COGNITIVE BEHAVIORAL THERAPY--TWO APPROACHES

 

Key Concepts

Cognitive Events—thoughts (including self-statements)

Cognitive Structures—beliefs and belief systems

Cognitive Processes—information processing (the acquisition, storage, retrieval, and utilization of information)

 

RATIONAL EMOTIVE BEHAVIOR THERAPY (REBT): ALBERT ELLIS

 

Basic Assumptions

      People have the innate potential for both rational and irrational thinking.

      Present beliefs are more important than past experiences in determining emotions and behavior.

      Emotional disturbances are not the result of external events but one's perceptions and attitudes about them.

 

The A - B - C Theory of Personality and Psychotherapy:

A (Activating event or Adversity) à B (Belief) à C (Consequences)

      Beliefs (B) can be rational or irrational.

      Consequences (C) are both emotional and behavioral.

      Consequences (C) can become a new Activating event (A).

Therapy:

      D = Dispute the Beliefs that are irrational.

      E = Effect of changes in the belief system = an increase in positive emotions and more adaptive behavior.

 

Blame is considered to be the core of most emotional disturbances and results in a self-defeating attitude.

Basic irrational beliefs (see attached handout) can be categorized into three major “musts”.

      1)  I must perform well and be approved of by significant others.....

      2)  You must treat me fairly.....

      3)  The world must be the way I want it to be.....

      Otherwise, it is terrible, horrible, and I cannot stand it.

 

Goal of therapy:  Decrease “demandingness”, increase tolerance--and develop a more realistic philosophy of life (more creative, scientific, skeptical).

Therapist: a counter-propagandist--an active, directive, persuasive teacher.

Techniques: many and diverse, though all primarily focus on changing cognitions (thoughts and beliefs) and behaviors, and have as a foundation the active disputing of irrational beliefs and substituting of more rational beliefs.

“Only hard work and practice will correct irrational beliefs!”--Ellis

 

 

COGNITIVE THERAPY: AARON BECK

 

Basic Assumptions

      Psychological problems are largely the result of rigid, absolutistic "rules", erroneous premises, and incorrect inferences (faulty logic or reasoning).

      Different problems in logic may be associated with different types of psychopathology (see below).

   Incoming information tends to be channeled and shaped to support preconceived notions—especially under stress.

Cognitive Structures (schemata)--determine how self, others, situations, and ideas will be perceived and conceptualized—and can be adaptive or dysfunctional in how they channel thought processes and behavior. 

      Confirmatory bias: Biased selection of information and distorted interpretations support existing attitudes.

      Self fulfilling prophesy: A person’s beliefs and related behaviors can cause the reactions from others that were predicted.

      Dysfunctional cognitive structures tend to be global, egocentric, rigid, and negative.

 

Systematic Errors in Information Processing (Faulty Reasoning)

      Examples include:

      Arbitrary Inferences: making conclusions without supporting and relevant evidence.

            Catastrophizing: thinking the absolute worst scenario/outcome will happen in a situation.

      Selective Abstraction: forming conclusions based on an isolated detail of an event.

      Overgeneralization: inappropriately forming a general conclusion based upon a single incident (and then applying it to all similar future situations).

      Magnification & Minimization: giving a situation more or less importance than it actually deserves.

      Dichotomous, Bipolar or Polarized Thinking: interpreting in “all-or-none”, “either-or” extremes.

      Personalization: relating an external event to oneself, when there is no basis for such a connection.

Different maladaptive emotional/behavioral styles are characterized by different cognitive biases, distortions or over-sensitivities.  For example clients who have symptoms related to:

            Anxiety—may have cognitive issues related to danger, threat, vulnerability.

            Anger—may have cognitive issues related to fairness, justice, acceptability.

            Depression—may have cognitive issues related to rejection, failure, loss.

                  Negative cognitive triad:

                  Self-concept: "I am a failure—incompetent and worthless."

                  World view: "The world is dangerous and frustrating, devoid of pleasure.”

                  Future: "There is no hope for the future."

Therapy consists of specific learning experiences designed to teach the client to:

      1) Monitor negative automatic thoughts (thoughts are not deeply buried, but can be “automatic”).

      2) Recognize cognitive-affective-behavioral connections and interactions.

      3) Examine evidence for and against automatic thoughts and previously unchallenged assumptions and conclusions.

      4) Substitute more deliberate thinking and more reality-oriented interpretations for automatic, negative cognitions.

      5) Modify "higher order" dysfunctional core beliefs or assumptions (these beliefs tend to be less easily accessible than automatic thoughts).

      Clients are helped to see that:

      a) Thoughts are not the same as behavior.

      b) Thoughts are not reality, only one's hypotheses about reality, i.e., there is a difference between reality and one's view of reality.

Therapist: uses collaborative empiricism, i.e. works with the client to translate interpretations and beliefs into specific hypotheses that then are empirically tested using logical analysis and/or unbiased experiments.

      Socratic dialogue-a series of questions is used to promote learning.

Techniques are both cognitive and behavioral, and include:

      Self-monitoring of activities, affect, and cognitions

      Hypothesis testing

      Activity scheduling

      Role playing and behavioral rehearsal

      Skills training (e.g., relaxation, social skills)

Research: Cognitive therapy has been demonstrated to equal or surpass antidepressants in the treatment of unipolar depression (with lower relapse rates).