Cognitive Behavioral Therapy RET

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Cognitive Behavioral Therapy - RET

• EDCE 655
• Theories Techniques II

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Cognitive Behavior TherapyIntroduction

• Rational Emotive Behavioral Therapy (REBT) is
  based on assumption that cognition, emotions, and
  behaviors interact significantly and have a
  reciprocal cause and effect relationship.
• Cognitive Behavioral Therapy is based on the
  assumption that a reorganization of ones
  self-statements will cause reorganization of
  ones own behavior.
• Our emotions stem from our beliefs, evaluations,
  interpretations, and reactions to life situation.
• The focus is working with thinking and acting
  rather than primarily with expressing feelings.

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Cognitive Behavior TherapyKey Concepts

• REBT attempts to help people accept themselves as
  creatures who will continue to make mistakes and
  at the same time learn to live more at peace with
  themselves.
• Blame is the CORE of most emotional disturbances
  and we have to accept ourselves despite our
  imperfections.
• We create our own disturbed thoughts and
  feelings, and have the power to control our
  emotional destiny.

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Cognitive Behavior TherapyA-B-C Theory of
Personality

• A the existence of fact, AN EVENT, or the
  behavior or attitude of an individual
• C the emotional and behavioral consequences or
  reaction of an individual. A does NOT cause C.
• B the persons belief (about A which causes C).
• D disputing, the application of the scientific
  method to help clients challenge their irrational
  beliefs. There are 3 components to the disputing
  process
• Clients learn how to detect their irrational
  beliefs, their absolute shoulds and musts,
  awfulizing and self-downing.
• Clients debate their dysfunctional beliefs by
  learning how to logically questions them and
  argue themselves out of and act against believing
  them.
• Clients learn to discriminate irrational beliefs
  from rational beliefs E an effect philosophy
  consisting of replacing inappropriate thoughts
  with appropriate ones.
• If successful at doing this we create F A new
  set of feelings.

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Cognitive Behavior TherapyA-B-C Theory of
Personality

• A Activating Event
• B Belief (A about C)
• C Emotional / Behavioral Consequences
• D Disputing
• E Replacing Irrational with Rational Thoughts
• F New Set of Feelings

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Cognitive Behavior TherapyTherapeutic Process(A
learning approach to counseling)

• Show clients that they have incorporated many
  irrational shoulds, oughts, and musts
• Clients keep their emotional disturbances active
  by repeating self-defeating meanings and
  philosophies
• The counselor helps the client modify their
  thinking
• Counselors challenge the client to develop a
  rational philosophy of life, so in the future
  they can avoid being the victim of their
  irrational beliefs
• The clients role is that of a learner the
  process focuses on the clients experience in the
  present
• A central issue is how the client can become
  aware of their self-defeating philosophies and
  can challenge and act against them
• The counselor helps the client avoid
  self-condemnation
• They show their acceptance by refusing to
  evaluate their clients as persons at the same
  time being willing to honestly confront clients
  nonsensical thinking and self-destructive
  behaviors

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Cognitive Behavior TherapyTherapeutic Process

• Cognitive Method
• Disputing irrational beliefs challenges
  irrational beliefs by asking questions.
• Cognitive homework clients are expected to make
  a list of their problems, look for absolutistic
  beliefs, and dispute these beliefs
• Changing ones language imprecise language is
  one of the causes of distorted thinking
• Use of humor emotional disturbances result from
  taking ones self too seriously
• Emotive Techniques
• Rational emotive imagery establish new emotional
  patterns. Clients imagine themselves thinking,
  feelings, and behaving exactly the way they would
  like to think, feel, and behave in real life.
• Role playing Counselor interrupts to show
  clients what they are telling themselves to
  create their disturbances and what they can do to
  change their inappropriate feelings to
  appropriate ones.
• Shame-attacking exercises We can refuse to feel
  ashamed by telling ourselves it is not
  devastating what someone thinks. Clients work to
  feel unashamed even when others disapprove of
  them.
• Use of force vigor Clients are shown how to
  conduct forceful dialogue with themselves in
  which they express their irrational beliefs and
  powerfully dispute them.
• Behavioral Techniques
• Operant conditioning, self-management, systematic
  desensitization, relaxation techniques, and
  modeling.

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Cognitive Behavior TherapyA-B-C Theory of
Personality

• Individual counseling Focus on a specific
  problem
• Group counseling Members are taught to apply
  principles to one another in a group setting.
  They can practice new behaviors that involve
  risks.
• Brief therapy The A-B-C approach can be learned
  in one to ten sessions. It is used for people who
  are experiencing a crisis.
• Marriage counseling Concern is with each person
  as an INDIVIDUAL, not with keeping the
  relationship together.
• Family counseling One member of the family has
  little power in changing another family member.
  Each member has the power to control their own
  thinking and feeling patterns. In controlling or
  modifying ones own behavior can effect the
  family as a unit.

