Theory and Practice of Counseling and
Psychotherapy
Chapter10: Cognitive Behavior Therapy
Rational Emotive Behavioral Therapy
(REBT)
■ Stresses thinking, judging, deciding, analyzing, and
doing
■ Assumes that cognitions, emotions, and behaviors
interact and have a reciprocal cause-and-effect
relationship
■ Is highly didactic, very directive, and concerned as
much with thinking as with feeling
■ Teaches that our emotions stem mainly from our
beliefs, evaluations, interpretations, and reactions to
life situations
View of Human Nature
■ We are born with a potential for both rational and
irrational thinking
■ We are self-talking, self-evaluating, and self-
sustaining.
■ We have an inborn tendency toward growth and
actualization
■ 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
View of Emotional Disturbance
■ We learn irrational belief from significant other during
childhood
■ Teach clients to feel undepressed even when they are
unaccepted and unloved by significant others.
■ Blame is at the core of most emotional disturbances
■ Irrational idea (e.g., I must be loved by everyone)!
internalize ! self-defeating
■ We have a tendency to make ourselves emotionally
disturbed by internalizing self-defeating beliefs
The A-B-C theory of personality
Case discussion 1
■ Tom, a college sophomore, want to overcomes his
shyness around women. He doe not date and even
des his best to keep away from women because he
is afraid they will reject him. But he want to
change this pattern.
■ Using A-B-C-D-E-F to analyze and help Tom
Case discussion 2
■ Mary would like to take a course in creative
writing, but she fears that she has no talent.
She is afraid of failing, afraid of being told
that she is dumb, and afraid of follow
through with taking the course.
■ Using A-B-C-D-E-F to analyze and help Mary
Case discussion 3
■ Each week John comes to his sessions with a new excuse
for why he has not succeeded in following through with
his homework assignments. Either he forgets, gets too
busy, gets scared. Or puts it off—anything but actually
doing something to change what he says he wants to
change. Instead of really doing much of anything, he
whines each week about how rotten he feels and how he so
much would like to change but just doesn’t know how.
■ What are the possible irrational beliefs, which keep
John from taking actions
■ What homework assignment might you suggest?
Case discussion 4
■ Brent feels that he must win everyone’s approval.
He has become a “super nice guy” who goes out
of his way to please everyone. Rarely does he
assert himself, for fear that he might displease
someone who then would not like him.
■ What are the possible irrational beliefs?
■ How do you help Brent?
■ If Brent is Asian American, what cultural components
you might take into account?
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.”
The Therapeutic Process
■ Therapy is seen as an educational process
■ Clients learn
■ To identify and dispute irrational beliefs
■ To replace ineffective ways of thinking with
effective and rational cognitions
■ To stop absolutistic thinking, blaming, and
repeating false beliefs
Therapeutic Goals
■ A basic goal is to teach clients how to change their
dysfunctional emotions and behaviors into health
ones.
■ Two main goals of REBT are to assist clients to
achieving unconditional self-acceptance and
unconditional other acceptance.
■ As clients become more able to accept themselves,
they are more likely to unconditionally accept others.
Therapist’s function and Role
■ 1. Encouraging clients to discover their irrational
beliefs and ideas
■ 2. Making connection of how these irrational
beliefs lead to emotional disturbances
■ 3. Challenging clients to modify or abandon their
irrational beliefs.
■ 4. Dispute the irrational beliefs and substitute
rational beliefs and behaviors.
Client’s Experience in Therapy
■ A learner---learn how to apply logical thoughts,
experiential exercises, and behavioral homework
to problem solving and emotional change.
■ Focus on here-and-now experiences
■ Not spend much time to exploring clients’ early
history and connecting present and past
■ Expect to actively work outside the therapy
sessions.
Relationship Between Therapist and Client
■ Intensive therapeutic relationship is not required. But,
REBT unconditionally accept all clients and teach them to
unconditionally accept others and themselves. (accept them
as persons but confront their faulty thinking and self-
destructive behaviors)
■ Ellis believes that too much warmth and understanding can
be counter-productive, fostering dependence for approval.
■ Therapists shows great faith in their clients’ ability to
change themselves.
