Cognitive and Rational Emotive Behavior Therapy

Cognitive Therapy Overview

• Cognitive therapy is a psychotherapy approach that challenges negative thought patterns related to oneself, the future, and the world.
• The goal is to modify unwanted behaviors or treat mood disorders.

Rational Emotive Behavior Therapy (REBT)

• REBT was created by Albert Ellis.
• It was influenced by Alfred Adler, Karen Horney, and Harry Stack Sullivan.
• REBT emphasizes interactional dynamics over intrapsychic processes.

Fundamentals of REBT

• Beliefs and irrational thoughts, rather than events, are the cause of emotional distress.
• ABC Model:
  • A: Activating Event
  • B: Beliefs
  • C: Consequence
• B (Beliefs) causes C (Consequence); A (Activating Event) does not directly cause C (Consequence).

REBT View of the Person

• Humans are fallible and prone to making errors.
• Humans have the capacity to challenge irrational thinking.
• Irrationality is considered innate or predisposed.
• Harmful emotions and dysfunctional behaviors stem from irrational thinking, which is reinforced over time.

Basic Goals of REBT

• Develop more realistic perspectives.
• Foster greater self-acceptance and life satisfaction.
• Replace absolute "musts" or desires with preferences.

Therapeutic Relationship in REBT

• Therapists aim to provide unconditional acceptance to clients.
• A strong therapeutic bond is helpful, but not essential for successful therapy.
• Therapist helps clients develop these acceptances:
  • Unconditional Self-Acceptance
  • Unconditional Other-Acceptance
  • Unconditional Life-Acceptance

Assessment in REBT

• Clients immediately begin working on their problems.
• There is minimal background information gathering.
• The therapy focuses on irrational ideas.
• The assessment targets specific activating events and associated rational and irrational beliefs.

Components of REBT

• Identifying thoughts rooted in irrational beliefs.
• Challenging those beliefs.
  • Acronym: ASS/U/ME

Types of "Musts" in REBT

• Include: must, have to, should, ought to

Emotive Techniques in REBT

• Educating clients about the distinctions between emotions.
• Using humor to encourage clients to avoid taking themselves too seriously.
• Modeling a rational philosophy through self-disclosure.
• Utilizing parables, poems, stories, songs.
• Rational role reversal: Taking on the role of the their rational self to challenge beliefs.

Behavioral Techniques in REBT

• Shame-attacking and risk-taking exercises.
• Encouraging clients to behave in ways that align with new rational thinking.

Aaron Beck: Background

• American psychiatrist, born in 1921.
• Studied at Brown University (English and Political Science) and Yale (MD, 1946).
• His daughter, Judith Beck, is a CBT therapist.
• Considered the father of Cognitive Behavioral Therapy (CBT).
• Authored over 600 professional journals,
• Best known for the Beck Depression Inventory (21 items) and Beck Hopelessness Scale (20 items).

Key Predecessors of Beck

• Epictetus: Greek philosopher who believed external events are beyond our control.
• Karen Horney: Focused on feminine psychology.
• Alfred Adler: Focused on individual psychology.
• Albert Ellis: REBT.
• Richard Lazarus: Developed the theory of cognitive appraisal and stress.
• Albert Bandura: Social cognitive theory and reciprocal determinism.

Cognitive Behavioral Therapy (CBT) Defined

• CBT is a way of conceptualizing psychological problems and their treatment.
• It offers a framework to understand why someone is struggling and how to address it.

Unique Elements of CBT

• Focused
• Present-oriented
• Short-term
• Active and directive

Development of CBT

• Beck found that helping patients identify and evaluate their thoughts led to more realistic thinking, improved emotions, and functional behavior.
• Different disorders are associated with distinct patterns of distorted thinking.
• Effective interventions teach individuals to recognize and challenge their distorted thinking.
• Frequent negative automatic thoughts reveal a person's core beliefs.
• Core beliefs are formed over a lifetime and are deeply felt to be true.

