1. Chapter 13 Cognitive Behavior Therapy
Nothing is so terrible as activity without thought.
Johann Wolfgang von Goethe
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Chapter Objectives
After reading this chapter, you should be able to:      
Outline the development of cognitive behavioral therapy
Explain the theory of cognitive behavioral therapy
Discuss the counseling relationship and goals in cognitive behavioral therapy
Describe assessment, process, and techniques
Demonstrate some therapeutic techniques
Clarify the effectiveness of cognitive behavioral therapy
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Aaron Beck
Childhood fears were handled with reasoning 
Likely motivated his work with cognitive therapy focusing on anxiety and depression
Graduated from Brown University and Yale Medical School
studied psychiatry and was trained as a psychoanalyst
eventually his research led him to formulate cognitive therapy, the focus of his career at the University of Pennsylvania where the Beck Institute for Cognitive Therapy and Research is housed
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Aaron Beck
Beck contended that various mental disorders have particular cognitive patterns and that the most effective and lasting therapy involves intervention into those patterns.
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Beliefs
People are not passive victims of their inborn tendencies 
People are actively creating and moving toward goals that are vital to them
Distress occurs when people experience a threat to their interests
The more crucial a person considers the goal to be, the greater the response. 
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6. Four levels of cognition
automatic thoughts,
intermediate beliefs,
core beliefs, and 
schemas.
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7. Cognitive distortions
Distortions convert incoming information to keep cognitive schema intact. 
They use the assimilation process to maintain homeostasis. 
The information contrary to core belief is cancelled out by the distortion process, and the person cannot identify any disconfirming evidence from his environment.
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Three assumptions
Cognitive activity impacts behavior. 
Cognitive activity can be monitored and changed. 
A desired change in behavior can be accomplished through changing cognitions.
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Cognitive distortions associated with distress and maladaptive behaviors
Catastrophizing: expecting disastrous event
Mental filtering: seeing an entire situation based on one detail with all else ignored
Blame or assigning internal responsibility entirely to external events
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Cognitive distortions associated with distress and maladaptive behaviors
All-or-nothing thinking: the person thinks in terms of two opposite categories
Discounting the positive: person says positives do not count
Overgeneralization: a sweeping negative conclusion that goes beyond facts
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Counselor
Both a guide to help the client understand how beliefs and attitudes interact with emotions and behavior, and a catalyst promoting corrective experiences, leading to cognitive change, and building skills.
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Case formation
Dynamic process 
Requires the counselor to generate and test their hypotheses
Five parts: 
problem list, 
diagnosis, 
working hypothesis, 
strengths and assets, and
treatment plan.
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Fundamental concepts
Collaborative empiricism - the cooperative working relationship of jointly determining goals and seeking feedback Socratic dialogue - a type of questioning designed to promote new learning Guided discovery - when the counselor coaches the child in a voyage of self-discovery in which the child does his or her own thinking and draws his or her own conclusions
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Session outline
Build an agenda that has meaning for the client
Ascertain and measure the intensity of the person’s mood
Identify and review presenting problems  
Ask about the client’s expectation for counseling
Teach the person about cognitive therapy and the client’s role in it 
Give information about the person’s difficulties and diagnosis
Establish goals 
Recommend homework 
Summarize
Obtain the client’s feedback
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15. Counseling Session Four Steps1
Review progress bringing counselor and client up to date. Homework assignments checked for completion.
Four quadrants for last week
List high points
Low points
How week could have been better
Plans for next week 2
Set agenda for current session based on 4 point quadrant 3
Clarify and set specific behavioral goals for next week 4
Have client summarize session as bridge to next week: review new homework, anticipate obstacles, evaluate session
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Stress inoculation
CBT technique that includes
Self talk
Practice tests
Visualization
Relaxation training
Deep breathing exercises
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Stress inoculation
Michenbaum’s 4 categories of self-talk
Preparation: what do you have to do
Confrontation: you can handle it
Coping: keep stress manageable
Reinforcing: I did it
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