Chapter 10: Cognitive Behavior Therapy

ABC framework cont.

- A does NOT cause C - B creates C - D (disputing intervention) comes after - then E (effect)(effective belief system) - then F (new set of feelings)

view of emotional disturbance

- REBT based on premise that we learn irrational beliefs from significant others during childhood and then re-create these irrational beliefs throughout our lifetime - it is our own repetition of irrational beliefs that keeps dysfunctional attitudes alive - goal: teach clients to be less emotionally reactive - blame is at the heart of most emotional disturbances

relationship between client and therapist

- a warm relationship is not required - unconditionally accept the patient - accept clients as imperfect

Aaron Beck's cognitive therapy

- abnormal behavior caused by negative schemas, automatic thoughts - see more below*

9. labeling and mislabeling

- an extreme form of overgeneralization - instead of describing your error, you attach a negative label to yourself (I'm a loser) - when someone elses behavior rubs you wrong way, you attach negative label to him "he's a bad person" - mislabeling is describing an event with language that is highly colored and emotionally labeled

D= disputing intervention

- application of methods to help client challenge their irrational beliefs - detecting, debating, discriminating

CT

- assist clients in examining and restructuring their core beliefs - encourage clients to gather and weight evidence in support of their beliefs - people commit logical errors that distort reality (keep disorders going) - teach clients how to identify distortions and help clients change

cognitive behavior therapy (CBT)

- behavioral techniques and theory from behavior therapy - #1 paradigm in clinical psychology programs and psychiatry - have a lot of research than any other therapy - dominated by EBT trails

CBT strengths*

- clients get it, easy to do - practical and commonsensical - not complicated - appreciate emphasis on cognition and action - popular with diversity - REBT teaches clients ways to carry on their own therapy without the direct intervention of a therapist - CT focuses on developing a detailed case conceptualization as a way to understand how clients view their world

disorder specific

- cognitive behavior

cognitive behavioral characteristics

- collaborative relationship between client and therapist - psychological distress is largely a function of disturbances in cognitive processes - a focus on changing cognitions to produce desired changes in affect and behavior - a present centered, time limited focus - an active and directive stance by the therapist - an educational treatment focusing on specific and structured target programs

contributions of CBT

- commitment to science and testing ideas and treatments - provide most EBT's to field - respect and reimbursement vs. la la land - spurs further research and grants - prestigious medical magazine award - always trying to improve - integrative forms of psychotherapy

disputing irrational beliefs

- common cognitive method of REBT - therapist actively disputes client's irrational beliefs and teaching them how to do this challenging on their own - lead to self-defeating behavior - eg: "i must have love or approval from all the significant people in my life"

schema

- core beliefs

11. glooming and dooming

- depressive/pessimistic attributional style - you see your stressors (bad outcomes) (failures) (hassles) as attributable to or caused by unchangeable character flaws that are personal/internal/global/stable - e.g.: "i was rejected or failed because I'm unlovable to everyone or stupid in everything"

techniques

- disputing irrational beliefs - doing homework (written or real world) - bibliotherapy - changing one's language (SHANL)*** -rational emotive imagery (REI) -using humor - roleplay - shame attacking exercises - other behavior therapy techniques

epictetus

- disturbed by view we take of bad things - eg: its not about boating accident, its about how he thinks he killed his brother

cont..

- disturbed emotional reactions (depression) are initiated and perpetuated by clients self-defeating belief systems which are based on irrational ideas clients have incorporated and invented

shame attacking exercises (in vivo exposure)

- emotional disturbance related to the self is often characterized by feelings of shame, guilty, anxiety, and depression - increasing self- acceptance and help clients see that much of what they think of as being shameful has to do with the way they define themselves

cont.

- emphasize role of homework - place responsibility on client to assume an active role both during and outside therapy

6. magnification (catastophizing) or minimization

- exaggerate the importance of things (goof-up or someone else's achievement) or you inappropriately shrink things until they appear tiny (your own desirable qualities or other's imperfections)

one size fits all

- existential - humanistic

changing one's language

- imprecise language is one of the causes of distorted thinking processes - musts, shoulds, oughts - SHANL**??

cognitive therapy (CT)

- insight-focused therapy with strong psychological component that emphasizes recognizing and changing unrealistic negative thoughts and maladaptive beliefs - came after REBT - most influential in world - started with depression but now works for all DSM disorder -disorder specific

5. jumping to conclusions

- make negative interpretation even though there are no definite facts that convincingly support your conclusion - mind reading: you conclude that someone is reacting negatively to you and don't bother to check it out - the fortune teller error: you anticipate that things will turn out badly and you feel convinced that your prediction is an already established fact

CBT limitations*

- negative view of dependency - extensive training is required to practice CBT - manualized treatment sounds scary BUT there is creativity - robbing therapists of freedom, creativity? ^ - REBT: potential problem with not paying attention to childhood/ past events - CT: too much positive thinking, too simple

Donald Leichenbaum's Cognitive Behavior Modification

- not used a lot

applications of CT

- outcome trails have established CT's efficacy for a wide range of problems - randomized clinical trails - family therapy

automatic thoughts

- personalized notions that are triggered by particular stimuli that lead to emotional responses

