Cognitive/

Behavioural
Therapies
Psychology 3371F/570

Adam Koenig, M.A., RP, CCC, CT

Brief Overview of Factors
that Influenced CBT
Cognitive Behavioural Therapy
 The way in which CBT treatment interventions
are used today has been influenced by
Behaviour Therapy (i.e., Skinner, Pavlov),
Rational Emotive Behaviour Therapy (Albert
Ellis)* and Cognitive Therapy (Aaron Beck).
 Central to Cognitive Behavioural Therapy is
having an understanding of the way that our
thoughts effect our emotions and behaviours.
 Becoming more aware of our thought
processes, and changing them to be more
adaptive is a key feature in this treatment
approach.
Basics of CBT (Newman, 2013)
 Psychological health = Adaptability of
individual’s thinking patterns, behaviours,
and ability to self-regulate
 Through observation and experiences
learn adaptive behaviour
 But at same time use cognition to
mediate behaviour
 Cognitive triad (view of themselves, their
world, their future) impact their
reactions/behaviour to situations
 Psychologically healthy individual would
use cognitions to positively mediate
behavioural reactions*
 View of Human Nature
(Neukrug, 2018)
 Operant conditioning, classical conditioning, and
modeling all play a role in development of
personality and in strategies one can use in helping
clients change
 Significant others and cultural influences play an
important role in how individual is conditioned
 Genetic and bio factors may play a significant role
in who we become, but does not necessarily
determine person’s way of thinking and acting
 View of Human Nature
(Neukrug, 2018)
 Behaviours and cognitions play a central role in the
development of normal and abnormal behaviour
 Past often plays role in conditioning how a person
thinks, acts, and feels but one only need to focus on
the present for change to occur
 Carefully identifying maladaptive cognitions and
behaviours, one can develop strategies to decrease
frequency of them
 Identifying adaptive behaviours and cognitions, one
can develop strategies to increase frequency of
them
 Change is possible in relatively short amount of time
Behavioural Therapy
Behavioural Therapy

 This approach states that psychopathology is

 the result of inadequate learning or a skills
deficit
 the learning of maladaptive behaviour
 Subsequently, psychopathology is treated by
unlearning problematic behaviours and
learning or relearning new ones.
 Early research included Classical
Conditioning (Pavlov) and Operant
Conditioning (Thorndike & Skinner)
Behavioural Therapy
 Therapeutic strategies include Exposure
Therapy and Aversion Therapy
 Other concepts such as modelling, or
flooding are also utilized
 The goals of therapy are to change target
behaviours that are clearly defined
 Currently, programs like Intensive Behavioural
Intervention or Applied Behavioural Analysis
have been found to be useful for ASD and
other behaviours along the developmental
spectrum
 Also Systematic Desensitization
Behavioural Therapy Example:
Systematic Desensitization*
 This technique begins with the client using
various relaxation methods
 An anxiety hierarchy is created, which
includes a ladder of graded degrees of
anxiety using a rating scale of how
upsetting each event would be
 The steps include: relaxing the client,
imagine a neutral scene, presents scenes of
increasing anxiety, relax when client
becomes anxious, return to a less anxious
scene, continue to move slowly up the
hierarchy
Rational Emotive Behaviour
Therapy
Rational Emotive Behaviour
Therapy
 At the beginning, Ellis called his approach
Rational Therapy (RT)
 By 1961 Ellis called his approach Rational
Emotive Therapy (RET)
 Required that the therapist help the client
understand that their personal philosophy
on life contains beliefs that cause emotional
pain.
 The past is not emphasized, yet
acknowledges past has influence*
Rational Emotive Behaviour Therapy

 The essence of REBT states that an

individual’s psychological problems stem
from misperceptions and mistaken
cognitions about what they perceive, rather
than from the event itself*
 Includes emotional overreactions or
underreactions, habitually dysfunctional
behavioural patterns (Neukrug, 2018)
Seven basic principles of
REBT (as cited in Neukrug, 2018)
 Cognitions, not events, are the most important
determinant of human emotion
 Irrational thinking leads to emotional distress
 Distress is best dealt with by addressing irrational
thinking
 Genetic and environmental factors are antecedents
to irrational or rational thinking
 Strong emotions are a sign that a problem needs to
be addressed
 Therapy should focus upon the continued and
ongoing self-indoctrination of irrational thinking, not
historical influences
 Although beliefs can be changed, changing one’s
beliefs takes work
Ellis’ Core Irrational Beliefs

Eventually, Ellis condensed his 12 irrational

beliefs into 3 core ones:
1. I must do well and be approved by
significant others and if I don’t then there must
be something rotten about me.
2. All people must treat me considerately and
fairly all the time.
3. All life conditions must be arranged such that
I can conduct my life with ease, and it’s
horrible when those conditions are harsh.
Goals of REBT Therapy
 Minimize emotional disturbance
 Decrease self-defeating behaviours
 Become more self-actualized
 Think more rationally
 Feel more appropriately
 Act more effectively
 Deal more effectively with negative
thoughts/feelings
 Learn the ABCDEF strategy
The ABCDEF approach of REBT

 A ~ activating event separate what happened from

what was perceived to have happened
 B ~ beliefs irrational beliefs are the focus of therapy
 C ~ consequence is important to discern beliefs from
outcomes
 D ~ dispute irrational beliefs by: detecting,
discriminating, debating
 E ~ effect having disputed their irrational beliefs, clients
develop an effective philosophy
 F ~ feelings new feelings and behaviours that arise from
effective rational beliefs; such interventions promote
change
REBT Cognitive Strategies
 Detecting, disputing and modifying irrational
cognitions
 Writing to express and explore
thoughts/feelings
 Discerning rational and irrational beliefs
 Confronting irrational beliefs
 Identifying and changing self-talk
 Reframing a situation
 Listing ways of coping (e.g., the worst situation)
 Distraction, visualization, imagery
 Promote a focus on happiness
 A-FROG (Beck & Emery as cited by Seligman &
Reichenberg, 2010)

 Questions to ask related to rational thinking or

not

 A = Does it keep me alive?

