cognitive behavioral therapy and rational emotive behavioral therapy notes

lecture notes

1. COGNITIVE BEHAVIOR THERAPY RATIONAL EMOTIVE BEHAVIORAL THERAPY

2. INTRODUCTION The term "cognitive-behavioral therapy (CBT)" is a very general term for a classification of therapies with similarities.  There are several approaches to cognitive-behavioral therapy. Among the more prominent are Rational Emotive Behavior Therapy, Cognitive Therapy, and Cognitive Behavior Modification, etc.

3. KEY FIGURES Albert Ellis (1913-2007): Rational Emotive Behavior Therapy Aaron Beck (Born 1921): Cognitive Therapy Donald Meichenbaum : Cognitive Behavior Modification These three therapies assume that distressing emotions are the results of maladaptive thoughts.

4. Rational Emotive Behavior Therapy Albert Ellis (1913-2007)

5. The purpose of this therapy is to expose and discourage clients irrational and illogical thoughts that cause maladaptive behavior. They believe that people are rational beings and that any irrational thoughts are illogical and need to be corrected. Internal dialogue of the clients play a major role in their behavior.

6.   Specific Objectives By the end of this unit the learners should be able to: Explain the background of Albert Ellis Discuss the key concepts of Rational Emotive Behavior Therapy Describe the acquisition and perpetuation of psychological disturbance Describe therapeutic process of Rational Emotive Behavior Therapy Discuss contributions and limitations of Rational Emotive Behavior Therapy  

7. RATIONAL EMOTIVE BEHAVIORAL THERAPY Rational Behavioral Emotive Therapy The basic assumption of REBT is that people contribute to their own psychological problems by the way they interpret events and situations. REBT holds that events, emotions and behaviors interact significantly and have a reciprocal cause-and-effect relationship.

8. REBT was developed by Albert Ellis who was born in 1913 in Pittsburgh but escaped in New York at age 4. As a child he was hospitalized nine times mainly with nephritis (inflammation of the kidneys) and developed renal glycosuria (excretion of glucose into the urine. Ordinarily, urine contains no glucose because the kidneys are able to reclaim all of the filtered )at the age of 19 and diabetes at age 40.

9. By rigorously taking care of his health and stubbornly refusing to make himself miserable about it, he lived an unusually robust and energetic life, until his death at age 93. He trained as a psychoanalyst and as he practiced psychoanalysis he came to a conclusion that it was relatively superficial and unscientific form of treatment. Early 1955 he combined humanistic, philosophical and behavioral therapy to form (REBT).

10. Ellis is rightly known as the grandfather of cognitive behavior therapy. To some extent Ellis developed his approach as a method of dealing with his own problems during his youth. He had exaggerated fears of speaking in public. During his adolescence he was extremely shy around young women.

11. At age 19 he forced himself to talk to 100 women over a period of one month. Although he never managed to get a date from these brief encounters, he does report that he desensitized himself from rejection by women. By applying cognitive behavioral methods, he managed to conquer some of his strongest emotional blocks. 

12. REBT’s basic hypothesis is that our emotions stem mainly from our beliefs, evaluations, interpretations, and reactions to life situations Through the therapeutic process, clients learn skills that give them the tools to identify and dispute irrational beliefs that have been acquired and self-constructed and are now maintained by self-indoctrination. 

13. BASIC ASSUMPTION People contribute to their own psychological problems, as well as to specific symptoms, by the way they interpret events and situations. Therefore, reorganization of a one’s statements result in a corresponding reorganization of a one’s behavior .

14. Key Concepts   View of Human Nature 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. They also have propensities (inclination) for self-destruction, avoidance of thought, procrastination, readiness repetition of mistakes, suspicion, intolerance, perfectionism, self-blame, and avoidance of actualizing (reality) growth potentials.

15. Ellis assumes that we are self-talking, self-evaluating, and self-sustaining. We develop emotional and behavioral difficulties when we mistake simple preferences (strong liking) like desires for love, approval, success- for dire needs. Ellis argues that we have an inborn tendency towards growth and actualization, yet we often sabotage our movements towards growth due to self-defeating patterns we have learned.  