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Cognitive Behavior TherapyCognitive Triad by A.
Beck

• Individuals view themselves from three
  perspectives. They are
• View of Self
• View of the World Around Them
• View of the Future
• Beck uses this Cognitive Triad as a benchmark
  for diagnosing mood disorders, and for judging
  the general view of self of the client. Beck
  suggests looking for the themes that run through
  the discussion of the client during intake and
  early sessions of counseling.

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Rational Emotive Therapy (RET)History

• Founder Albert Ellis born 1913
• Ph.D. in Clinical Psychology
• Trained in psychoanalysis at the Karen Horney
  school
• Became disenchanted with classical psychotherapy
  and in 1955 began RET
• Ellis credits the influence of first century A.D.
  stoic philosophers and Alfred Adler

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Rational Emotive Therapy (RET)Current Status

• The Institute for Rational Emotive Therapy, a
  non-profit educational foundation, offers
  clinics, education, training and workshops. The
  Institute publishes the Journal of Rational
  Emotive Therapy in which the latest developments
  in RET are published.

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Rational Emotive Therapy (RET)Applications

• Not appropriate for individuals out of contact
  with realty or the mentally retarded.
• Most effective with mildly disturbed individuals
  with a single major symptom.
• Applicable for preventative purposes REE
  Rational Emotive Education
• Used in Individual and Group Counseling,
  Encounter Groups, Brief Therapy, and Marriage
  Family Therapy

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Rational Emotive Therapy (RET)Evaluation

• Positives
• Client responsibility stressed
• Action oriented
• Thoughts, feelings, and behaviors are emphasized
• Faster to produce results than many other
  techniques
• Negatives
• Counselor can overpower client
• Need verbal, educated clients
• Does not get at deeply buried issues

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Becks Cognitive Therapy (CT)Basic Principles

• It like REBT, CT is an active, directive,
  time-limited, present-centered, and structured
  approach
• It is an insight-focused therapy that emphasizes
  recognizing and changing negative thoughts and
  maladaptive beliefs, otherwise referred to as
  schemata
• The goal is to change the way clients think by
  using their automatic thoughts (personalized
  notions that are triggered by particular stimuli
  that lead to emotional responses) to reach the
  core schemata and begin to introduce the idea of
  schema restructuring. This is done by encouraging
  clients to gather and weigh the evidence in
  support of their beliefs (collaborative
  empiricism)
• Beck contends that people with emotional
  difficulties tend to commit characteristic
  logical errors that tilt the objective reality
  in the direction of self deprecation.
• Psychological problems stem from commonplace
  processes such as faulty thinking, making
  incorrect inferences on the basis of inadequate
  or incorrect information, and failing to
  distinguish between fantasy and reality.
• Dysfunctional beliefs are problematic because
  they interfere with normal cognitive functioning,
  not because they are irrational. Ideas are not
  irrational, but rather, too absolute, broad, and
  extreme.

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Becks Cognitive Therapy (CT)Cognitive
Distortions

• Cognitive distortions are errors in reasoning
  that lead to faulty assumptions and
  misconceptions
• Arbitrary inferences making conclusions without
  supporting relevant evidence. This includes
  catastrophizing, or thinking of the absolute
  worst scenario and outcomes for most situations.
• Selective abstraction forming conclusions based
  on an isolated detail of an event.
• Overgeneralization holding extreme beliefs on
  the basis of a single incident and applying them
  inappropriately to dissimilar events or settings.
• Magnification Minimization perceiving a case
  or situation in a greater or lesser light than it
  truly deserves.
• Personalization tendency for individuals to
  realate external events to themselves, even when
  there is no basis for making this connection.
• Labeling Mislabeling portraying ones identity
  on the basis of imperfections and mistakes made
  in the past and allowing them to define ones
  true identity.
• Polarized thinking thinking and interpreting in
  all-or-nothing terms, or categorizing experiences
  in either-or extremes.

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Becks Cognitive Therapy (CT)The Client /
Counselor Relationship

• Role of the Counselor where REBT focuses on the
  teaching role of the therapist, Beck uses a
  Socratic dialogue by posing open-ended, questions
  with the aim of getting clients discover their
  misconceptions for themselves, and he generally
  applies more structure than REBT USES OPEN
  ENDED QUESTIONS
• The quality of the therapeutic relationship is
  basic to the application of cognitive therapy.
  Core characteristics involve genuine warmth,
  accurate empathy, nonjudgmental acceptance, and
  the ability to establish trust and rapport with
  clients.
• Counselor must also have a cognitive
  conceptualization of cases, be creative and
  active, be able to engage clients through a
  process of Socratic questioning, and be
  knowledgeable and skilled in the use of cognitive
  and behavioral strategies aimed at guiding
  clients in significant self-discoveries.
• Counselors functions as a catalyst and a guide
  who helps clients understand how their beliefs
  and attitudes influence the way they feel and
  act.
• Promotes corrective experiences that lead to
  cognitive change and acquiring of new skills.

