alternate “rules”

Application

CT has been applied to a wide variety of disordersUse of alternative interpretationsApplications to Depression

Cognitive triad: negative view of self, negative interpretation of experiences, negative projection of the future

Selective abstraction Beck Depression Inventory (BDI)

Applications for Family Therapy Schema (core beliefs) – “family schemata” Family relationships, cognitions, emotions, and behavior

exert mutual influence on one another

The Beck Institute

http://www.beckinstitute.org/Aaron and Judith Beck’s CBT training and

resource center, located in PhiladelphiaMission: “To encourage the growth and

dissemination of CBT throughout the world through leadership in the field and through the provision of professional training, outpatient clinical services, and research”

Soldier Suicide Prevention ProgramThe Beck Diet Solution

Meichenbaum’s Cognitive Behavior Modification

Focus on changing self-verbalizations, which affect behavior as much as others’ comments

Self-instructional training: Help clients become aware of self-talk, self-instruction, and the stories they tell about themselves

Behave our way into a new way of thinkingPractice in role-play situations of daily

problemsBehavior change: Self-observation, start new

internal dialogue, learn new skills

Stress Inoculation Training (SIT)

Gradually develop a tolerance for stress stimuli

Modify our beliefs and self-statements about our performance in stressful situations

Conceptual-educational phase: Teach clients to be aware of their own role in their stress; self-monitor

Skills acquisition and consolidation phase: Acquire and rehearse new self-statements and behavior

Application and follow-through phase: Practice increasingly demanding “homework”; relapse prevention and follow-up sessions

The Constructivist Approach to CBT

Constructivist narrative perspective (CNP): Focus on stories people tell about significant life events

Clients construct their own realitiesEmphasis on past development, deep core

beliefs, and behavioral/emotional impactClients’ stories show how they view

themselves, their world, and their futureTell the “rest of the story” – survival and

copingUse positive metaphors to describe self

Multicultural Perspective

Strengths: Use individual’s belief system for self-exploration Individualized, structured, active, and participatory Learn practical skills for daily life Focus on influence of external environment

Limitations: REBT’s negative view of interdependence Therapists may be too direct or confront too quickly Too much focus on present, not enough on past Emphasis on assertiveness and change (instead of

acceptance)

Compare/Contrast

In contrast to Psychoanalytic: No free association or emphasis on dreams, less focus on past history, & no significant exploration of feelings and transference

Comparison to Person-Centered & Existential: Focus on the here and now

Comparison to Person-Centered: Unconditional positive regard

Summary

Cognitive processes determine behaviorClients’ feelings and behavior influenced by

their subjective interpretation of eventsReorganization of one’s self-statements will

result in reorganization of one’s behaviorInterconnectedness of thinking, feeling, &

behavingClient assumes active roleEmphasis on homework and practice

Strengths

Changes clients subjective views of themselvesClients identify and challenge basic beliefsHomework—putting change into actionCollaborative therapist-client relationshipDemystification of therapy processREBT: teaching clients to carry on their own

therapy Tapes, self-help books, workshops, behavior/thought records

Beck: wide range of clinical populations, bringing private experience into realm of scientific inquiry

Meichenbaum: self-instruction, stress-innoculation

Limitations

Practice is especially vulnerable to therapist’s skill level and techniques

Limited focus on past experiencesREBT: confrontational style difficult w/out

rapportCT: too strong on positive thinking, too

superficial and simplistic, eliminating symptoms w/out looking at root causes

Meichenbaum: Is teaching a client less effective than allowing them a process of self-discovery?

References

BeckInstitute (2012, January 6). CBT and Learning Disabilities. Retrieved October 29, 2012, from http://www.youtube.com/watch?v=dD7DlOfeKo0

Corey, C. (2013). Theory and Practice of Counseling and Psychotherapy, Ninth Edition. Belmont, CA: Brooks/Cole.

http://www.beckinstitute.org/