Cognitive Behavioral Therapy Flashcards
fundamental premise
feelings are based on what we believe, what we think, how we perceive, how we interpret and react to life situations. For the sake of simplicity, this module will be general and will discuss principles that are relevant to both Cognitive Behavior Therapy (CBT) and Rational Emotive Behavioral Therapy (REBT). Corey does an excellent job of going into the important details and differences of these theories.
key concepts
- Humans are born with the ability to be both rational and irrational.
- Humans tend to make mistakes, but are capable of learning to accept and forgive themselves for failing to be “perfect.”
- Emotional disturbance come when simple preferences are transformed into dire needs.
- Blame is a key element in emotional distress.
- “Shoulds”, “oughts”, and “musts” produce negative beliefs, which often lead to emotional problems.
- Traditional CBT is a highly didactic and directive approach to therapy which is more concerned about thoughts than feelings.
- Stresses that humans think, emote and behave simultaneously.
- Defines neurosis as “irrational thinking and behaving.”
- Psychopathology is originally learned and aggravated by the inculcation of irrational beliefs from significant others during childhood (such as parents and siblings).
- Teaches that emotions are the products of human thinking (when we think something is bad, we feel bad about the thing).
- Insists that blame is the core of most emotional disturbances (so we should stop blaming ourselves and others).
- Human beings are largely responsible for creating their own emotional reactions and disturbances.
ABC Process [Rational Emotive Behavior Therapy] (Ellis)
Ellis postulated the simple ABC PROCESS. An activating event is filtered through a belief about that event and produces a consequence (an emotion or behavior based on the belief). If the belief is rational, the consequence will be rational; if the belief is irrational, the consequence will be irrational.
A-B-C (D-E-F) Theory
A = ACTIVATING EVENT B = BELIEF C = EMOTIONAL/BEHAVIORAL CONSEQUENCE
D = DISPUTING INTERVENTION E = EFFECT F = NEW FEELING
The understanding of cognitive dysfunction is the key to the REBT process.
The effective REBT therapist needs to understand how faulty cognition is developed and expressed in dysfunctional behavior. AA has picked up on this and calls these types of erroneous cognitions “Stinkin’ Thinking.”
“Stinkin Thinkin”
Stinkin’ Thinking is common not only in the recovery community, but most of us use this when we are facing difficult times and have doubt about our ability to complete something successfully.
Faulty Cognitions are learned in 5 Ways
a. DIRECT EXPERIENCE: One bad experience is generalized to cover all similar experiences. EX. “I can’t hit a baseball with a bat, so I’m no good at sports”
b. VICARIOUS EXPERIENCE: Observation of the way another person handles the difficulties of life generalized to cover all similar experiences. EX. “Mom was always depressed when having to make a hard decision, so I learned that as a way of dealing with life’s difficulties.”
c. SYMBOLIC LOGIC: Applying the same logic to all situations. EX. “All anger is bad.” Rather than “some anger is dangerous and some anger can be constructive.”
d. DIRECT INSTRUCTION: Observation or participation in a faulty cognition. EX. “Mother has repeatedly told me, ‘Sex is bad and dirty.’ That ingrained instruction will influence all my sexual experiences”
e. MISCONSTRUING CAUSE AND EFFECT Interpreting a consequence or event without acknowledging all the reasons for the event. EX. A student is driving to class and is running late. The student gets a flat on the way to class, which led to missing class. The student may state, “Gosh the universe is out to get me and doesn’t want me to succeed!” when really, they had driven over a nail which punctured their tire.
cognitive distortions are usually expressed in the following categories:
a. OVERGENERALIZATIONS: Women are bad drivers. Men are only interested in sex. All effeminate men are homosexual.
b. ALL OR NOTHING CONCEPTS: Either I get accepted in graduate school or my life is over. Either you love me unconditionally or you don’t really love me.
c. ABSOLUTE STATEMENTS: I must obey my parents. I must
be nice. I must be right all the time. I must be perfect. I have to have someone to love me or I have no value.
d. SEMANTIC INACCURACIES: I failed versus I made a mistake. I am defeated versus this is just a setback.
e. TIME DISCERNMENT: What was valid in the past is not necessarily valid in the present. What is valid in the present will not necessarily be valid in the future. “Counseling doesn’t work for me because I tried it a couple of times and it didn’t work.”