Basic Principles of CBT

• CBT is based on an evolving understanding of a patient's problems and their individual cognitive conceptualization.
• It examines current thinking, precipitating factors, developmental events, and enduring patterns of interpretation.
• Dysfunctional thought patterns that influence mood and behavior are common to all psychological disturbances.
• Examining and challenging core beliefs leads to lasting improvement.

ABCDE Model in CBT

• Activating Event - Beliefs about the event - Emotional Consequences - Disputations (to challenge irrational thinking) - Effective New Beliefs (replace irrational ones)

Structure of Therapy Sessions in CBT

• Establish a therapeutic alliance.
• Check on the patient's mood, symptoms, and experiences from the past week.
• Set an agenda by asking the patient for a problem to solve.
• Review self-help activities or homework.

Challenging Automatic Thoughts in CBT

• Automatic thoughts are evaluated for their validity and utility (helpfulness).
• Validity questions:
  • "Is this thought based on facts or assumptions?"
  • "Am I interpreting the situation correctly, or could there be another explanation?"
• Utility questions:
  • "Does this thought help me achieve my goals or improve the situation?"
  • "Is it motivating or discouraging?"
• Thoughts that are neither valid nor useful should be restructured.

CBT Over Time and Across Sessions

• Therapist assesses the client and understands the target problem(s).
• Therapist collaborates with the client to develop a cognitive-behavioral conceptualization of the problem(s).
• Therapist and client agree on the goals of therapy.
• They agree on general principles such as duration and frequency of treatment, expectations of the therapist and client, time frame for reassessment and reevaluation of the plan, and so forth.

Case Conceptualization in CBT

• Learn basic skills of conceptualization.
• Refine conceptualization during sessions.
• Use conceptualization to plan treatment.
• Become proficient at integrating conceptualization and techniques.
• Use conceptualization to make decisions about interventions
• Automatically integrate new information into conceptualization

Setting Goals in CBT

• Three "Yes" Rules for effective goals:
  • Do my goals involve changing myself rather than expecting others to change?
  • Do my goals involve changing things within my control?
  • Are my goals realistic?
• Making Goals Specific Questions
  • What would be different if I were approaching the goals I set in Unit 1?
  • What changes would I see?
  • What smaller steps are necessary in order to achieve my initial goal?
  • What is giving me trouble now?
  • How will I know when I’m doing better - What will happen?

Recognizing the "Five Roads" in CBT

• Triggers
• Thoughts
• Feelings
• Behaviors
• Physical Responses

Emotional and Wellness Mind in CBT

• Emotional Mind:
  • Automatic Negative Thoughts lead to
  • Automatic Negative Feelings which lead to
  • Automatic Negative Behaviors
• Wellness Mind:
• Automatic Positive Thoughts lead to
• Positive Feelings lead to
• Positive Behaviors

Identifying and Responding to Dysfunctional Cognitions

• Sessions often involve helping patients respond to negative automatic thoughts, images, and underlying beliefs.
• Guided discovery and behavioral experiments help evaluate thinking and challenge automatic negative thoughts (ANTs)..

Socratic Questioning in CBT

• Involves logical questioning in many directions to arrive at the truth.

Distinctive Characteristics of CBT

• Collaborative relationship between therapist and client.
• Time-limited
• Set schedule

Common Myths About CBT

• The therapeutic relationship isn't important in CBT.
• CBT is mechanistic
• CBT is about positive thinking.
• CBT doesn't deal with the past.
• CBT deals with superficial symptoms
• CBT is adversarial
• CBT is for simple problems.
• CBT is interested in thoughts and not emotions.
• CBT is only for clients who are psychologically minded
• CBT is quick to learn and easy to practice
• CBT is not interested in the unconscious
• CBT demands high intelligence

Characteristics of Automatic Thoughts

• Automatic thoughts co-exist with more explicit conscious thoughts.
• They are typically brief and outside of awareness.
• Automatic thoughts can verbal, visual, or both.

