COGNITIVE BEHAVIORAL THERAPY

 A cognitive perspective on clinical problems emphasizes the role of thinking in the etiology and maintenance of
problems.
 Cognitive therapy seeks to modify or change patterns of thinking that are believed to contribute to a patient’s
problems.
 These techniques have a great deal of empirical support and in combination with behavioral approaches (i.e., CBT) are
seen as among the most efficacious of all psychological interventions.
 Although several effective treatments based on traditional behavioral learning principles had been developed, by the
early 1970s it was clear that a number of frequently encountered clinical conditions were not so easily addressed by
treatments based on classical or operant conditioning.
 Historically, behaviorists hold one of two views of cognitive therapy.
 On the one hand, most mainstream behaviorists, including the 5,000 or so members of the Association for
Advancement of Behavior Therapy, view all cognitive approaches, to the extent they are empirically based, as forms of
behavior therapy.
 On the other hand, members of the Association for Behavior Analysis (the followers of B. F. Skinner) reject cognitive or
cognitive-behavioral principles and approaches

Implications as discussed by Rotter (1970)

 Psychotherapy is regarded as a learning situation, and the role of the therapist is to enable the patient to achieve
planned changes in observable behavior and thinking.
 A problem-solving framework is a useful way in which to view most patients’ difficulties.
 Most often, the role of the therapist is to guide the teaming process so that not only are inadequate behaviors and
attitudes weakened but more satisfying and constructive behaviors are learned.
 It is often necessary to change unrealistic expectancies; in so doing, one must realize how it was that certain behaviors
and expectancies arose and how prior experience was misapplied or overgeneralized by the patient.
 In therapy, the patient must learn to be concerned with the feelings, expectations, motives, and needs of others.
 New experiences or different ones in real life can often be much more effective than those that occur only during the
therapy situation.
 In general, therapy is a kind of social interaction.

 Another highly significant contribution that has facilitated the cognitive swing in behavior therapy has been the work of
Bandura.
 Bandura demonstrated the importance of vicarious learning and the role of cognitive mediators in both affect and
performance.
 Bandura’s emphasis on the ways in which various treatment procedures increase the patient’s sense of self-efficacy is a
further step toward unifying the behavioral and cognitive realms
 In his proposed model, Bandura argues that expectations of personal efficacy arise from the patient’s actual
accomplishments, verbal persuasion, vicarious experience, and physiological states. Various forms of therapy are seen as
particularly productive in leading patients to an increased belief in their personal efficacy.
 Social learning theorists such as Rotter, Bandura, and others highlighted the idea that learning is an active, not a passive,
process.
 That is, a host of personal characteristics and cognitive processes influence behavior, sometimes independently of stimuli,
situations, or reinforcements.

 MODELLING
  Bandura advocated the use of modeling, or observational learning, as a means of altering behavior patterns, particularly
in children.

 Imitation, modeling, or observation is a much more efficient technique for learning than is a simple reliance on
punishment for incorrect responses and reward for correct ones.

 A new skill or a new set of behaviors can be learned more efficiently by observing another person.

 Seeing others perform a behavior can also help eliminate or reduce associated fears and anxieties.

 Finally, through observation one can learn to use behaviors that are already part of the behavioral repertoire.

 CBT is based on the idea that how we think (cognition), how we feel (emotion) and how we act (behavior) all interact
together.

 Specifically, our thoughts determine our feelings and our behavior.

 Therefore, negative and unrealistic thoughts can cause us distress and result in problems.

 When a person suffers with psychological distress, the way in which they interpret situations becomes skewed, which in
turn has a negative impact on the actions they take.

 CBT aims to help people become aware of when they make negative interpretations, and of behavioral patterns which
reinforce the distorted thinking.

 Cognitive therapy helps people to develop alternative ways of thinking and behaving which aims to reduce their
psychological distress.

 Cognitive behavioral therapy is, in fact, an umbrella term for many different therapies that share some common elements.

 Earliest forms of Cognitive Behavioral Therapy were Rational Emotive Behavior Therapy (REBT), developed by Albert Ellis in
the 1950s and Cognitive Therapy, developed by Aaron T. Beck in the 1960s.

 The cognitive therapist teaches clients how to identify distorted cognitions through a process of evaluation.

 The clients learn to discriminate between their own thoughts and reality.

 The behavior part of the therapy involves setting homework for the client to do (e.g. keeping a diary of thoughts). The
therapist gives the client tasks that will help them challenge their own irrational beliefs.

 They learn the influence that cognition has on their feelings, and they are taught to recognize observe and monitor
their own thoughts.

 The idea is that the client identifies their own unhelpful beliefs and them proves them wrong. As a result, their beliefs
begin to change. For example, someone who is anxious in social situations may be set a homework assignment to meet
a friend at the pub for a drink.

ALBERT ELLIS – REBT

 Focuses on resolving emotional and behavioral problems.

