Counseling and Psychotherapy Theory Week 6. Cognitive-Behavioral Approach II : Cognitive Approach
Contents 1 2 3 Major Concepts and Propositions 1 Overview 2 Ellis s REBT Beck s CT 3 Change Mechanisms & Intervention Methods Moving from the Problem State to the Changed State 1 2 3 Strategies and Techniques : Ellis s REBT Strategies and Techniques : Beck s CT Theory s Current State and Prospect 1 2 Current State and Prospect Implications
Ⅰ. Major Concepts and Propositions 1 Overview 1 2 Overview of the Cognitive Approach A-B-C-D Model
Overview of the Cognitive Approach Assumptions There is a reciprocal causal relationship among cognition, emotion, and behavior. Emotions are triggered from beliefs, evaluations, thoughts, or interpretations. The way we interpret an event or situation triggers symptoms and problems. Changes in cognition can be used to facilitate changes in emotion and behavior.
Overview of the Cognitive Approach Practice Focused on making clients think and behave differently than working on client's emotion awareness or expression. an integrative approach format uses various cognitive-emotional-behavioral intervention strategies Stresses the importance of specific and structured goals Takes account of time limitation Actively utilizes educational approach
Overview of the Cognitive Approach Subtype approaches Beck s CT Cognitive Therapy Ellis s REBT Rational Emotive Behavioral Therapy Beck & Ellis
A-B-C-D Model Assumptions of behavioral approach A Activating events a fact or event that supports or frustrates a personal goal B C Belief system Consequences Conscious & unconscious thought system, based on which we deal with the activating events Emotional and behavioral consequences that result from the interaction between A and B D Dispute A technique used to revise the belief system
A-B-C-D Model A B C Activating events Beliefs, thoughts Consequences Dispute D
A-B-C-D Model A B C Activating events Rational thinking Irrational thinking Adequate emotional/behavioral consequences Inadequate emotional/behavioral consequences Dispute D
A-B-C-D Model Example a client who fell into depression after a divorce Depression (C) is caused not by divorce (A) itself, but by the client's belief or thinking system (B) related to failure or rejection or the fact that she had lost her spouse. Divorce Thinking related to loss Depression Dispute
Ⅰ. Major Concepts and Propositions 2 Ellis s REBT 1 2 Irrational Belief Dispute
Irrational Belief Initial stage (made a list of irrational beliefs) 1. I must be loved by every person I know. 2. I should be thoroughly adequate, and achieving in all worthwhile aspects. 3. Certain people are wicked, and they should be severely blamed or punished for their deeds. 4. It is awful when things don t go the way I want them to. 5. Everything should proceed in the way I want them to.
Irrational Belief Initial stage (made a list of irrational beliefs) 6. I should be concerned about dangerous situations that I cannot control. 7. One should be dependent on others and needs someone stronger than oneself on whom to rely. 8. One should be thoroughly competent, social, and successful in order to be considered worthwhile. 9. One should become worried about other people s problems 10. I need to find a right solution to my problems.
Irrational Belief Later stage (described the characteristics of irrational beliefs) Irrational beliefs Rational beliefs Flexibility rigid, absolute/extreme flexible Logicality lots of logical contradictions without logical contradiction Practicalit y Usefulne ss not consistent with our experiential reality not helpful for fulfilling life s purposes consistent with experiential reality helpful for life's purposes
Irrational Belief Consequence (C) s Spectrum Emotion classification Maladaptive Negative Emotion Adaptive Negative Emotion Positive Emotion Sadness related Depression Sadness/ Disappointment Joy Anger related Rage Anger Happiness
Irrational Belief Emotional/Behavioral Consequences (C) Consequences of when irrational thinking changes into rational thinking Maladaptive negative emotion Maladaptive negative emotion Positive emotion Adaptive negative emotion X O
Dispute Meaning A representative method of challenging client's irrational beliefs Activating event Beliefs (emotional/behavioral) Consequences Dispute Effect
Dispute The focus of dispute Rigidity I must do (be) xxx. It would be nice to do (be) xxx. Logicality How logical is it? Practicality How fitting is it to the reality? Usefulness How helpful is it for myself?
Ⅰ. Major Concepts and Propositions 3 Beck s CT 1 2 3 Automatic Thoughts Cognitive Schema Cognitive Distortions
Automatic Thoughts Meaning Thoughts that occur spontaneously without a person's choice or effort. Cognitive response pattern formed in specific situations Frequently distorted or extreme (client) Similar to the unconsciousness or preconsciousness of psychoanalysis. (Sharf, 2013) [Ex] A student preparing for a job interview - I am bad at expressing myself. - Other people will do better than me.