Cognitive dysfunction and faulty assumptions are maintained by
a. Selective Attention: Focusing only on the negative. EX. “The data that supports the assumption is the only thing I hear.”
b. Selective Inattention: Ignoring things that would counter the faulty assumption.
c. Fictitious Rewards: Creating subjective lies to make one feel better. EX. “His harsh words and treatment shows that he really loves me when he makes it up with gifts.”
d. Solicited Feedback: “I’m OK, aren’t I?” If a person responds, “Yes, you are,’ the usual thought of the asking individual is, “She really doesn’t mean that. I know better.”
e. Intermittent Reinforcement: sometimes the cognitive dysfunction pays off in a limited way giving just enough reinforcement to keep the behavior active.
f. Cognitive Dissonance: Thoughts don’t match actions. I am really thinking or feeling bad, but I am going to act happy— like nothing at all is wrong.
Major cognitive themes: Early in the therapeutic process it is helpful to elicit the client’s thinking about:
a. Self—how does the client see himself?
b. The World—is the client’s worlds safe, happy, peaceful, or a living hell?
c. Life—what are the client’s views on life and living?
d. Future—how does the client see the future?
e. Past—how does the client perceive the past?
MORE COGNITIVE DISTORTIONS
- ALL OR NOTHING THINKING: Things are viewed in black and white categories. If a performance falls short of perfection, one sees themselves as a total failure.
- OVERGENERALIZATION: A single negative event as a never-ending pattern of defeat.
- MENTAL FILTER: A single negative detail is identified and dwelled upon exclusively so that it becomes darkened, like the drop of ink that discolors an entire beaker of water.
- DISQUALIFYING THE POSITIVE: Positive experiences are rejected by claiming that they “don’t count” for some reason or another. This allows the individual to maintain a negative belief that is contradicted by every day experiences.
- JUMPING TO CONCLUSIONS: A negative interpretation is made even though there are no definite facts that convincingly support this conclusion.
- MAGNIFICATION (CATASTROPHIZING) OR MINIMIZATION:
The importance of things is magnified, such as an individual mistake or another’s achievement. The alternative is the “shrinking” or minimization of things that are important to the individual until they appear tiny such as one’s own desirable qualities or anothers’ imperfections. This is also called the
“binocular trick.” - EMOTIONAL REASONING: The assumption that negative
emotions necessarily reflect the way things really are: “I feel it therefore it must be true.” - SHOULD STATEMENTS: The use of “should” and “should nots” to motivate one to act, as if you were to be whipped and punished before you could be expected to do anything. “Musts” and “Oughts” are also offenders. The emotional consequence is guilt. When should statements are directed toward others, one feels anger, frustration, and resentment.
- LABELING AND MISLABELING: This is an extreme form of overgeneralization. Instead of describing one’s error, you attach a negative label is attached instead, “I am a loser.” When someone else’s behavior is frustrating, a negative label can be attached them: “What a scumbag!” Mislabeling involves describing an event with language that is highly colored and emotionally loaded.
- PERSONALIZATION: One is seen as the cause of some negative external event which in fact they were not responsible for.
BECK’S CONCEPT OF CORE BELIEFS AND AUTOMATIC THOUGHTS
A. Aaron Beck is well known for his work with depression and the scales he developed to assess depression. He charts the A-B-C process a little differently by identifying Core Beliefs, Intermediate Beliefs and Automatic Thoughts into the process. His schema looks like this:
Core belief –> intermediate belief –> automatic thoughts (activated by stimulus, result in behavior)
COGNITIVE THERAPY THERAPEUTIC METHODS
Cognitive therapists hold that insight in itself does not lead to change. There must be hard work and commitment on behalf of the client to move toward change in order to improve mental health. The following steps to change must be involved in the client’s therapy:
a. Take responsibility for creating your own emotional problems
b. Accept the ability to change
c. Realize that one’s emotional difficulties come from irrational thoughts and beliefs
d. Understanding what these beliefs are
e. See value in disputing them
f. Decide to use emotive and behavioral ways to change and work hard on changing.
