1. Cognitive Behavior Therapy
Dr. Sparrow EPSY 6363
Cognitive Behavior Therapy

2. Founders
Albert Ellis -- Rational Emotive Behavior Therapy (REBT) originated in mid-1950s
Aaron Beck -- Cognitive Therapy (CT)
Donald Meichenbaum -- Cognitive Behavior Therapy (CBT)

3. 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

4. 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

5. 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

6. 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.

7. 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

8. Therapeutic Goals of REBT
Minimizing emotional disturbances
Acquiring more realistic philosophy
Acquiring unconditional self acceptance (USA)
Developing unconditional other acceptance (UOA)

9. 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

10. The Client’s Experience in Therapy
Learner
Doer
Expected to work outside session
Homework is carefully co-designed

11. 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

12. 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

13. 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

14. Interventions of REBT, continued
Behavioral Techniques
standard behavior therapy techniques, such as operant conditioning, systematic desensitization, etc.
Research Efforts
technical eclecticism makes research difficult.

15. 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.”

16. 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

17. 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.

18. 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

19. Applications of CT Applying CT
Helping clients become aware of automatic thoughts (cognitive distoritions)
Helping clients make alternative interpretations

20. 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

21. 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

22. 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

23. 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

24. Contributions of REBT, CT, CBM, continued
Meichenbaum
Like CT, based on educational model; dymystifies therapy
Encourages a working alliance
Empowers the individual

25. 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