COGNITIVE BEHAVIORAL THERAPY

Common attributes of each therapy:

 Collaborative relationship between client and therapist

 Premise that psychological distress is largely a function of disturbances in cognitive processes
 Focus on changing cognitions to produce desired changes in affect and behavior
 Present-centered, time-limited focus
 An active and directive stance by the therapist
 Educational treatment focusing on specific and structured target problems

ALBERT ELLIS’S RATIONAL EMOTIVE BEHAVIOR THERAPY

 Basic assumption: people contribute to their own psychological problems, as well as to specific symptoms, by
rigid and extreme beliefs they hold about events and situations
 Cognitions, emotions, and behaviors interact significantly and have a reciprocal cause-and-effect relationship.
 Influential schools of thought:
o Alfred Adler
o Karen Horney’s ideas on “tyranny of the shoulds”
o Epictetus (Stoic Philosopher): People are disturbed not by events, but by the views which they take of
them  Restated as: People disturb themselves by the rigid and extreme beliefs hey hold about events.
 Basic Hypothesis: our emotions stem mainly from our beliefs, which influence the evaluations and
interpretations we make of the reactions we have to life situations.
 Therapeutic implications:
o Focus is on working with thinking and acting rather than primarily with expressing feelings
o Therapy is seen as an educational process – therapist functions like a teacher: homework assignments,
teaching strategies for straight thinking; client is a learner who practices these new skills in everyday life.
 Transference is not encouraged, and when it does occur, the therapist is likely to confront it.
o Transference relationship is based on irrational belief that the client must be like and loved by the
therapist or parent figure.
o Such cathartic work may result in clients feeling better, but it will rarely aid them in getting better.

View of Human Nature

 Assumption: human beings are born with a potential for both rational thinking (straight) and irrational thinking
(crooked).
 Rational thinking predispositions:

o Self-preservation o Loving
o Happiness o Communion with others
o Thinking and verbalizing o Growth and self-actualization

 Irrational thinking predispositions:

o Self-destruction o Superstition
o Avoidance of thought o Intolerance
o Procrastination o Perfectionism and self-blame
o Endless repetition of mistakes o Avoidance of actualizing growth
potentials

 REBT encourages people accept themselves even though they will make mistakes.

View of Emotional Disturbance

 Premise: We learn irrational beliefs from significant others during childhood and then re-create these irrational
beliefs throughout our lifetime.
 We reinforce our self-defeating beliefs through the processes of autosuggestion and self-repetition, and we
then behave in ways that are consistent with these beliefs. Hence, it is largely our own repetition of early-
 indoctrinated irrational beliefs (not the parent’s repetition) that keeps dysfunctional attitude alive and operative
within us.
 Goal of REBT: encourage clients to be less emotionally reactive, e.g. by feeling sadness and disappointment
about life’s adversities rather than by feeling anxiety, depression, and shame.
 Blame is at the core of most emotional disturbances.
o To become psychologically healthy, we had better stop blaming ourselves and others; learn to fully and
unconditionally accept ourselves despite our imperfections.
o We have strong tendencies to transform our desires and preferences into dogmatic “should,” “must,”
“ought,” demands and commands. (We have to identify these!)
o Three basic musts (or irrational beliefs):
 I must do well and win the approval of others for my performance or else I am no good.
 Other people must treat me considerately, fairly, kindly, and in exactly the way I want to treat
me. If they don’t, they are no good and they deserve to be condemned and punished.
 I must get what I want, when I want it; and I must not get what I don’t want. If I don’t get what I
want, it’s terrible, I can’t stand it, and life is no good for depriving me of what I must have.

A-B-C Framework

 ABC framework is central to REBT theory and practice

 A (activating agent) – existence of a fact, or an influence about an event, of an individual
 C – emotional and behavioural consequence or reaction of the individual: healthy or unhealthy
 B – person’s belief about A, largely creates C, the emotional reaction

 Believing that human beings are largely responsible for creating their own emotional reactions and disturbances
and showing people how they can change their irrational beliefs that directly “cause” their disturbed emotional
consequences is at the heart of REBT
 How is an emotional disturbance fostered?
o Fed by self-defeating sentences clients continually repeat to themselves.
 You mainly feel the way you think.
 D – disputing; application of methods to help clients challenge their irrational beliefs
o Three components of disputing process:
 Detect – their irrational beliefs
 Debate – their dysfunctional beliefs by learning how to logically and empirically question them
and to vigorously argue themselves out of and act against believing them
 Discriminate – irrational (self-defeating) beliefs from rational (self-helping) beliefs
 Results in cognitive restructuring – teaches people how to improve themselves by replacing
irrational beliefs with rational beliefs; involves monitoring their self-talk, identify maladaptive
self-talk, substitute adaptive self-tale for their negative self-talk
 How to significantly change our cognitions, emotions, and behaviors?
o avoid preoccupying ourselves with A
o acknowledge the futility of dwelling endlessly on emotional consequences at C
o examine, challenge, modify, and uproot B
 E – effective philosophy which has a practical side; a new and effective belief system consists of replacing
unhealthy thoughts with healthy ones.
  F – a new set of feelings. Instead of feeling seriously anxious and depressed, we feel healthily sorry and
disappointed in accord with a situation

THERAPEUTIC PROCESS

Therapeutic Goals

 Teach clients how to separate the evaluation of their behaviors from the evaluation of themselves—their
essence and their totality—and how to accept themselves in spite of their imperfections (e.g. total person based
on our performance)
 Help clients differentiate between realistic and unrealistic goals and also self-defeating and self-enhancing goals
 Teach clients how to change their dysfunctional emotions and behaviors into healthy ones
 Two main goals of REBT:
o Achieve unconditional self-acceptance (USA)
o Achieve unconditional other acceptance (UOA)
 As clients become more able to accept themselves, they are more likely to unconditionally accept others.