 F = Do I feel better as a result of this thought?
 R = Is this thought based on reality?
 O = Does it help me in my relationships with
others?
 G = Does it help me achieve my goals?
REBT Behavioural Strategies
 Relaxation strategies
 Create challenging situations and cope
with them
 Role-play or reverse roles
 2-chair exercise
 Acting as if a person is someone else
 Self-help books, tapes
 Skill development
 Planning pleasurable activities
REBT Affective Strategies
 Imagine the worst that could happen
 Provide emotionally powerful stories,
metaphors
 Use humour
 Encourage willpower and determination to
change
 Promote unconditional acceptance
RT “REBT” with Gloria

 https://www.youtube.com/watch?v=odnoF8V3g6g&t
=528s
Cognitive Therapy
Cognitive Therapy Highlights

 Cognitive therapy has become one of the

most empirically validated approaches
 A phenomenological model that assists
clients in making meaning of events based
on what they think about them (not how
they feel about them)
 Changing thinking leads to changes in
feelings and actions
 Treatment is short term, goal oriented,
problem focused, active, structured
Levels of Cognition
 Automatic thoughts – stream of cognitions;
mediate between a situation and an
emotion
 Intermediate beliefs – extreme and
absolute rules, expectations, assumptions,
and attitudes that shape automatic
thoughts
 Core beliefs (sometimes called Schemas) –
central ideas that support many automatic
cognitions and are often reflected in
intermediate beliefs
 Schemas – ‘cognitive structures in the
mind’ that contain the core beliefs; also
include thoughts, emotions and actions
Treatment Process
 Establish an agenda
 Determine and measure intensity of mood
 Identify and review presenting problems
 Elicit expectations for treatment
 Educate client about therapy, role of client
 Provide information about
difficulties/diagnosis
 Establish goals
 Tasks/homework
 Summarize session and ask for feedback
Therapeutic Alliance
 Clinician communicates support, empathy,
caring, warmth, interest and optimism
 Clinician makes effort to know and
understand client
 Assume nonjudgmental position
 Do not elicit transference, but will address it
if need be
 Effective therapy requires a solid alliance
Case Formulation
 List of problems and concerns
 Hypothesis regarding core beliefs or
schema
 Relationship of belief to current problem
 Precipitants of current problem
 Understanding of background relevant to
formation of underlying beliefs
 Anticipated obstacles
Cognitive Distortions
All or nothing thinking
Overgeneralization
Mental filter/selective abstraction
Disqualifying the positive
Jumping to conclusions
Magnification/minimization
Emotional reasoning
‘Should’ and ‘must’ statements
Labeling and mislabeling
Personalization
Mind reading
Tunnel vision
Strategies in CT
 Activity scheduling
 Mental and emotional imagery
 Cognitive rehearsal
 Thought stopping
 Diversions or distractions
 Self-talk
 Affirmations
 Keeping diaries
 Letter writing
Aaron Beck

 Contributed a significant amount to our

understanding of depression, anxiety,
panic, suicide, assessment techniques
 Published over 500 articles and written/co-
authored 17 books, lectured around the
world
 BDI, BAI
Main Differences of CBT from
Other Theoretical Orientations
 A de-emphasis on early childhood.
 Focus on present, not past.
 Use of psychological homework.
 Awareness is central, but insight* is not.
 Emotions and behaviours are secondary to
thoughts
 Strengths-Based CBT
Padesky & Mooney (2012)

 These authors wanted to incorporate positive

psychology with CBT to increase happiness
and promote resilience
 Goal is to help people build a model in order
to help deal with life’s obstacles
 Resilience is a process, not a trait.
 Focus is to construct resilient beliefs and
behaviours rather than dismantle beliefs and
behaviours that are roadblocks*.
Strengths-Based CBT
Padesky & Mooney (2012)

1. Search for strengths

2. Construct a personal model
3. Apply the PMR to areas of life
difficulty
4. Practise resilience
Search for Strengths
Padesky & Mooney (2012)

 Within positive, sustained activities

 Introduce obstacles
 Many different types of strengths
Construct PMR
Padesky & Mooney (2012)

 Turn strengths into general strategies

 Use client’s words
 Include images and metaphors
Apply PMR
Padesky & Mooney (2012)

 Identify problem areas in need of resilience

 Plan which PMR strategies to use
 Focus on resilience, not outcome
Practice
Padesky & Mooney (2012)

 Design behavioral experiments

 Resilience predictions
 Many different types of strengths
Highlights of Strengths-Based CBT
 There are many pathways and combinations
of strengths that can lead to positive qualities
 Often, it is not necessary to teach clients new
skills, but to highlight existing ones and find
ways to utilize them
 The approach assumes that people are
already resilient in various aspects of their life
 People are often unaware of their strengths
as they can be hidden
 Finding strengths in everyday activities can
yield rich information not found in
questionnaires
Highlights of Strengths-Based CBT
Examples of finding strengths that lead to
resilience:

 Having a good sense of humour and good

problem solving skills
 Strong social ability can result in asking others
for help
In Treatment