Cognitive Behavior Therapy

Cognitive Behavior Therapy

1. Prepared by John NEMAR K. Filler Report in Psychotherapy

2. Cognitive Behavioral Therapy Chapter 10

3. Cognitive behavior therapy (CBT) is a type of psychotherapeutic treatment that helps patients understand the thoughts and feelings that influence behaviors. What is Cognitive Behavior Therapy?

4. CBT is generally short-term and focused on helping clients deal with a very specific problem. CBT is commonly used to treat a wide range of disorders including phobias, addiction, depression and anxiety.

5. Our thoughts and feelings play a fundamental role in our behavior. The goal of CBT is to teach patients that they can take control of how they interpret and deal with things in their environment. Basic Principles of CBT

6. There are a number of different approaches to CBT. These types are: Rational Emotive Therapy Cognitive Therapy Behavior Modification Therapy Types of Cognitive Behavioral Therapy

7. Albert Ellis’ Rational Emotive Behavior Therapy

8. Albert Ellis (1913 – 2007) He was born in Pittsburgh. Who is Albert Ellis?

9. He went to New York at the age of 4 and lived there (except for a year in New Jersey) for the rest of his life. Albert Ellis

10. As a child, he was hospitalized 9 times mainly with nephritis, and developed renal glycosuria at the age of 19 and diabetes at the age of 40. He died at the age of 93. Albert Ellis

11. He decided to become a psychologist when he realized that he could counsel people skillfully and that he greatly enjoyed doing so. He was analyzed and supervised by a training analyst. Albert Ellis

12. He then practiced psychoanalytically oriented psychotherapy, but eventually he became disillusioned with the slow progress of his clients. Albert Ellis

13. He observed that the clients improved more quickly once they changed their ways of thinking about themselves and their problems. Early in 1955 he developed rational emotive behavior therapy (REBT). Albert Ellis

14. He has rightly been called the “grandfather of cognitive behavior therapy”. Until his illness during the last 2 years of his life, he generally worked 16 hours a day. Albert Ellis

15. He married an Australian psychologist, Debbie Joffe, in November 2004. They have the same life goals and ideals. They worked as a team presenting workshops in many parts of the world. Albert Ellis

16. Rational emotive behavior therapy (REBT) was one of the 1 st cognitive behavior therapies that continues to be a major cognitive behavioral approach today. What is Rational Emotive Behavior therapy?

17. The basic assumption of REBT is that people create their own psychological problems by the way they interpret events and situations. Rational Emotive Behavior therapy

18. REBT is based on the assumptions that cognitions, emotions, and behaviors interact significantly and have a mutual cause – and – effect relationship. Rational Emotive Behavior therapy

19. Ellis argued that the psychoanalytic approach is sometimes very inefficient because people often seem to get worse instead of better. Rational Emotive Behavior therapy

20. Ellis argued how people disturb themselves: “People disturb themselves by the things that happen to them, and by their views feelings, and actions.” Rational Emotive Behavior therapy

21. Ellis also gives credit to Adler as an influential precursor. Adler believed that our emotional reactions and lifestyle are associated with our basic beliefs and are therefore cognitively created. Rational Emotive Behavior therapy

22. REBT’s basic hypothesis is that our emotions stem mainly from our beliefs, evaluations, interpretations, and reactions to life situations. Rational Emotive Behavior therapy

23. Our emotional dilemmas, psychological problems, etc. are caused by how we perceive things, the way we interpret our thoughts & ideas, how we evaluate events and situations in our lives. My explanation on REBT:

24. According to Ellis, “people are not disturbed by things but rather by their view of things.” If we always hold irrational beliefs about ourselves, then we would always find problems. My explanation on REBT:

25. In order for the clients to feel better, the way they perceive things should be rational. Dispute the irrational way of thinking and replace them with more rational alternatives. My explanation on REBT:

26. By the help of REBT, people are being guided to alter illogical beliefs and negative thinking patterns in order to overcome psychological problems and mental distress. My explanation on REBT:

27. View of Human Nature Key Concepts

28. REBT is based on the assumption that human beings are born with a potential for both rational or “straight” thinking, and irrational or “crooked” thinking. View of Human Nature

29. People have predispositions for self-preservation, happiness, thinking and verbalizing, loving, communion with others, growth and self-actualization. View of Human Nature

