Cognitive behavior therapy - Cognitive Behavioral Approaches

Question 1

Founders:

Answer 1

Albert Ellis and A. T. Beck. Albert Ellis founded rational emotive behavior therapy, a highly didactic, cognitive, action-oriented model of therapy, and A. T. Beck founded cognitive therapy, which gives a primary role to thinking as it influences behavior. Judith Beck continues to develop CBT; Christine Padesky has developed strengths-based CBT; and Donald Meichenbaum, who helped develop cognitive behavior therapy, has made significant contributions to resilience as a factor in coping with trauma.

Question 2

Basic Philosophies

Answer 2

Individuals tend to incorporate faulty thinking, which leads to emotional and behavioral disturbances. Cognitions are the major determinants of how we feel and act. Therapy is primarily oriented toward cognition and behavior, and it stresses the role of thinking, deciding, questioning, doing, and redeciding. This is a psychoeducational model, which emphasizes therapy as a learning process, including acquiring and practicing new skills, learning new ways of thinking, and acquiring more effective ways of coping with problems.

Question 3

Key Concepts

Answer 3

Although psychological problems may be rooted in childhood, they are reinforced by present ways of thinking. A person’s belief system and thinking is the primary cause of disorders. Internal dialogue plays a central role in one’s behavior. Clients focus on examining faulty assumptions and misconceptions and on replacing these with effective beliefs.

Question 4

Goals of Therapy

Answer 4

To teach clients to confront faulty beliefs with contradictory evidence that they gather and evaluate. To help clients seek out their faulty beliefs and minimize them. To become aware of automatic thoughts and to change them. To assist clients in identifying their inner strengths, and to explore the kind of life they would like to have.

Question 5

The Therapeutic Relationship

Answer 5

In REBT the therapist functions as a teacher and the client as a student. The therapist is highly directive and teaches clients an A-B-C model of changing their cognitions. In CT the focus is on a collaborative relationship. Using a Socratic dialogue, the therapist assists clients in identifying dysfunctional beliefs and discovering alternative rules for living. The therapist promotes corrective experiences that lead to learning new skills. Clients gain insight into their problems and then must actively practice changing self-defeating thinking and acting. In strengths-based CBT, active incorporation of client strengths encourages full engagement in therapy and often provides avenues for change that otherwise would be missed.

Question 6

Techniques of Therapy

Answer 6

Therapists use a variety of cognitive, emotive, and behavioral techniques; diverse methods are tailored to suit individual clients. This is an active, directive, time-limited, present-centered, psychoeducational, structured therapy. Some techniques include engaging in Socratic dialogue, collaborative empiricism, debating irrational beliefs, carrying out homework assignments, gathering data on assumptions one has made, keeping a record of activities, forming alternative interpretations, learning new coping skills, changing one’s language and thinking patterns, role playing, imagery, confronting faulty beliefs, self-instructional training, and stress inoculation training.

Question 7

Applications of the Approaches

Answer 7

Has been widely applied to treatment of depression, anxiety, relationship problems, stress management, skill training, substance abuse, assertion training, eating disorders, panic attacks, performance anxiety, and social phobias. CBT is especially useful for assisting people in modifying their cognitions. Many self-help approaches utilize its principles. CBT can be applied to a wide range of client populations with a variety of specific problems.

Question 8

Contributions to Multicultural Counseling

Answer 8

Focus is on a collaborative approach that offers clients opportunities to express their areas of concern. The psychoeducational dimensions are often useful in exploring cultural conflicts and teaching new behavior. The emphasis on thinking (as opposed to identifying and expressing feelings) is likely to be acceptable to many clients. The focus on teaching and learning tends to avoid the stigma of mental illness. Clients are likely to value the active and directive stance of the therapist.

Question 9

Limitations in Multicultural Counseling

Answer 9

Before too quickly attempting to change the beliefs and actions of clients, it is essential for the therapist to understand and respect their world. Some clients may have serious reservations about questioning their basic cultural values and beliefs. Clients could become dependent on the therapist choosing appropriate ways to solve problems.