Cognitive Schema Meaning Basic beliefs one holds about self and the world The consequences of early childhood experiences (characteristic of CT) Cognitive response patterns formed in certain situations [Ex] Support and love from parents and others - When received: forms a schema about self = I m a lovable person. This positive perception about self is maintained into adulthood. - When not received: forms and maintains a schema about self = I m not a lovable person. Durability: resistant to change even when situations change
Cognitive Schema Development of schema Early childhood experience our schemas, basic beliefs, and conditional beliefs Critical event Related schemas, basic beliefs, and conditional beliefs activated Automatic thoughts Emotion Behavior Physiological response
Cognitive Schema Young (1999) s 5 basic maladaptive schemas 1 2 Disconnection/ Rejection Impaired Autonomy/ Performance Beliefs that one's needs for stability, care, acceptance and empathy are not going to be met Beliefs that one has always failed in life and will continue to fail 3 Impaired Limits 4 Other-Directedness One cannot respect other s rights, cannot cooperate, and cannot control one's actions Overly emphasizing other's needs over one s own needs (*the opposite of the "Impaired Limits ) 5 Overvigilance/ Inhibition Presenting perfect and high standards
Cognitive Distortions Types Dichotomous reasoning Selective abstraction "Since I didn't get an A on the test, I'm a failure." An athlete who only focuses on his mistakes. Mind-reading Negative prediction Since my friend is not doing me a favor, she probably doesn't like me anymore. Even when one has done well on the test and has prepared sufficiently, one expects failure.
Cognitive Distortions Types Catastrophizing Overly concerned and fearful about a particular event Overgeneralization Extracting a general rule based on several negative events Mislabeling I m a fool because I got 80 out of 100 Magnification /minimization Personalization Magnifying shortcomings or minimizing strengths There s a terrible traffic jam whenever I go shopping.
ⅠI. Change Mechanisms & Intervention Methods 1 Moving from the Problem State to the Changed State 1 2 Problem State vs. Changed State Change Facilitating Factor
Problem State vs. Changed State Problem state Ellis Rigid beliefs Illogical beliefs Unrealistic beliefs Impractical beliefs Beck Maladaptive schema Maladaptive automatic thoughts Cognitive distortions Reorganizing the problem state By taking account of the change process
Problem State vs. Changed State Problem state rigid /demanding unrealistic beliefs/thought system/ Information Processing method automatic impractical resistant to environmental change
Problem State vs. Changed State Problem state Impractical Difficult to think in terms of practicality - Moving from the evaluation centered thinking paradigm to practicality centered thinking paradigm: Right, wrong It s good for me, It s bad for me It s helpful, It s not helpful One holds onto an impractical belief/thought/information processing method due to emotional reactivity even when it s impractical - Need to weaken emotional reactions
Problem State vs. Changed State Problem state Rigid/demanding (must, should) When does not have alternative thoughts Need to suggest alternative thoughts Triggers rigid or demanding emotional responses (fear/anxiety) Need to alleviate emotional reactivity
Problem State vs. Changed State Problem state Automatic (gets processed without me knowing ) Unaware cognitive responses - need to make one become aware of this automatic information processing process - need to stop by getting insight, awareness, and understanding
Problem State vs. Changed State Problem state Resistant to environmental change Even when the environment is changed, thoughts do not easily reflect such change due to the emotional reactions and automaticity - need to weaken our clients' emotional reactiveness or automaticity
Problem State vs. Changed State Problem state Unrealistic Due to lack of understanding about the reality: need to provide new information about the reality Due to emotional reactivity: need to dull the emotional reactivity
Problem State vs. Changed State Changed state rigid /demanding flexible/ undemanding (wishful) unrealistic beliefs/thought system/ Information Processing method automatic realistic beliefs/thought system/ Information Processing method After stopping for awareness, insight impractical resistant to environmental change practical In tune with the changed environment
Change Facilitating Factor The common goal of every strategy and technique To bolster flexibility of beliefs/thoughts/information processing methods To help clients choose a more realistic and practical alternative beliefs/thoughts/information processing methods.
Change Facilitating Factor Strategies Intellectual explanations / dispute Explain the irrational or illogical aspects of clients' thoughts and dispute them Consciously judge whether the thoughts are realistic and practical Emphasize the discrepancy between what clients are pursuing and what they are actually doing
Change Facilitating Factor Strategies Awareness Externalize automatic thoughts Contents Contents (automatically) processed outside of consciousness Awareness that the current automatic responses are not adequate in reality Process Processes (automatically) processed outside of consciousness Awareness about reflex response process about emotions
Change Facilitating Factor Strategies Internal emotional processing alleviate emotional reactivity Reinforcement reinforce corrected thinking style and its consequences form new belief/thought/behavior
ⅠI. Change Mechanisms & Intervention Methods 2 Ellis s REBT 1 2 3 Cognitive Techniques Emotional Techniques Behavioral Techniques
Cognitive Techniques Dispute The most representative technique Working on self statements Develop alternative statements that could replace the selfstatements used when irrational beliefs are at work. [Ex] My child must be perfect / My child s presentation must be perfect My child must be perfect / My child s presentation must be better than before
Cognitive Techniques Cost-benefit analysis Making a list of benefits that occur when a maladaptive behavior is modified as well as the costs of prolonging the behavior. Contemplating on this list about 10~20 times daily. Psychoeducational method Providing manuals or practice handbooks and explaining
Cognitive Techniques Teaching Teaching the principles of REBT to others Imagining Imagining negative scene that triggers maladaptive emotions Leave the negative imagination as is, and encourage clients to feel healthy emotions Maladaptive emotions Depression, hostility Adaptive emotions Disappointment, sadness, pain [Ex] Man who broke up with his girlfriend
Emotional Techniques Role play In order to draw out client's emotions, ask the client to try out a particular behavior Repeat the behavior once the emotions are activated [Ex] activating the fear when asking someone on a date
Emotional Techniques Shame attack exercise Doing exaggerated behaviors in a situation where shame is activated [Ex] - Talking loudly to the shop manager - Small violations
Emotional Techniques Resolute self-statements and self-talks Strong and resolute statements that can stand against the "mustdo" beliefs [Ex] "I don't really have to do this."