30. People also have propensities for self-destruction, avoidance of thought, endless repetition of mistakes, superstition, intolerance, perfectionism and self-blame, and avoidance of actualizing growth potentials. View of Human Nature

31. Humans are fallible. REBT attempts to help people accept themselves as creatures who will continue to make mistakes yet at the same time learn to live more at peace with themselves. View of Human Nature

32. View of Human Nature Belief: Assumes that individuals have the capacity to be completely rational, irrational, sensible or crazy, which Ellis believes is biologically inherent. Additional information from other references:

33. View of Human Nature Thoughts : Believes that each human has the ability to control their thoughts, feelings & actions. However, an individual must first understand Additional information from other references:

34. What they are telling themselves (self-talk) about the event or situation. Additional information from other references:

35. Humans are both rational & irrational. People disturb themselves by what they think & what they believe. People have the ability to control thoughts, feelings & behaviors; but they must first become aware of their self-talk. My explanation on the View of Human nature:

36. View of Emotional Disturbance Key Concepts

37. REBT is based on the premise that although we originally learn irrational beliefs from significant others during childhood, we create irrational dogmas by ourselves. View of Emotional Disturbance

38. We do this by actively reinforcing self-defeating beliefs by the process of autosuggestion and repetition, and behaving as if they are useful. View of Emotional Disturbance

39. “People don’t need to be accepted and loved even though this may be highly desirable”, according to Ellis. The therapist teaches clients how to feel undepressed even they are unaccepted & unloved by someone. View of Emotional Disturbance

40. Although REBT encourages people to experience healthy feelings over being unaccepted, it attempts to help them find ways of overcoming unhealthy feelings of depression, anxiety, loss of self-worth & hatred. View of Emotional Disturbance

41. It is important that we learn to fully accept ourselves despite our imperfections. Ellis hypothesizes that we have strong tendencies to rise our desires & preferences into View of Emotional Disturbance

42. dogmatic “shoulds”, “musts”, “oughts”, demand and commands. Such demands create disruptive feelings and dysfunctional behaviors (Ellis. 2001a, 2004a). View of Emotional Disturbance

43. Ellis places irrational beliefs (3 basic musts) into 3 categories correlated with emotional disturbance. View of Emotional Disturbance

44. “I must do well and win the approval of others for my performance or else I am no good.” - Result: Severe feelings of anxiety, depression, & demoralization often leading to severe inhibition. View of Emotional Disturbance

45. “Other people must treat me considerately, fairly, kindly, and in exactly the way I want them to treat me. If they don’t, they are no good and they deserve to be condemned and punished.” View of Emotional Disturbance

46. - Result: Severe feelings of anger, rage, fury, often leading to fights, child abuse, assault, rape, murder and genocide. View of Emotional Disturbance

47. “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 and I can’t stand it.” View of Emotional Disturbance

48. - Result: Severe feelings of frustration tolerance, often leading to compulsion, addiction, avoidance, inhibition, and public reaction. View of Emotional Disturbance

49. A-B-C Framework Key Concepts

50. Ellis suggested that people mistakenly blame external events for unhappiness. It is our interpretation of these events that truly lies at the heart of our psychological distress. ABC Framework

51. ABC Framework A – Activating event B – Beliefs (rational or irrational) C – Consequences D – Dispute of the beliefs E – The new effect or consequence F – The new feeling

52. (A) Is the activating event; something that happens in the environment around you. (B) Is the belief; You hold a belief about the event or situation (rational or irrational) ABC Framework

53. (C) Is the consequence; You have an emotional response to your belief. (D) Is for disputing; As a result of disputing irrational beliefs, we will emerge with more rational alternatives. ABC Framework

54. (E) Is the new effect or the consequence; After disputing, eventually clients arrive at E, an effective philosophy, which has a practical side. ABC Framework

55. (F) Is the new set of feelings; If we are successful in doing (E), we also create (F), a new set of feelings (feelings that are more desirable) ABC Framework

56. Example 1: Irrational Belief A: You are told by your boss that he is unhappy with your work B: I’m a failure C: Anxiety and depression ABC Framework

57. Rational Belief A: You are told by your boss that he is unhappy with your work B: I did my best C: Disappointed but confident that things will get better ABC Framework

58. The activating event triggers an emotion that we believe to be true, the consequence is that we become anxious & depressed because we have negative view about ourselves and our capability. My explanation on Example 1:

59. Example 2: A: I fail a test B: I am incompetent C: I will feel depressed, embarrassed, rage and other negative emotions. ABC Framework