Therapist’s Function and Role

 First Step: show clients how they have incorporated many irrational absolute “should,” “ought,” “must”
 Second Step: demonstrate how clients are keeping their emotional disturbances by continuing to think illogically
and unrealistically
 Third Step: help clients modify their thinking and minimize their irrational ideas.
 Fourth Step: challenge clients to develop a rational philosophy of life so that in the future they can avoid
becoming the victim of other irrational beliefs
o Insight alone does not typically lead to psychotherapeutic change, but it helps clients to see how they
are continuing to sabotage themselves and what they can do to change.

Client’s Experience in Therapy

 Clients learn how to apply logical thought, participate in experiential exercises, and carry out behavioural
homework
 Can realize that life does not always work out the way they would like it to, but life can be bearable and that
even suffering can be honourable.
 Focus on client’s experiences in the present.
o Clients are presently disturbed because they still believe in and act upon their self-defeating view of
themselves, other people, and the world
 Are expected to actively work outside the therapy sessions
o Homework – carefully designed and agreed upon; aimed at getting clients to carry out positive actions
that induce emotional and attitudinal change; checked in later sessions
 At the end of therapy, clients review their progress, make plans, and identify strategies for dealing with
continuing or potential problems.

Relationship between Therapist and Client

 Warm relationship between T and C is NOT required

 Too much warmth and understanding can be counterproductive and foster a sense of dependence of approval
from the therapist; accept clients as imperfect human beings who can be helped through a variety of techniques
 Therapists are often open and direct on disclosing their own beliefs and values
o Some are willing to share their own imperfections to dispute client’s unrealistic notions that therapists
are “completely put together” persons.

APPLICATION: TECHNIQUES AND PROCEDURES

 Multimodal and integrative

Cognitive Methods

 Disputing irrational beliefs – clients go over a particular “must” until they no longer hold that irrational beliefs,
or at least diminish it in strength
 o Why must people treat me fairly?
o How do I become a total flop if I don’t succeed at important tasks I try?
 Doing cognitive homework – make lists of their problems, look for their absolutist beliefs, and dispute these
beliefs
o Homework assignments by applying ABC model
o Clients are encouraged to put themselves in risk-taking situations that will allow them to challenge their
self-limiting beliefs
o Help replace irrational beliefs with more positive messages
o Clients often create a negative, self-fulfilling prophecy and actually fail because they told themselves in
advance that they would
o Take time to record and think about how their beliefs contribute to their personal problems
 Bibliotherapy – utilized as an adjunctive (additional) form of treatment
o Advantages:
 Cost-effectiveness
 Widespread availability
 Potential of reaching a broad spectrum of populations
o REBT self-help books
 Changing one’s language
o Premise: imprecise language is one of the causes of distorted thinking processes.
o Must  preferences
o Awful  inconvenient
o Language that are helpless and self-condemnation can learn to employ new self-statements. As a
consequence, they also begin to feel differently.
 Psychoeducational methods – T educates C about the nature of their problems and how treatment is likely to
proceed
o Ask clients how particular concepts apply to them
o Clients will cooperate more with the treatment program if they understand how the therapy process
works and why they are being used

Emotive Techniques

 C is taught the value of USA.

 Even though their behavior may be difficult to accept, they can decide to see themselves as fallible human
beings
 Purpose: dispute client’s irrational beliefs; NOT to provide cathartic experience, but help clients CHANGE some
of their thoughts, emotions, and behaviors
 Rational emotive imagery – C is asked to vividly imagine one of the worst things that might happen to them.
Then they are shown how to train themselves to develop healthy emotions in place of disruptive ones.
 Using humor
o Emotional disturbances often result from taking oneself too seriously, thus, this approach employs a
good deal of humor
o Teaches client to laugh—not at themselves, but at their self-defeating ways of thinking
 Role-playing
o Therapists often interrupts to show clients what they are telling themselves to create their disturbances
and what they can do to change their unhealthy feelings to healthy ones
 Shame-attacking exercises
o Rationale: emotional disturbance related to the self is often characterized by feelings of shame, guilt,
anxiety and depression
o We can stubbornly refuse to feel ashamed by telling ourselves that it is not catastrophic if someone
thinks we are foolish
o Increase self-acceptance and mature responsibility
o Help C see that much of what they thought of as being shameful has to do with the way they define
reality for themselves
o Learn that they have no reason for continuing to let other’s reactions or possible disapproval stop them
from doing the things they want (except illegal activities)