Question 10

Contributions of the Approaches

Answer 10

Major contributions include emphasis on a comprehensive therapeutic practice; numerous cognitive, emotive, and behavioral techniques; an openness to incorporating techniques from other approaches; and a methodology for challenging and changing faulty or negative thinking. Most forms can be integrated into other mainstream therapies. REBT makes full use of action-oriented homework, various psychoeducational methods, and keeping records of progress. CT is a structured therapy that has a good track record for treating depression and anxiety in a short time. Strengths-based CBT is a form of positive psychology that addresses the resources within the client for change.

Question 11

Limitations of the Approaches

Answer 11

Tends to play down emotions, does not focus on exploring the unconscious or underlying conflicts, de-emphasizes the value of insight, and sometimes does not give enough weight to the client’s past. CBT might be too structured for some clients.

Question 12

ABC Framework

Answer 12

A is the existence of an activating event or the inference about an event by an individual
B which is the persons belief about A, largely creates C
C the emotional and behavioural reaction

Question 13

Rational Emotive Behaviour Therapy (REBT)

Answer 13

persuasive cognitive methodologies in the therapeutic process
-disrupting irrational beliefs
- doing cognitive homework
- bibliotherapy
- changing ones language
- psychoeducational methods
- humor
- role playing
- shame-attacking exercises
- behavioural techniques and homework
Uses rational emotive imagery - REI - imagine on of the worst things that might happen and to describe their feelings

Question 14

Application To Group Counselling

Answer 14

learn how their beliefs influence what they feel and what they do
explore ways to change self-defeating thoughts
learn to minimise symptoms through a change in their philosophy

Question 15

Cognitive Therapy - Beck (CT)

Answer 15

allows therapists to link assessment, conceptualisation and treatment strategies.

Cognitive Model
- psychological distress can be though of as an exaggerated of normal adaptive human functioning
- faulty information processing is a prime cause of exaggerations in adaptive emotional and behavioural reactions.

Common distortions:
- arbitrary inferences - conclusions drawn without evidence
- selective abstraction - forming conclusions based on an isolated detail
- overgeneralisation - holding extreme beliefs on the basis of 1 incident
- magnification and minimisation - greater or lesser than a situation is
- personalisation - relate external events to themselves
- labeling and mislabeling - one identity on the basis of imperfections
- dichotomous thinking - categorizing experiences in either or extremes

• our beliefs play a major role in determining what type of psychological distress we will experience
• central to cognitive therapy is the empirically supported observation that changes in beliefs lead to changes in behaviours and emotions.
• if beliefs are not modified, clinical conditions are likely to reoccur

Principles - psychological problems as an exaggerated of adaptive responses resulting from commonplace cognitive disorders.

Goal - is to help clients learn practical skills that they can make use of and change these behaviours and emotions

Treatment Approach - thought records which help identify negative automatic thoughts

Applications of Strength - search, construct, apply and practice

Question 16

Differences between CT and REBT

Answer 16

• REBT is highly directive, persuasive and confrontational
• CT uses socractic dialogue, open ended questions
• CT places more emphasis on helping clients identify misconceptions for themselves rather than being taught

Question 17

Cognitive Behaviour Modification (CBM)

Answer 17

combines BT and CT. clients must become aware of how they think, feel and behave and impact they have on others before they can change.

Phase 1: self-observation
Phase 2: Starting a new internal dialogue
Phase 3: Learning new skills

Stress Inoculation Training - based on the assumption that we can affect our ability to cope with stress by modifying our beliefs and self-statements. Combination of information giving, socractic discovery-oriented inquiry, cognitive restructuring, problem solving, relaxation training, behaviour rehearsals, self-monitoring, self-reinforcement and modifying environmental situations.

Phase 1: the conceptual-educational - primary focus is on creating a therapeutic alliance

Phase 2: the skills acquisition and consolidation - focus on giving clients a variety of behavioural and cognitive coping skills to apply to stressful situations

Phase 3: the application and follow-through - focus on carefully arranging for transfer and maintenance of change from the therapeutic situation to everyday life. Relapse prevention - which consists of procedures for dealing with the inevitable setbacks clients are likely to experience.