60. According to Ellis, interpretation is everything. It’s not what happens to us (A) that creates our misery. It’s what we believe (B) about what happens to us. My explanation on Example 2:

61. We can interpret any event (A) according to rational/irrational beliefs (B). If our beliefs are irrational, we’ll suffer greatly (an undesirable C). Continuation…

62. But if our beliefs are generally rational, we’ll suffer less and rebound faster (a more desirable C). Continuation…

63. Therapeutic Goals The Therapeutic Process

64. Teach the clients how to separate the evaluation of their behaviors from the evaluation of themselves – their essence & totality - & how to accept themselves in spite of their imperfections. Therapeutic Goals

65. Minimize the client’s emotional disturbances and self-defeating behaviors by acquiring a more realistic and workable philosophy of life. Therapeutic Goals

66. Help clients differentiate between realistic and unrealistic goals and also self-defeating and self-enhancing goals. Teach the clients how to change their dysfunctional emotions and behaviors into healthy ones. Therapeutic Goals

67. 2 of the main goals of REBT: Assist the clients in the process of achieving unconditional self-acceptance (USA) and unconditional other acceptance (UOA), and to see how these are related. Therapeutic Goals

68. Therapist’s Function and Role The Therapeutic Process

69. Disputes the clients’ irrational beliefs and encourages clients to engage in activities that will counter their self-defeating beliefs and to replace their rigid “musts” with preferences. Therapist’s Function and Role

70. Demonstrate how clients are keeping their emotional disturbances active by continuing to think illogically and unrealistically. Therapist’s Function and Role

71. Helping clients modify their thinking and minimize their irrational ideas. Challenge clients to develop a rational philosophy of life so that they can avoid becoming the victim of other irrational beliefs. Therapist’s Function and Role

72. The therapist takes the mystery out of the therapeutic process, teaching clients about the cognitive hypothesis of disturbance & showing how faulty beliefs lead to negative consequences. Therapist’s Function and Role

73. Client’s Experience in Therapy The Therapeutic Process

74. Clients are able to participate effectively in the cognitive restructuring process once they begin to accept that their beliefs are the primary cause of their emotions & behaviors. Client’s Experience in Therapy

75. Clients learn how to apply logical thought, participate in experiential exercises & carry out behavioral homework as a way to bring about change. Clients can realize that life does not always work out the way they would like it to. Client’s Experience in Therapy

76. Clients are expected to work hard & carry out behavioral homework assignments so that they can learn to minimize faulty thinking which leads to emotional & behavior disturbances. Client’s Experience in Therapy

77. Homework is carefully designed & agreed upon & is aimed at getting clients to carry out positive actions that induce emotional and attitudinal change. Client’s Experience in Therapy

78. Toward the end of therapy, clients review their progress, make plans, and identify strategies for dealing with continuing or potential problems. Client’s Experience in Therapy

79. Relationship Between Therapist and Client The Therapeutic Process

80. REBT practitioners unconditionally accept all clients and also teach them to unconditionally accept others and themselves. Relationship Between Therapist and Client

81. REBT practitioners accept their clients as imperfect beings who can be helped through a variety of techniques such as teaching, bibliotherapy & behavior modification. Relationship Between Therapist and Client

82. Ellis builds rapport with his clients by showing them that he has great faith in their ability to change themselves and that he has the tools to help them do this. Relationship Between Therapist and Client

83. End of Presentation JOHN NEMAR K. FILLER

84. Report in Psychotherapy Prepared by: richard john v. francisco

85. Application: Therapeutic Techniques and Procedures Practice of Rational Emotive Behavior Therapy Application of REBT to Client Populations REBT as a Brief Therapy Application to Group Counseling

86. The Practice of REBT (Rational Emotive Behavioral Therapy) REBT use on client with distorted feeling (such irrational beliefs and negative thinking). Modalities (cognitive, behavioral and Interpersonal)

87. Cognitive Methods REBT relies on thinking, disputing, debating, challenging, interpreting, explaining and teaching. REBT encourage client to acquire a philosophy based on reality and change their way of thinking.

88. Cognitive Techniques Disputing irrational beliefs Therapists actively disputing clients irrational beliefs and teaching them to do this challenging on their own. Change irrational belief to rational.

89. 2. Doing cognitive homework Is a list or a way of tracking down the absolute beliefs and dispute these beliefs.

