1. Cognitive Behavior Therapy
Chapter 10
Lucy Hester & Claire Nawojchik

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. CBT and Learning Disabilities… Beck in Action

11. 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

12. 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”

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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)

19. 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

20. 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

21. 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

22. 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?

23. References
BeckInstitute (2012, January 6). CBT and Learning Disabilities. Retrieved October 29, 2012, from
Corey, C. (2013). Theory and Practice of Counseling and Psychotherapy, Ninth Edition. Belmont, CA: Brooks/Cole.