Characteristics of the Emotional Mind

• It generates automatic, self-defeating thoughts.
• The Mind wants you to believe negative things about yourself, your future. And your world
• The mind is fast .
• It likes to trick you
• It uses keywords such as “never”, “should”, “always”, “if then”, and “everything”
• It keeps you stuck in your negative emotional cycle
• It often gives you the same interpretation of different triggers that, over time, causes core beliefs to develop

Evaluating Automatic Thoughts in CBT

• Assess for validity (truthfulness or factual accuracy).
• Evaluate for utility (usefulness or helpfulness).
• Thoughts that are neither valid nor useful should be restructured.

Cognitive Distortions (17 Listed)

• Mind reading
• Fortune telling
• Catastrophizing
• Labeling
• Discounting positives
• Negative filter/selective abstraction
• Overgeneralizing
• Dichotomous thinking
• “Shoulds”
• Personalizing/excessive responsibility
• Blaming
• Unfair comparisons
• Regret orientation
• What ifs
• Emotional reasoning
• Inability to disconfirm
• Judgment focus

Eliciting Automatic Thoughts

• Have patients describe a problematic situation that arose.
• Pay attention to shifts in affect, especially negative emotions, during a session.

Difficulties in Eliciting Automatic Thoughts

• Start by asking how they were feeling and where in their body they experienced emotion.
• Elicit a detailed description of the problematic event.
• Request the patient visualize the distressing situation
• Suggest the patient role place, elicit an image, supply thoughts opposite, ask for the meaning of the situation, phrase a question differently

Differentiating Between Automatic Thoughts and Interpretations

• If a patient reports interpretations instead of automatic thoughts, help them identify the thoughts that preceded the interpretation.
• Identify associated feelings or physiological responses to uncover the underlying thought

Recognizing Situations That Evoke Automatic Thoughts

• Both external stimuli and internal experiences can trigger automatic thoughts
• Through non-verbals, rapport, probings, reflection of feelings paraphrases, summarisings, unconditional positive regard, non-judgemental attitude
• Externalizing the positives, internalizing the negatives

Thought-Behavior Connection

• Thoughts and behaviors are closely linked.
• We often aren't aware of the thoughts guiding our behavior when our actions have become routine

Thought-Environment Connection

• Environment and life experiences shape beliefs and moods.
• Influences present, as well as past experiences, shape beliefs
• Culture, family, neighborhood, gender, religion, and the media influence us

Identifying Emotions in CBT

• Patients may display excessive or inappropriate emotional intensity.
• Evaluate the thoughts and beliefs underlying their distress, without judging their emotions.

Distinguishing Automatic Thoughts from Emotions

• Be attentive to times when patients confuse their thoughts and emotions.
• Depending on the timing/flow of the session either ignore the confusion, address it in the present, or address it later.
• Feelings are what you feel emotionally- usually one word
• Thoughts are ideas

Importance of Distinguishing Among Emotions

• The interrelation of a patients thought, emotion and behavior should make sense.
• The therapist should investigate further when a patient reports an emotion that doesn't seem to match their content or their automatic thoughts.

Rating Degrees of Emotion

• Can use rating scale, percentage or word scale to rate the intensity of their emotion
• This allows for comparison from one week to the next or event to the next

Open-Ended Questions for Goal Setting

• What do I want to achieve?
• How will I know when I reach the goal?
• What challenges may I face, and how can I address them to get to the goal?
• What steps do I need to take to reach the goal?

Cognitive Errors

• Over-Generalizing: Drawing broad conclusions based on limited experience.
• Labeling: Assigning labels to oneself or others based on isolated events.
• Emotional Reasoning: Letting emotions become concrete evidence.
• Fortune Telling: Predicting the future negatively.
• Mind Reading: Assuming someone's thoughts or emotions, generally about oneself.
• Catastrophizing: Assuming the worst possible scenario will occur.
• "Shoulds": Imposing rigid expectations or demands on oneself or others. Replace with i can or i prefer.
• Selective Abstraction: Focusing only on positive or negative aspects while ignoring others.

Explore cognitive therapy's approach to challenging negative thought patterns and learn about Rational Emotive Behavior Therapy (REBT). REBT, created by Albert Ellis, emphasizes the role of beliefs in emotional distress. Understand the ABC Model and the REBT view of human fallibility and capacity for change.