Theories of Counseling and Psychotherapy

cognitive behavior therapy

Rosell Rabina

MA in Clinical Psychology
OVERVIEW
The traditional behavior therapy has significantly evolved, with the cognitive behavior therapy
now the dominant approach. To a large degree, cognitive therapy and cognitive behavior therapy
are based on the assumption that beliefs, behaviors, emotions, and physical reactions are all
reciprocally linked (Corey, 2017).

OBJECTIVES
1. Identify common attributes shared by all cognitive behavior approaches
2. Describing A-B-C model as a way of understanding the interaction among feelings,
thoughts, and behavior.
3. Application of Cognitive methods
4. Discuss different cognitive behavior approaches
5. Identify the strengths and limitations of cognitive behavior therapy from a multicultural
perspective.

INTRODUCTION
Cognitive Behavior Therapy (CBT) is a widely recognized and empirically supported form of
psychotherapy. It focuses on the interconnection of thoughts, feelings, and behaviors, aiming to
equip individuals with practical strategies to manage and improve their mental well-being. CBT
builds a set of skills that enables an individual to be aware of thoughts and emotions; identify
how situations, thoughts, and behaviors and improve feelings by changing dysfunctional
thoughts and behaviors. This report will delve into the core principles of CBT and its
applications. Prominent cognitive behavioral approaches will be covered. These approaches
share the following attributes:
1. A collaborative relationship between client and therapist
2. The premise that psychological distress is often maintained by cognitive processes
3. A focus on changing cognitions to produce desired changes in affect and behavior
4. A present-centered, time-limited focus
5. An active and directive stance by the therapist
6. An educational treatment focusing on specific and structured target problems

COGNITIVE BEHAVIORAL APPROACHES

Mahoney and Arnkoff (1978) organized the CBTs into three major divisions:
 (1) Cognitive restructuring – emotional distress is the consequence of maladaptive
thoughts and the goal of clinical intervention is to examine and challenge maladaptive
thought patterns, and to establish more adaptive thought patterns.
 (2) Coping skills therapies – focus on the development of a repertoire of skills designed
to assist the client in coping with a variety of stressful situations.
  (3) Problem-solving therapies – may be characterized as a combination of cognitive
restructuring techniques and coping skills training procedures. It emphasize the
development of general strategies for dealing with a broad range of personal problems ,
and stress the importance of an active collaboration between client and therapist in the
planning of treatment programs.

I. ALBERT ELLIS’S RATIONAL EMOTIVE BEHAVIOR

THERAPY

Rational Emotive Behavior Therapy (REBT) – first cognitive behavior therapy, based on the
basic assumption that cognitions, emotions, and behaviors interact significantly and have a
reciprocal cause-and-effect relationship.
 Developed by Albert Ellis in 1955
 Ellis gave credit to Alfred Adler as an influential precursor of REBT, Karen
Horney’s (1950) ideas on the “tyranny of the shoulds” are apparent in the
conceptual framework of REBT
 He also acknowledged his debt to some of the Eastern philosophies and the
ancient Greeks, especially the stoic philosopher Epictetus (2000 years ago) who
said: “People are disturbed not by events, but by views which they take of them”
(as cited in A. Ellis, 2001a, p. 16)

A. KEY CONCEPTS

1. VIEW OF EMOTIONAL DISTURBANCE

 We learn irrational beliefs from significant others during childhood and

then re-create these irrational beliefs throughout our lifetime.
 Blame can be at the core of many emotional disturbances
 Three basic musts (or irrational beliefs) we internalize that inevitably lead
to self-defeat (A. Ellis & Ellis, 2011):
o “I must do well and be loved and approved by others”
o “Other people must treat me fairly, kindly, and well”
o “The world and my living conditions must be comfortable,
gratifying, and just, providing me with all that I want in life”

2. A-B-C FRAMEWORK

 Central to REBT theory and practice

 A – activating event or adversity, or an inference about an event by an
individual. C – is the emotional and behavioral consequence or reaction of
 the individual (can either be health or unhealthy). B – is the person’s belief
about A, largely creates C, the emotional reaction.

