Cognitive Behavior Therapy Chapter 10 Lucy Hester & Claire Nawojchik

Key People Albert Ellis (1913-2007) Aaron Temkin Beck (1921-) Rational Emotive Behavior Therapy (REBT) Aaron Temkin Beck (1921-) Cognitive Therapy (CT) Founded Beck Institute Judith S. Beck (1954-) Daughter of Aaron Beck; Co-Founder/President Beck Institute Donald Meichenbaum (1940-) Cognitive Behavior Therapy (CBT) Constructivist Narrative Therapy

All Cognitive Behavior Therapies Share: Collaboration between therapist and client Idea that psychological distress is caused by disturbances in cognitive processes Focus on changing cognitions to produce desired changes in affect and behavior Present-centered, time-limited focus An active and directive stance by the therapist Educational treatment focusing on target problems

Ellis’s Rational Emotive Behavior Therapy First of the cognitive behavior therapies (1955) Peoples beliefs about events shape their emotions and irrational beliefs contribute to problems Cognitions, emotions, and behaviors have a cause-and-effect relationship Therapy is educational: therapist is teaching healthy thinking skills, client is practicing in homework/life Focus on thoughts and actions rather than emotion

Key Concepts View of Human Nature View of Emotional Disturbance People born with potential for rational and irrational thinking Have positive and negative predispositions People are encouraged to accept their imperfections View of Emotional Disturbance People blame themselves when they do not fulfill the irrational beliefs internalized in childhood. “Shoulds” and “musts” --three basic musts Learn to be less emotionally reactive—sad but not depressed

A-B-C Framework A (activating event)  B (belief)  C (emotional and behavioral consequence)  D (Disputing intervention) E (effect)  F (new feeling) A person’s beliefs about an event rather than an event itself shapes their emotional reaction Detect, debate, discriminate Cognitive restructuring: replace irrational beliefs with rational beliefs Disputing irrational beliefs leads to a new, effect philosophy

The Therapeutic Process Therapeutic Goals Separating evaluation of behaviors from evaluation of self Unconditional Acceptance of Self and Others (USA/UOA) Therapist’s Function and Role Therapist teaches client to modify irrational thinking and develop a sustainable rational philosophy and skills for future Client’s Experience in Therapy Focus on present ability to change irrational patterns Homework Relationship Between Client and Therapist Self-disclosure, acceptance, egalitarianism

Application Cognitive Methods: dispute irrational beliefs, do cognitive homework, bibliotherapy, change one’s language, psychoeducational methods Take risks to challenge self-limiting beliefs Emotive Techniques: Rational emotive therapy, humor, role playing, shame-attacking exercises Behavioral Techniques: homework—client desensitizes themselves through real-world practice

Beck’s Cognitive Therapy Came out of research on depression Similarities with REBT and Behavior Therapy Problems come from: faulty thinking, failure to distinguish between fantasy and reality, making false assumptions Schema restructuring based on cognitive content of stream of thoughts surrounding upsetting events Theoretical underpinnings: Introspection, beliefs with personal meanings, discovery and interpretation of meaning by client

CBT and Learning Disabilities… Beck in Action

Key Concepts Automatic thoughts Cognitive distortions—arbitrary inferences, selective abstraction, overgeneralization, magnification and minimization, personalization, labeling and mislabeling, dichotomous thinking What is the evidence for _____? Therapist teaches client to identify dysfunctional thinking, evaluate and replace with rational thought Focus on present problems Collaborative empiricism

Compare to REBT Similar emphasis on reality-testing Teacher/student (REBT) vs. Socratic dialogue (CT) REBT is directive, persuasive, confrontational CT helps clients self-reflect and make their own conclusions Irrational, non-functional thoughts (REBT) vs. Inaccurate thoughts (CT) REBT uses rational disputation CT therapist suggests alternate “rules”

Application CT has been applied to a wide variety of disorders Use of alternative interpretations Applications to Depression Cognitive triad: negative view of self, negative interpretation of experiences, negative projection of the future Selective abstraction Beck Depression Inventory (BDI) Applications for Family Therapy Schema (core beliefs) – “family schemata” Family relationships, cognitions, emotions, and behavior exert mutual influence on one another

The Beck Institute http://www.beckinstitute.org/ Aaron and Judith Beck’s CBT training and resource center, located in Philadelphia Mission: “To encourage the growth and dissemination of CBT throughout the world through leadership in the field and through the provision of professional training, outpatient clinical services, and research” Soldier Suicide Prevention Program The Beck Diet Solution

Meichenbaum’s Cognitive Behavior Modification Focus on changing self-verbalizations, which affect behavior as much as others’ comments Self-instructional training: Help clients become aware of self-talk, self-instruction, and the stories they tell about themselves Behave our way into a new way of thinking Practice in role-play situations of daily problems Behavior change: Self-observation, start new internal dialogue, learn new skills

Stress Inoculation Training (SIT) Gradually develop a tolerance for stress stimuli Modify our beliefs and self-statements about our performance in stressful situations Conceptual-educational phase: Teach clients to be aware of their own role in their stress; self-monitor Skills acquisition and consolidation phase: Acquire and rehearse new self-statements and behavior Application and follow-through phase: Practice increasingly demanding “homework”; relapse prevention and follow-up sessions

The Constructivist Approach to CBT Constructivist narrative perspective (CNP): Focus on stories people tell about significant life events Clients construct their own realities Emphasis on past development, deep core beliefs, and behavioral/emotional impact Clients’ stories show how they view themselves, their world, and their future Tell the “rest of the story” – survival and coping Use positive metaphors to describe self

Multicultural Perspective Strengths: Use individual’s belief system for self-exploration Individualized, structured, active, and participatory Learn practical skills for daily life Focus on influence of external environment Limitations: REBT’s negative view of interdependence Therapists may be too direct or confront too quickly Too much focus on present, not enough on past Emphasis on assertiveness and change (instead of acceptance)

Compare/Contrast In contrast to Psychoanalytic: No free association or emphasis on dreams, less focus on past history, & no significant exploration of feelings and transference Comparison to Person-Centered & Existential: Focus on the here and now Comparison to Person-Centered: Unconditional positive regard

Summary Cognitive processes determine behavior Clients’ feelings and behavior influenced by their subjective interpretation of events Reorganization of one’s self-statements will result in reorganization of one’s behavior Interconnectedness of thinking, feeling, & behaving Client assumes active role Emphasis on homework and practice

Strengths Changes clients subjective views of themselves Clients identify and challenge basic beliefs Homework—putting change into action Collaborative therapist-client relationship Demystification of therapy process REBT: teaching clients to carry on their own therapy Tapes, self-help books, workshops, behavior/thought records Beck: wide range of clinical populations, bringing private experience into realm of scientific inquiry Meichenbaum: self-instruction, stress-innoculation

Limitations Practice is especially vulnerable to therapist’s skill level and techniques Limited focus on past experiences REBT: confrontational style difficult w/out rapport CT: too strong on positive thinking, too superficial and simplistic, eliminating symptoms w/out looking at root causes Meichenbaum: Is teaching a client less effective than allowing them a process of self-discovery?

References BeckInstitute (2012, January 6). CBT and Learning Disabilities. Retrieved October 29, 2012, from http://www.youtube.com/watch?v=dD7DlOfeKo0 Corey, C. (2013). Theory and Practice of Counseling and Psychotherapy, Ninth Edition. Belmont, CA: Brooks/Cole. http://www.beckinstitute.org/