Cognitive-Behavioral

Theory:
Foundations and Practice
A general category of theories or a set of
related theories that reflect the importance
of both behavioral and cognitive
approaches to counseling.
Quote:
“ The best years of your life are the
ones in which your problems are
your own. You do not blame them
on your mother, the ecology, or
the president. You realize that you
control your own destiny.”
Albert Ellis
 Cognitive-Behavioral Theories:
Commonalities
 A general category of theories or a set of related
theories that reflect the importance of both behavioral
and cognitive approaches to counseling.
 Four common tenets across cognitive-behavioral
theories
 Collaborative Relationship Between Therapist and
Client
 Psychological distress is a function of disturbance in
cognitive processes
 Focus on changing cognitions to change affect and
behavior
 Treatment is educational and time-limited and focused
on specific and structured target problems
Cognitive Behavioral Theorists
 Albert Ellis (1913-2007)
 Rational-Emotive Behavior Therapy
(REBT)
 Aaron Beck (1921- ) pic at left
 Cognitive Therapy
 Donald Meichenbaum
 Cognitive Behavior Modification
 Stress Innoculation Training and Self-
Click pic to watch
Instruction Training video of Ellis
 More than 20 different theories labeled interview.
cognitive or cognitive-behavioral
Rational Emotive Behavior
Therapy (REBT)
 Considered the parent of the CB approaches
 Developed by psychologist Albert Ellis in 1955
 Roots in Greek philosopher Epictetus
 “People are disturbed not by things, but by the view
which they take of them”
 Credits Adler with emphasis on teaching and
persuasive methodology
 People should accept themselves, even if
they make mistakes yet at the same time
learn to live more at peace with others!
Ellis believed…..
 the empathic,
therapeutic relationship
may be “undesirable”
because the temporary
mood elevation brought
on by empathy may
prevent the client from
doing “necessary work”
to get better.

Please click on picture to watch a video clip of Ellis

introducing his theory and working with Gloria.
Basic Hypotheses
 Our emotions stem mainly from our
beliefs,evaluations, interpretations and
reactions to life situations.
“You feel the way you think”

 Therapy is essentially a process of

“reeducation” – a process of learning how to
think more rationally about our experience.
 Focus is on working with thinking and acting
View of Human Nature
 Humans are born with a propensity for both rational
and irrational thinking.
 Humans are born with propensities toward self-
actualization and self-destruction
 Humans are “self-talking”, self-evaluating, and self-
sustaining.
 Humans often sabotage their movement toward self-
actualization as a result of their tendency toward
crooked thinking and through self-defeating patterns
they have learned.
 Humans do not need to be loved and respected even
though they may strongly prefer it.
Emotional Disturbance
 Blame is at the core of most emotional disturbance.
 Exists when a person makes the mistake of irrationally
thinking that simple preferences are dire needs.
 During childhood we learn patterns of irrational, self-
defeating thinking and we create these patterns
ourselves. Examples include:
 “I must have love or approval from all the significant
people in my life.”
 “I must perform important tasks competently and
perfectly well.”
 “If I don’t get what I want, it’s terrible and I can’t stand it.”
 Occurs when we escalate our desires and preferences
into “shoulds,” “musts,” and “oughts.”
To avoid emotional disturbance…
 We are able to maintain emotional health by
recognizing our preferences and by taking a
rational view of our own imperfections
 A-B-C Theory of Personality

A (activating event) B (belief) C (emotional & behavioral) cons.

D (disputing intervention) E (effect) F (new feeling)

A-B-C Theory of Personality
 Individuals have goals that may be supported
or thwarted by activating events (A). They
then react, consciously or unconsciously, with
their belief system (B), by which they respond
to the activating event. The consequence (C)
is the emotional and behavioral result of the
reaction.
Further…..
 D = Disputing intervention (detecting,
debating, and discriminating
 E = Effect of the disputing intervention
(hopefully the successful challenge and
dispute of irrational behavior)
 F = new feeling (rational, logical,helpful)
Therapeutic Goals
 Minimizing self-defeating behaviors and
emotional disturbance
 Acquiring a more realistic and workable
philosophy of life
 Reducing the tendency to blame self and
others for what goes wrong in life.
 Learning ways to deal with future difficulty
The Therapy Process
 Step 1 – Building a “collaborative therapeutic
alliance”
 Step 2 – Goal setting
 Step 3 Orientation of client to the therapeutic
process
 Step 4 Therapist disputing of irrational beliefs
 Step 5 – Assignment of Homework
 Progress check upon completion
 Teaching new ways of thinking and acting
 Reassignment
 Step 6 – Progress review; Planning for
dealing with future problems.
 Techniques: Cognitive
Typically directive and aimed at revising faulty cognitions