A B C
Activating Event Beliefs Consequences

Thus, to maintain a state of emotional health, individuals must constantly monitor and challenge
their basic belief systems.

B. THE THERAPEUTIC PROCESS

1. THERAPEUTIC GOALS
 Basic aim is to teach clients how to change their dysfunctional emotions
and behaviors into healthy ones.
 Assist clients in the process of achieving unconditional self-acceptance
(USA), unconditional other-acceptance (UOA), and unconditional life-
acceptance (ULA)

2. THERAPIST’S FUNCTION AND ROLE

 To show clients how they have incorporated many irrational absolute
“should”, “oughts”, and. “musts” into their thinking
 Demonstrate how clients are keeping their emotional disturbances active
by continuing to think illogically and unrealistically.
 Help clients change their thinking and minimize their irrational ideas
 Strongly encourage clients to develop a rational philosophy of life so that
in the future they can avoid hurting themselves again by believing other
irrational beliefs.

3. CLIENT’S EXPERIENCE IN THERAPY

 Emphasizes here-and-now experiences and client’s present ability to
change the patterns of thinking and emoting that they constructed earlier.
 Transference is not encouraged
 Clients are encouraged to actively work outside therapy sessions –
homework

4. RELATIONSHIP BETWEEN THERAPIST AND CLIENT

  Respectful relationship between therapist and client
 Clients are taught about the cognitive hypothesis of disturbance and help
clients understand how they are continuing to sabotage themselves and
what they can do to change.

C. APPLICATION: THERAPEUTIC TECHNIQUES AND

PROCEDURES

1. THE PRACTICE OF RATIONAL EMOTIVE BEHAVIOR

THERAPY
 REBT practitioners are multimodal and integrative.

o Cognitive Methods
 Disputing traditional beliefs – clients dispute a particular
“must”, absolute “should”, or “ought” until they no longer
hold the irrational belief, or at least until it is diminished in
strength. Ex. If life doesn’t always go the way I would like
it to, it isn’t awful, just inconvenient.
 Doing cognitive homework – clients are expected to make
a list of their problems, look for their absolutist beliefs, and
dispute these beliefs. Homework assignments like REBT
Self-Help Form are used.
 Bibliotherapy – cost-effective, widespread availability;
have empirical support for a range of clinical problems
including the treatment of depression and many anxiety
disorders (Jacobs, 2008)
 Changing one’s language
 Psychoeducational methods

o Emotive Techniques
 Rational Emotive imagery – form of intense mental
practice designed to establish new emotional patterns in
place of disruptive ones by thinking in healthy ways.
 Humor
 Role Playing
 Shame-attacking exercises

o Behavioral techniques – operant conditioning, self-management

principles, systematic desensitization, relaxation techniques, and
modeling.

2. APPLICATIONS OF REBT AS A BRIEF THERAPY

Ellis maintained that the best and most effective therapy quickly teaches
clients how to tackle present as well as future problems.
 3. APPLICATION TO GROUP COUNSELING
In group therapy members are taught how to apply REBT principles to one
another.

II. AARON BECK’S COGNITIVE THERAPY

Beck’s Cognitive Theory (CT) – was based on empirical research. It is also similar to REBT
and unlike behavior therapy that it is based on the theoretical rationale that the way people feel
and behave is influenced by how we perceive and place meaning on their experience. The three
theoretical assumptions of CT are:
 People’s thought processes are accessible to introspection
 People’s beliefs have highly personal meanings
 People can discover these meanings themselves rather than being taught or
having them interpreted by the therapist

Schemas are defined as cognitive structures that organize and process incoming information.

