An overview of cognitive behavioural therapy. Techniques. Goals of CBT.

1. COGNITIVE
BEHAVIORAL
THERAPY
Dr.V.Veera Balaji Kumar PhD
Psychologist

2. “Big” Names associated with Cognitive
Behavioral Therapy
1. Epictetus, Greek philosopher. Observed
that people are not disturbed by things that
happen but by the view they take of things
that happen.
2. Albert Ellis, Ph.D. “grandfather of cognitive
behavioral therapy.”
3. Aaron Beck, MD, a psychiatrist (University
of Pennsylvania)

3. Characteristics of
Cognitive-Behavioral Therapies:
1. Thoughts cause Feelings and Behaviors.
2. Brief and Time-Limited.
Average # of sessions = 16 Vs
psychoanalysis = several years
3. Emphasis placed on current behavior.

4. 4. CBT is a collaborative effort between the
therapist and the client.
Client role - define goals, express
concerns, learn & implement learning
Therapist role - help client define goals,
listen, teach, encourage.
5. Teaches the benefit of remaining calm or
at least neutral when faced with difficult
situations. (If you are upset by your
problems, you now have 2 problems:
1) the problem, and 2) your ‘upsetness’.

5. 6. Based on "rational thought." - Fact not
assumptions.
7. CBT is structured and directive. Based on
notion that maladaptive behaviors are the
result of skill deficits.
8. Based on assumption that most emotional
and behavioral reactions are learned.
Therefore, the goal of therapy is to help clients
unlearn their unwanted reactions and to learn
a new way of reacting.
9. Homework is a central feature of CBT.

6. THE COGNITIVE MODEL OF DEVELOPMENT
• As individuals develop, they think about their
world (World-view) and themselves in
different ways.
• Their beliefs and assumptions about people,
events, and themselves are cognitive schemas.
• Individuals have automatic thoughts that are
derived from these beliefs that they are not
aware of.
• How individuals shift from adaptive beliefs to
distorted beliefs is referred to as cognitive
shifts in Beck’s system.

7. COGNITIVE THEORY OF PERSONALITY
• Beck believes that psychological disorders are
caused by a combination of biological,
environmental, and social factors.
• Rarely is one of these a cause for a disorder.
• In understanding a disturbance, Beck includes the
impact of early childhood experiences on the
development of cognitive schemas and automatic
thoughts.
• Beliefs and schemas are subject to cognitive
distortions, a key concept in cognitive therapy.

8. Situation/
Event
Cognitive Processing
Response:
Behavioral
Emotional
Cognitive

9. Schemas or cognitive schemas:
• Ways of thinking that comprise a set of core
beliefs and assumptions about how the world
operates.

10. Automatic thoughts:
• Notions or ideas that occur without effort or
choice, that can be distorted, and lead to
emotional responses. Automatic thoughts
provide data about core beliefs.

11. COGNITIVE DISTORTIONS
• Automatic thoughts are subject to cognitive
distortions. Cognitive therapists have identified a
variety of cognitive distortions that can be found in
different psychological disorders.
• Cognitive distortions: Definition: Systematic errors
in reasoning, often stemming form early childhood
errors in reasoning; an indication of inaccurate or
ineffective information processing.

13. Personalization:
• A cognitive distortion in which an individual
takes an event and relates it to himself or
herself even when there is no relationship.
• An example would be, A mother whose child
is struggling in school blames herself for being
a ‘bad mother’, because she believes that her
deficient parenting is responsible for her
child's issues.
• In fact, the real cause may be something else
entirely..

14. Selective abstraction:
• Selecting one idea or fact from an event while
ignoring other facts in order to support
negative thinking.

15. Magnification:
• A cognitive distortion in which an
imperfection is exaggerated into something
greater than it is.

16. Minimization:
• Making a positive event much less important
than it really is.

17. Overgeneralization:
• An example of distorted thinking that occurs
when individuals draw a very broad conclusion
from a single incident or a single piece of
evidence.
• Even if something bad happens only once, it is
expected to happen over and over again
• A woman is lonely and often spends most of her
time at home. Her friends sometimes invite her to
dinner. She was ignored during a party few
months back. She says, “No one really likes me”

18. All-or-nothing thinking (Splitting)
• Engaging in black-or-white thinking.
Thinking in extremes, such as all good or all
bad, with nothing in the middle.
• Example: When an admired person makes a
minor mistake, she or he renders the admiration
as contempt
• Even small imperfections seem incredibly
dangerous and painful. Splitting involves using
terms like "always", "every" or "never" when
they are false and misleading.

19. Mind reading:
• Believing that we know the thoughts in
another person’s mind.

20. Negative prediction:
• Believing that something bad is going to
happen even though there is no evidence to
support this prediction.

