Theory and Practice of Counseling and Psychotherapy TENTH EDITION Gerald Corey Cengage Learning

Cognitive Behavior Therapy Chapter 10 Cognitive Behavior Therapy

Cognitive Behavioral Approaches (slide 1 of 2) The various cognitive behavioral approaches share the following attributes: A collaborative relationship between client and therapist The premise that psychological distress is often maintained by cognitive processes A focus on changing cognitions to produce desired changes in affect and behavior Theory and Practice of Counseling and Psychotherapy - Chapter 10 (1)

Cognitive Behavioral Approaches (slide 2 of 2) The various cognitive behavioral approaches share the following attributes: A present-centered, time-limited focus An active and directive stance by the therapist An educational treatment focusing on specific and structured target problems Theory and Practice of Counseling and Psychotherapy - Chapter 10 (2)

Albert Ellis’s REBT Rational Emotive Behavior Therapy (REBT) Assumes that cognitions, emotions, and behaviors interact and have a reciprocal cause-and-effect relationship Is highly didactic and directive Teaches that our emotions stem mainly from our beliefs, evaluations, interpretations, and reactions to life situations Theory and Practice of Counseling and Psychotherapy - Chapter 10 (3)

REBT: An Educational Process Clients learn to identify the interplay of their thoughts, feelings, and behaviors and to identify and dispute irrational beliefs maintained by self-indoctrination Clients learn to stop absolutistic thinking, blaming, and repeating false beliefs and replace ineffective ways of thinking with effective and rational cognitions Theory and Practice of Counseling and Psychotherapy - Chapter 10 (4)

The A-B-C Theory of Personality Activating event B Belief C Consequence D Disputing intervention E Effective philosophy F New feeling Theory and Practice of Counseling and Psychotherapy - Chapter 10 (5)

Irrational Beliefs Three basics MUSTS we internalize that inevitably lead to self-defeat: “I MUST do well and be loved and approved by others.” “Other people MUST treat me fairly, kindly, and well.” “The world and my living conditions MUST be comfortable, gratifying, and just, providing me with all that I want in life.” Theory and Practice of Counseling and Psychotherapy - Chapter 10 (6)

Therapeutic Goals To help clients differentiate between realistic and unrealistic goals and between self-defeating and life-enhancing goals To assist clients in the process of achieving: Unconditional self-acceptance (USA) Unconditional other-acceptance (UOA) Unconditional life-acceptance (ULA) Theory and Practice of Counseling and Psychotherapy - Chapter 10 (7)

Therapeutic Techniques (slide 1 of 2) Therapists practicing REBT use the following techniques: Disputing irrational beliefs Doing cognitive homework Bibliotherapy Changing one’s language Psychoeducational methods Theory and Practice of Counseling and Psychotherapy - Chapter 10 (8)

Therapeutic Techniques (slide 2 of 2) Therapists practicing REBT use the following techniques: Rational emotive imagery Using humor Role playing Shame-attacking exercises Standard behavior therapy procedures Theory and Practice of Counseling and Psychotherapy - Chapter 10 (9)

Application of REBT to Group Counseling (slide 1 of 2) Tailored for specific diagnoses such as anxiety, panic, eating disorders, and phobias Treatments are standardized and based on empirical evidence Use of homework allows lessons learned in group to generalize to the client’s daily environment Theory and Practice of Counseling and Psychotherapy - Chapter 10 (10)

Application of REBT to Group Counseling (slide 2 of 2) Group REBT affords many opportunities to Practice assertiveness skills Take risks by practicing different behaviors Challenge self-defeating thinking Learn from the experiences of others Interact therapeutically and socially with each other in after-group sessions Theory and Practice of Counseling and Psychotherapy - Chapter 10 (11)

Aaron Beck’s Cognitive Therapy (slide 1 of 2) Insight-focused therapy with an emphasis on changing negative thoughts and maladaptive beliefs Clients’ distorted beliefs are the result of cognitive errors Psychological problems are an exaggeration of adaptive responses resulting from commonplace cognitive distortions Theory and Practice of Counseling and Psychotherapy - Chapter 10 (12)

Aaron Beck’s Cognitive Therapy (slide 2 of 2) Through Socratic dialogue/reflective questioning, clients test the validity of their cognitions (collaborative empiricism) Change results from reevaluating faulty beliefs based on contradictory evidence that clients have gathered Hundreds of studies have confirmed the theoretical underpinnings of CT and established its efficacy for a wide range of psychiatric disorders Theory and Practice of Counseling and Psychotherapy - Chapter 10 (13)

Theoretical Assumptions People’s internal communication is accessible to introspection Clients’ beliefs have highly personal meanings These meanings can be discovered by the client rather than being taught or interpreted by the therapist Theory and Practice of Counseling and Psychotherapy - Chapter 10 (14)

CT’s Cognitive Distortions Personalization Labeling and mislabeling Dichotomous thinking Arbitrary inferences Selective abstraction Overgeneralization Magnification and minimization Theory and Practice of Counseling and Psychotherapy - Chapter 10 (15)

