Cognitive Behavioral Therapy

Three Basic Musts

I must do well and win the approval of others or else I am no good. Others must treat me the way I want them to treat me or they are no good. I must get what I want when I want it , and I must not get what I don't want for if I do life is no good.

Process of Behavioral Therapy

1.) clarifying the problem 2.) formulating initial goals for therapy 3.) identifying target behavior 4.) designing a treatment plan 5.) evaluating the success of plan 6.) identifying next target behavior

Albert Ellis

1913-2007; Field: cognitive-behavioral; Contributions: Rational-Emotive Therapy (RET), focuses on altering client's patterns of irrational thinking to reduce maladaptive behavior and emotions

Behavioral Therapy

A form of psychotherapy that applies the principles of learning and conditioning (classical and operant) to eliminate symptoms and modify maladaptive or ineffective patterns of behavioral

Cognitive Therapy

A form of psychotherapy using imagery, self-instruction, and related techniques to alter distorted attitudes and perceptions.

Key Figures

Aaron Beck, Donald Meichenbaum, Albert Ellis, Leon Festinger, George Kelly, Steve de Shazer, Insoo Kim Berg, Bill O'Hanlon

LOTCA, KELS, AMPS

Assessment of Motor and Process Skills (AMPS) • Barthel Index • Kohlman Evaluation of Living Skills (KELS). 3rd ed. • Loewenstein Occupational Therapy Cognitive Assessment (LOTCA)

What is CBT

Cognitive therapy is a widely used form of psychotherapy that focuses on changing dysfunctional cognitions (thoughts), emotions and behavior.

Cognitive Therapy is based on?

Cognitive therapy is based on the theory that individuals with depression, anxiety and other emotional disorders have maladaptive patterns of information processing and behavioral-related difficulties.

Aaron Becks Cognitive Therapy: Selective Abstraction

Consists of forming conclusions based on isolated details of the event. The assumption is that the events that matter are those dealing with failure and assumptions.

REBT: Four Steps of Therapist

First , Show clients how they have incorporated irrational absolute should, oughts and musts. Second, Demonstrate how clients are keeping their emotional disturbances active. Third, Help clients modify their thinking and minimize irrational ideas. Fourth, challenge clients to develop a rational philosophy of life to aid them in the future.

Overgeneralization

Holding extreme beliefs on the basis of a single incident and applying them inappropriately to dissimilar events or settings.

Patients are taught

In cognitive therapy, patients are usually taught how to detect cognitive errors and to use this skill in developing a more rational style of thinking

REBT: Anxiety

Initiated and perpetuated by clients' self-defeating belief systems, which are based on irrational ideas clients have incorporated and invented.

What involves

Involves helping clients develop skills for modifying beliefs, identifying distorted thinking, relating to others in different ways and changing behaviors

Negative automatic thoughts

Negative automatic thoughts can be associated with behaviors (e.g., helplessness, withdrawal or avoidance) that make the problem worse. In depression or anxiety disorders, there is often a "vicious cycle" of dysfunctional cognitions, emotions and behaviors.

Relevance

It is used to treat Depression, anxiety disorders, phobias and other forms of mental disorders. Medication is often used in conjunction with this approach to treat mood disorders and more severe forms of mental disorders.

Main goal of Cognitive Therapy

It seeks to help the client overcome difficulties by identifying and changing dysfunctional thinking, behaviors, and emotional responses.

Theory

Maladaptive behavior is associated with patterns of thinking and response that do not result in mentally healthy outcomes. The focus of therapy is on the present rather than the past. The central premise is that behavior is maintained by its consequences: • Consequences that accelerate behavior are called reinforcers • Consequences that decelerate behavior are called punishers

Assessment for CBT

Observation and interview first LOTCA, KELS, AMPS, basic living skills battery, stress management questionnaire

Role of Client

Once they understand the role of irrational beliefs, they are to participate effectively in the cognitive restructuring process. Even though life is not always pleasant, they learn that it can be bearable and suffering can be honorable.

Albert Ellis , RET

Pioneer in Rational-Emotive Therapy (RET), focuses on altering client's patterns of irrational thinking to reduce maladaptive behavior and emotion

Cognitive Behavior Modification

Procedures based on both behavioral and cognitive learning principles for changing your own behavior by using self-talk and self-instruction.

REBT: Role of Therapist

Takes mystery out of therapeutic process, teaches clients about cognitive hypothesis of disturbance, and explains how rigid and extreme irrational beliefs lead to negative consequences.

Treatment

The goal of cognitive-behavioral therapy is to change or substitute these patterns with more realistic and useful thoughts and responses.

Primary Target

The identification of negative or distorted automatic thoughts.

What are automatic thoughts

The relatively autonomous thoughts that occur rapidly while an individual is in the midst of a particular situation or is recalling significant events from the past. Automatic thoughts are frequently based on faulty logic or errors in reasoning. Cognitive therapy is directed, in part, at helping patients recognize and change these cognitive errors (sometimes called cognitive distortions).

Disputing Irrational Belief

Therapist actively disputing clients' irrational beliefs and teaching them how to do this challenging on their own. Therapist goes over musts , should , or oughts.

CBT areas to change

Thoughts, attitudes, knowledge and skills

REBT: Emotional Disturbances as a result of

We learn irrational beliefs from significant others during childhood and then re-create these irrational beliefs throughout our lifetime. Reinforce beliefs through autosuggestion and self-repetition. Three basic musts.

Techniques Cognitive

challenge thoughts, challenge assumptions, journaling, mental imagery, thought stopping, self instruct training, role playing or role reversal

Schemas

cognitive structures are thought to be the templates, or basic rules, for interpreting information from the environment.

Donald Meichenbaum

developed cognitive behavior modification (CBM) as an alternative to Ellis's REBT. A crucial element of CBM is that the client must learn how they are impacting others and become aware of how they feel, think and behave. To make changes in their behavior, the "clients need to interrupt the scripted nature of their behavior so that they can evaluate their behavior in various situations

Techniques Behavior

graded task assignment, activity schedule, social skill training, assertive training, behavior rehearsal