■ Open and direct in disclosing their own beliefs and values
■ Transference is not encouraged, when it occur, the therapist
is likely to confront it (e.g., clients believe that they must
be liked and loved by their therapists.)
Therapeutic techniques and procedures
■ Cognitive methods
■ Disputing irrational beliefs
■ If I don’t get what I want, it is not at the end of the world
■ Doing cognitive homework
■ Applying ABC theory in daily life’s problems
■ Put themselves in risk-taking situations to challenge their self-
limiting beliefs.
■ Replace negative self-statement to positive message
■ Changing one’s language
■ It would be absolutely awful..!It would be inconvenient
■ Using humor
■ Humorous songs
Therapeutic techniques and procedures
■ Emotional Techniques
■ Rational-emotional imagery
■ Imagine the worst things that could happen to them
■ Role playing
■ Shame-attacking exercises
■ Take a risk to do something that they are afraid to do because
of what others might think…until they realize that their
feelings of shame are self-created.
■ Use of force and vigor
■ From intellectual to emotional insight
■ Reverse role playing
Therapeutic techniques and procedures
■ Behavioral Techniques
■ Use most of the standard behavioral therapy
approaches.
■ Research Efforts
■ Most studies focus only on cognitive methods
and do not consider emotive and behavioral
methods.
Applications of REBT
■ REBT has been widely applied to several
areas: anxiety, depression, psychotic
disorders, problems of sex, love, and
marriage, crisis, couple and family
therapy…
Aaron Beck’s Cognitive Therapy (CT)
■ Insight-focused therapy
■ Emphasizes changing negative thoughts and
maladaptive beliefs
■ Theoretical Assumptions
■ People’s internal communication is accessible to
introspection
■ Clients’ beliefs have highly personal meanings
■ These meanings can be discovered by the client rather
than being taught or interpreted by the therapist
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:
■ Observe automatic thoughts, identify cognitive distortions, and
ask for evidences for reality testing the cognitive distortions
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
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
The Client-Therapist Relationship
■ Therapeutic relationship is necessary, but not
sufficient, to produce therapeutic effect.
■ Encourage clients to take an active role in self-
discovery.
■ Aim to teach client how to be their own therapist,
educate clients about the nature of their problem,
about the process of cognitive therapy, and how
thoughts influence their emotions and behaviors.\
■ Use homework to test their beliefs in daily-life
situations
CT’s Cognitive Triad
■ Pattern that triggers depression:
1. Client holds negative view of themselves and
blames themselves
2. Selective abstraction: Client has tendency to
interpret experiences in a negative manner
3. Client has a gloomy vision and projections
about the future
Application of CT
■ Treatment of depression and anxiety
■ Managing stress, in parent training,
and in treating various clinical
disorders
Donald Meichenbaum’s Cognitive Behavior
Modification (CBM)
■ Focus:
■ Changing 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
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
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
■
Coping Skills Programs
■ Coping skills programs – Stress inoculation
training (3 phase model)
■ 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
From a multicultural perspective
■ Contributions
■ Diverse populations!appreciate the emphasis
on cognition and actions
■ Challenge rigid thinking (e.g., “should”)
instead of questioning the values
■ Stress the relationship of individuals to the
family, community, and systems
From a multicultural perspective
■ Limitations
■ Exploring core beliefs is important in CBT-!needs to
sensitive to cultural background and context
■ Value “working hard”!feel ashamed for not living up to the
expectations; divorce!bring shame to her family
■ Diverse clients may be hesitant to question their basic
cultural values
■ Diverse clients may value interdependence and may
feel difficult to be independent
Summary and Evaluation
■ Contributions
■ REBT: focus on how we interpret and react to the
events; put insight into action; teach clients ways to
carry out their own therapy without depending on
therapists
■ CT: research support that CT is as empirically
validated treatment; focus on a detailed case
conceptualization to understand clients; is an eclectic
psychotherapy
Summary and Evaluation
■ Limitations
■ Ellis: being too confrontational; ignoring “past”;
power imbalance
■ CT: focusing too much on positive thinking, being too
simplistic, denying past, being too technique-oriented,
failing to use the therapeutic relationship, working
only to reduce symptoms, failing to explore the
underlying causes of difficulties, ignoring
unconscious factors and emotions.