g. Practice Cognitive and REBT methods for the rest of one’s life
TECHNIQUES USED TO LEAD THE CLIENT THROUGH THE THERAPEUTIC PROCESS ARE:
- DISPUTING IRRATIONAL BELIEFS The therapist
challenges the client’s irrational beliefs and then teaches the client how to challenge their own irrational beliefs - COGNITIVE HOMEWORK Client applies A-B-C concepts to daily life situations. One example is the technique of Thought Stopping. A client who is bothered by a recurring negative thought is assigned to sat to self, “STOP,” and then immediately repeat an affirmation or mantra using positive statements.
- CHANGING ONE’S LANGUAGE This teaches clients to observe their self-talk and to remove “shoulds, oughts, and musts.”
- HUMOR Learning to laugh at self and not taking self too seriously
EMOTIVE TECHNIQUES
- RATIONAL-EMOTIVE IMAGERY Image yourself as you would like to be and then act that way even if it does not feel right.
a. This is the same as AA’s, “Fake it till you make it” one-liners.
b. Clients are taught to imagine difficult situations and then to imagine themselves using more appropriate behaviors. - ROLE PLAYING Role playing can take on many forms. The therapist can play a boss and the client role plays a potentially uncomfortable conversation. They could reverse roles. This could also include the empty chair technique or the two-chair technique.
- SHAME ATTACKING EXERCISES
a. Genuine shame is natural and healthy. It lets us know we have some something wrong and need to do something to correct the situation.
b. Toxic Shame, on the other hand, is a cognitive distortion of immense proportions. Just about everyone who has been abused, grown up in a highly dysfunctional family or has an addiction knows what it is like.
c. A person with toxic shame cannot say, “I did something bad,” they say, “I am bad!” Any negative act or consequence is attributed to personally; the self and not be separated from the behavior.
Toxic shame causes people to constantly look for external approval and feel shame when others disapprove. They need to learn to do the things they want without worrying about outside reactions. This is also called desensitization training. - USE OF FORCE AND VIGOR This is teaching the client to vigorously self-debate on negative feelings and thoughts.
OTHER BEHAVIORAL TECHNIQUES
a. operant Conditioning
b. self-management
c. desensitization
d. relaxation techniques
e. modeling
f. planning
g. accomplishing assignments.
Rational Emotive Behavior Therapy (REBT)
first of the cognitive behavioral therapies. people contribute to their own psych probs, and to specific symptoms, by the rigid and extreme beliefs they hold. cognitions, emotions, and behaviors interact significantly and have a reciprocal cause-and-effect relationship. generally conceded to be parent of today’s cognitive behavioral approaches [albert ellis]
irrational beliefs
people disturb themselves as a result of rigid and extreme beliefs they hold about events more than the events themselves.
emotions
mainly created from our beliefs, which influence evaluations and interpretations and fuel our reactions
where irrational beliefs are learned
from significant others during childhood. we re-create them throught life. actively renforce our self-defeating beliefs through the processes of auto-suggestion and self-repetation, and behave in ways consistent with these beliefs. it is our own repitition of early-indoctrinated irrational beliefs that keeps dysfunctional attitudes aalive and operative w/in us
3 basic musts (irrational beliefs) we internalize that inevitably lead to self defeat
- “i must do well and be loved and approved by others.”
- “other people must treat me farily, kindly, and well.”
- the world and my living conditions must be comfortable, gratifying, and just, providing me with all that i want in life.”
cognitive methods (rebt)
most efficient way to bring about lasting emotional and behavioral change is for clients to change way of thinking:
- disputing irrational beliefs
- doing cognitive homework
- bibliotherapy
- changing one’s language
- psychoeducational methods