21. Catastrophizing:
• Exaggerating the potential or real consequences of an
event and becoming fearful of the consequences.
• Giving greater weight to the worst possible outcome,
however unlikely, or experiencing a situation as
unbearable or impossible when it is just
uncomfortable

22. Labeling:
• Creating a negative view of oneself based on
errors or mistakes that one has made. It is a type of
over-generalizing which affects one’s view of
oneself.
• Example of labelling: Instead of believing that you
made a mistake, you believe that you are a loser,
because only a loser would make that kind of
mistake.
• Or, someone who made a bad first impression
considers himself or herself a "jerk", regardless of
alternative, extrinsic factors.

23. ASSESSMENT IN COGNITIVE THERAPY
• Attention to detail is a hallmark of cognitive therapy.
• In interviews, therapists ask many questions about the
presenting problem, past problems, past traumatic experiences,
and medical history.
• Questions elicit details to help therapists make assessments
about distorted thinking.
• Scales and questionnaires, several developed by Aaron Beck,
assess for depression, suicide, and other concerns.
• These may be administered to clients prior to each session.
Another method is self monitoring that uses forms such as the
Dysfunctional Thoughts Record.
• Still other methods are used for sampling thoughts.

24. Self-monitoring:
• A method of assessing thoughts, emotions, or
behaviors outside of therapy in which clients
are asked to keep records of events, feelings,
and/or thoughts.

25. Thought sampling:
• A means of obtaining samples of thoughts
outside of therapy by asking the client to
record thoughts on tape or in a notebook at
different intervals.

26. THERAPEUTIC TECHNIQUES
• Cognitive therapy techniques are often challenging and specific.
• Socratic dialogue helps to challenge maladaptive beliefs and assumptions.
• Basically, it is a series of questions that help the client arrive at logical
answers to and conclusions about a certain hypothesis.
• The three-question technique is a form of guided discovery.
• Clients are often asked to specify automatic thoughts by recording them on
the Dysfunctional Thought Record or through thought sampling.
• The client can then bring material to therapy so that the client and therapist
can challenge maladaptive assumptions or ineffective beliefs.
• Several different techniques are used for challenging different distorted
beliefs.

27. Challenging absolutes:
• Statements that include words such as
“everyone”, “never”, and “always” are usually
exaggerations which therapists point out to the
client.

28. Reattribution:
• Helping clients distribute responsibility for an
event (such as an argument) so as to equally
place responsibility for the event.

29. De-catastrophizing:
• A “What if” technique, in which the clients are
asked, “What if X happened, what would you
do?” It is designed to explore actual rather
than feared events.

30. Scaling:
• A technique of turning a dichotomy into a
continuum so that individuals do not see things
as “all or nothing.” It is used in challenging
dichotomous thinking.
• On a scale of 0 to 10, with 10 being the most disturbed, and 0
being not disturbed at all, where would you put yourself now?
• 1 10

31. Cognitive rehearsal:
• A means of using imagination to think about
having a positive interaction or experience.
For example, to imagine a positive interaction
with one’s future in-laws.

32. Rational Emotive Therapy aka Rational Emotive
Behavioral Therapy
A form of cognitive-behavioral therapy in which
somebody is encouraged to examine and change
irrational thought patterns (irrational thinking) and
beliefs in order to reduce dysfunctional behavior.
What is irrational thinking?
What types of thinking are problematical for human
beings?

33. The Self-Defeating Rules (Irrational Beliefs)
Ellis suggested that a small number of core beliefs underlie most unhelpful emotions
and behaviours. Core beliefs are underlying rules that guide how people react
to the events and circumstances in their lives. Here is a sample list of such of
these:
1. I need love and approval from those around to me.
2. I must avoid disapproval from any source.
3. To be worthwhile as a person I must achieve success at whatever I do.
4. I can not allow myself to make mistakes.
5. People should always do the right thing. When they behave obnoxiously,
unfairlyor selfishly, they must be blamed and punished.
6. Things must be the way I want them to be.
7. My unhappiness is caused by things that are outside my control – so there is
nothing I can do to feel any better.
8. I must worry about things that could be dangerous, unpleasant or frightening –
otherwise they might happen.
9. I must avoid life’s difficulties, unpleasantness, and responsibilities.
10. Everyone needs to depend on someone stronger than themselves.
11. Events in my past are the cause of my problems – and they continue to influence
my feelings and behaviours now.
12. I should become upset when other people have problems, and feel unhappy
when they’re sad.
13, I shouldn’t have to feel discomfort and pain.
14, Every problem should have an ideal solution.

34. Two Types of Disturbance
Ego disturbance:
- emotional tension resulting from the perception that
one’s ‘self’ or personal worth is threatened – and lead
to other problems such as avoidance of situations
where failure, disapproval, etc. might occur.
- looking to other people for acceptance; and
unassertive behaviour through fear of what others
may think.
Discomfort disturbance:
- results from demands about others (e.g. ‘People must
treat me right’) and about the world (e.g. “The
circumstances under which I live must be the way I
want”).

35. Discomfort disturbance - two types:
Low frustration-tolerance (LFT) results from
demands that frustration not happen,
followed by catastrophizing when it does.
It is based on beliefs like: “The world
owes me contentment and happiness.”
Low discomfort-tolerance (LDT) arises from
demands that one not experience
emotional or physical discomfort, with
catastrophizing when discomfort does
occur. It is based on beliefs like: “I must
be able to feel comfortable all of the time.”