90. - Clients are instructed to replace negative self-statement into more positive message. - In this way clients gradually learn to deal with anxiety and challenge basic irrational thinking.

91. 3. Changing one’s language Imprecise language is one of the causes of distorted thinking process. - Avoid language patterns that reflect helplessness and self-condemnation.

92. 4. Psychological methods REBT and most other cognitive behavior therapy programs introduce clients to various educational materials.

93. Emotive Techniques REBT practitioners use pairs a variety of emotive process such as unconditional acceptance, rational emotive role playing, modeling, rational emotive imaging and shame- attacking exercise.

94. 1. Rational emotive imagery Clients imagine themselves thinking, feeling and behaving exactly the way they would like to think, feel and behave in real life.

95. -Clients imagine one of the worst things that could happen to then, how to feel unhealthy upset about the situation, how to change the experience to a healthy negative feeling.  

96. -Practicing rational emotive imaging in several weeks, we can reach the point that we no longer feel upset over negative events.

97. 2. Using humor - Emotional disturbance often result from taking oneself too seriously. Don’t take it seriously.

98. 3. Role playing Client can rehearse certain behavior to bring out what they feel in a situation.

99. 4. Shame-attacking exercises -Ellis developed exercises to help people reduce shame over behaving in certain ways. -This exercises are aimed at increasing self-acceptance and mature responsibility.

100. 5. Use of force and vigor - Force energy is a basic part of shame-attacking exercises. - It helps the client go from intellectual to emotional insights.

101. Behavioral Techniques Such as operant conditioning self-management prompts systematize, desensitization, relaxation techniques and modeling.

102. Application of REBT to client population - REBT is applicable to a wide range of setting and population, including elementary and secondary schools and;

103. - REBT has been widely applied to the treatment of anxiety, hostility, and characters disorders, psychotic disorders and depression. Also with the problems like sex, love and marriage.

104. REBT as a brief theory -Ellis originally developed REBT to try to make psychotherapy shorter and more efficient than most other systems of therapy. - A-B-C framework is 1 to 10 sessions.

105. Application to Group counseling -REBT is also suitable for group therapy because the members are taught to apply its principles to one another in the group setting.

106. -It helps group members see how their beliefs influence what they feel and what they do.

107. End of Presentation Richard john v. francisco

108. Report in Psychotherapy Prepared and Presented by: Mark Adrian D. Francisco

109. Aaron Beck’s Cognitive Therapy

110. Here we are going to discuss… Aaron Beck’s Short Life Story Introduction The Basic Principles of Cognitive Therapy The CT’s Client-Therapist Relationship Application

111. Aaron Beck’s Life Story Born on July 18, 1921 Lived his life with a variety of fears. A life-threatening illness interrupted his schooling but later on overcame it.

112. Aaron Beck’s Life Story He is a graduate from Brown University and Yale School of Medicine. At first, Beck practiced neurology but switched to psychotherapy later on.

113. Aaron Beck’s Life Story He is the father of Cognitive therapy and tried to validate Freud’s works on motivation but ended up with different findings.

114. Aaron Beck’s Life Story He joined the University of Pennsylvania in 1954 where he currently holds the position as a professor (emeritus) of psychiatry.

115. Aaron Beck’s Life Story He is also the founder of Beck institute and still continues to work on different researches and paper works regarding psychiatry.

116. Cognitive Therapy

117. Introduction Beck formulated this therapy with his observations towards depressed persons. It revealed that these individuals have a negative outlook in certain life events which contributes to their cognitive distortions.

118. Introduction Cognitive Therapy perceives psychological problems from a person’s negative thinking.

119. Introduction Three assumptions of Cognitive Therapy ( Weishaar , 1993) People’s internal communication is accessible to introspection. Clients’ beliefs have highly personal meanings.

120. Introduction (cont.)Meanings in life can be discovered by the client rather than being taught or interpreted by the therapist.

121. Introduction The goal of CT is to change the way clients think by using their automatic thoughts to reach the core of schemata and introduce schema restructuring.

122. Basic Principles of Cognitive Therapy

123. Basic Principles (Automatic Responses) Automatic Responses are personalized notions that are triggered by particular stimuli that lead to emotional responses. Beck believed that depressed people keep on having negative automatic thoughts even though it’s in contrary of the real situation.

