COGNITIVE THERAPY (CT), AARON T.

BECK
WHAT IS IT ABOUT:
Cognitive therapy (or cognitive
behavioural therapy) helps the
client to uncover and change
distortions of thought or
perceptions which may be
causing or prolonging
psychological distress.
PURPOSE:To treat patient with
depression, anxiety or panic
disorder, attention deficit-
hyperactivity disorder (ADHD),
eating disorders, mood
disorders, obsessive-
compulsive disorder (OCD),
personality disorders, post-
traumatic stress disorder
(PTSD),
CONCEPT:
CT is based on the principle that
maladaptive behavior
(ineffective, self-defeating
behavior) is triggered by
inappropriate or irrational
thinking patterns, called
automatic thoughts/insight
Instead of reacting to the reality
of a situation, an individual
automatically reacts to his or her
own distorted viewpoint of the
situation.
Cognitive therapy focuses on
changing these thought patterns
(also known as cognitive
distortions), by examining the
rationality and validity of the
assumptions behind them. This
process is termed cognitive
restructuring.

Treatment techniques:
Validity testing. The therapist asks the patient to defend his or her
thoughts and beliefs. If the patient cannot produce objective evidence
supporting his or her assumptions, the invalidity, or faulty nature, is
exposed.
Cognitive rehearsal. The patient is asked to imagine a difficult situation
he or she has encountered in the past, and then works with the therapist
to practice how to successfully cope with the problem. When the patient
is confronted with a similar situation again, the rehearsed behavior will
be drawn on to deal with it.
Guided discovery. The therapist asks the patient a series of questions
designed to guide the patient towards the discovery of his or her
cognitive distortions.
Journaling. Patients keep a detailed written diary of situations that arise
in everyday life, the thoughts and emotions surrounding them, and the
behavior that accompany them. The therapist and patient then review
the journal together to discover maladaptive thought patterns and how
these thoughts impact behavior.
Homework. In order to encourage self-discovery and reinforce insights
made in therapy, the therapist may ask the patient to do homework
assignments. These may include note-taking during the session,
journaling (see above), review of an audiotape of the patient session, or
reading books or articles appropriate to the therapy. They may also be
more behaviorally focused, applying a newly learned strategy or coping
mechanism to a situation, and then recording the results for the next
therapy session.
Modeling. Role-playing exercises allow the therapist to act out
appropriate reactions to different situations. The patient can then model
this behavior.


All-or-nothing thinking : You view a situation in strictly black or white terms, with
no shades of grey.
Since I didnt get an A, Ive failed. (You dont consider that a B is a good mark and
that a B does not equal an F.)
Selective Abstraction : You focus on one negative detail excluding the larger
picture.
Getting two problems wrong means that I dont know anything. (You ignore the
fact that you got 18 problems right).
Overgeneralisation : You make a sweeping negative conclusion that goes far
beyond the present situation.
Since I did poorly on this exam, Ill do poorly on the course and every other maths
course. (You are jumping to conclusions based on one small event and are
ignoring all your past accomplishments that dont support this view.
Fortune Telling : You predict the future negatively, usually catastrophizing, with
little or no basis.
Ill never make it as a mathematician. (You dont allow for other possibilities and
only consider the worst outcome).
Magnifying/Minimizing : You make the situation out to be much worse than it is
and/or you minimize your strengths and assets.
Getting a B is going to ruin my life. I dont have what it takes to succeed. (You
dont put the event in proper perspective or give yourself credit for other
achievements or attributes.
Labelling : You put a fixed, overgeneralized label on yourself or others based on
one or a few behaviours or performances.
Im stupid. (You equate one performance with stupidity. Even an F on a test
wouldnt necessarily mean youre completely stupid in every way.
Emotional Reasoning : You think something must be true because you believe it so
strongly.
Since I feel like such a failure, I must be one. (You ignore evidence that
challenges your view, relying on your feeling which is really just your belief).
Mind-reading : You believe you know what others are thinking and how they view
a situation.
The professor must think Im stupid. (You jump to conclusions, failing to consider
that your professor is probably considering the larger picture).
Personalization : You believe others are behaving the way they are because of
something you did.
The professor is ignoring me in class today because I disappointed him. (You
dont consider other possibilities for his behaviour. For example, perhaps he is
paying more attention to students who are asking questions or hes concentrating
on his notes.
Cognitive Distortions:
Cognitive disortions are negative
ways of thinking that are both
illogical (unsupported by evidence)
and harmful. They are harmful
because they lead to further
negative thoughts, beliefs, feelings
and behaviour.

STEPS TO TREAT CLIENT
Start of Therapy
goals for the treatment :assessment, giving the client an understanding of
cognitive therapy, and dealing with patients hopelessness. Assessment includes
administering the Becks Depression Inventory to measure the level of depression.
At this stage intervention is aimed at the clients hopelessness, and involves
working through some tasks that clients find difficult to attempt.
Middle Stage
During the middle stage, there is a shift from the client's symptoms more to his or
her pattern of thinking. There is also the emphasis is on clients reinforcing the
skills they learned in the early stages of therapy. For example, the clients use the
Daily Record of Dysfunctional Thoughts (DRDT) to keep records of situations,
thoughts and emotional reactions. The therapist reviews the DRDT with the client,
and helps him or her to see how he or she could attempt different analyses of his
or her automatic thoughts.
Final Stage
In the final stage of therapy, the therapist reviews the gains that have been made
by the client. At this time the therapist emphasizes the clients ability to handle
problems on his or her own, by placing more responsibility on the client for his or
her treatment. Another focus in this stage is the prevention of relapse, by helping
clients anticipate future events that could be challenging to cope with

Cognitive Techniques
Cognitive techniques are to change cognition, and this in turn will
change affect and behavior. Specific cognitive techniques include:
Decatastrophizing: This technique is also known as the "what if"
technique, and assist the clients to identify problem-solving
strategies to prepare them for the things they fear.
Reattribution: This helps clients to consider the alternative causes
of events in order to assign responsibility where it is due.
Redefining: This enables clients to move from from believing that
a problem is beyond their personal control.
Decentering: This helps anxious clients who feel that they are the
center of attention to examine the logic behind these thoughts.



