Cognitive behavior therapy

“You are today where your thoughts have brought you; you will be tomorrow where your thoughts take
you”- James Allen

2 MAJOR PROPONENTS

1. Albert Ellis
-founder of the rational emotive therapy; grandfather of cognitive behavior theory
- graduated with a degree in business administration in 1934 at City College of New York
- earned master’s degree in clinical psychology in 1943 and Ph. D in 1947 from Columbia
University
-was interested in psychoanalysis until he noticed the slow progress of the therapy for his clients;
realized that improvement can be made quick if the client would change their way of thinking
about themselves and their problems
-HUMOR was an important part of his philosophy (he applied to his own life challenges)

2. Aaron Beck
- Pioneering figure in cognitive therapy
- Graduate of Brown University and Yale School of Medicine
- Initially practiced as neurologist then switched to psychiatry during residency
- Developed the cognitive theory of depression
-he found the cognitions of depressed persons to be characterized by errors in logic
(cognitive distortions)

- founder of Beck institute

HISTORICAL DEVELOPMENT

- RET originiated from the philosophy of Stoicism (ancient Greece)

-“we are not so much disturbed by what happens to us, as by how we interpret what
happens to us”
- Ellis developed a humanistic theory of psychotherapy that “squarely places the man in the
center of the universe and of his emotional fate and gives him full responsibility for choosing
to make or not to make himself seriously disturbed” (Ellis, 1973, p.10)
- Ellis began studying learning theory but observed that dysfunctional behavior stems from
irrational ideas and thoughts
- Ellis himself had a social phobia; he challenged himself by approaching 100 unfamiliar
women in the Bronx Botanical Gardens until he could be comfortable

VIEW OF HUMAN NATURE

Basic assumption of REBT:

-Human beings are born with a potential for both rational, or “straight” thinking and “irrational, or
“crooked” thinking.

(means that we are fallible, yet REBT attempts to help us accept ourselves as creatures who will
continue to make mistakes yet at the same time learn to live more at peace with ourselves)
-When we behave and think rationally, we are effective, happy and competent; When we are
irrational, we think illogically resulting to psychological disturbance

REBT BELIEVES THAT:

People have the capacity to confront their value systems and reindoctrinate(condition themselves)
with different beliefs, ideas and values.

**A-B-C theory of behavior

- People come to therapy because of a consequence (C)- emotional or behavioral condition

that disturbs them
- People attribute their emotional or behavioral consequence to an activating event (A)- an
external event (e.g financial setback, a fight with friend)
- People are disturbed by their beliefs (B) they hold about those events
- A (activating event) does not cause C (emotional consequence), it is the B, (person’s
beliefs) about A which largely causes C.

EX: Lino is depressed because he got poor grades on his subjects this semester.

A- He failed the test

B- He feels worthless
C- Feels depressed

DEVELOPMENT OF MALADAPTIVE BEHAVIOR

- Maladaptive behavior results from a number of major illogical ideas that are held and
perpetuated until a new way of thinking is learned
- ILLOGICAL IDEAS- inappropriate and self-defeating that lead to feelings of
WORTHLESSNESS, DEPRESSION, RAGE, ANXIETY, MANIA or SELF-PITY
- Blame- core of most emotional disturbances (self or others)
- “should”, musts”, “oughts”

Common Irrational beliefs:

a. Being loved and approved by virtually every significant person in our world is necessary
for happiness and fulfillment
b. To be worthwhile, one should be thoroughly adequate, fully competent, and high
achieving in all possible respects.
c. Certain people are bad, wicked, or villainous and should be severely blamed and punished.
d. It is awful and catastrophic when conditions are not the way one would very much like
them to be.
e. Unhappiness is caused externally; therefore people have little or no ability to control their
sorrows and disturbances
f. If something is or may be dangerous or frightening, one should be terribly concerned
about it, and should keep dwelling on the possibility of its occurring.
g. People need to be dependent on someone stronger than themselves

2 most common irrational beliefs:

 1. Approval from others (If I am not liked and approved by others, that is terrible and I
am no good)
2. Perfection (if I don’t consistently do a perfect job, then I am no good)

internalizing self-defeating beliefs->>>>emotional disturbance.

Therapeutic techniques and procedures:

The practice of rational emotive behavior therapy

Therapists:

MULTIMODAL

INTEGRATIVE

Starts with client’s distorted feelings + in connection with thoughts and behaviors

DIFFERENT MODALITIES:

- COGNITIVE
- IMAGERY
- EMOTIVE
- BEHAVIORAL
- INTERPERSONAL

*Flexible and creative to tailor the unique needs of each client

We can significantly change our cognitions, emotions, and behaviors.

