Cognitive Behavior TherapyCognitive Behavior Therapy

Dr. Sparrow EPSY 6363

Founders

• Albert Ellis -- Rational Emotive Behavior Therapy (REBT) originated in mid-1950s

• Aaron Beck -- Cognitive Therapy (CT)

• Donald Meichenbaum -- Cognitive Behavior Therapy (CBT)

The Common Ground

• Collaborative relationship

• Psychological distress originates in faulty cognitive processes

• Changing cognitions will change feelings and behaviors

• Short-term educational model

• homework

• client responsibility in and out of session

• variety of technique

Ellis’s REBT• Thoughts, emotions and behaviors have a

reciprocal cause and effect relationship

• We do not need to be loved or accepted.

• People are not disturbed by things, but the view they take of them

• Adlerian:

• social interest

• goals and purposes

• teaching and persuasion

• Emotions follow beliefs, so therapy focuses mainly on changing beliefs

Human Nature and Source of Distress

• Humans are capable of rational lives, but also susceptible to faulty thinking

• We are self-talking, self-evaluating, and self-sustaining

• We mistake our preferences for essential needs

Sources of Faulty Thinking

• Significant others

• Our own thought processes -- superstitions and dogmas

• Assumption that we need acceptance

• Assumption that there’s someone or something to blame

• Our preferences turn into shoulds and musts.

A-B-C Theory of Personality

• A is activating event

• B is belief

• C is emotional and behavioral consequence

• D is disputing (either by therapist or client) -- by detecting, debating, discriminating

• E is effect of intervention, that is, an effective belief system or philosoph

• F is new feeling

Therapeutic Goals of REBT

• Minimizing emotional disturbances

• Acquiring more realistic philosophy

• Acquiring unconditional self acceptance (USA)

• Developing unconditional other acceptance (UOA)

Therapist’s Function

• Encourages and persuades client to change “musts” into preferences

• Demonstrate how client is keeping emotional disturbance active

• Helping client modify thinking

• Challenge client to develop rational philosophy

The Client’s Experience in Therapy

• Learner

• Doer

• Expected to work outside session

• Homework is carefully co-designed

Therapeutic Relationship

• Relationship is minimized

• Therapist models UOA, encouraging clients to do likewise

• Therapist discloses in order to model healthy imperfection

• Transference is challenged as unnecessary, part of irrational beliefs

Interventions of REBT

• Cognitive

• Disputing irrational beliefs

• Doing cognitive homework, making lists of problems, detecting absolutist beliefs and disputing them.

• Client is expected to take risks to overcome negative expectations.

• Changing one’s language

• Using humor, laughing at oneself

Interventions of REBT, continued

• Emotive Techniques

• Rational emotive imagery-- imagining worst case scenarios and feeling appropriate reactions

• Role playing -- noting specific beliefs and feelings that arise as evidence of irrational philosophy

• Shame attacking exercises, going counter to usual efforts to win acceptance

• Use of force and vigor, role playing with therapist

Interventions of REBT, continued

• Behavioral Techniques

• standard behavior therapy techniques, such as operant conditioning, systematic desensitization, etc.

• Research Efforts

• technical eclecticism makes research difficult.

Aaron Beck’s CT• Similar to REBT in that focus is on changing faulty

thoughts and beliefs

• But CT is based on three tenets.

• Client’s internal dialogue can be accessed through introspection

• Beliefs have highly personal meanings, so therapist can’t presume to know what’s best.

• These meanings have to be discovered by the client.

• By accessing cognitive content of upsetting experience, therapist can work with restructuring underlying “core schema.”

Aaron Beck’s CT, continued

• Cognitive distortions

• arbitrary inferences -- conclusions that are without supporting evidence

• selective abstraction -- forming conclusions on the basis of one detail

• overgeneralization

• magnification and minimization

• personalization

• mislabeling

• polarized thinking, all-or-nothing, either-or

Differences Between REBT and CT

• REBT is highly confrontive and focuses on teaching role of therapist. Beck uses an inquiring method.

• Disputes Ellis’s method of confronting irrational beliefs, believing that people think they are being rational.

• Beck prefers collaborative empiricism, arriving at the facts together, so that confrontation can be based on discovery, rather than on therapist’s impressions.

• Beck prefers to see problems as a misapplication of underlying rules that may be okay. Beliefs are not so much irrational as interfering.

Therapeutic Relationship in CT

• Much more emphasis on quality of relationship

• Therapist functions as catalyst and guide

• Client expected to take an active role

• Therapist’s teaching role minimized in favor of supporting client’s role in self discovery

• Client becomes her own therapist

Applications of CT

• Applying CT

• Helping clients become aware of automatic thoughts (cognitive distoritions)

• Helping clients make alternative interpretations

Applications of CT, continued

• Treatment of depression: It’s basis:

• 1) negative self concept

• 2) interpreting experiences negatively

• 3) projection of negativity into future

• Treatment of depression: Interventiosn

• Getting client to do something

• Pointing out “tyranny of shoulds”

• Breaking tasks into manageable units to offset tendency of depressed persons to exaggerate the obstacles

Meichenbaum’s Cognitive Behavior Modification

• Self instructional training helps clients become aware of self talk

• self observation

• starting new internal dialogue

• learning new “coping” skills practiced in real life situations

Meichenbaum’s CBM continued

• Stress management

• stress innoculation

• conceptual -- becoming aware of nature of stress and how they are responding to it, as well as creating it

• skills acquisition and rehearsal -- strategizing new responses

• application -- transfer and maintenance of changes

Contributions of REBT, CT, CBM

• RBT

• Confrontation is important

• Action orientation

• Becoming your own therapist

• CT

• Extremely effective for depression

• focuses on client’s inner world -- existentialist

Contributions of REBT, CT, CBM, continued

• Meichenbaum

• Like CT, based on educational model; dymystifies therapy

• Encourages a working alliance

• Empowers the individual

Limitations of Cognitive Behavioral Approach

• Ellis’s REBT

• Denies past

• Encourages misuse of power

• Beck’s CM and Meichenbaum’s CBM

• simplistic and superficial

• emotions are overlooked

• teaching isn’t only way learning takes place