16. View of Emotional Disturbance REBT is based on the assumption that although we learn originally learn irrational beliefs from significant others during childhood, we create irrational dogmas by ourselves. We actively reinforce self-defeating beliefs by a process of autosuggestion (self-suggestion) and self-repetition and by behaving as if they are useful. It is largely our own repetition that keeps dysfunctional attitudes alive and operative within us.

17. Ellis contends that people do not need to be accepted and loved- (rejection), even though this may be highly desirable. REBT encourages people to feel undepressed even when they are unaccepted and unloved by significant others. It attempts to help them find ways of overcoming unhealthy feelings of depression, anxiety, hurt, loss of self-worth, hatred, among others.  

18. Ellis insists that blame is at the core of most emotional disturbance thus it is important to learn to accept ourselves despite our imperfections. We have strong tendencies to escalate our desires and preferences into dogmatic “ shoulds ” “musts” and “ oughts ” demands and commands. Such demands create disruptive feelings and dysfunctional behaviors. When we are upset, it is a good idea to look to our hidden dogmatic ‘musts’ and absolutist ‘ shoulds ’.

19. Group work Examples Basic musts (or irrational beliefs) 1 2 3 4 5 6

20. EXAMPLES Basic musts (or irrational beliefs): “I must do well and win the approval of others for my performances otherwise I am no good”. “Other people must treat me considerably, fairly, kindly, and in the way I want to be treated. If they don’t, they deserve to be condemned and punished”. “I must get what I want ,when I want it; and I must not get what I want. If I don’t get what I want, its terrible, and I cant stand it”.

21. People have a tendency to make and keep themselves emotionally disturbed by internalizing self-defeating beliefs such as these. It is therefore a challenge to maintain good psychological health.

22. A-B-C Theory of Personality   The A-B-C theory of personality is central to ( REBT) theory and practice A (activating event) B (belief) C (emotional and behavioral consequence) D (disputing intervention) E (effect) F (new feeling) This model provides a useful tool for understanding the relation between event, thoughts and behavior.

23. A- activating event B- believe C- consequences D- disputing (irrational believes) E- effect (a new effective belief system) F- new feeling

24. Ellis states that A (the activating event) does not cause the emotional consequence. Instead B which is the person’s belief about A largely causes C (the emotional reaction). After A, B, C, comes D (disputing). Essentially, D is the application methods to help the client challenge the irrational thoughts. These include: Detecting the irrational beliefs particularly absolutist “ shoulds ”, “musts”, and “ oughts ” .

25. Debating their dysfunctional beliefs by learning how to logically question them and vigorously argue themselves out and act against believing them; and finally they learn to discriminate irrational from rational beliefs. Eventually they arrive at E, an effective rational way of looking at things. Restructuring involves helping clients learn to monitor their self-talk, identify maladaptive self-talk, and substitute adaptive self-talk for their negative self-talk.

26. We can choose to examine, challenge, modify, and uproot B-the irrational beliefs we hold about the activating events at A. This consists of replacing inappropriate thoughts with appropriate ones. If we are successful in doing this we create F or a new set of feelings. That is, instead of feeling anxious and depressed, we feel healthily sorry and disappointed in accord with a situation.

27. The therapeutic process Goals of Therapy Most cognitive behavior therapists have the general goals that include: to teach clients how to separate the evaluation of their behaviors from the evaluation of themselves- and accept themselves instead of their imperfections; to minimize their emotional disturbance and self-defeating behaviors by acquiring a more realistic and workable philosophy of life;

28. to teach them how to change their dysfunctional emotions and behaviors into healthy ones; and to assist clients in the process of achieving unconditional self-acceptance.

29. Therapist’s Function and Role Step 1: The therapist has specific tasks that include: to show the clients that they have in cooperated many irrational “ shoulds ,” “ oughts ,” “musts.” Step 2: to demonstrate that clients are keeping their emotional disturbance active by continuing to think illogically and unrealistically ( reindoctrinating themselves);

30. Step 3: to assist clients in understanding the vicious circle of self-blaming process by confronting client with the beliefs they originally accepted unquestioningly and continue to indoctrinate themselves Step 4:challenge clients develop a rational philosophy of life so that in the future they can avoid becoming victims of irrational beliefs.

