Cognitive 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