124. Basic Principles (Automatic Responses) From his observations, he formulated the theory of depression and it states that people with emotional difficulties tend to commit characteristic logical errors that tilt objective reality in the direction of self-deprecation.

125. Basic Principles Seven Cognitive Distortions according to Beck and his colleagues: Arbitrary Inferences Selective Abstraction Overgeneralization Magnification and Minimization

126. Basic Principles Seven Cognitive Distortions according to Beck and his colleagues: Personalization Labeling and Mislabeling Dichotomous Thinking

127. Basic Principles Arbitrary Inferences refer to making conclusions without supporting relevant evidence.

128. For example, suppose a friend passes you in the school corridor but fails to say hello because he is so absorbed in his own thoughts that he doesn't notice you. Example:

129. You might have jump to the conclusion that, "He is deliberately ignoring me, he must not like me any more." You may have responded to this imagined negative reaction by withdrawal or counter-attack.

130. Basic Principles Selective Abstraction consist of forming conclusions based on an isolated event.

131.  In a math exam a student finished the paper but was sure she had missed 17 questions out of the 100. For days after the exam she couldn't stop thinking about those 17 questions and came to the conclusion that she should drop out of college. Example:

132. Basic Principles Overgeneralization holding extreme beliefs on the basis of a single incident and applying them to dissimilar events.

133. For example, the common statement - "things are always going wrong for me" is often said after one bad thing has happened. However, when you take a step back and thing about this statement you will realize that this is a huge overgeneralization. Example:

134. Basic Principles Magnification & Minimization perceiving a case or situation in a greater or lesser light than it truly deserves.

135. If you take part in a group project at school but it gets a lower grade than expected, in your head you may over exaggerate any mistake you may have made and blame yourself for the low grade. Example:

136. Basic Principles Personalization relating external events to themselves, even when there is no basis for making connection.

137. Basic Principles Labeling and mislabeling involve portraying one’s identity on the mistakes made in the past.

138. A depressed person at a party will not only remember the person who ignored them, but they will also forget or downplay the others that chatted to them for hours, saying "oh they just felt sorry for me." Example:

139. Basic Principles Dichotomous Thinking involves categorizing experiences in either-or extremes.

140. A straight-A student may believe that they are a total failure because they received a B on an exam. This all-or-nothing thinking forms the basis for perfectionism. Example:

141. It causes you to fear any imperfection or mistake because you will then see yourself as a complete loser, and you will feel inadequate and worthless, leading to anxiety.

142. Basic Principles The cognitive therapist operates on the assumption that the most direct way to change dysfunctional emotions and behaviors is to modify inaccurate and dysfunctional thinking .

143. Basic Principles In cognitive therapy, clients learn to engage in more realistic thinking, especially if they consistently notice times when they tend to get caught up in catastrophic thinking.

144. Basic Principles After they have gained insight into how their unrealistically negative thoughts are affecting them, clients are trained to test these automatic thoughts against reality by examining and weighing the evidence for and against them.

145. Basic Principles Clients form hypotheses about their behavior and eventually learn to employ specific problem-solving and coping skills. Through a process of guided discovery, clients acquire insight about their thinking and the ways they act.

146. Some Differences between Cognitive Therapy and Rational Emotive Behavioral Therapy

147. CT vs. REBT Both the CT and the REBT focuses on reality testing or it recognize the importance of realization for the client.

148. CT vs. REBT However, some differences can still be observed in its methods and techniques.

149. CT vs. REBT CT Uses a Socratic dialogue by posing open-ended questions to clients REBT Highly directive, persuasive, and confrontational; it also focuses on the teaching role of the therapist. vs

150. CT vs. REBT CT CT places more emphasis on helping clients discover and identify their misconceptions REBT The therapist models rational thinking and helps clients to identify and dispute irrational beliefs. vs

151. CTs view dysfunctional beliefs as being problematic because they interfere with normal thinking, not because they are irrational CT vs. REBT Re

152. Beck maintains that some ideas are too absolute, broad, and extreme. For him, people live by rules (premises or formulas); they get into trouble when they label, interpret, and evaluate by a set of rules that are unrealistic or when they use the rules inappropriately. CT vs. REBT Re

153. Mark adrian d. francisco End of Presentation

154. Applications of Cognitive Therapy Reported by: Paul John Buenaventura

155. Cognitive therapy initially gained recognition as an approach to treating depression, but extensive research has also been devoted to the study and treatment of anxiety disorders.(Beck & Weishaar )

156. One of the reasons of the popularity of cognitive therapy is due to “strong empirical support for its theoretical framework and to the large number of outcome studies with clinical populations”.

