Cognitive-behavioral therapy (CBT) is a therapeutic approach that attempts to change dysfunctional thoughts and behaviors. It was developed by Aaron Beck and focuses on modifying cognitive processes like thinking patterns. CBT encompasses several therapies including behavioral parent training, which teaches parents strategies to modify child behaviors; behavioral marital therapy, which aims to increase positive behaviors between spouses; and conjoint sex therapy, an educational approach to treating sexual problems. Therapists employing CBT act as experts, teachers, and coaches to reinforce positive behaviors and teach skills like communication and problem solving. Common techniques involve contingency contracting, positive reinforcement, modeling, role playing, and thought challenging. While some criticize CBT as too rigid, its strengths include reliable assessment

1. Cognitive-Behavioral Therapy
Michelle Fournier
Sarah Peara
Psyc 5790

2. Cognitive Therapy
 Developed by Aaron Beck
 Cognitive pertains to mental processes, such as
thinking, remembering, perceiving, and planning
 Attempts to modify client’s cognitive processes
 Beck focused on depression

3. Behavioral Therapy
 Behavioral Parent Training
 Goal is to help parents learn to have more
effective control of their child’s behavior
 4 steps
 Precisely define targeted problem bx
 Analyze the antecedent/consequences
 Monitor the frequency of bx to establish a baseline

4. Behavioral Parent Training
 Train parents in specific procedures for changing
the targeted bx
 Define rules
 Changing conditions of antecedent
 Procedures to positively reward compliance
(reinforcement)
 Discipline I.e. time out/ loss of privileges
Before implicating BPT look at Gordan/Davidson’s 4
factors

5. Behavioral Marital Therapy
 Goals are to increase the frequency of + bx and decrease
in - bx; increase skill in communication and problem
solving
 Initial interview is important source of data (history)
Tools
- Areas of Change Questionnaire(A-C)
- Martial Status Inventory (MSI)
- Locke-Wallace Marital Adjustment Test (MAI)
- Dyadic Adjustment Scale (DAS)

6. Behavioral Marital Therapy
 Teach skills
- contracts (contingency contract and good
faith contract)
- Modeling (done by therapist)
- Defining the problem

7. Functional Family Therapy
 Combines systems theory, behaviorism,
cognitive therapy in an integrated approach
 Therapist take position that all bx by all
family members is adaptive
 Focus is on cognitions/bx
 Bx change and skill training (education)
relabeling is crucial

8. Conjoint Sex Therapy
 Behavioral sex therapist is an educator who
teaches sexual physiology, techniques, changes
maladaptive bx patterns & cognitions and uses
direct methods to reduce anxiety & improve skill
performance
 Came of age w/the publication of Masters and
Johnson’s Human Sexual Inadequacy (1970)

9. Conjoint Sex Therapy
 Discuss general factors important in the sexual
relationship such as
- Flexibility in sex role
- Openness or being receptive & expressive
- active intimacy or involvement
- Trust & commitment
Assessment should be multidimensional and include
physiological and medical factors

10. Conjoint Sex Therapy cont..
 It involves setting specific goals and increasing
communication
 Therapist plays active role: provides info,
facilitates communication and corrects
misinformation
 Teaching methods
- systematic desensitization
- Assertiveness training
- Sensate focus (key to anxiety reduction)

11. What is Cognitive-Behavioral Therapy?
 “A set of of therapeutic procedures that
attempts to change feelings and actions by
modifying or altering faulty thought
patterns or destructive self-verbalizations.”
(Goldenberg & Goldenberg, 1991)

12. Major Theorists
 Gerald Patterson
 1960’s
 Began practice of applying behavioral
theory to family problems.
 Taught parents to act as agent of change in
children’s environment.
 Candy, modeling, time-out

13. Major Theorists cont…
 Neil Jacobson
 1970’s
 Developed clinical practice based on
research
 Contributed to marital therapy & DV
 On leading edge of family therapy
 Longitudinal research w/ couples
 Some findings controversial

14. Role of the Therapist
 Expert, teacher, collaborator and coach
 Tailors tx to fit ea. case
 Reinforces pos. alternative to target bx to rid of
problem bx
 Applies learning theory principals to rid of
problem
 Teaches communication, problem solving and
negotiation skills
 Acknowledges importance of therapeutic
relationship.

