Cognitive behavioral therapy (CBT) aims to change maladaptive thoughts and behaviors. Three major contributors are Aaron Beck, Albert Ellis, and Donald Meichenbaum. Ellis developed rational emotive behavioral therapy which teaches that emotions stem from beliefs and thinking patterns. Beck's cognitive therapy focuses on identifying and modifying negative schemas and cognitive distortions. Meichenbaum's cognitive behavior modification emphasizes self-statements and developing coping skills. Therapists use techniques like cognitive restructuring, behavioral experiments, and stress inoculation training.

1. CHAPTER 10
Cognitive Behavior
Therapy

2. Cognitive-Behavior Therapy
Contributors:
Aaron Beck; Albert Ellis, Donald
Meichenbaum
Assumption:
Maladaptive cognitions are at the
root of problems
Websites:
http://www.nacbt.org/
http://www.rebt.org/

3. Ellis’ Rational-Emotive Behavioral Therapy
• Teaches that our emotions stem
mainly from our beliefs,
evaluations, interpretations, and
reactions to life situations.
• Stresses thinking, judging,
deciding, analyzing, and doing.
• Assumes that cognitions, emotions,
and behaviors interact and have a
reciprocal cause-and-effect
relationship

4. Rational Emotive Behavioral Therapy
• Is highly didactic, very directive, and concerned as
much with thinking as with feeling
• Musterbations
• irrational belief that you must do or have something
• Awfulizing
• mental exaggeration of setbacks

5. REBT: An Educational Process
• Clients learn
• To identify the interplay of their thoughts, feelings
and behaviors
• To identify and dispute irrational beliefs that are
maintained by self-indoctrination
• To replace ineffective ways of thinking with effective
and rational cognitions
• To stop absolutistic thinking, blaming, and repeating
false beliefs

6. View of Human Nature
• We are born with a potential for both rational and
irrational thinking
• We have the biological and cultural tendency to think
crookedly and to needlessly disturb ourselves
• We learn and invent disturbing beliefs and keep
ourselves disturbed through our self-talk
• We have the capacity to change our cognitive,
emotive, and behavioral processes

7. Ellis’ABC theory of emotions
A = activating event in the environment
Loss of job
I’m
worthless
Depression
Loss of job
My boss
is a jerk
No
Depression
B = belief triggered in client’s mind by event
C = emotional consequence of the belief
Healthy Pattern

8. Example Rationale Thinking
• A= fail a midterm examination
• 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
• C=no consequences (emotional disturbance
avoided)

9. Example Irrational Thinking: Leads to
Emotional Disturbance
• A= Fail exam
• B= I’m stupid, I’ll never be able to pass this course
and I will fail this course
• C=depression

10. The A-B-C Theory of Personality
A
activating
event
B
belief
D
disputing
interventio
n
E
effective
philosophy
F
New
feeling
C
consequence

11. Irrational Ideas
• Irrational ideas lead to self-defeating behavior
• Some examples:
• “I must have love or approval from all the significant
people in my life.”
• “I must perform important tasks competently and
perfectly.”
• “If I don’t get what I want, it’s terrible, and I can’t
stand it.”

12. Therapeutic Techniques
• Therapists practicing REBT use the following
techniques:
• Disputing irrational beliefs
• Doing cognitive homework
• Bibliotherapy
• Changing one’s language
• Psychoeducational methods

13. Therapeutic Techniques
• Therapists practicing REBT use the following
techniques:
• Rational emotive imagery
• Using humor
• Role playing
• Shame-attacking exercises
• Standard behavior therapy procedures

14. Beck’s Cognitive Therapy
 Treatment of depression
 Depressed people
 distort experiences &
maintain negative views of
themselves, the world, their
future
 minimize positive &
maximize negative
experiences
 misattribute negative
experiences to own
deficiencies

15. Aaron Beck’s Cognitive Therapy
• Insight-focused therapy with an emphasis on
changing negative thoughts and maladaptive beliefs
• Theoretical Assumptions
• People’s internal communication is accessible to
introspection
• Clients’ beliefs have highly personal meanings
• Depressed people have negative schemas or frames of
reference through which they interpret all events and
experiences
• These meanings can be discovered by the client
rather than being taught or interpreted by the
therapist