Behavioral Techniques Assignments Giving assignments that will help reduce irrational beliefs [Ex] Assignment: Not quitting the job and working alongside unfair boss Reinforcement and punishment Skill training
ⅠI. Change Mechanisms & Intervention Methods 2 Beck s CT 1 2 Characteristics of CT Strategies CT s Techniques
Characteristics of CT Strategies Comparison of REBT and CT Relationship Emotions Past Ellis s REBT Considers counseling relationship less important Different type of relationship is stressed (e.g. psychoeducation) Considers client s cognition, behavior important Understanding emotions considered less important Less emphasis on the formation process of irrational beliefs Beck s CT Considers counseling relationship important Understanding cognition, behavior, emotions that guide client is considered important Emphasizes and explores the formation process of schemas & automatic thoughts
CT s Techniques Understanding unique meanings Reviewing and trying to understand clients' verbal habits [Ex] a failure, depressed, lost Challenging the absoluteness Challenging clients' extreme or absolute expressions [Ex] everyone, always, no one etc.
CT s Techniques Reattribution Reviewing and adjusting the locus of responsibility regarding a particular event [Ex] It's all my fault. Labeling distortions naming the categories of cognitive distortions [Ex] Dichotomous thinking, overgeneralization etc.
CT s Techniques De-catastrophizing Questioning the assumptions that underlie the state in which clients are fearful of unlikely results with what-if questions, and confirming that the situation is no catastrophic [Ex] "What happens when you actually get a B as you fear?" Challenging dichotomous thinking Asking client to think on a continuum instead of black-or-white [Ex] High scorer => which point along 0~10 score spectrum
CT s Techniques Listing pros and cons Writing down the pros and cons of a particular belief or behavior [Ex] I need to get on the High Honors list => write down the pros and cons of this belief Cognitive demonstration Imagining and demonstrating the things to come [Ex] Imagining a situation in which one needs to self-assert, and actually demonstrating the behavior
ⅠII. Theory s Current State and Prospect 1 2 Current State and Prospect Implications
Current State and Prospect Schema therapy (Jeffrey Young) Intense exploration of schemas formed in early childhood Expanding as the cognitive-behavioral approach by combining with behaviorism (in the broad sense) Counseling procedures have been manualized Evidence Based Practice Practice Based Evidence - Session Rating Scale (SRS) / Outcome Rating Scale (ORS) (Wampold, Miller)
Current State and Prospect Cognitive psychotherapy based on mindfulness Based on the Buddhist philosophy Does not modify or fix a person's thoughts or emotions Focuses on awareness (Does not assume thoughts to be the reality) Thoughts are just thoughts Applies the principles of classical conditioning or systematic desensitization at the same time
Implications Development of cognitive structures Irrational belief, schema, automatic thought, cognitive distortion occurs When we understand this occurrence of cognitive structure as the result of emotional reactivity, then connections can be make with other approaches - Psychodynamics: defense mechanism - Object relations/attachment theories: relationship representation/working model - Behaviorism: habit/information processing method - Experiential: response style (as a result of processing internal experience) Can introduce strategies, techniques used in other approaches
Implications Maintained cognitive structures Irrational belief, schema, automatic thought, cognitive distortion are maintained Reasons - Emotional barrier: psychoanalysis, object relations/attachment, experiential - Potential loss/fear that may occur when what has been done is not done - Emotional reactivity: classical conditioning - Response style (as a result of processing internal experience): experiential - Habit: operant conditioning - Unexamined structure: examining logicality, practicality, usefulness, etc. through dispute Behavioral economics: Responds in a way to avoid negative results
Implications Changes in cognitive structures Changes in irrational belief, schema, automatic thought, cognitive distortion belief Method - Becoming aware, confronting, breaking through emotional barriers: experiential, existentialism, dispute - Experiencing and becoming aware of problem formation mechanism: awareness, insight - Experiencing new situations through relationship experience: object relations/attachment theories - Reducing emotional reactivity: classical conditioning - Forming new behavioral habits: operant conditioning
Implications CT/Schema therapy REBT : emotional techniques Past me CT Schema therapy Present me CT/Schema therapy REBT : Cognitive and behavioral techniques
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