cognitive behavior therapy chapter

1. CHAPTER 10
Cognitive Behavior
Therapy

2. Cognitive-Behavior Therapy
Contributors:
Aaron Beck; Albert Ellis, Donald
Meichenbaum
Assumption:
Maladaptive cognitions are at the
root of problems
Websites:
http://www.nacbt.org/
http://www.rebt.org/

3. Ellis’ Rational-Emotive Behavioral Therapy
• Teaches that our emotions stem
mainly from our beliefs,
evaluations, interpretations, and
reactions to life situations.
• Stresses thinking, judging,
deciding, analyzing, and doing.
• Assumes that cognitions, emotions,
and behaviors interact and have a
reciprocal cause-and-effect
relationship

4. Rational Emotive Behavioral Therapy
• Is highly didactic, very directive, and concerned as
much with thinking as with feeling
• Musterbations
• irrational belief that you must do or have something
• Awfulizing
• mental exaggeration of setbacks

5. REBT: An Educational Process
• Clients learn
• To identify the interplay of their thoughts, feelings
and behaviors
• To identify and dispute irrational beliefs that are
maintained by self-indoctrination
• To replace ineffective ways of thinking with effective
and rational cognitions
• To stop absolutistic thinking, blaming, and repeating
false beliefs

6. View of Human Nature
• We are born with a potential for both rational and
irrational thinking
• We have the biological and cultural tendency to think
crookedly and to needlessly disturb ourselves
• We learn and invent disturbing beliefs and keep
ourselves disturbed through our self-talk
• We have the capacity to change our cognitive,
emotive, and behavioral processes

7. Ellis’ABC theory of emotions
A = activating event in the environment
Loss of job
I’m
worthless
Depression
Loss of job
My boss
is a jerk
No
Depression
B = belief triggered in client’s mind by event
C = emotional consequence of the belief
Healthy Pattern

8. Example Rationale Thinking
• A= fail a midterm examination
• B=It’s unfortunate that I failed-I did not study hard
enough and I must make sure that I study harder
for the final
• C=no consequences (emotional disturbance
avoided)

9. Example Irrational Thinking: Leads to
Emotional Disturbance
• A= Fail exam
• B= I’m stupid, I’ll never be able to pass this course
and I will fail this course
• C=depression

10. The A-B-C Theory of Personality
A
activating
event
B
belief
D
disputing
interventio
n
E
effective
philosophy
F
New
feeling
C
consequence

11. Irrational Ideas
• Irrational ideas lead to self-defeating behavior
• Some examples:
• “I must have love or approval from all the significant
people in my life.”
• “I must perform important tasks competently and
perfectly.”
• “If I don’t get what I want, it’s terrible, and I can’t
stand it.”

12. Therapeutic Techniques
• Therapists practicing REBT use the following
techniques:
• Disputing irrational beliefs
• Doing cognitive homework
• Bibliotherapy
• Changing one’s language
• Psychoeducational methods

13. Therapeutic Techniques
• Therapists practicing REBT use the following
techniques:
• Rational emotive imagery
• Using humor
• Role playing
• Shame-attacking exercises
• Standard behavior therapy procedures

14. Beck’s Cognitive Therapy
 Treatment of depression
 Depressed people
 distort experiences &
maintain negative views of
themselves, the world, their
future
 minimize positive &
maximize negative
experiences
 misattribute negative
experiences to own
deficiencies

15. Aaron Beck’s Cognitive Therapy
• Insight-focused therapy with an emphasis on
changing negative thoughts and maladaptive beliefs
• Theoretical Assumptions
• People’s internal communication is accessible to
introspection
• Clients’ beliefs have highly personal meanings
• Depressed people have negative schemas or frames of
reference through which they interpret all events and
experiences
• These meanings can be discovered by the client
rather than being taught or interpreted by the
therapist

16. Theory, Goals & Principles of CT
• Basic theory:
• To understand the nature of an emotional episode or disturbance it
is essential to focus on the cognitive content of an individual’s
reaction to the upsetting event or stream of thoughts
• Goals:
• To change the way clients think by using their automatic thoughts to
reach the core schemata and begin to introduce the idea of schema
restructuring
• Principles:
• Automatic thoughts: personalized notions that are triggered by
particular stimuli that lead to emotional responses

17. CT’s Cognitive Distortions
• Arbitrary inferences
• Making conclusions without supporting and relevant
evidence
• Selective abstraction
• Forming conclusions based on an isolated detail of an
event
• Overgeneralization
• Based on one single incident and applying them to
dissimilar events

18. CT’s Cognitive Distortions
• Magnification and minimization
• Perceiving a case or situation in a greater or lesser light
than it truly deserves
• Personalization
• Relate external events to themselves even when there
is no basis for the connection.
• Labeling and mislabeling
• Portraying one’s identity on the basis of imperfections or
mistakes made in the past
• Polarized thinking
• Thinking in all-or-nothing terms

19. Beck’s Cognitive Triad
Pattern that triggers depression:
1. Clients hold negative views of themselves
 “I am a lousy person”
2. Selective Abstraction
 Client interprets life events through a negative filter
 “The world is a negative place where bad things are
bound to happen to me”
3. Client holds a gloomy vision of the future
 “The world is bleak and it isn’t going to improve”

20. Applications of Cognitive Therapy
• Hundreds of outcome trials have established CT’s
efficacy for a wide range of problems
• Cognitive techniques focus on identifying and
examining a client’s beliefs and the origins of these
beliefs, and modifying them if the client cannot
support these beliefs
• Behavioral techniques used by cognitive therapists
include activity scheduling, behavioral experiments,
skills training, role playing, behavioral rehearsal, and
exposure therapy

21. Donald Meichenbaum’s Cognitive
Behavior Modification (CBM)
 Focus:
 Client’s self-verbalizations or self-statements
 Premise:
 As a prerequisite to behavior change, clients must notice
how they think, feel, and behave, and what impact they
have on others
 Basic assumption:
 Distressing emotions are typically the result of
maladaptive thoughts

22. Meichenbaum’s CBM
 Self-instructional therapy focus:
 Trains clients to modify the instructions they give to
themselves so that they can cope
 Emphasis is on acquiring practical coping skills
 Cognitive structure:
 The organizing aspect of thinking, which seems to
monitor and direct the choice of thoughts
 The “executive processor,” which “holds the blueprints
of thinking” that determine when to continue, interrupt,
or change thinking

23. How Behavior Changes?
• 3 Phases of Behavior Change
1. Self-observation
• Listen to themselves, realize they contribute to
their depression through how they think, and
develop new cognitive structures
2. Starting a new internal dialogue
• See adaptive behavioral alternatives
3. Learning new skills
• Teaching more effective coping skills

24. Meichenbaum’s Stress
Inoculation Training (SIT)
• SIT is a three-phase coping skills program
1. The conceptual phase
• Creating a working relationship with clients
2. Skills acquisition and rehearsal phase
• Giving coping skills to apply to stressful situations
3. Application and follow-through phase
• Transfer change to real world

25. Cognitive Techniques
 Automatic Thoughts- Challenge people's irrational assumptions
using logic and evidence.
 Changing Language- Changing "need" to "want"
 Decatastrophizing- Anticipating worse-case-scenario and
preparing for it through role play and problem solving.
 Shame Attacking- Encouraging client to deliberately fail or draw
unwanted attention in or to demonstrate that they can survive.
 Socratic Dialogue- Asking a series of questions leading client to
inescapable conclusion that their beliefs are irrational.
 Stress Inoculation- Similar to decatastrophizing but with
addition of relaxation exercises.