 Disputing irrational beliefs: Challenging the “shoulds” and

“musts”.
 Cognitive homework: Clients are expected to make lists of
their problems, look for their absolutionistic beliefs, and dispute
these beliefs.
 Changing one’s language: Replace “musts”, “oughts”, and
“shoulds” can be replaced by preferences; increase personal
power
 Use of humor: Don’t take life so seriously!
 Techniques: Emotive
Designed to reduce the feelings that stand in the way of

dealing with irrational patterns of thinking

 Rational-Emotive Imagery: clients imagine
themselves thinking, feeling, and behaving exactly
the way they would like to behave in real life.
 Role playing: To rehearse ways to change
inappropriate feelings to appropriate ones.
 Shame-attacking exercises: Clients work to feel
unashamed even when others clearly disapprove
 Use of force and vigor: Use forceful dialogues with
themselves to express irrational beliefs and the
powerfully dispute them.
 Techniques: Behavioral
“Acting differently can also lead to a change of irrational beliefs”
 Self-management  Reinforcement
 Systematic  Extinction
desensitization  Shaping
 Relaxation  Any other techniques
 Modeling from Behavioral Theory
 Homework assignments
Differences between CT & REBT
REBT is: Cognitive Therapy is:

 highly directive  more open-ended

 persuasive  reflective
 confrontational  more structured, more
 Counselor is a teacher helpful
 Relationship is more
collaborative
Beck’s Cognitive Therapy:
10 Principles
1. Based on cognitive 6. Structured and
model of emotional directive
disorders. 7. Problem-oriented
2. Brief and time-limited 8. Based on an
3. Based on a sound educational method
therapeutic 9. Relies on inductive
relationship model
4. Collaborative effort 10. Uses homework as a
between client and central feature.
counselor
5. Uses the Socratic
method
Beck’s Cognitive Therapy
 View of Human Nature
 Same as REBT but more phenominological
(idiosyncratic nature of thoughts)

 Doing something will feel better than doing

nothing.
Dysfunction & Goals of Therapy
 Nature of Pathology
 Views problematic thinking more as
dysfunctional than irrational

 Goals of Therapy
 Assist client in identifying and confronting
rules they live by that might be too absolute,
broad or extreme
Therapeutic Relationship…
 Warm personal relationship is essential,
though not sufficient for therapeutic change
 Labeling behavior that has meaning for
someone as irrational sends up defenses
Role of the Counselor
 Functions to guide the client toward personal
discovery and skill development through
deliberative corrective experiences (rather
than direct teaching)
 Use of Socratic questioning rather than
disputing
Cognitive Therapy Process
 Provide client with a cognitive rationale for
counseling
 Have client monitor thoughts that are
distressful
 Implement cognitive & behavioral techniques
 Identify & challenge cognition that may be
problematic
 Examine beliefs and assumptions through
reality testing
 Teach clients coping skills to prevent relapse
Cognitive Therapy Techniques
Cognitive Strategies:
 Collaborative
Empiricism
 Socratic dialogue