157. CT has been successfully used in a wide variety of other disorders and clinical areas, some of which include treating phobias, psychosomatic disorders, anger, panic disorders, and generalized anxiety disorders.

158. Applying Cognitive Techniques - Cognitive techniques focus on identifying, and examining a client’s cannot support these beliefs.

159. Examples of behavioral techniques typically used by cognitive therapist include skills training, role playing, behavioral rehearsal, and exposure therapy.

160. Treatment of Depression - Beck (1987) writes about the cognitive triad as a pattern that triggers depression.

161. In the first component of the triad, clients hold a negative view of themselves. The second component of the triad consists of the tendency to interpret experiences in a negative manner.

162. The third component of the triad pertains to depressed clients’ gloomy vision and projections about the future.

163. Depression-prone people often set rigid, perfectionist goals for themselves that are impossible to attain.

164. Beck’s therapeutic approach to treating depressed clients focuses on specific problem areas and the reasons clients give for their symptoms.

165. Some of the behavioral symptoms of depression are inactivity, withdrawal, and avoidance. Some depressed clients may harbor suicidal wishes.

166. Cognitive therapy strategies may include exposing the client’s ambivalence, generating alternatives, and reducing problems to manageable proportions.

167. A central characteristics of most depressive people is self-criticism. Underneath the person’s self-hate are attitudes of weakness, inadequacy, and lack of responsibility.

168. Depressed clients typically experience painful emotions. Another specific characteristic of depressed people is an exaggeration of external demands, problems and pressures.

169. The therapist typically has to take the lead in helping clients make a list of their responsibilities, set priorities, and develop a realistic plan of action.

170. Application to the Family Therapy The cognitive behavioral approach focuses on family interaction patterns, and family relationships cognitions, emotions, and behavior are viewed as exerting a mutual influence on one another.

171. Cognitive therapy, as set forth by Beck (1976), places a heavy emphasis on schema, or what have elsewhere been defined as core beliefs.

172. A key aspect of the therapeutic process involves restructuring distorted beliefs (or schema), which has a pivotal impact on changing dysfunctional behaviors.

173. These schemata have a major impact on how the individual thinks, feels, and behaves in the family system ( Dattilio , 2001, 2005, 2006).

174. End of Presentation Paul John Buenaventura

175. Donald Meichenbaum’s Cognitive Behavior Modification Maita Jeca V. Manota Presenter

176. How Behavior Changes?

177. Meichenbaum (1977) proposes that “behavior change occurs through a sequence of mediating processes involving the interaction of inner speech, cognitive structures, and behaviors and their resultant outcomes”.

178. He describes a three-phase process of change in which those three aspects are interwoven. According to him, focusing on only one aspect will probably prove insufficient.

179. Phase 1: Self-observation The beginning step in the change process consists of clients learning how to observe their own behavior.

180. This process involves an increased sensitivity to their thoughts, feelings, actions, physiological reactions, and ways of reacting to others.

181. Phase 2: Starting a new internal dialogue As a result of the early client–therapist contacts, clients learn to notice their maladaptive behaviors, and they begin to see opportunities for adaptive behavioral alternatives.

182. Phase 3: Learning new skills Consists of teaching clients more effective coping skills, which are practiced in real-life situations.

183. Coping Skills Program

184. The rationale for coping skills programs is that we can acquire more effective strategies in dealing with stressful situations by learning how to modify our cognitive “set,” or our core beliefs.

185. Coping skills procedures: Exposing clients to anxiety-provoking situations by means of role playing and imagery Requiring clients to evaluate their anxiety level

186. Teaching clients to become aware of the anxiety-provoking cognition they experience in stressful situations Helping clients examine these thoughts by reevaluating their self-statements Having clients note the level of anxiety following this reevaluation

187. A particular application of a coping skills program is teaching clients stress management techniques by way of a strategy known as stress inoculation.

188. Three-stage model for stress inoculation training: the conceptual-educational phase the skills acquisition, consolidation, and rehearsal phase, the application and follow-through phase.

189. Conceptual- Educational Phase

190. The primary focus is on creating a working relationship with clients. This is mainly done by helping them gain a better understanding of the nature of stress and conceptualizing it in social interactive terms.