31. Techniques and procedures A. Cognitive Methods These include: 1. Disputing Irrational Belief Clients go over a particular “must,” “should,” or “ought’ until they no longer hold that irrational belief or at least it is diminished in strength Examples: “If life doesn’t go the way I would like it to, it isn't awful, just inconvenient”. “If I don’t get the job I want, it may be disappointing, but I can certainly stand it”

32. 2 . Doing Cognitive Homework Clients are expected to make lists of their problems, look for the absolutist beliefs, and dispute these beliefs. Homework assignments are a away of tracking down the absolutistic “should” and “musts” that are part of their internalized self-messages. Example: Someone afraid to act may be asked to take a small part in a stage play and replace negative self-statements such as “I will fail”, with more positive messages such as “I can act”.

33. 3 . Changing one’s Language REBT contends that imprecise language is one of the causes of distorted thinking process. Clients learn that “musts,” “ shoulds ,” and “ oughts ” can be replaced by preferences e.g. instead of saying “It must be absolutely awful if….” They learn to say “it would be inconvenient if…” Clients who use language patterns that reflect helplessness and self-condemnation can learn to employ new self-statements, which help them think and behave differently. As a consequence, they also begin to feel different.

34. 3 . Psychoeducational methods CBT programs introduce clients to various educational materials about the nature of their problems and how treatment is likely to proceed. 4. Using Humor REBT contends that emotional disturbances often result from taking oneself too seriously and losing one sense of perceptive and humor over the events of life. Humor has both cognitive and emotional benefits in bringing about change.

35. Humor shows the absurdity of certain ideas that clients steadfastly maintain, and it can be of value in helping clients take themselves less seriously. Clients are encouraged to sing humor songs to themselves or in groups when they feel depressed or anxious.

36. B. Emotive Methods 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. They can also be shown how to imagine one of the worst things that could happen to them, how to feel unhealthily upset about this situation, how to intensely experience their feelings, and then how to change the experience to a healthy negative feeling .

37. As clients change their feelings about adversities, they change their behavior in the situation. NOTE: If we keep practicing rational emotive imagery several times a week for a few weeks, we can reach the point we no longer feel upset over negative events.  

38. 2. Role Playing Role playing has emotive, cognitive and behavioral components. Clients are shown what they are telling themselves to create their disturbances and what they can do to change their unhealthy feelings to healthy ones. Clients can rehearse certain behaviors to bring out what they feel in a situation Example: fear of being accepted e.g for an admission may make one feel stupid. The client can role play an interview to find out the beliefs leading to the fears and challenge them.

39. 3. Shame Attacking Exercise This involves both emotive and behavioral components. Clients work to feel unashamed even when others disapprove of them. The exercises are aimed at increasing self-acceptance and mature responsibilities as well as helping clients see that much of what they think of being shameful has to do with the way they define reality for themselves .

40. Clients may accept a homework assignment to take the risk of doing something that they are ordinarily afraid to do because of what others might think. They continue practicing these exercises until they realize the feelings of shame are self-created and until they are able to behave in less inhibited ways.  

41. 4. Use of Force and Vigor Clients are also shown how to conduct forceful dialogue with themselves in which they express their unsubstantiated beliefs and then powerfully dispute them. Sometimes therapists engage in reverse role-playing by strongly clinging to the client’s self-defeating philosophy. Then the client vigorously debate with the therapist in an attempt to persuade him or her to give up these dysfunctional ideals.

42.   C . Behavioral Techniques REBT practitioners use most of the standard behavioral procedures, especially operant conditioning, self-management principles, systematic desensitization, relaxation techniques, modeling, and homework assignments. NB: therapists typically use a combination of cognitive, emotive, and behavioral methods within a single session with a given client.

43. REBT contribution to Multicultural Counseling Ellis describes REBT as multicultural in its principles and practices because it does not question the goals and values of clients but only challenges their rigid inflexible demands and their absolutist “ shoulds ” “ oughts ” and “musts.” He explains that it is not the strict rules of the original culture that makes people disturbed but their view of these rules.

44. When clients surrender their absolutist beliefs about following rules, they are in a position to decide whether to follow the rules, give them up, or make some kind of compromise with them. Clients decide which values to adopt. The therapist’s role is to help the clients become more flexible in their thinking, feeling, and behaving.

45. Ellis 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. Thus, individuals can make a mistake of being too self-centered and self-indulgent. REBT stresses the relationship of individuals to the family, community, and other systems. This orientation is consistent with valuing diversity and the interdependence of being an individual and a productive member of the community.

