Cognitive-Behavior Therapy

Proponents: Aaron Beck, Albert Ellis

Albert Ellis: Grandfather of Cognitive Behavior Therapy
∙ Change the behavior of the clients and not the totality.
∙ REBT is one of the first cognitive behavior therapy.
∙ Ellis used to practice psychoanalytically-oriented psychotherapy but he became disillusioned because of the
slow progress of his clients.
∙ He observed that clients improve more quickly if they change their way of thinking about themselves and
about their problems.

ALBERT ELLIS’ RATIONAL EMOTIVE BEHAVIOR THERAPY (REBT)

View of Human Nature
∙ Human beings are born with the potential for both rational (straight) thinking and irrational (crooked)
thinking.
∙ Humans are self-talking, self-evaluating, and self-sustaining.
∙ Humans develop emotional and behavioral difficulties when they mistake simple preferences (e.g. love,
approval, success) for dire needs.
∙ For Ellis, humans will continue to make mistakes yet at the same time we have to learn how to live more at
ease with ourselves.
∙ Main Goal of REBT: helps clients accept themselves.
- For Ellis, people have natural tendency for growth and actualization and we sabotage this tendency because
of irrational thoughts, probably because of our inborn tendency toward group thinking and self-defeating
behaviors.

View of Emotional Disturbance

∙ People do NOT need to be accepted and loved, even though this may be highly desirable.
∙ REBT actually attempts to help clients find ways of overcoming these unhealthy feelings (anxiety, depression,
hurt, loss, self-worth or hatred).
∙ Blame is the core of most emotional disturbances.
∙ We need to learn to accept ourselves despite our imperfections.
∙ Our hidden dogmatic “musts” and absolutistic “should” create disruptive feelings and dysfunctional behaviors.
∙ Examples of Irrational Beliefs:
- “I must have love or approval from all the significant people in my life”
- “I must perform important tasks competently and perfectly well”
* It is our musts and shoulds that give us emotional disturbance. We have the strong tendency to make and keep
ourselves emotionally disturbed by internalizing self-defeating beliefs.

Key Concepts
Therapeutic Goals
∙ To minimize emotional disturbances and self-defeating behaviors (by acquiring a more realistic and workable
philosophy in life).
∙ To reduce the tendency for blaming oneself or others for what goes wrong in life and learning ways to deal
with future difficulties.
∙ To induce people to examine and change some of their most basic values that keeps them disturbed (we have
to separate the evaluation of our behaviors to the evaluation of ourselves).
* If a client learn to accept themselves, then they are more likely to unconditionally accept others as well.
* Acceptance of oneself first before the acceptance of other people.
Therapeutic Process: A-B-C Theory of Personality
∙ DEF (under belief) - we have to put an intervention on belief
without waiting that its consequence is what they will believe.
∙ D (Disputing Intervention)
- because only after disputing some intervention to our belief, that’s
the only time it will have an effect (different effects could yield the
feelings). Instead of the emotional and behavioral consequences, by
the intervention and the effect then we will come up with a new
feeling.
∙ F (New Feeling)
- Our belief about A is what results to C.
- It is the belief about the activating event that causes the consequences.
∙ We want to challenge the client to change their irrational beliefs by 3Ds:
- Detect: the behavior
- Debate: whether the behavior is right or wrong
- Discriminate: discriminate or remove if it causes negative emotions.
- because only then can we actually have the effect. (= we replace unhealthy thoughts to healthy ones already).

Therapist’s Function and Role

∙ Therapists need to show first the clients that they have incorporated many irrational beliefs.
- encourage and persuade them to engage in activities that can counter their self-defeating beliefs/behavior.
∙ Therapists need to demonstrate how clients are keeping their emotional disturbance active.
- by continuing to think illogically and unrealistically.
∙ Therapists have to help the clients modify their thinking and minimize their irrational ideas.
∙ Therapist has to challenge clients to develop a rational philosophy of life.
- so they can avoid being the victim of other irrational beliefs in the future as well.
* If you help your client dispute their problem, it’ll help them when the situation arises again in the future.

Client’s Experience in Therapy

∙ Once clients begin to accept that their beliefs are the primary cause of their emotions and behaviors, they are
able to participate effectively in the cognitive restructuring process.
- Clients are acting as learners because they’re learning new behavior.
∙ The clients are not encouraged to make connections between their remote past and present behavior.
∙ Clients are expected to actively work outside the therapy sessions (homework in REBT).
- Home works should be well-designed and should be agreed upon by the client so they will actually do it
outside the session (to carry out positive actions that could actually induce emotional and attitudinal changes).
- Check progress when terminating phase na (review together with your clients).

Relationship Between Therapist and Client

∙ Just like person-centered approach’s unconditional positive regard, the cognitive approach has the concept of
full acceptance and tolerance.
∙ Therapists refuse to evaluate their clients as persons while at the same time they are willing to honestly
confront clients’ nonsensical thinking and self-destructive behavior.
* We have to accept the client regardless.
* The warmth is confrontative
* The intense relationship between therapist and client is not really required because REBT therapists are open
and direct in disclosing their beliefs and values.