3. mental filter

- pick out a single negative detail and dwell on it exclusively so that you vision of all reality becomes darkened eg: drop of ink colors the entire beaker of water

Albert Ellis's REBT

- rational emotive behavior therapy (REBT) - cognitive behavior therapy approach - you feel what you think - people contribute to their own psychological problems - cognitions, emotions and behaviors interact significantly and have a reciprocal cause and effect relationship - interactive approach - emotions stem mainly from our beliefs, which influence the evaluations and interpretations we make of the reactions we have to life situations - does not focus on free association, dreams, focusing on clients past

bibliotherapy

- read books - use as an adjunctive form of treatment

1. all or nothing thinking

- see things in black and white e.g.: if performance is not perfect, then you are a failure

12. unhealthy thinking

- somehow you are looking at this situation in a way that keeps you stuck and miserable, even though it seems accurate, unbiased or logical to you

advantages of REBT

- suitable for group therapy - wide range or settings and populations - brief from of therapy

REBT cont.

- taught everywhere - 1st cognitive and CBT approach* - educational, directive, important - concerned with thinking and feeling - emotions stem mainly from our beliefs, evaluations, interpretations and reactions to life situations ellis: (doing these keep ourselves emotionally disturbed) - dont "should" on yourself - stop "musterbation" - "ought"

goals:

- teaching clients how to separate the evaluation of their behaviors from the evaluation of themselves and how to accept themselves in spite of their imperfections

CT -client and therapist relationship

- the quality of the therapeutic relationship is basic to the application of cognitive therapy - CEU (necessary but not sufficient)

techniques of CT

- thought record (e.g.: Peter Pan) - activity scheduling - skills training - behavioral rehearsal - role reversal technique* (you switch roles with client)

CT goals

- to change the way clients think by using their automatic thoughts to figure out core schemas and begin to introduce the idea of schema restructuring (cognitive restructuring)

cognitive triad

- triggers depression 1. negative view of self 2. negative view of world 3. negative view of the future (where suicide happens)

Marsha

- walking around with the idea that she wasn't lovable and that's the underlying problem - Beck will go over this with her - thought record and teach her to be her own therapist - her husband left her - she has suicidal depression - she thinks she is unlovable (core schema) - overgeneralization (husband did not want her so no one else will) - personalization (she blames herself)

view of human nature

- we are born with a potential for both rational and irrational thinking - we have a 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

7. emotional reasoning

- you assume that your negative emotions necessarily reflect the way things really are eg: "i feel it, therefore it must be true"

CT- basic theory

- you feel what you think - intervene on cognitive level to make change - ultimate causation?

4. disqualifying the positive

- you reject positive experiences by insisting they "don't count" for some reason

2. overgeneralization

- you see a negative event as a never ending pattern of defeat

10. personalization

- you see yourself as the cause of some negative external event which in fact you were not primarily responsible for

8. should statements

- you try to motivate yourself with shoulds and shouldn'ts as if you have to be punished before you could be expected to do anything - musts and oughts are offenders - emotional consequence is guilt - Ellis"s "Don't should on yourself"

ABC framework

-central to REBT - tool for understanding the client's feelings, thoughts, events, behavior - focus on B A= activating event, existence of a fact B= person's belief about A C= emotional and behavioral consequence or reaction of the individual (healthy or unhealthy)

rational emotive imagery (REI)

-clients vividly imagine one of the worst things that might happen to them -imagine specific situations and experience disturbing feelings

cognitive distortions

1. all or nothing thinking 2. overgeneralization 3. mental filter 4. disqualifying the positive 5. jumping to conclusions 6. magnification (catastrophizing) or minimization 7. emotional reasoning 8. should statements 9. labeling and mislabeling 10. personalization 11. glooming and dooming 12. unhealthy thinking

SHANL

???

ABC example

A= gun pointed at New Yorker B= run for your life C= ? A= gun pointed at stone age tribesman B= interesting object C= ? -it's not about the event, its about the interpretation that matters - B

CBT limitations from diversity perspective

Ellis: - rapid fire approach - strong confrontational style of Ellis's REBT may overwhelm some clients Beck: - kinder, gentler, socratic (uses questions)

cont,

REBT is - highly didactic, very directive, concerned with thinking as it is with feeling - teaches that our emotions stem mainly from our beliefs, evaluations, interpretations, and reactions to life situations

cognitive restructuring

a central technique of cognitive therapy that teaches people how to improve themselves by replacing irrational beliefs with rational beliefs - helping clients learn to monitor their self-talk, identify maladaptive self-talk, and substitute adaptive self-talk for their negative self-talk

REBT: an educational process

clients learn to - identify and dispute irrational beliefs that are maintained by self-indoctrination - iBs vs. rBs - irrational > maladaptive, self-defeating - to replace ineffective ways of thinking with adaptive, effective and rational cognitions - cognitive restructuring - to stop absolutistic thinking (shoulds or musts), blaming, and repeating false beliefs - SHANL elements in iBs (Frisch)**?

hopeless is a _______________ of depression

sign