16. Theory, Goals & Principles of CT
• Basic theory:
• To understand the nature of an emotional episode or disturbance it
is essential to focus on the cognitive content of an individual’s
reaction to the upsetting event or stream of thoughts
• Goals:
• To change the way clients think by using their automatic thoughts to
reach the core schemata and begin to introduce the idea of schema
restructuring
• Principles:
• Automatic thoughts: personalized notions that are triggered by
particular stimuli that lead to emotional responses

17. CT’s Cognitive Distortions
• Arbitrary inferences
• Making conclusions without supporting and relevant
evidence
• Selective abstraction
• Forming conclusions based on an isolated detail of an
event
• Overgeneralization
• Based on one single incident and applying them to
dissimilar events

18. CT’s Cognitive Distortions
• Magnification and minimization
• Perceiving a case or situation in a greater or lesser light
than it truly deserves
• Personalization
• Relate external events to themselves even when there
is no basis for the connection.
• Labeling and mislabeling
• Portraying one’s identity on the basis of imperfections or
mistakes made in the past
• Polarized thinking
• Thinking in all-or-nothing terms

19. Beck’s Cognitive Triad
Pattern that triggers depression:
1. Clients hold negative views of themselves
 “I am a lousy person”
2. Selective Abstraction
 Client interprets life events through a negative filter
 “The world is a negative place where bad things are
bound to happen to me”
3. Client holds a gloomy vision of the future
 “The world is bleak and it isn’t going to improve”

20. Applications of Cognitive Therapy
• Hundreds of outcome trials have established CT’s
efficacy for a wide range of problems
• Cognitive techniques focus on identifying and
examining a client’s beliefs and the origins of these
beliefs, and modifying them if the client cannot
support these beliefs
• Behavioral techniques used by cognitive therapists
include activity scheduling, behavioral experiments,
skills training, role playing, behavioral rehearsal, and
exposure therapy

21. Donald Meichenbaum’s Cognitive
Behavior Modification (CBM)
 Focus:
 Client’s self-verbalizations or self-statements
 Premise:
 As a prerequisite to behavior change, clients must notice
how they think, feel, and behave, and what impact they
have on others
 Basic assumption:
 Distressing emotions are typically the result of
maladaptive thoughts

22. Meichenbaum’s CBM
 Self-instructional therapy focus:
 Trains clients to modify the instructions they give to
themselves so that they can cope
 Emphasis is on acquiring practical coping skills
 Cognitive structure:
 The organizing aspect of thinking, which seems to
monitor and direct the choice of thoughts
 The “executive processor,” which “holds the blueprints
of thinking” that determine when to continue, interrupt,
or change thinking

23. How Behavior Changes?
• 3 Phases of Behavior Change
1. Self-observation
• Listen to themselves, realize they contribute to
their depression through how they think, and
develop new cognitive structures
2. Starting a new internal dialogue
• See adaptive behavioral alternatives
3. Learning new skills
• Teaching more effective coping skills

24. Meichenbaum’s Stress
Inoculation Training (SIT)
• SIT is a three-phase coping skills program
1. The conceptual phase
• Creating a working relationship with clients
2. Skills acquisition and rehearsal phase
• Giving coping skills to apply to stressful situations
3. Application and follow-through phase
• Transfer change to real world

25. Cognitive Techniques
 Automatic Thoughts- Challenge people's irrational assumptions
using logic and evidence.
 Changing Language- Changing "need" to "want"
 Decatastrophizing- Anticipating worse-case-scenario and
preparing for it through role play and problem solving.
 Shame Attacking- Encouraging client to deliberately fail or draw
unwanted attention in or to demonstrate that they can survive.
 Socratic Dialogue- Asking a series of questions leading client to
inescapable conclusion that their beliefs are irrational.
 Stress Inoculation- Similar to decatastrophizing but with
addition of relaxation exercises.