How?

Avoiding preoccupying ourselves with A

Acknowledging the futility of dwelling endlessly on emotional consequences at C

What should we do:

Examine, challenge, modify and uproot B- the irrational beliefs we hold about the activating events at A.

REBT stresses the process of DISPUTING – BELIEFS (therapy sessions and in everyday life)

Arrive at E, an effective philosophy, which has a practical side.

New and effective belief system--- replacing unhealthy thoughts w/ healthy ones
Then we create F, a new set of feelings (instead of feeling seriously anxious and depressed, we feel
healthily sorry and disappointed in accord with a situation)

PHILOSOPHICAL RESTRUCTURING – TO CHANGE OUR DYSFUNCTIONAL PERSONALITY

Involves :

1. Fully acknowledging that we are largely responsible for creating our own emotional problems
2. Accepting the notion that we have the ability to change these disturbances significantly
3. Recognizing that our emotional problems largely stem from irrational beliefs
4. Clearly perceiving these beliefs
5. Seeing the value of disputing such self-defeating beliefs
6. Accepting the fact that if we expect to change we had better work hard in emotive and
behavioral ways to counteract our beliefs and the dysfunctional feelings and actions that follow
7. Practicing REBT methods of uprooting or changing disturbed consequences for the rest of our
life.

In less parrott

THREE GENERAL MODES OR PHASES

1. COGNITIVE
2. EMOTIVE
3. BEHAVIORISTIC

-EACH ACCOMPANIED BY ITS OWN SET OF TECHNIQUES

COGNITVE- PRESENT the cognitive rationale for the therapy to client

“What problems have you been bothering yourself about?”
--implies that clients can learn to control their emotions by learning how to become aware
of their underlying thoughts and by learning to substitute alternative thoughts

EMOTIVE- to become aware of their thoughts

Asking clients to write down their troublesome thoughts

BEHAVIORISTIC- clients are trained to verbalize alternative cognitions and to change their
behavior

RET Techniques:

1. IDENTIFYING BELIEFS
- Basically, at the first stage the client has a trouble responding to the counselor’s questions about
what thought really influenced their emotional consequences since their irrational beliefs stem
from their feelings
- So what can the counselor do? They will facilitate the identification of irrational beliefs
- Sample questions are:
If you bugged yourself, what would you hear?
Suppose you were tape-recording
 What is going on in your mind? Parang facebook lang no
Can you replay the tape? Tell me what it says

- Once the client identifies their irrational beliefs, the counselor can group them into themes
o All-or-nothing thinking- client Got C thinks he is a failure; clients tend to categorize matters in
terms of black or white, yes or no, for or against; a conversation less than perfect is a total failure
o Mind reading- making inferences- making inferences about how people feel, and think,
imagining for instance that the president doesn’t like people
o Overgeneralization- seeing a single event as a never-ending pattern of defear; commonly
emerges; always or never
o Discounting- rejecting positive experiences by insisting they don’t count; perfectionist (anyone
could have done it)
o Magnification- exaggerating the importance of problems and shortcomings (with my iq I can
never relaly get a good job)
o Emotional reasoning- assumimg that negative emotions reflect the way things really are (I feel
guilty so I must be guilty; tamang hinala)
o Self-blame- taking personal responsibility for events that are beyond one’s control

2. DISPUTING—challenges the irrational beliefs of the clients; asking them to produce

evidence to support the beliefs

-occurs in two stages

a. more specific stage- initial stage that requires meticulous sentence by sentence
examination and challenge of any irrational belief reported by the client
b. general stage- seeks to develop alternate, more rational way of thinking

three forms of disputation

a. Cognitive
b. Imaginal
c. behavioral

COGNITIVE DISPUTATION- uses persuasion and direct questioning

“can you prove it?”
“how do you know?”
“if that’s true, what’s the worst thing can happen?”
“Where’s the evidence?”
“as long as you believe, how will you feel?”