Negative Cognitive Triad Pattern that triggers depression: Clients hold negative views of themselves “I am a lousy person” Selective abstraction Client interprets life events through a negative filter “The world is a negative place where bad things are bound to happen to me” Client holds a gloomy vision of the future “The world is bleak and it isn’t going to improve” Theory and Practice of Counseling and Psychotherapy - Chapter 10 (16)

Applications of Cognitive Therapy The length and course of CT varies greatly and is determined by the therapy protocols used for specific diagnoses Examples: CT for depression: lasts 16 to 20 sessions and begins with behavioral activation CT for panic disorder: lasts 6 to 12 sessions and targets catastrophic beliefs about internal physical and mental sensations Theory and Practice of Counseling and Psychotherapy - Chapter 10 (17)

Strengths-Based Cognitive Behavioral Therapy Developed by Christine Padesky and Kathleen Mooney, S-B CBT is a variant of Aaron Beck’s cognitive therapy Involves identifying and integrating client strengths at each phase of therapy Active incorporation of client strengths encourages clients to engage more fully in therapy and often provides avenues for change that otherwise would be missed Theory and Practice of Counseling and Psychotherapy - Chapter 10 (18)

Applications for Strengths-Based CBT An add-on for classic CBT A four-step model to build resilience and other positive qualities The NEW paradigm for chronic difficulties and personality disorders Theory and Practice of Counseling and Psychotherapy - Chapter 10 (19)

Donald Meichenbaum’s Cognitive Behavior Modification Focus: Client’s self-statements or self-talk Premise: As a prerequisite to behavior change, clients must notice how they think, feel, and behave, and what impact they have on others Basic assumption: Distressing emotions are typically the result of maladaptive thoughts Theory and Practice of Counseling and Psychotherapy - Chapter 10 (20)

Meichenbaum’s CBM Self-instructional therapy focus: Trains clients to modify the instructions they give to themselves so that they can cope more effectively Emphasis is on acquiring practical coping skills Cognitive structure: The organizing aspect of thinking, which seems to monitor and direct the choice of thoughts The “executive processor” Theory and Practice of Counseling and Psychotherapy - Chapter 10 (21)

Behavior Change in CBM Three phases of behavior change 1. Self-observation Starting a new internal dialogue Learning new skills Theory and Practice of Counseling and Psychotherapy - Chapter 10 (22)

Meichenbaum’s Stress Inoculation training SIT is a three-phase coping skills program 1. The conceptual-educational phase 2. Skills acquisition and skills consolidation phase 3. Application and follow-through phase Theory and Practice of Counseling and Psychotherapy - Chapter 10 (23)

Cognitive Narrative Approach to CBT Focuses on the plots, characters, and themes in the stories people tell about themselves and others Meichenbaum claims that we are all “story tellers” In therapy, clients learn how they construct reality, examine the implications and conclusions they draw from their stories, and develop resilient-engendering behaviors Theory and Practice of Counseling and Psychotherapy - Chapter 10 (24)

Strengths from a Diversity Perspective CBT uses the individual’s belief system, or worldview, as part of the method of self-exploration Emphasis on cognition and action, and on relationship issues appeals to clients from diverse backgrounds CBT and multicultural therapy share common assumptions that make integration possible Theory and Practice of Counseling and Psychotherapy - Chapter 10 (25)

Limitations from a Diversity Perspective (slide 1 of 2) REBT’s negative view of dependency clashes with the view of interdependence as necessary to good mental health The “rapid-fire active approach,” used by some clinicians may alienate those who value being reflective Terms such as “irrational” or “maladaptive” may seem disrespectful and insensitive to clients who have felt marginalized in society Theory and Practice of Counseling and Psychotherapy - Chapter 10 (26)

Limitations from a Diversity Perspective (slide 2 of 2) The emphasis on assertiveness, independence, verbal ability, rationality, cognition, and behavioral change may limit CBT’s use in cultures that hold different values Inexperienced therapists may overemphasize cognitive restructuring to the neglect of environmental interventions Theory and Practice of Counseling and Psychotherapy - Chapter 10 (27)

Contributions of CBT (slide 1 of 2) Both Ellis’s REBT and Beck’s CT represent the most systematic applications of CBT The approaches are relatively brief and structured treatments that are cost effective The cognitive behavioral theorists have demystified the therapy process Theory and Practice of Counseling and Psychotherapy - Chapter 10 (28)

Contributions of CBT (slide 2 of 2) The credibility of this model grows out of the fact that many of its propositions have been empirically tested All cognitive behavioral approaches place emphasis on practicing new skills both in therapy and in daily life, and homework is a key part of the learning process Theory and Practice of Counseling and Psychotherapy - Chapter 10 (29)

Limitations of CBT Extensive training is required to practice CBT Therapists may misuse power by imposing their ideas of what constitutes “rational” thinking on a client The strong confrontational style of Ellis’s REBT may overwhelm some clients Some clinicians think CBT interventions overlook the value of exploring a client’s past experiences Theory and Practice of Counseling and Psychotherapy - Chapter 10 (30)