 The goal of the therapy is to change irrational beliefs to more rational ones.

 REBT encourages a person to identify their general and irrational beliefs (e.g. I must be perfect") and subsequently
persuades the person challenge these false beliefs through reality testing.

 Albert Ellis (1957, 1962) proposes that each of us hold a unique set of assumptions about ourselves and our world that
serve to guide us through life and determine our reactions to the various situations we encounter.

 Unfortunately, some people’s assumptions are largely irrational (basic irrational assumptions), guiding them to act and
react in ways that are inappropriate and that prejudice their chances of happiness and success.
  Some people irrationally assume that they are failures if they are not loved by everyone they know - they constantly
seek approval and repeatedly feel rejected. All their interactions are affected by this assumption, so that a great party
can leave them dissatisfied because they don’t get enough compliments.

12 Irrational Ideas by Ellis (1977)

1. The idea that you must, yes, must have sincere love and approval almost all the time from all the people you find
significant.

2. The idea that you must prove yourself thoroughly competent, adequate, and achieving; or that you must at least have
real competence or talent at something important.

3. The idea that people who harm you or commit misdeeds rate as generally bad, wicked, or villainous individuals, and that
you should severely blame, damn, and punish them for their sins.

4. The idea that life proves awful, terrible, horrible, or catastrophic when things do not go the way you would like them to
go.

5. The idea that emotional misery comes from external pressures and that you have little ability to control your feelings or
rid yourself of depression and hostility.

6. The idea that if something seems dangerous or fearsome, you must become terribly occupied with and upset about it.

7. The idea that you will find it easier to avoid facing many of life’s difficulties and self-responsibilities than to undertake
some rewarding forms of self-discipline.

8. The idea that your past remains all-important and that, because something once strongly influenced your life, it has to
keep determining your feelings and behavior today.

9. The idea that people and things should turn out better than they do; and that you have to view it as awful and horrible
if you do not quickly find good solutions to life’s hassles.

10. The idea that you can achieve happiness by inertia and inaction or by passively and uncommittedly “enjoying yourself.”

11. The idea that you must have a high degree of order or certainty to feel comfortable; or that you need some
supernatural power on which to rely.

12. The idea that you give yourself a global rating as a human and that your general worth and self-acceptance depend
upon the goodness of your performance and the degree that people approve of you.

The ABC Model

 A major aid in cognitive therapy is what Albert Ellis (1957) called the ABC Technique of Irrational Beliefs.

 The first three steps analyze the process by which a person has developed irrational beliefs.

 A - Activating Event or objective situation. The first column records the objective situation, that is, an event that
ultimately leads to some type of high emotional response or negative dysfunctional thinking.

 B - Beliefs. In the second column, the client writes down the negative thoughts that occurred to them

 C - Consequence. The third column is for the negative feelings and dysfunctional behaviors that ensued. The third
column C is next explained by describing emotions or negative thoughts that the client thinks are caused by A. This
could be anger, sorrow, anxiety, etc.

Rational Restructuring

 Drawing on the work of Albert Ellis (1962), Goldfried and Davison (1994) accept the notion that much maladaptive
behavior is determined by the ways in which people construe their world or by the assumptions they make about it.

 To facilitate this rational restructuring of events, the therapist may sometimes use argument or discussion in an attempt
to get patients to see the irrationality of their beliefs.
  In addition to providing patients with a rational analysis of their problems, the therapist may attempt to teach them to
“modify their internal sentences.”

 REBT aims to change behavior by altering the way the patient thinks about things.

 In the ABCs of REBT, Ellis argued that it is beliefs (B) about activating events or situations (A) that determine the
problematic emotional or behavioral consequences (C).

 In a sense, the basic goal of REBT is to make people confront their own illogical thinking.

 According to Ellis, however, all behavior, whether maladjusted or otherwise, is determined not by events but by the
person’s interpretation of those events.

 Ellis tried to get the client to use common sense. The therapist becomes an active and directive teacher.

Aaron Beck’s Cognitive Therapy

 Beck’s (1967) system of therapy is similar to Ellis’s, but has been most widely used in cases of depression.

 Cognitive therapists help clients to recognize the negative thoughts and errors in logic that cause them to be
depressed.

 The therapist also guides clients to question and challenge their dysfunctional thoughts, try out new interpretations,
and ultimately apply alternative ways of thinking in their daily lives.

 Aaron Beck believes that a person’s reaction to specific upsetting thoughts may contribute to abnormality.

 When a person’s stream of automatic thoughts is very negative you would expect a person to become depressed

 As we confront the many situations that arise in life, both comforting and upsetting thoughts come into our
heads. Beck calls these unbidden cognition’s automatic thoughts.

 (“I’m never going to get this essay finished, my girlfriend fancies my best friend, I’m getting fat, I have no money, my
parents hate me - have you ever felt like this?). Quite often these negative thoughts will persist even in the face of
contrary evidence.

