CBT Therapy Session PDF

Theme 4: Sessions 7 & 8COGNITIVE BEHAVIOUR THERAPY (CBT) Chapter 10 Learning Outcomes Discuss the unique contributions of Albert Ellis, Aaron Beck, and Judith Beck to the development of cognitive therapy, basic principles of cognitive therapy, common attrib...

Theme 4: Sessions 7 & 8COGNITIVE BEHAVIOUR THERAPY (CBT) Chapter 10 Learning Outcomes Discuss the unique contributions of Albert Ellis, Aaron Beck, and Judith Beck to the development of cognitive therapy, basic principles of cognitive therapy, common attributes shared by all cognitive behaviour approaches Describe how the A-B-C model and the generic cognitive model is a way of understanding the interaction between feelings, thoughts and behaviour and how cognitive methods can be applied to change thinking and behaviour Discuss all the key concepts and the therapeutic process of CBT Discuss the generic cognitive model proposed by Beck and the basic principles of Cognitive therapy Evaluate the strengths and limitations of cognitive behaviour therapy from a multicultural approach Critically evaluate the approach in application to the case of Stan and Bonolo Cognitive behavioural approaches The various cognitive behavioural approaches share the following attributes: o A collaborative relationship between client and therapist o The premise that psychological distress is often maintained by cognitive processes o A focus on changing cognitions to produce desired changes in affect and behaviour Cognitive behavioural approaches The various cognitive behavioural approaches share the following attributes: o A present-centred, time-limited focus o An active and directive stance by the therapist o An educational treatment focusing on specific and structured target problems Albert Ellis’s REBT Rational emotive behaviour therapy (REBT) o Practical and symptom-focused o Assumes that cognitions, emotions and behaviours interact and have a reciprocal cause-and-effect relationship o Is highly didactic and directive o Teaches that our emotions stem mainly from our beliefs, evaluations, interpretations and reactions to life situations o Clients learn to stop absolutistic thinking, blaming and repeating false beliefs and replace ineffective ways of thinking with effective and rational cognitions – change takes place Basic Assumptions o People have the potential to be both​ o Rational, self-preserving, creative, functional, and to use metathought​ o Irrational, self-destructive, short-range pleasure seekers, intolerant, and grandiose​ o Culture and family can perpetuate irrational thinking​ o REBT emphasizes unconditional acceptance of self, others, and life. ​ Basic Assumptions o A warm therapeutic relationship is not a necessary or sufficient condition for change.​ o REBT uses whatever techniques work; focus is not symptom removal but real cognitive change.​ o Neurotic thinking is the result of unrealistic, illogical, self- defeating thinking, and that disturbance-creating ideas can be disputed. o The causes of an individual’s emotional distress are not the events that have happened, but what the individual believes about the events.​ o There is an element between stimulus and response; it is thought and emotional response. Irrational beliefs Three basic MUSTS we internalise that inevitably lead to self-defeat: o ‘I MUST do well and be loved and approved by others.’ o ‘Other people MUST treat me fairly, kindly and well.’ o ‘The world and my living conditions MUST be comfortable, gratifying and just, providing me with all that I want in life.’  The A-B-C framework A B C Activating event Belief Consequence D E F Disputing intervention Effective philosophy New feeling 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: o Unconditional self-acceptance (USA) o Unconditional other-acceptance (UOA) o Unconditional life-acceptance (ULA) Therapeutic techniques REBT therapists use the following cognitive methods: o Disputing irrational beliefs o Doing cognitive homework o Bibliotherapy o Changing one’s language o Psychoeducational methods Therapeutic techniques REBT therapists use the following emotive techniques: o Rational emotive imagery o Using humour o Role playing o Shame-attacking exercises REBT Self- Help Form Think about a recent situation that evoked an uncomfortable emotional response. Complete the REBT Self-help form about that situation. Create a homework assignment based on the irrational belief you have identified. We will discuss it at the end of this theme. Aaron Beck’s Cognitive Therapy 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. Basic Assumptions People respond to life events through a combination of cognitive, affective, motivational, and behavioral responses.​ The cognitive system deals with the way individuals perceive, interpret, and assign meanings to events.​ Sometimes responses are maladaptive because of misperceptions, misinterpretations, or dysfunctional interpretations of situations. Cognitive Model Automatic thoughts are influenced by these underlying core beliefs and conditional assumptions. Cognitive Model We all have cognitive vulnerabilities (i.e., core beliefs) that predispose us to interpret information in a certain way.​ These vulnerabilities are developed early.​ When these beliefs are rigid, negative, and ingrained, we are predisposed to pathology.​ Core beliefs give rise to conditional assumptions (i.e., rules for living) as we mature. Negative cognitive triad Pattern that triggers depression: 1. Clients hold negative views of themselves (Self) o ‘I am a lousy person.’ 2. Selective abstraction (World) o Client interprets life events through a negative filter o ‘The world is a negative place where bad things are bound to happen to me.’ 3. Client holds a gloomy vision of the future (Future) o ‘The world is bleak and it isn’t going to improve.’ CT’s cognitive distortions Arbitrary inferences: drawing conclusions without evidence Selective abstraction: focusing only on specific details, ignoring the bigger picture. Overgeneralisation: apply a negative experience to all situations. Magnification and minimization: exaggerate the importance of negative events (magnification) or downplay positive ones (minimization CT’s cognitive distortions Personalisation: taking things personally and assuming that external events or other people’s actions are directly related to you Labelling and mislabelling: attaching negative labels to yourself or others based on specific behaviors or mistakes ◦ Labelling: creating a negative self-image based on errors ◦ Mislabelling: overgeneralizing and using extreme language Dichotomous thinking: Also known as “black-and-white thinking,” this distortion involves seeing situations as all-or- nothing, with no shades of gray in between. 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 behavioural activation. ◦ CT for panic disorder: lasts 6 to 12 sessions and targets catastrophic beliefs about internal physical and mental sensations.  REBT vs CT ​ CT​ REBT​ Therapist’s approach​ More collaborative​ More confrontational​ View of the problem​ Multiple cognitive distortions​ Pathology arises from shoulds, musts, and oughts​ Emphasis​ Psychoeducation an early and Higher reliance on critical component of psychoeducation​ treatment​ Focus​ “Hot cognitions” (emotionally More focus on emotional- charged) critical, but obtained evocative methods and core in a less aggressive manner​ set of irrational beliefs​ View of the problem​ Functional​ Philosophical​ 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. Limitations from a diversity perspective 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 marginalised in society. Limitations from a diversity perspective The emphasis on assertiveness, independence, verbal ability, rationality, cognition and behavioural change may limit CBT’s use in cultures that hold different values. Inexperienced therapists may overemphasise cognitive restructuring to the neglect of environmental interventions. Contributions of CBT The approaches are relatively brief and structured treatments that are cost effective. The cognitive behavioural theorists have demystified the therapy process. The credibility of this model grows out of the fact that many of its propositions have been empirically tested. All cognitive behavioural approaches place emphasis on practising new skills both in therapy and in daily life, and homework is a key part of the learning process. Limitations of CBT Extensive training is required to practise 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 CBT Therapy Session  Case Study How did your homework assignment go? Let’s apply CBT to the case of Stan.