191. Skills Acquisition, Consolidation, and Rehearsal Phase

192. The focus is on giving clients a variety of behavioral and cognitive coping techniques to apply to stressful situations. Clients are taught that adaptive and maladaptive behaviors are linked to their inner dialogue.

193. Application and Follow-through Phase

194. The focus is on carefully arranging for transfer and maintenance of change from the therapeutic situation to everyday life. It is clear that teaching coping skills is a complex procedure that relies on varied treatment programs.

195. The Constructivist Approach to Cognitive Behavior Therapy

196. Focuses on the stories people tell about themselves and others regarding significant events in their lives. This approach begins with the assumption that there are multiple realities.

197. The constructivist approach gives more emphasis to past development, tends to target deeper core beliefs, and explores the behavioral impact and emotional toll a client pays for clinging to certain root metaphors.

198. Maita Jeca V. Manota

199. Cognitive Behavioral Therapy From a Multicultural Perspective PREPARED BY DARRYL S. BUENO

200. Strengths From a Diversity Perspective There are several strengths of cognitive behavioral perspective. If the therapist understands the core values of their culturally diverse clients then client & therapist can work together to modify selected beliefs & practices.

201. Cognitive behavior therapy tends to be culturally sensitive because it uses the individual belief system, or worldview, as part of the method of self-challenge.

202. Ellis (2001b) believes that an essential part of people’s lives is group living and their happiness depends largely on the quality of their functioning within their community.

203. REBT stresses the relationship of individuals to the family, community & other systems. According to Spiegler (2008), because of its basic nature & the way CBT is practiced, it is inherently suited to treating diverse clients.

204. Factors that Spiegler identifies that makes CBT diversity effective include: Individualized treatment, focusing on the external environment, active nature, emphasis on learning, reliance on empirical evidence, focus on present behavior, and brevity.

205. Shortcomings From a Diversity Perspective Exploring values and core beliefs plays an important role in all of the cognitive behavioral approaches, and it is crucial for therapists to have some struggles.

206. Wolfe (2007) suggest that the therapist's job is to help clients examine and challenge long-standing cultural assumptions only if they result in dysfunctional emotions or behaviors.

207. Datillio (1995) notes that some Mediterranean and middle eastern cultures have strict rules with regard to religion, marriage and family, and child-rearing practices .

208. Cognitive Behavior Therapy Applied to Case of Stan From a cognitive behavioral perspective the therapist is interested in Stan challenging and modifying his self-defeating beliefs, which will likely result in acquiring more effective behavior.

209. Stan’s therapist follows a clear structure for every session. The basic procedural sequence includes: 1. Preparing him by providing a cognitive rationale for treatment and demystifying treatment;

210. 2. Encouraging him to monitor the thoughts that accompany his distress; 3. Implementing behavioral & cognitive techniques; 4. Assist him in identifying & challenging some basic beliefs & ideas;

211. 5.teaching him ways to examine his beliefs and assumptions by testing them in reality; and 6. teaching him basic coping skills that will enable him to avoid relapsing into patterns.

212. In working with Stan’s fears, the therapist proceeds with four steps: Educating him about his self-talk; having him monitor and evaluate his faulty beliefs; using cognitive and behavioral interventions; and

213. collaboratively designing homework with Stan that will give him opportunities to practice new behaviors in daily life.

214. Summary and Evaluation REBT has evolved into a comprehensive and integrative approach that emphasizes thinking, judging, deciding, and doing.

215. This approach is based on the premise of the interconnectedness of thinking, feeling, and behaving. Therapy begins with clients’ problematic behaviors & emotions & disputes the negative thoughts.

216. To block the self-defeating beliefs that are reinforced by a process of self-indoctrination, REBT therapist employ active and directive techniques

217. Such as teaching, suggestion, persuasion, and home-work assignments, and they challenge clients to substitute a rational belief system for an irrational one.

218. REBT therapist are typically eclectic in selecting therapeutic strategies. Cognitive therapist also practice from an integrative stance, using many methods to assist clients in modifying their self-talk.

219. The working alliance is given special importance in cognitive therapy as a way of forming a collaborative partnership. Although the client-therapist relationship is viewed as necessary.

220. Cognitive behavioral approaches stress the importance of cognitive process as determinants of behavior. It is assumed that what people feel and do is largely influenced by their subjective assessment of situations.