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Becks Cognitive Therapy (CT)Basic Clinical
Procedures

• Lasting changes in the clients thinking and
  behavior are most likely to occur with the
  clients initiative, understanding, awareness,
  and effort.
• Prepare the client by providing a rationale for
  treatment and demystifying treatment
• Apply the client to monitor thoughts that
  accompany distress
• Implement behavioral and cognitive techniques
• Identify and challenge cognitions through the
  process of being in problematic situations that
  evoke such thoughts
• Examine beliefs and assumptions by testing them
  in reality
• Prepare clients by teaching them coping skills
  that will work against relapse

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Becks Cognitive Therapy (CT)Techniques

• Cognitive Techniques include
• Challenging clients to come up with evidence for
  beliefs they hold
• Assisting clients in exploring their cognitive
  distortions
• Helping replace negative imagery with more
  positive and successful coping scenes
• Participating in cognitive rehearsal
• Behavioral Techniques include
• Assertiveness training
• Behavioral rehearsal
• Shame-attacking exercises
• Homework
• Bibliotherapy

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Cognitive Behavior Modification (CBM)

• Created by Donald Meichenbaum
• Focuses on changing clients self verbalizations
• Client notices how they think, feel, behave
  how it impacts others
• REBT is different in its confrontation approach
  to disputing irrational thoughts CBM focuses
  more on helping clients be more cognizant of self
  talk and training the client to incorporate
  coping skills
• Cognitive structure organizing aspects of
  thinking, which monitors and directs the choice
  of thoughts.

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Becks Cognitive Therapy (CT)How Behavior Changes

• Through a sequence of inner speech, cognitive
  structure, and behaviors, Meichenbaum created a 3
  phase process of change. A focus on the one phase
  will not create change.
• PHASE 1 (Self Observation)
• Clients learn how to observe behaviors
• Clients usually displays negative talk imagery
• Clients have to be willing able to listen to
  themselves how they react to others.
• They contribute to their feelings by what they
  tell themselves
• Counselors help client view problems in a new
  lights
• PHASE 2 (Starting a New Internal Dialogue)
• Clients develop more healthy self talk which in
  turn helps direct new behaviors EFFECTING
  CLIENTS COGNITIVE STRUCTURES
• PHASE 3 (Learning New Skills)
• Clients learn effective coping skills to be
  practiced in real life situations
• Tell themselves new sentences observe assess
  outcomes
• Clients ask questions of their own thoughts

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Becks Cognitive Therapy (CT)Coping Skills
Programs

• Clients are exposed to anxiety ridden situations
  by role playing and imagery
• Clients are to evaluate their anxiety level and
  become aware of anxiety provoking thoughts they
  evoke in stressful times.
• They are to examine their thoughts by
  reevaluating their self statements.
• Clients note their level of anxiety after
  reevaluation.
• These are highly effective with clients with test
  and speech anxieties, phobias, anger problems,
  addiction problems, and sexual dysfunction.

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Rational Emotive Therapy (RET)Glossary of Key
Terms

• ABC Model The theory that peoples problems do
  not stem from activating events but, rather, from
  their beliefs about such events. Thus, the best
  route to changing negative emotions is the
  changing of ones beliefs about situations.
• Automatic thoughts Personal ideas that result
  from a particular stimulus and that lead to
  emotional responses.
• Cognitive errors In cognitive therapy, the
  clients misconceptions and faulty assumptions.
• Cognitive restructuring A process of actively
  altering maladaptive thought patterns and
  replacing them with constructive thoughts and
  beliefs.
• Cognitive structure The organizing aspect of
  thinking, which monitors and directs the choice
  of thoughts.
• Cognitive Therapy An approach and set of
  procedures that attempts to change feelings and
  behavior by modifying faulty thinking and
  believing.
• Collaborative empiricism A strategy of viewing
  the client as a scientist who is able to make
  objective interpretations.

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Rational Emotive Therapy (RET)Glossary of Key
Terms

• Coping Skills Program A behavioral procedure for
  helping clients deal effectively with stressful
  situations by learning to modify their thinking
  patterns.
• Distortion of Reality Erroneous thinking that
  disrupts ones life.
• Internal dialogue The sentences that people tell
  themselves and the debate that often goes on
  inside their head.
• Irrational belief An unreasonable conviction
  that leads to emotional and behavioral problems.
• Musturbation A term by Ellis referring to
  behavior that is absolutist and rigid Must
  Ought Should
• Rationality The quality of thinking, feeling,
  and acting in ways that will help us attain our
  goals.
• Self-Instructional Therapy An approach to
  counseling based on the assumption that what
  people say to themselves directly influences the
  things they do.