A. A GENERIC COGNITIVE MODEL

The generic cognitive model provides a comprehensive framework for
understanding psychological distress, and some of its major principles. The
following are the major principles on which the model is based:
 Psychological distress can be thought of as an exaggeration of normal
adaptive human functioning.
 Faulty information processing is a prime cause of exaggerations in
adaptive emotional and behavioral reactions. Beck identified several
common cognitive distortions:
o Arbitrary inferences – conclusions drawn without supporting
evidence
o Selective abstraction – forming conclusions based on an isolated
detail of an event while ignoring the other information
o Overgeneralization – process of holding extreme beliefs on the
basis of a single incident and applying them inappropriately to
dissimilar events or settings
o Magnification and minimization – consist of preserving a case or
situation in a greater or lesser light than it truly deserves
o Personalization – tendency for individuals to relate external events
to themselves, even when there is no basis for making this
connection.
o Labeling and Mislabeling – involve portraying one’s identity on
the basis of imperfections and mistakes made in the past and
allowing them to define one’s true identity
o Dichotomous thinking – involves categorizing experiences in
either-or extremes.
  Our beliefs play a major role in determining what type of psychological
distress we will experience
 Central to cognitive therapy is the empirically supported observation that
“changes in beliefs lead to changes in behaviors and emotions”
 If beliefs are not modified, clinical conditions are likely to occur

B. BASIC PRINCIPLES OF COGNITIVE THERAPY

 CT is an insight-focused therapy with a strong psychoeducational component
that emphasizes recognizing and changing unrealistic thoughts and
maladaptive beliefs.
 Highly collaborative and involves designing specific learning experiences to
help clients understand the links between their thoughts, behaviors, emotions,
physical responses, and situations
 The goal of CT is to help clients learn practical skills that they can use to
make changes in their thoughts, behaviors, and emotions and how to sustain
these changes over time
 CT is focused on present problems, regardless of a clients diagnosis.

C. THE CLIENT-THERAPIST RELATIONSHIP

 Therapeutic relationship is basic to the application of cognitive therapy.
 Therapist must have a cognitive conceptualization of cases
 Cognitive therapist functions as a catalyst and a guide who helps clients
understand how their beliefs and attitudes influence the way they feel and act
 Cognitive therapist identify specific, measurable goals and move directly into
the areas that are causing the most difficulty for clients (Dienes et al, 2011 as
cited in Corey, 2017)

D. APPLICATIONS OF COGNITIVE THERAPY

 Cognitive therapy has been successfully used to treat depression and other
psychological disorders.
 With children and adolescents, CT has been shown to be effective in the
treatment of depression and anxiety disorders and more effective than
medications for these problems.

1. APPLYING COGNITIVE TECHNIQUES

 Activity scheduling
 Behavioral experiments
 Skills training
 Role playing
 Behavioral rehearsal
 Exposure therapy
 2. TREATMENT APPROACHES
 Length and course varies and dependent on specific diagnoses. Examples
are as follows:
o Depression – usually last 16-20 sessions and begins in behavioral
activation. Therapist will try to guide the clients to activities that
can boost moods. As depression lifts, they introduce new skill such
as thought that helps client identify negative automatic thoughts
and test them. When thoughts are not supported by evidences,
clients learn to generate alternative explanations that are less
depressing. If the evidence support the negative thoughts hey are
helped to create action plan to solve the problem. Before the end
of treatment, underlying assumptions are tested with behavioral
experiments.
o Panic Disorder – generally lasts only 6-12 sessions and targets
catastrophic beliefs about internal physical and mental sensations.

3. APPLICATION TO FAMILY THERAPY

 Cognitive theory emphasizes schema (core beliefs) as key aspect of
therapeutic process. Therapist help families restructure distorted beliefs
(schema) in order to change dysfunctional behaviors.
 Family schemata – influenced by the parent’s family of origin

III. CHRISTINE PADESKY AND KATHLEEN MOONEY’S

STRENGTHS-BASED COGNITIVE BEHAVIORAL THERAPY

Strengths-based cognitive behavior therapy (SB-CBT) – is a variant of Aaron Beck’s

cognitive therapy developed by Christine Padesky and her colleague Kathleen Mooney. One
central addition is an emphasis on identification and integration of client strengths at each phase
of therapy.

A. BASIC PRINCIPLES OF STRENGTHS-BASED CBT

 Strengths are integrated into each phase of treatment in SB-CBT beginning
with the intake interview
 Positive interests and strengths are identified in early therapy sessions
 SB-CBT therapist help clients develop and construct new positive ways of
interacting in the world.