36. HOMEWORK
Probably the most important REBT strategy is
homework. This can include such activities as:
Reading
Self-help exercises
Experiential activities
Journaling
Thought Stopping
Intentional Reframing
Therapy sessions are really ‘training sessions’, between
which the client tries out and uses what they have
learned.

37. ABC’s of REBT
A →B → C
A = Activating Event
B = Beliefs, Thoughts, Attitudes, Assumptions
C = Consequences, Feelings, Emotions,
Behaviors, Actions

38. Nouveau ABC’s

39. Clinical Applications of REBT
● Depression
● Anxiety disorders, including obsessive-compulsive disorder,
agoraphobia, specific phobias, generalised anxiety,
posttraumatic stress disorder, etc.
● Eating disorders, addictions, impulse control disorders
● Anger management, antisocial behaviour, personality disorders
● Sexual abuse recovery
● Adjustment to chronic health problem, physical disability, or
mental disorder
● Pain management
● General stress management
● Child or adolescent behaviour disorders
● Relationship and family problems
● Personal growth
● Workplace effectiveness

40. CBT effective for use with
● Self / Personal Growth
● Individual Clients
● Groups
● Marriage / relationships
● Family
● Workplace
● Varying Intellectual ability/learning impairments
CAUTION: Cognitive therapies do not appear to
work as well with those who are cognitively
impaired.

41. Principles of REBT
The basic aim of REBT is to leave clients at the
completion of therapy with
● The freedom to choose their emotions, behaviours and
lifestyle (within physical, social and economic restraints)
A method of self-observation and personal change that will
help them maintain their gains.
● Realistic thoughts, emotions, and behaviours that are in
proportion to the events and circumstances an individual
experiences.
● A Here and Now orientation.
● Finally, the emphasis is on profound and lasting
change in the underlying belief system of the client,
rather than simply eliminating the presenting
symptoms. The client is left with self-help techniques
that enable coping in the long-term future.

42. LEARNING TO USE CBT/REBT
● Techniques of CBT/REBT are best
learned by attending an appropriate
training course.
● To practice it is important to have a
good understanding of irrational
thinking.
● The most effective way to learn how
to help clients uncover and dispute
irrational beliefs is to practice on
oneself.

43. How is REBT and cognitive therapy
different from each other?
• Both approaches try to make changes in the clients’ belief
system.
• Ellis focuses on irrational beliefs and uses the A-B-C-D-E
theory to challenge irrational beliefs of all types.
• Beck identifies types of cognitive distortions (a concept
similar to irrational beliefs) and has developed different
methods for challenging these distortions.
• Ellis applies his approach to all disorders.
• Beck has different suggestions and techniques for different
disorders. In many ways, their approaches seem to be quite
similar, but the language that they use is different.
• Beck uses different challenging methods for different
disorders, whereas Ellis uses disputing, primarily, for most
disorders.

44. Treatment Plan
• Who is involved? Mental Health Techs, Nurses,
Clinicians, Case Managers
• Reinforce/implement cognitive interventions
included in the tx plan.
• Read the tx plan & reinforce items within your
scope of practice
• Chart to the treatment plan.
• If the Treatment Plan indicates “client will be
redirected from discussing substance use” you
may chart something like, “client was redirected
from discussing substance use four times this
evening.”
• Separate course on charting to the Treatment

45. References / Resources / Bibliography
• Bernard, M. E. (1986). Staying Rational In an Irrational World: Albert Ellis and Bond,
F.W. & Dryden, W. (2002). Handbook of Brief Cognitive Behaviour Therapy.
Chichester. John Wiley & Sons Ltd.
• Dryden, W. (1995). Brief Rational Emotive Behaviour Therapy. Chichester. John
Wiley & Sons.
• Ellis, A. (1988). How To Stubbornly Refuse To Make Yourself Miserable About
Anything. New York. Lyle Stuart.
• Ellis, A. & Harper, R. A. (1975). A New Guide to Rational Living. Hollywood. Wilshire
Book Co.
• Ellis, A., Wolfe, J. & Moseley, S. (1980). How to Raise an Emotionally Healthy,
Happy Child. Hollywood. Wilshire Book Co
• Steinberg, D. & Dryden, W. (2003). How to Stick to a Diet. London. Sheldon Press
• Ellis, A. & Dryden W. (1997). The Practice of REBT (Second edition). London. Free
Association Books.
• National Association of Cognitive-Behavioral Therapists,
http://www.nacbt.org/whatiscbt.htm
• Still, A. & Dryden, W. (2003). Ellis and Epictetus: Dialogue vs. method in
psychotherapy. Journal of Rational-Emotive & Cognitive-Behaviour Therapy. 21:2,
37-56
• Ziegler, D.J. (2002). Freud, Rogers, and Ellis: A comparative theoretical analysis.
Journal of Rational-Emotive and Cognitive-Behavior Therapy. 20(2)