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Hal Pete A Gay Couple Seek Counseling (RET)
Hal and Pete seek the services of a clinical
social worker in private practice. The following
is some background data Hal and Pete have been
living together in a homosexual relationship for
several years. In a manner very much the same as
a heterosexual couple, they experience conflicts
in their relationship. Lately, the situation has
taken a turn for the worse, and Hal wants to
either resolve certain problems or break up the
relationship. Pete is very anxious about being
deserted, and he agrees to come for counseling as
a couple. Neither of them is troubled with the
fact that they are in a gay relationship, and
from their perspective this is not the problem.
They want you to know at the outset they are not
seeking counseling to cure them of their
homosexuality. Rather, they seem to be having
major problems that they are unable to work out
themselves and that is what led them to wonder if
they want to continue living together. Pete feels
unappreciated, and he does not feel that Hal
cares for him in the way I would like. He
initially tells you the following I try so hard
to do what I think Hal expects. Its really
important that I please him, because Im afraid
that if I dont, hell get fed up and simply
leave. And if he left, I imagine all sorts of
terrible things happening. Fist of all, I feel
the constant threat of being left. I need someone
to rely on someone who will listen to me, who I
know cares for me and accepts me the way I am,
who wants to be with me, and who will approve of
what I do. I feel I MUST have this in a person I
live with. If I dont then this just proves that
the other person doesnt love me. I need to be
loved. My parents didnt love me, they never gave
me the approval I need to have, and I think that
this alone is more than enough for me to have to
bear. I feel that life often plays dirty tricks
on me. For a long time I felt that I could REALLY
trust Hal and that hed stay with me and approve
of me and care about me, regardless of who I was.
Now, after I trust him, he decides to tell me
that Im too demanding and that hes not able to
handle all my demands. I dont think Im
demanding I just want to be loved and accepted
by some other significant person. If I cant find
this in at least one person, then I cant see
much value in living. Hal responds in the
following initial statement, in which he
describes how if is for him to be in this
relationship Frankly, Im so tired of always
feeling that I must prove myself and my constant
love for Pete. No matter what I say, I typically
end up feeling that Im not enough and that
regardless of what I do, it just wont measure
up. Im tired of hearing that I dont care. Im
sick of being made to feel that Im insensitive,
I hate being made to feel inadequate, and I dont
want to constantly feel that I have to weigh
everything I say for fear that Ill offend Pete
and make him upset. I just cant stand having
people be upset at me it makes me feel lousy
and guilty like I somehow should be more that I
am, that I ought to be better than I am. If I
cant get over being made to feel inadequate
around Pete, then I want out!
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Hal Pete Questions for Reflection
Assume that Hal and Pete agree to attend six
sessions as a couple. By the end of that time
they would like to have decided whether they want
to stay together. If they do decide to continue
living together, they would be open to consider
to continue working on their separate problems
and finding ways of improving their
relationship. What are your initial reactions to
Pete? To Hal? To them as a couple? How do you see
them individually and as a couple? Would you want
to work with them as a couple? Do you think that
you could work with them effectively? Why or why
not? Are your feelings toward this gay couple
different than they would be if the couple were
heterosexual? What are your views toward
homosexual relationships? How do you think they
would influence your approach and the goals you
had in mind? Would you tell them how you felt
toward them both as separate individuals and as
a couple? Why or why not? What difference do you
think it would make whether you shared your
reactions with them? Pete and Hal initially said
that they did not consider the fact of their
homosexual preferences to be a problem in itself
and that they were not asking you to cure what
they consider a nonexistent problem. Would you
avoid attempting to change their sexual
orientation? How might you answer to the above
question determine the direction you would
precede in counseling this couple? From the
perspective of rational-emotive therapy, some of
the following should be identified as Petes
irrational beliefs. Show how you would
demonstrate to him that they are self-defeating
attitudes that are the direct cause of his
misery I must please Hal, and if I dont hell
leave, and the consequences will be horrible! I
must have someone to rely on, or else I cant
make it on my own! I must have someone to show
me caring, love, approval and if I dont get
this, then life is hardly worth living! If I
dont get what I want from life, then life is
damn unfair! Again as a RET counselor, how might
you work with Hals irrational beliefs How would
you teach him to dispute them? How would you show
him that these beliefs are at the root of his
problems? I must prove myself, I must be able to
meet anothers expectations of me and If I
dont, Ill feel inadequate, guilty, rotten, and
deficient as a person! If I dont meet Petes
needs, then I am made to feel inadequate. Show
how both Hals and Petes beliefs and assumptions
are related to the problems they are having in
their relationship. In what ways do you imagine
that working on their irrational beliefs will
affect their relationship?