221. This appraisal of life situation is influenced by beliefs. Attitudes, assumptions, and internal dialogue, such as cognitions become the major focus of therapy.

222. Contributions of Cognitive Behavioral Approaches The cognitive behavioral approaches focus on undermining faulty assumptions and beliefs and teaching clients the coping skills needed to deal with their problems.

223. ELLIS’S REBT has built on the Adlerian notion that events themselves do not have the power to determine us; rather, it is our interpretations of these events that is crucial.

224. The A-B-C framework simply and clearly illustrates how human disturbances occur and the ways in which problematic behavior can be changed .

225. Rather than focusing on the events themselves, therapy stresses how client interpret and react to what happens to them and the necessity of actively disputing a range of faulty beliefs.

226. Another contribution of the cognitive behavioral approaches is the emphasis on putting newly acquired insights into action. Homework are well suited to enable clients practice new behaviors for reconditioning.

227. It is important that homework be a natural outgrowth of what is taking place in the therapy session. Clients are more likely to carry out their homework if the assignments are collaboratively created.

228. REBT focuses on teaching clients ways to carry on their own therapy without the direct intervention of a therapy. A major contribution of REBT is its emphasis on a comprehensive and integrative therapeutic practice.

229. Numerous cognitive, emotive, and behavioral techniques can be employed in changing one’s emotions and behaviors by changing the structure of one’s cognitions.

230. BECK’S COGNITIVE THERAPHY – Beck’s key concepts share similarities with REBT, but differ in underlying philosophy and the process by which therapy proceeds.

231. Beck developed specific cognitive procedures that are useful in challenging a depressive clients assumption & beliefs and in providing a new cognitive personality that lead to optimism and changed behavior.

232. One of Beck’s major theoretical contribution has been bringing private experience back into the realm of legitimate scientific inquiry ( Weishaar , 1993).

233. According to Leahy (2002), “over the past 20 years, the cognitive model has gained wide appeal and appears to be influencing the development of the field more than any other.

234. Leahy identifies several reasons this approach has found such wide appeal: It works It is an effective, focused, and practical treatment for specific problems.

235. It is not mysterious or complicated which facilitates of knowledge from therapist to client. It is cost-effective form of treatment.

236. A major contribution made by Ellis, Beck, and Meichenbaum is the demystification of the therapy process. The cognitive behavioral approaches are base on an educational model that stresses a working alliance between therapist and client.

237. The models encourage self-help, provide for continues feedback from the client on how well treatment strategies are working, and provide a structure and the direction to the therapy process that allows for evaluation of outcome.

238. Limitations and Criticisms of the Cognitive behavioral approaches A potential limitation of any of the cognitive behavioral approaches is the therapist’s level of training, knowledge, skills, and perceptiveness.

239. ELLIS REBT - Another potential limitation involves the misuse of the therapist’s power by composing ideas of what constitutes rational thinking.

240. As Ellis practices it, REBT is a forceful and confrontational therapy. Some clients will have trouble with a confrontational style, especially if a strong therapeutic alliance has not been established.

241. Indeed, a therapist can be soft-spoken and gentle and still use REBT concepts and methods.

242. Ann Vernon (2007) encourages practitioners to recognize that they can adhere to the basic principles of REBT, which have been effectively used with both adults and children, without emulating Ellis’s style.

243. Beck’s Cognitive Therapy CT has been criticized for focusing too much on the power of positive thinking; being too superficial and simplistic; denying the importance of the client’s past; being too technique-oriented; failing to use the T. Relationship.

244. Working only on eliminating symptoms, but failing to explore the underlying causes of difficulties; ignoring the role of unconscious factors; and neglecting the role of feelings (Freeman & Dattilio , 1992; Weishaar , 1993).

245. Weishaar (1993) concisely addresses a number of criticism leveled at the approach.

246. Although the cognitive therapist is straightforward and looks for than complex simple solutions, this does not simply that the practice of cognitive therapy is simple.

247. One of my criticisms of cognitive therapy, like REBT , is that emotions tend to be played down in treatment.

248. Meichenbaum’s Cognitive Behavior Modification Is directly teaching the client the most effective approach? Is the client’s failure to think rationally or logically always due to a lack of understanding of reasoning or problem solving?

249. Although we don’t have definitive answers to those questions yet, we cannot assume that learning occurs only by teaching. It is a mistake to conclude that therapy is mainly a cognitive process

250. END OF PRESENTATION Darryl S. Bueno