Three Mechanisms that are responsible for Depression

 The Cognitive Triad (of negative automatic thinking)

 Errors in Logic
 Negative Self Schemas

 The cognitive triad are three forms of negative (i.e helpless and critical) thinking that are typical of individuals with
depression: namely negative thoughts about the self, the world and the future. These thoughts tended to be automatic
in depressed people as they occurred spontaneously.
  As these three components interact, they interfere with normal cognitive processing, leading to impairments in
perception, memory and problem solving with the person becoming obsessed with negative thoughts.

Negative Self-Schemas

 People with negative self-schemas become prone to making logical errors in their thinking and they tend to focus
selectively on certain aspects of a situation while ignoring equally relevant information.
 Beck believed that depression prone individuals develop a negative self-schema. They possess a set of beliefs and
expectations about themselves that are essentially negative and pessimistic.

 Beck claimed that negative schemas may be acquired in childhood as a result of a traumatic event. Experiences that
might contribute to negative schemas include

 Death of a parent or sibling.

 Parental rejection, criticism, overprotection, neglect or abuse.
 Bullying at school or exclusion from peer group.

Cognitive Distortions
 Beck (1967) identifies a number of illogical thinking processes (i.e. distortions of thought processes). These illogical
thought patterns are self-defeating, and can cause great anxiety or depression for the individual.
 Arbitrary interference - Drawing conclusions on the basis of sufficient or irrelevant evidence.
 Selective abstraction - Focusing on a single aspect of a situation and ignoring others
 Magnification - exaggerating the importance of undesirable events.
 Minimisation - underplaying the significance of an event
 Overgeneralization - drawing broad negative conclusions on the basis of a single insignificant event
 Personalisation - Attributing the negative feelings of others to yourself.
 Emotional Reasoning - This distortion involves thinking that if we feel a certain way, it must be true.
 Fallacy of Change - The fallacy of change lies in expecting other people to change as it suits us.
 Global Labeling / Mislabeling -This cognitive distortion is an extreme form of generalizing, in which we
generalize one or two instances or qualities into a global judgment.
 Shoulds - Should statements (“I should pick up after myself more…”) appear as a list of ironclad rules about
how every person should behave. People who break the rules make a person following these should
statements angry. They also feel guilty when they violate their own rules. A person may often believe they are
trying to motivate themselves with shoulds and shouldn’ts, as if they have to be punished before they can do
anything.
 Control Fallacies - This distortion involves two different but related beliefs about being in complete control of
every situation in a person’s life.
 Externally controlled - we see ourselves as helpless a victim of fate.
 Internal control - assuming responsibility for the pain and happiness of everyone around us
  Blaming - When a person engages in blaming, they hold other people responsible for their emotional pain.
They may also take the opposite track and instead blame themselves for every problem — even those clearly
outside their own control.
 Always Being Right - While we all enjoy being right, this distortion makes us think we must be right, that being
wrong is unacceptable.
 Heaven’s Reward Fallacy - This distortion involves expecting that any sacrifice or self-denial on our part will pay
off.

Differences between REBT & Cognitive Therapy

 Albert Ellis views the therapist as a teacher and does not think that a warm personal relationship with a client is
essential. In contrast, Beck stresses the quality of the therapeutic relationship.
 REBT is often highly directive, persuasive and confrontative. Beck places more emphasis on the client discovering
misconceptions for themselves.
 REBT uses different methods depending on the personality of the client, in Beck’s cognitive therapy, the method is
based upon the particular disorder.

CBT Exercises
 Cognitive Restructuring - a cognitive behavioral therapy exercise designed to help people examine unhelpful thinking
patterns, and devise new ways of reacting to problematic situations.
 Cognitive restructuring often involves keeping a thought record, which is a way of tracking dysfunctional
automatic thoughts, and devising adaptive alternative responses.

 Activity Scheduling - a cognitive behavioral therapy exercise that helps people engage in behaviors they ordinarily
would not engage in.
 The intervention involves identifying a low frequency behavior, and finding time throughout the week to
schedule the behavior to increase its frequency.

 Graded Exposure - designed to reduce anxiety and fear through repeated contact with what is feared.
 This has been to shown to be among the most effective treatments for any psychological problem.
 The underlying theory has to do with avoidance of things that we fear resulting in increased fear and anxiety.
By systematically approaching what you might normally avoid, a significant and lasting reduction in anxiety
takes place.

 Successive Approximations - helps people tackle difficult or overwhelming goals.

 By systematically breaking large tasks into smaller steps, or by performing a task similar to the goal, but less
difficult, people are able to gain mastery over the skills needed to achieve the larger goal.

 Mindfulness Meditation - helps people disengage from harmful ruminating or obsessing by learning to connect to the
present moment.
 Mindfulness comes from Buddhist meditation, and is the subject of a significant amount of new research on
effective treatment of psychological problems.