*catch – clients can be so defensive ; that’s why we have to PROFESSIOANALLY SENSITIVE to their
responses

IMAGINAL DISPUTATION- also called rational emotive therapy

- assumption that the emotional consequences of client’s imaginings are similar to those
produced by a real stimuli
- technique used to provide safe opportunities for trying new ways of thinking
 - the clients are asked to imagine themselves in a problematic situation they dread
- guided into the feelings of the moment
- change their fear to mild apprehension; anger to mild irritation; depression to sadness
(in other words they are)asked to imagine themselves feeling or behaving differently in that
situation

BEHAVIORAL DISPUTATION- challenges clients to alter their irrational beliefs by behaving in diff
ways
-crucial step toward adopting a more rational philosophy
-takes the form of reading books called
Bibliotherapy and systematic hw assignments that include both written and in vivo practice

3. COUNTERING- identifying counters for each of their IB and then argue against it
- Rules:
a. Counters must be directly opposite to the false belief
Ex: I’m a failure if my wife leaves me; My wife’s behavior is independent of my own success
and accomplishment
b. Counters must be believable statements of reality
Ex; I don’t have to go to high school to get a reasonably good job
I don’t need to get straight As in highschool to get a reasonable good job after graduation

c. many counters to counteract the effects of those irrational beliefs have produced over time

d. must be concise, capable of being summarized – must be assertive and has emotional
intensity
e. clients must create and own these counters

role of counselor – our role needs to be limited to coaching

4. Rational self-analysis
-allows the client to apply the ABC theory to their situations which helps them to
actively dispute their own irrational beliefs

What are more likely to bring positive chang ?

Only the repeated investigation and disputation of irrational beliefs
And earnest practice of new and actualizing behaviors

-complete daily homework assignments

*Picture

5. Action homework- encourage clients to dsispute their IB ebheaviorally, n addition to

rational self-analysis
Ex: rejection- told to collect at least 3 rejectiosn for 3 consc days and to note their self-
talk immediately after each attempt

Impt characteristcics:
Consistency
Specificity
 Sysmatic follow-through
Large steps

6. Heightening awareness- becoming aware of the effects of the ABCEF model thru use of
numerical ratings and self-recording; recording levels of emotional distress during actual
situations
7. Humor- lightening up; view things in the light of day; highlight the absurdity of their
irrational beliefs

APPLICATION

Stan was 35 years old,

He was a very troubled young man
He cant take control of acoholic and sometimes drugs substances
His real problems come from his extremely low self-esteem. This stemmed from his
childhood
During his childhood his whole family contributed to his current issues.
His mother shattered his view of women due to the fact she dominated his father and
Stan himself

Cognitive Behavioral Therapy

During his childhood and part of his adolescence he was compared with his brother and
sister.
His family was the main root of his problems

Identify his problems and formulate goals

Structure; procedural sequence
1. Providing a cognitive rationale for treatment and demystifying tx’
2. Encouraging him to monitor the thoughts that accompany his distress
3. Implementing behavioral and cognitive techniques
4. Working with him to assist him in identifying and challenging some basic beliefs and
ideas
5. Teaching him ways to examine his beliefs and assumptions by testing them in reality
6. Teaching him basic coping skills that will enable him to avoid relapsing into old patterns

-review of the week

-feedback from previos session
Reviews homework assign
-encourage personal experiments and practice oping skills

GOAL: work on his fear of women

Because he feels threatened by most women especially by women he perceives
powerful

Fear:
1. Educating him about his self-talk
-it all starts by examining his automatic thoughts. This could be his should, oughts,
musts .
Let’s say “If I fail, I am then a failure as a person, I’m not a man if I show any signs of
weakness.
2. having him monitor and evaluate his faulty beliefs
-as a therapist, once you get to the core of his faulty thinking, we can now challenge
those specific problems
“Do you think you need to continue accepting w/o question your parent’s
judgements about yout worth?
Where is the evidence that they were right in their assessment of you
“you say you’re such a failure and you feel inferior. Do your present activities support
this?
“if you were not so hard on yourself, how might your life be different?”
3. Using cognitive and behavioral interventions
-once he understands the nature of his cognitive distortions and his self defeating
beliefs, the therapist can now apply the ___
Socratic questioning
Guided discovery
Cognitive restructuring

*by the use of cognitive restructuring, he would observe his behavior in various
situations
Ex: in a week he has to pay particular situation that is problematic to him, what he
will do is to play close attention to his automatic thoughs and internal dialogue,
what is he telling himself as he approaches a difficult situation- he attends to his
maladaptive behaviors—confronting instead of avoiding
From there we can begin to learn a new , more functional internal dialogue
4. Collabortively designing homework with Stan that wil give him opportunities to
practice new behaviors in daily life
Not enough to merely say new things to himself
Needs to apply his new cognitive and behavioral copng skills in various daily
situations

Example: he has to approach a woman for a date

Pag successful, he can now challenge his catastrophic expectations of what might
happen

What would be so terrible if she did not like him or if she refused the date?
He has to tell himself over and over that he must be approved of by women and if
not the consquences are more than he can bear
He learns to lable distortions and is able to automatically identify his dysfunctional
thoughst and monitor his cognitive pattermns
He can aquire new infor change his beliefs or schemata and implement new and
more effective behavior.