1. Cognitive Behaviour Therapy (CBT) Gerhard Ohrband - ULIM University, Moldova 9th lecture Rational Emotive Therapy

2. Course Structure 1. Introduction: What is CBT? What are differences and similarities with other therapy schools? 2. Diagnostics in CBT 3. Classification of Psychological Disorders (ICD- 10, DSM-IV), Clinical Psychology (Etiology, prevalence, comorbidity and symptoms) 4. Etiological concepts in CBT: learning theories (classical and operant conditioning, vicarious learning, Mowrer’s Two-factor theory) 5. Systematic desensitization: in-vivo exposure and imaginatory 6. Aversion training: overt and covert

3. Course Structure 7. Response prevention: treating obsessive-compulsive disorder (OCD) 8. Social skills training: anger management, assertiveness training 9. Rational-emotive Therapy (RET) 10. Beck’s Cognitive Therapy for depression 11. Marital and Sex Therapy 12. Trauma Therapy: Expressive writing, work with affirmations, visualizations; working with victims of crimes, accidents and other difficult life-events 13. Relaxation techniques: yoga, meditation, Alexander technique, Feldenkrais 14. CBT at school: helping children with autism, hyperactivity, social phobia, social adjustment problems, learning difficulties and antisocial behaviour. 15. CBT in treating addiction and substance abuse

4. Rational-Emotive Therapy (RET) Albert Ellis, clinical psychologist from New York Maladaptive thoughts are at the root of many psychological problems Therapist challenges a patient’s beliefs Differences/similarities with other cognitive therapies

5. Albert Ellis

6. ABC model of maladaptive behaviour Final exam night “I’m stupid.” “If I don’t get an A, I’m worthless.” Fear; severe anxiety Poor test performance 3-year-old son throws tantrum “I’m an incompetent Parent.” Guilt Lack of effective discipline Boss does not give raise “I must get a raise or else the world isn’t fair.” Righteous indignation Loss of motivation A ctivating event irational B eliefs aboutnegative activating event C onsequences

7. Essence of RET Not activating events (A) but beliefs (B) about activating events lead to emotional distress or bad behavioural consequences (C) “must”urbation RET therapists attempt to change patient’s thinking through logic, persuasion, occasional lecturing, and even prescribing specific activities

8. Basic assumptions Ellis believes that most irrational beliefs derive from a few basic assumptions that people wrongly make I must do extremely well and win approval or else I am a rotten person Others must treat me considerately and kindly and precisely the way I want them to treat me The conditions in which I live must be arranged so that I get everything I want in life, quickly and easily, and I don’t get anything I don’t want. I must be loved and admired by everyone who comes in contact with me

9. 10 irrational beliefs First-order beliefs: 1. I have to be loved and appreciated in everything, always and by the whole world. 2. I have to have talent and to be able to succeed in every important activity 3. Life is a catastrophe if things do not go the way I want.

10. Second-order beliefs 4. People who do bad things are detestable and deserve to be punished. 5. If there is something troubling, I am concerned and shocked by this thing. 6. I have to find solutions to make life better. 7. Inner and emotional unhappiness come from outside pressures, but I have possibilities to control my feelings and to escape from hostility and depression.

11. Second-order beliefs 8. It is easier to evade the confrontation of life’s difficulties than to start more profitable activities to control myself. 9. My past is of capital importance and, something which influenced your life in the past has to govern your present feelings and behaviours. 10. You can reach to happiness through inertness, through inactivity or through passive enjoyment and without personal commitment, engagement.

12. A-B-C-D-E D – discussion. Modification of beliefs. The therapist helps the patient to modify his irrational belief system E - effect. The effect represents the adoption of a more rational conception about the world

13. Example Carla is a college student with a problem. She is anxious all the time about her schoolwork. All day she worries that she is not working hard enough. At night she dreams about failing tests. She has few friends and almost no outside interests because she believes she must devote herself totally to her work. Although Carla has been a consistent B student, she feels she can do better. But her anxiety makes it hard to concentrate in class or to study in the evenings. She’s tired all the time because her sleep is fitful. And on tests her mind sometimes goes blank, even when she is well prepared.

14. Example If Carla visited Ellis and said to him, “B’s aren’t good enough. I have to get A’s,” Ellis might actually yell at her: “So B’s aren’t good enough? You have to be perfect? Why? Why are you making yourself crazy by thinking you have to be perfect? Shoulds! Musts! Don’t you know the first commandment? Thou shalt not ‘should’ on thyself!” Ellis might point out that Carla’s belief that she should be perfect is completely irrational. She might want to do better in school, but that is different from believing she must do better in school.

15. Example In Carla’s case, the distribution of a final exam might be the activating event (A). Carla might experience panic as a consequence (C) and perform poorly on the exam, not because the activating event but because of her irrational beliefs (B) about tests – beliefs such as “I know I am going to fail” or “I didn’t study enough” or “The teacher is out to get me.”

16. Criticism “RET therapists do not try to build warm, caring relationships with their clients.” Assumption: such a relationship is crucial to successful therapy RET point of view: an overly warm and caring therapist reinforces the client’s desire to be loved by everyone – an irrational belief that is often the root of the client’s problem in the first place

17. Literature Dryden, W. and Ellis, E. (1988). Rational-emotive therapy. In K.S. Dobson (Ed.), Handbook of cognitive-behavioral therapies (pp. 214-272). New York: Guilford. Ellis, E. (1984). Rational-emotive therapy. In R.J. Corsini (Ed.), Current psychotherapies (pp 196-238). Itasca, IL: Peacock. Ellis, E. and Bernhard, M.E. (1985). Clinical applications of rational-emotive therapy. New York: Plenum Haaga, D.A.F. and Davison, G.C. (1991). Cognitive changes models. In F.H. Kanfer and A.P. Goldstein (Eds.), Helping people change (3 rd ed., pp. 248-304). Elmsford, NY: Pergamon Press.

18. Internet resources http://rebt-cbt.net/ http://rebt-cbt.net/ REBT-CBT NET The Internet Guide to Rational Emotive Behavior Therapy and Cognitive Behavior Therapy http://www.albertellisinstitute.org/aei/in dex.html http://www.albertellisinstitute.org/aei/in dex.html Albert Ellis Institute- REBT