Cognitive Behavioral Therapy

Rational vs Irrational Thinking

Essential Concepts

Thinking Feeling Behavior

This is an Automatic Process

Merges Cognitive Principles with Behavioral Approaches

Psychological distress is due to disturbances in the cognitive process

ABC’s of CBT and RET

A= activating event B= belief about event C= emotional and behavioral consequence

Ellis Rational Emotive Therapy and Interventions

A (event) - B (beliefs ) C (consequence)

D (disputing intervention) E (effect)

F (New Feeling)

Examples of Beck’s Biases in Thinking

Depression – negative view of self, experience, and future

Hypomania- Inflated view of self and future Anxiety- Sense of physical or psychological

danger Phobia- Sense of danger in specific,

avoidable situations Paranoia- Attribution of bias onto others

Ellis’s Eleven Irrational Beliefs

It is essential that a person be loved or approved of by virtually everyone in the community

Some people are bad/wicked and therefore should be blamed and punished

A person must be perfectly competent, adequate and achieving to be considered worthwhile

It is a terrible catastrophe when things are not as we want them to be

Unhappiness is caused by outside circumstances, and a person has no control over it

Dangerous or fearsome things are a great cause for concern and their possibilities must be dwelt opon

cont

It is easier to avoid certain difficulties and self-responsibility than to face them

A person should be dependent on others and should have someone stronger on whom to rely

Past events are determinants of present behavior; the influence of the past can not be eradicated

A person should be quite upset over other people’s problems

There is always a right or perfect solution to every problem, and it must be found or the results will be catastrophobic

Beck’s Cognitive Therapy and Errors in Information Processing

Arbitrary Inference- drawing conclusions without enough evidence

Selective Abstraction-Focusing on details out of context

Overgeneralizing- Drawing a conclusion about all events based on only a few

Magnification and minimization- Errors in evaluating the significance or magnitude of an event

Personalization- Relating external events to yourself with no rational basis for doing so

Absolutist dichotomous thinking- splitting

Beck’s Core Schemas

Systems of beliefs in which we consistently view situations.

Developed from past experiences, upbringing and trauma (Beck was trained psychodynamically and holds more from this theory than Ellis does-thus these schema’s can lie dormant and be triggered by events)

Beck’s Cognitive Triad

How you see self, experience and future

Example of a depressed person: Sees self as defective, inadequate, deprived and

diseased Interprets experience as negative, even when

evidence exists for a neutral or positive interpretation.

See future as continuing in this grim fashion and expect failures

Process of Therapy

Identify problem and dysfunctional thought patterns

Challenge thought patterns

Change thought patterns

CT and REBT differences

Cognitive Therapy-Beck Therapist uses Socratic

Dialog to elicit exceptions and counter arguments to challenge thoughts

Client does not take on philosophical system

REBT- Ellis Structured Induction to

Philosophical system Therapist is more

directive and confrontational

Specific Worksheet Techniques

Glasser’s Reality Therapy

The tough, smart drill sergeant approach Excuse making, assigning blame to external events, upbringing

or bad environment is discouraged Emphasizes Natural Consequences Individual choice and responsibility is emphasized Meeting needs for survival, belonging, power, freedom,

independence and fun leads to vision of what we want Choice theory- Maladaptive behavior arises from flaws in

matching desired outcomes to our actions due to 1) lack of knowledge, 2) previous failure and giving up or 3) faulty beliefs about what will work

Glasser’s Realty Theory InterentionsWDEP

Wants- Cl. Identifies and understands wants from life in all arenas.

Direction and Doing- Is the client’s behavior taking them closer or further away from their wants

Evaluating- Look at behavior and it’s impact on others and their own wants. Evaluation of wants is also conducted for realism and worthwhilness to client

Planning- Client’s evaluation leads to formulation of action plan

Attributes of a Reality Therapist beyond empathy, congruence and positive regard

High energy Actively able to confront with a caring attitude Positive, but not naïve view of human behavior High hope and ability to reframe lazy, resistant, and

manipulative behaviors into creative expressions Culturally sensitive in realizing reality is not the same

for all clients

Lazarus’s Multimodal TherapyBASIC-ID

Patients are troubled by seen problems and all seven realms should be explored as possible

Behavior, affect, sensations, imagery, cognition, interpersonal relationships, and biological functions

Very Intergrative

Linehan’s Dialectical Behavioral Therapy DBT

Designed for use with Borderline Clients Looks at interrelatedness of client’s behaviors,

thoughts, and emotions Focuses on Dialects of clients need to accept self

and change; getting what she needs and loosing it in order to grow, and client maintaining the validity of her experience while learning to interpret it differently

Focus on emotional regulation and mindfulness

Shapiro’s Eye Movement Desensitization Reprocessing

EMDR

Other Techniques

RET BOOK DTR Daily Thought Record Self-talk Relaxation techniques Visualizations Meditation 1-10 symptom report and log