B. THE CLIENT-THERAPIST RELATIONSHIP

 Similar with Beck CT, therapist are collaborative, active, here-and-now
focused, and client centered
 Therapist do not take an “expert” stance but instead serve as curious assistants
and guides clients to their own discovery and growth
 C. APPLICATIONS OF STRENGTHS-BASED CBT
Three current application of SB-CBT are:
 An add-on fort classic CBT – when clients come to therapy with goals to
reduce problematic moods(depression, anxiety, anger), behaviors (eating
disorders, substance misuse) or other difficulties (psychoses,
hypochondriasis)
 A four step model to build resilience and other positive qualities: (1)
Search, (2) Construct, (3) Apply and (4) Practice
 The new paradigm for chronic difficulties and personality disorders –
comprehensive and requires clients to vividly construct new ways to feel,
think, and behave in their life. Steps include (1) Conceptualize the OLD
system of operating and help clients understand they do things for “good
reasons” (2) Construct NEW systems (3) strengthen the NEW and (4)
relapse management

IV. DAVID MEICHENBAUM’S COGNITIVE BEHAVIOR

MODIFICATION

Donald Meichenbaum’s Cognitive Behavior Modification (CBM) focus on changing the

client’s self-talk. In some books it is called Self-Instructional Training
 Self-statements affect a person’s behavior in much the same way as statements made by
another person.
 Basic premise: clients, as a prerequisite to behavior change, must notice how they think,
feel, and behave and the impact they have on others
 Meichenbaum’s self-instructional training focuses more on helping clients become aware
of their self-talk and the stories they tell about themselves.

A. HOW BEHAVIOR CHANGES

Phase 1: Self-Observation
Phase 2: Starting a new internal dialogue
Phase 3 : Learning a new skill

B. STRESS INOCULATION TRAINING

Stress inoculation training – application of a coping skills program teaching
clients stress management techniques by way of strategy. The following
procedures are designed to teach these coping skills:
 Expose clients to anxiety-provoking situations by means of role playing
and imagery
 Require clients to evaluate their anxiety level
 Teach clients to become aware of the anxiety-provoking cognitions they
experience in stressful situations
 Help clients examine these thoughts by reevaluating their self-statements
 Have clients note the level of anxiety following this reevaluation
 The phases of Stress Inoculation Training:
 The conceptual-educational phase: primary focus is on creating a
therapeutic alliance with clients
 The skills acquisition and consolidation phase: focus is on giving clients a
variety of behavioral and cognitive coping skills to apply to stressful
situations
 The application and follow-through phase: the focus is on carefully
arranging for transfer and maintenance of change from the therapeutic
situation to everyday life.

V. COGNITIVE BEHAVIOR THERAPY FROM A

MULTICULTURAL PERSPECTIVE

A. STRENGTHS FROM A DIVERSITY PERSPECTIVE

Cognitive behavioral approaches have several strength in working with individuals
from diverse cultural, ethnic, and racial backgrounds. Aspects that contribute to an
integrative framework:
 Interventions are tailored to the unique needs and strengths of the individual
 Clients are empowered by learning specific skills they can apply in daily life (CBT) and
by the emphasis on cultural influences that contribute to client’s uniqueness
(multicultural therapy)
 Inner resources and strengths of clients are activated to bring about change
 Clients make changes that minimize stressors, increase personal strengths and supports,
and establish skills for dealing more effectively with their physical and social (cultural)
environments

B. SHORTCOMINGS FROM DIVERSITY

 Emphasis of CBT on assertiveness, independence, verbal ability, rationality,
cognition, and behavioral change may limit its use in cultures that value subtle
communication over assertiveness, independence, listening and observing
over talking, and acceptance over behavior change.

REFERENCES

Corey, G. (2017). Theory and Practice of Counseling and Psychotherapy, Tenth Edition.
Cengage Learning.

Cully, J. A. & Teten, A.L. (2008). A therapist’s Guide to Brief Cognitive Behavioral Therapy.
Department of Veterans Affairs South Central MIRECC, Houston.

Dobson, K. S. (2010). Handbook of Cognitive-Behavioral Therapies, Third Edition. Guilford

Press, New York.