Cognitive Behavioral Therapy

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A presentation concerning CBT used during EFL classes and pscyhology club classes.

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Cognitive Behavioral Therapy

  1. 1. Cognitive Behavioral Therapy A Brief Introduction
  2. 2. Cognition Re-enters <ul><li>Behaviorism focused on observable behavior (J.B. Watson, B.F. Skinner) </li></ul><ul><li>Albert Bandura re-opened the door to cognitions with modeling </li></ul><ul><li>The Cognitive Revolution </li></ul>
  3. 3. Cognitive Therapy <ul><li>Rational Emotive therapy (Albert Ellis) </li></ul><ul><li>Cognitive therapy (Aaron Beck) </li></ul>
  4. 4. Albert Ellis
  5. 5. A. Beck
  6. 6. Rational Emotive Therapy: Ellis <ul><li>A-B-C theory of dysfunctional behavior </li></ul>
  7. 7. Example Rationale Thinking <ul><li>A= fail a midterm examination </li></ul><ul><li>B=It’s unfortunate that I failed-I did not study hard enough and I must make sure that I study harder for the final </li></ul><ul><li>C=no consequences (emotional disturbance sequelae </li></ul>
  8. 8. Example Irrational Thinking: leads to Emotional Disturbance <ul><li>A= Fail exam </li></ul><ul><li>B= I’m stupid, I’ll never be able to pass this course and I will fail this course </li></ul><ul><li>C=depression </li></ul>
  9. 9. Ellis’ List of Common Irrational Ideas <ul><li>I absolutely must have sincere love and approval almost all the time from all the significant people in my life </li></ul><ul><li>I must be thoroughly competent, adequate and achieving in all respects, or I must at least have real competence or talent at something important; otherwise I am worthless. </li></ul><ul><li>People who harm me or who do a bad thing are uniformly bad or wicked individuals, and I should severely blame, damn, and punish them for their sins and misdeeds </li></ul>
  10. 10. Ellis’ List of Common Irrational Ideas (continued) <ul><li>When things do not go the way I would like them to go, life is awful, terrible, horrible, or catastrophic </li></ul><ul><li>Unhappiness is caused by external events </li></ul><ul><li>over which I have almost no control. I also have little ability to control my feelings or rid myself of feelings of depression and hostility. </li></ul>
  11. 11. Rational Emotive Therapy <ul><li>Identify patient’s irrational beliefs </li></ul><ul><li>Add “D” and “E” to A-B-C theory </li></ul><ul><li>Teach the patient to dispute the beliefs and substitute logical and rational beliefs </li></ul><ul><li>Evaluate the effects of disputing their irrational beliefs </li></ul>
  12. 12. <ul><li>SOCRATIC QUESTIONING </li></ul><ul><li>Therapist: John, I see that on the Beliefs About Change Inventory under “Defeatist Beliefs,” you </li></ul><ul><li>placed a checkmark next to the statement, “My partner is incapable of change.” </li></ul><ul><li>What immediate thoughts come to your mind when you say that statement? </li></ul><ul><li>Spouse: Well, you see, it was a mutual decision for both of us to come here for counseling; </li></ul><ul><li>however, I really do not believe that my wife is capable of changing her ways, even </li></ul><ul><li>though she may act motivated to do so when in your presence of the presence of others. </li></ul><ul><li>Therapist: Then your thought is that while she appears motivated, there is little likelihood that she </li></ul><ul><li>will change. </li></ul>
  13. 13. Spouse: Yes, it’s almost a waste of time. Therapist: Any other thoughts or beliefs about it? Spouse: Yes, I also think that I will be placed in a position of expending a lot of energy toward making the marriage work, and then the joke will be on me when we still end up in divorce. So, I view it to some degree as a trap. Therapist: So, you believe that going ahead in marital therapy will only result in making a fool of you. Spouse: Yes, I do and, therefore, I am reluctant to believe my wife when she says that she wants to try.
  14. 14. Therapist: What is your belief about change in general? Spouse: Well, basically, if you want to know the truth, I truly feel that people basically remain the way they are and are impervious to change, even though they might state that they wish to change. I believe in the old adage, “ A leopard never changes its spots .” Therapist: I see. Then your underlying belief is that change is futile. Therefore, nothing can improve your relationship.
  15. 15. Beck’s Cognitive Therapy <ul><li>Early observation of negative content of depressed people’s dreams </li></ul>
  16. 16. Beck’s Theory <ul><li>Depressed people have a negative view of: </li></ul><ul><li>Themselves </li></ul><ul><li>The world </li></ul><ul><li>The future </li></ul><ul><li>Depressed people have negative schemas or frames of reference through which they interpret all events and experiences </li></ul>
  17. 17. Depression and Negative Schemas <ul><li>Negative schemas: </li></ul><ul><li>Always present </li></ul><ul><li>Unconscious </li></ul><ul><li>Become activated with stressful events </li></ul>
  18. 18. Example <ul><li>Person with negative schema involving rejection will become depressed when a partner leaves him or her </li></ul>
  19. 19. Beck’s Cognitive Therapy: First Sessions <ul><li>Identify and changing maladaptive thoughts </li></ul><ul><li>First sessions: therapist explains cognitive theory of emotional disorders (negative cognitions contribute to distress) </li></ul><ul><li>Middle Sessions: Client is taught to identify, evaluate and replace negative automatic thoughts were more positive cognitions </li></ul><ul><li>Therapist is a collaborator (fellow scientists in therapy) </li></ul><ul><li>Final Sessions: solidify gains, focus on prevention of recurrence </li></ul>
  20. 20. Therapist as Collaborator <ul><li>Therapist and client work together to test the logic and consistency of each negative thought. </li></ul>
  21. 21. Behavioral Component <ul><li>Behavioral coping strategies (problem solving skills and assertiveness training) </li></ul>
  22. 22. Solidifying Gains and Prevention <ul><li>Solidify gains: broaden range of identified negative thoughts and strengthen more positive cognitions </li></ul><ul><li>Anticipate future stressful life events that might trigger a future depression and role play more adaptive responses </li></ul>
  23. 23. Cognitive Behavioral Therapy: Efficacy/Effectiveness (old question) <ul><li>Identified as a well established treatment for the treatment of unipolar depression </li></ul><ul><li>As effective (and sometimes more effective than) alternate forms of treatment for depression including antidepressant medication </li></ul><ul><li>However (despite focus on prevention of relapse) 2/3 of patients who receive cognitive therapy have another episode of depression within two years </li></ul>
  24. 24. CBT Effective for which type of patients (new question) <ul><li>Outcome not predicted by level of intelligence </li></ul><ul><li>Patient with lower levels of dysfunctional thinking benefit the most (paradoxically) </li></ul><ul><li>Interpersonally avoidant patients do better in CBT (rather than interpersonal psychotherapy) </li></ul><ul><li>Patients with more obsessional styles do better in Interpersonal Psychotherapy </li></ul>
  25. 25. CBT: Effective for Which Disorders? <ul><li>Empirically supported treatment for </li></ul><ul><li>Depression </li></ul><ul><li>Generalized anxiety disorder </li></ul><ul><li>Obsessive compulsive disorder </li></ul><ul><li>Panic disorder </li></ul>
  26. 26. Clips to see… <ul><li>http://www.youtube.com/watch?v=LIzm4jiyvXI&feature=related </li></ul><ul><li>http://www.youtube.com/watch?v=MCyfMFXR-n0&feature=related </li></ul><ul><li>http://www.youtube.com/watch?v=DMmf8BIwpdQ </li></ul>

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