Behavioral Strategies:
 Relaxation Therapy
 Cognitive Modeling
Meichenbaum’s Cognitive
Behavior Modification
 Self-talk is at the heart of the way that a person
functions.
 Goal of therapy is cognitive restructuring (modify self-
talk and cope more effectively)
 Process includes:
 Self-observation
 Starting a new internal dialogue
 Learning new skills
Meichenbaum’s theories
 Self-instructional  Stress inoculation
training (Cognitive training: consists of
Behavior Modification): three phases---
clients learn to keep 1. Conceptualization
track of self-statements 2. Skills acquisition &
and to substitute more rehearsal
adaptive statements
through homework & 3. Application & follow-
rehearsal) through
 Cognitive-Behavioral View of
Human Nature:
 Behavior is learned  Development is based
 Behavior is developed upon each person’s
and maintained by learning history, unique
external cues, experiences, and
reinforcers, or internal cognitive understanding
processes, such as of the world.
cognition.
 Past problems are
 Here-and-now
orientation to problems considered only as
relating to present.
Important constructs:
 The Importance of Cognitions: Emphasis on
the importance of cognitive workings; all
cognitive interventions attempt to produce
change by influencing thinking
 The Importance of Learning: Asserts that
abnormal behavior is learned and developed
the same as normal behavior and can be
changed through cognitive-behavioral
approaches.
Important constructs (cont.)
 The Importance of Operational Definitions:
Problems are viewed operationally; problems
are functionally related to internal and
external antecedents and consequences
 The Importance of Therapeutic Empathy:
Some feel the techniques are more important
than the relationship (like Ellis) Others feel
here is a necessity for an empathic
relationship.
4 Questions to Establish
Counseling Goals:
1. What are the problems that need to be
addressed (presenting problems)?
2. How can progress in counseling be
measured and monitored?
3. What are the environmental contingencies
maintaining the behavior?
4. Which interventions are more likely to be
effective (cognitive, behavioral, or both)?
REBT & Treatment
 REBT has been applied to treatment of
anxiety, depression, OCD, panic disorder,
and agoraphobia.
 There is some concern that the notion of
“How you feel is based on what you think”
may send a message to clients that they are
responsible for their mental illness.
CBT Strengths
 Empowerment of the client to create change
 Clarity of models
 Emphasis on teaching
 Technical eclecticism
 Beck has brought the “private experience back into
the realm of scientific inquiry”
 Demystification of the therapy process
 Focus on self-help
Multicultural Issues & REBT
 Therapist must listen carefully for cultural
values and issues of client.
 REBT emphasizes self-sufficiency as
opposed to dependency on the support of
others; many cultures promote
interdependence rather than independence
 Active nature of REBT techniques sometimes
conflict with passive nature of some cultures
Gender & REBT
 May be more appropriate for work with
women because women are subject to more
gender-role socialization messages that
promote irrational beliefs.
 Can be applicable to both genders because
counselors can examine the irrational beliefs
of any client, regardless of gender
Limitations of CBT
 De-emphasis on client-counselor relationship
 Rejection of transference
 Rejection of unconscious realm
 REBT: Power of the therapist to manipulate
and judge a client
Limitations of CBT
 Over simplistic with regard to
psychopathology: based on the power of
positive thinking
 De-emphasis on the past
 Underplaying the role of emotions as a direct
agent for change
Limitations
 Lack of attention to
unconscious or internal
factors which may affect
behavior
 Not very attentive to
feelings
 Insight and emphasis
on the past are not
emphasized.
Contributions/Advantages
 Brief and time-limited
 Action oriented
 Puts newly acquired insights into action
 Teaches clients to carry on their own “therap
y” without counselor
 Eclectic techniques that can be applied to
individual client needs
Research and REBT

 A review of 158 outcome studies found that

REBT was significantly more effective than
other therapies on various issues
 There is some question about how well
therapists in research actually represent “tru
e” REBT; what they may be calling “REBT”
may simply be an “integration” of cognitive
and behavioral concepts.
 To see cognitive behavioral theories in
practice with clients, check out these video
links:
 Albert Ellis Doing REBT with Jeffery {Video
file}. (2006). http://www.youtube.com/watch?
v=A9tj8p5TfgI&feature=related

 Cognitive Behavior Therapy {Video file}.

(2006).http://www.youtube.com/watch?
v=GqW8p9WPweQ

 Ellis: The Man
Click on picture to
Play audio clip about
Ellis

“I am a charismatic individual with

characteristics which many
people find distasteful.”
(Ellis, 2001)

Perhaps one of the biggest limitations of REBT has been the negative influences of Ellis himself. In his opinion, professionals may oppose
or slight REBT because they don’t like him. He admitted that his public manner and use of four-letter words is controversial and
unconventional and that his use of the term rational may be aversive to empirically minded psychologists. Because it is irrational to
demand that Ellis change his style, professionals must recognize that they can adhere to the basic principles of the theory without
emulating Ellis’ less-than-nurturing style.