15. Techniques
 Classical Conditioning- A neutral stimulus paired with another to elicit
certain emotions through association. (Pavlov’s dog, ringing the bell
when presenting food).
 Coaching- Therapist helps clients make appropriate responses giving
verbal instructions. (Marcy, when you want Mike to stop and pay
attention to you, tap him gently. Mike, this will be your cue that she
needs your attention).
 Contingency Contracting- Sets the terms for exchanging of behaviors
and reinforcers between individuals.

16. Techniques cont…
 Extinction- Previous reinforcers are withdrawn so behavior returns to
original state. (Important that replacement behavior be positively
reinforced to take place of extinguished).
 Positive Reinforcement- Usually a material used to increase desired
behaviors. (Money, medals, praise)
 Quid Pro Quo “something for something”- A spouse agrees to do
something as long as other does something comparable.
 Reciprocity- Two people will reinforce each other at approximately
equitable rates over a period of time.

17. Techniques cont…
 Shaping- Process of learning in small steps. (potty training)
 Systematic Desensitization- Dysfunctional anxiety is reduced through
pairing with mental relaxation.
 Time-Out- Removal of person from an environment in which they are
reinforced for certain actions.
 Job Card Grounding- Behavior mod technique used with pre &
adolescents (age 11-18) .
 Grounding- Disciplinary technique used with adolescents where
individual is removed from stimuli, limiting reinforcement.

18. Techniques cont…
 Charting- Asking a client to keep an accurate record of problematic
behaviors. (Used to find a baseline before interventions).
 Premack Principle- Behavioral intervention where family member
must do less pleasant task before allowed to engage in pleasurable
activities.
 Disputing Irrational Thoughts- Using ABC format. A is the event, B is
the thought, C is the emotion. (Who says all your needs should be
filled in marriage?)
 Thought Stopping- Therapist teaches individual to stop unproductively
obsessing by yelling, “Stop”.

19. Techniques cont…
 Self-Instructional Training- Form of self-management focusing on
people instructing self. Can interrupt automatic behaviors encouraging
more adaptive coping strategies. (Children & self-talk)
 Modeling and Role Playing- Individual asked to act “as if” they were
person they wanted to be. Feedback and correction given by therapist
or family member.

20. Cons of CBT
 Some therapist are rigid
 Client picks out problem. Therapist only works on that
problem and typically won’t address other maladaptive bx
 Brings about linear changes, which can hinder a complete
family change
 Lack of spontaneity could result in losing rapport with
families. Therapist & family could end up becoming
frustrated and therapy won’t be as effective
 Too much emphasis may be given to using methods like time
out without the family members understanding the root of
problem

21. Pros of CBT
 Offers techniques for treating problems with children and
troubled marriages
 Weakness can be corrected by boarding the focus of
conceptualization and scope of tx to include family systems
 Greatest strength is its insistence on observing what happens
and then measuring change
 Developed many reliable assessment methods
 Teaches general problem solving,cognitive and
communicational skill (addresses distorted cognitions)
 Modular tx interventions organized to meet the specific and
changing needs of the individual and family

22. References
Bevcar, D. S. &Bevcar, R. J. (2003). Family therapy: A systematic integration. (5th ed.). Boston: Pearson.
Gladding, S. T. (2007). Family therapy: History, theory, and practice. (4th ed.). New Jersey: Pearson.
Goldenberg, I. & Goldenberg, H. (1991). Family therapy: An overview (3rd ed.). Pacific Grove:
Brooks/Cole.
Piercy, F. P., Sprenkle, D. H., & Associates. (1986). Family therapy sourcebook. New York: The Guildford
Press.