* REBT IS MORE ON OPEN AND DIRECT in disclosing beliefs and values.

Therapeutic Techniques and Procedure
Cognitive Methods
∙ Disputing Irrational Beliefs
- As a counselor you have to actively dispute the irrational beliefs, and teach them how to do this challenging
on their home.
∙ Doing Cognitive Homework
- Clients are expected to make lists of their problems, look for their absolutistic beliefs, and dispute these
beliefs.
- Doing homework outside the session could help client revise their thinking or feeling and therefore can
revise their behavior effectively.
∙ Changing One’s Language
- Clients who use statements which reflect helplessness and self-condemnation can learn new and positive
statements.
- If language is changed, they may think less negatively.
∙ Psycho-Educational Methods
- Therapists educate clients about the nature of their problems and how treatment is likely to proceed.
- Educate because not all people are psychology students.

Emotive Techniques
∙ Rational Emotive Imagery
- Clients imagine themselves thinking, feeling, and behaving exactly the way they would like to think, feel and
behave in real life.
- One of the intense mental practices; designed to establish new emotional patterns for clients.
∙ Role Playing
- Clients are allowed to rehearse certain behaviors to bring out what they think and feel in the situation.
- The focus is on working through the underlying irrational beliefs that are related to unpleasant feelings.
- Don’t hesitate to interrupt clients especially if they’re showing disturbance.
- Practicing your client on how to react and feel in certain situations (so you will see how they will act).
∙ Shame-Attacking Exercises
- Clients need to work to feel unashamed over certain behaviors even when others clearly disapprove of them.
- Shame = negative impact; aim is to increase self-acceptance even if other disapprove of them.
∙ Use of Vigor and Force
- Clients are encouraged to do forceful dialogues with themselves in which they express their irrational beliefs
and then powerfully dispute them.
- Self-talking
∙ Using Humor
- Emotional disturbances often result from taking oneself too seriously and losing one’s sense of perspective
and humor over the events of life; use humor to counterattack the situation (over-seriousness of your client)

AARON BECK’S COGNITIVE THERAPY

Description
∙ Beck created this therapy the same time Ellis made REBT..
∙ Cognitive Therapy is an insight-focused therapy.
∙ Cognitive Therapy targets the client’s thinking; REBT targets the client’s behavior.
∙ In order to understand the nature of an emotional disturbance, it is essential to focus on the cognitive content
of an individual’s reaction to the upsetting event or stream of thoughts.
∙ Its main goal is to change the way clients think.
∙ The clients are encouraged to gather and weigh the evidence in support of their beliefs.
∙ Less persuasive, less directive, less confrontative.
Cognitive Distortions
Arbitrary Inference
∙ Making conclusions without supporting and relevant evidence.
∙ Mind-reading - thinking that someone has a negative thought about them even if it is not true.
∙ Fortune-telling - predicting that something will turn out badly.
∙ Catastrophizing - expecting the worst to happen.

Selective Abstraction
∙ Forming conclusions based on an isolated detail of an event.
∙ Discounting and filtering - focusing on the negative side of things despite the positive ones.

Overgeneralization
∙ Holding extreme beliefs on the basis of a single incident and applying them inappropriately to similar events
or settings.

Magnification and Minimization

∙ You perceive the situation in a greater (magnification) or lesser (minimization) than it truly deserves.

Personalization
∙ Incorporate external events to oneself even when there is no basis for making this connection.

Externalization or External Blaming

∙ Holding other people responsible for one’s own pain.

Labeling and Mislabeling

∙ You portray one’s identity on the basis of imperfections and mistakes made in the past and allow them to
define one’s true identity.

Emotional Reasoning
∙ Basing one’s decisions or judgments, decision, and conclusion exclusively for one’s feelings.

Limitations and Criticisms

Ellis’ REBT
∙ Personal warmth, empathy, transference and caring are not considered as essential ingredients for effective
therapy (warmth is deemphasized).
∙ Some clients have trouble interacting with a confrontative therapist and they tend to terminate the therapy.
∙ Not enough emphasis is given in encouraging clients to express and explore their feelings.
∙ Past unfinished businesses and childhood experiences are ignored (deals with the exact thinking of the client).
∙ REBT therapists can misuse their power by imposing their ideas of what constitutes rational thinking.
∙ Clients sometimes see this approach as a process of persuasion, indoctrination, logic and advice.

Beck’s Cognitive Therapy

∙ Focuses too much on the power of positive thinking.
∙ The approach does not encourage emotional ventilation or emotionally re-experiencing painful events.
∙ Focuses only on eliminating symptoms but failing to explore the underlying causes of difficulties.
∙ Ignore the role of unconscious factors.