46. Limitation for Multicultural Counseling Exploring values and core beliefs plays is essential in all CBT approaches, and it is crucial for a counselor to understand cultural background of clients and to be sensitive to their struggles. Counselor’s job is to help clients examine and challenge long-standing cultural assumptions only if they result in dysfunctional emotions or behaviors. The client is assisted to think about “potential conflicts with the values of the dominant culture to work toward achieving their own personal goals within their own sociocultural context ”.

47. REBT views dependency negatively, while many cultures view interdependence as necessary to good mental health. REBT aims at inducing people to examine and change some of their most basic values. Therefore, clients with long-cherished cultural values pertaining to interdependence are not likely to respond favorably to forceful methods of persuasion toward independence. Modifications in a therapist’s style need to be made depending on the client’s culture .

48. Summary REBT has evolved into a comprehensive and integrative approach that emphasizes thinking, judging, deciding and doing. Therapy begins with clients’ problematic behaviors and emotions and disputes the thoughts that directly create them. To block the self-defeating beliefs that are reinforced by a process of self-indoctrination, REBT therapists employ active and directive techniques such as teaching, suggestions, persuasions, and homework assignments, and they challenge clients to substitute a rational belief system for an irrational one.

49. Therapists demonstrate how and why dysfunctional beliefs lead to negative emotional and behavioral results. Change comes about mainly by a commitment to consistently practice new behaviors that replace old and ineffective ones. It assumed that assumed that how people feel and what they actually do is largely influenced by their subjective assessment of situations and the interpretation of these events.

50.   Contributions Confrontation of clients empowers them such that the client is not dependent on the therapist. This helps the clients change the way they reason. The A-B-C framework that illustrates how human disturbances occur and the ways in which problematic behavior can be changed. Focusing on disputing faulty believes brought about by the interpretation and reaction to events. Another contribution is emphasis on putting newly acquired insights into actions.

51. Focuses on teaching clients ways to carry on their own therapy without the direct intervention of a counselor especially in psychoeducational approaches such as listening to tapes, reading self-help books, keeping of what they are doing and thinking. This helps to reduce dependency. Emphasis on comprehensive and eclectic practice. Numerous cognitive, emotive, and behavioral techniques can be employed in changing one’s emotions and behaviors by changing the structure of one’s cognitions.

52. EMPATHY Validating the client's experience STRONG THERAPEUTIC RELATIONSHIP GENUINENESSS Being Authentic POSITIVE REGARD Respect

53. Limitations It ignores the past, deals with the problem in the here and now. Misuse of the counselor’s power by imposing ideas of what constitutes rational thinking. Client may feel pressured to adopt goals and values that the counselor sells to them. Due to the directive nature of REBT and power of persuasion, psychological harm is more possible in this approach than others. REBT is a forceful and confrontational therapy. Some clients will have trouble with a confrontational style, in the absence of strong therapeutic alliance.

54. Questions for reflection Do you believe that it is desirable for one to “think” one’s way through “irrational” aspects of life such as joy, ecstasy, craziness, sadness, despair, abandonment and loneliness, rage, fear, and hatred? What would life be like if one were almost exclusively rational? Ellis maintains that blaming ourselves or others is pernicious (exceedingly harmful). Do you agree? Is it desirable to remove all guilt, does this mean that one is and accomplished psychopath? What kind of guilty is healthy? What kind is unhealthy? Can you apply to yourself the view that one tends to keep irrational ideas alive by repeating those ideas to oneself? What are some examples in your own life? Working with clients very forcefully and in a confrontational manner can raise some ethical issues, especially if you attempt to impose your values by suggesting what they should value. As you review Ellis work, do you have any concerns that Ellis is pushing values?

55. References Colledge , R. (2002). Mastering Counseling theory. New York: Palgrave macmillan . Corey, G. (2005). Theory and practice of counseling and psychotherapy ( 7 th ed.). Pacific Grove: Brooks/Cole Corey, G. (1996). Theory and practice of counseling and psychotherapy (4 th ed.). Pacific Grove: Brooks /Cole McLeod, J. (2003). An Introduction to Conselling (3 rd ed.) Great Britain: Bell & Bain Ltd.: Glasgrow