WHAT IIS REBT?
Rational Emotive Behavior Therapy
(REBT) is a form of psychotherapy is
based on the theory that an
individuals beliefs affect her
emotions created by Albert Ellis in
the 1950's.
Concept: THEORY OF CAUSATION:
based on the premise that whenever
we become upset, it is not the events
taking place in our lives that upset
us; it is the beliefs that we hold that
cause us to become depressed,
anxious, enraged.
TECHNIQUES USED IN REBT
a) Cognitive Techniques
i) Rational analysis :Focussing on specific
incidents from CTs lives and
demonstratthe art of disputing the
irrational beliefs underlying their distress
ii) Double-standard dispute :If CTs are
holding a should or are self-downing
about theirbehaviour, ask them whether
they would recommend that their best
friend hold this same should or would
they assess their
Devils Advocate :CR argues vigorously
for irrational belief of CT while CT tries to
convince CR that belief is irrational.
Good to use for consolidation purposes.
TECHNIQUES USED IN REBT
. b) Emotive Techniques
Rational-emotive imagery :A form
of mental practice, according to
Corey, that allows a person to
imagine himself thinking, feeling
and behaving exactly the way he
would like to in actual life
Shame-attacking exercises:Aim of
these exercises is for CTs to feel
unashamed even when others
disapprove of their actions.
Example:as shouting out the stops
on a bus or train, wearing loud
clothes to attract attention, singing
at the top of their lungs

TECHNIQUES USED IN REBT
c) Behavioural Techniques
Exposure: lonely people go
out and talk to a dozen
people in their shopping
centre or at their next party
Stepping out of
character:This technique is
the use of a paradoxical
behaviour. a person who
doesnt care for himself
because he believes that to
be selfish would be invited
to indulge in a personal treat
each day for a week.

The role of counsellor in REBT:
Stage 1:
Develop a positive relationship by
showing empathy, listening,
creating a conducive environment.
Stage 2:
Guide the CT by using ABC model to
show their emotive and behavioural
behaviour.
Stage 3:
CL helps the clients to understand
the rational and irrational belief and
the cause of it.
Stage 4:
the CR helps the client to challenge
the irrational belief (B) from time to
time. The CR gives lots of exercise
so that the CL will be able to have
rationale thought.

FUNCTION OF REBT
it is largely our thinking about events
that leads to emotional and
behavioral upset.
Individuals are taught how to
examine and challenge their
irrational thinking which creates
unhealthy emotions and self-
defeating/self-sabotaging behaviors.

GOALS:
Helping your clients
understand that situations
dont create difficulties;
rather, the persons beliefs
and ensuing thoughts can
cause problems.
You can help your clients
realize that disasters dont
occur just because a desire
isnt met.
Teach them how to
appropriately respond to
different situations
Encourage them to accept
themselves and build a
tolerance of others as a
means to more fulfilling lives.

REBT
CR:Counsellor CL:Client

ABC MODEL

ABC MODEL example:
(The A) Event: This person is passed in the street by a friend who
doesnt acknowledge her.
Beliefs about A:
(The B) 1. I could end up without any friends and that would be
terrible!
2. For me to be happy and feel worthwhile, people must like me.
3. Im unacceptable as a friend so I must be worthless as a person.
(The C) Feelings: lonely, depressed. Behaviours: avoiding people
generally.
I must do well and win the
approval of others for my
performances or else I am no
good.(leads to anxiety,
depression, shame, and guilt)
Other people must treat me
considerately, fairly and kindly,
and in exactly the way I want
them to treat me. If they don't,
they are no good and they
deserve to be condemned and
punished.( leads to rage,
passive-aggression and acts of
violence)
I must get what I want, when I
want it; and I must not get
what I don't want. It's terrible
if I don't get what I want, and I
can't stand it.( leads to self-
pity and procrastination)
HELPING PEOPLE CHANGE: (D E F)
The goal of REBT is to help people change
their irrational beliefs into rational beliefs
Disputing:
The essence of the change process is the
DISPUTING of the validity of the core
beliefs that the CT holds (D). CL lead the
client through imaginal disputation,
asking her to come up with more positive
self-talk:
Is this statement/idea/belief true?
Is it healthy?
Is it helpful?
Is it realistic?
Is it logical?
Effect:
Successful disputation, whether by
CR or by (ultimately) CT, leads to a
new EFFECT (E).

Feeling:
This E leads to a new, more
appropriate FEELING (F).

3 types of Belief lead to
irrational thinking
DISADVANTAGES:
1) Harsh on patients. REBT has always drawn criticism from
counselors as being harsh. Ellis even said that a caring
relationship does not need to exist for REBT to work.
2) When working in schools, REBT can be very difficult because
often times students lack the emotional or cognitive levels
needed for this to be successful.
3) Another disadvantage is that the client needs to be willing to
work on their problem. Often time's, REBT requires the use of
homework so if the client is not willing to even work on it during
the session, its a sure bet that they will not do any type of
homework.
4) Some emotional techniques are forceful and degrading.
Activities like shame-attacking exercises can be difficult for the
client to enjoy and really understand the purpose and whether is
worth it.
5) People with a low frustration tolerance level will struggle.
*REBT is just like other theories, you have to choose your patients
wisely because it will not always be effective.