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Systems of Psychotherapy COGNITIVE THERAPIES

A SKETCH OF ALBERT ELLIS

Albert Ellis (1913-2007): changed the scene of psychotherapy


1957 demonstrated innovative system at annual convention of American Psychological Assn.
confrontational, charismatic, prolific
Get over it. No one ever died from a panic attack.
Established Institute for Rational Emotive Therapy in New York City
directive therapist, did not mince words
tribes to convince people to use their cognitive processes to create a life that maximizes
pleasure and minimizes pain of existence
Rational-Emotive Behavior Therapy (REBT) = original name, Rational Emotive Therapy (RET)

REBT THEORY OF PERSONALITY

we make ourselves emotionally healthy or absent by the way we think, not environment
activating events are not crucial, rather perceptions and interpretations of the events
ABC (not AC):
o Activating events, such as rejection or failure
o Beliefs, rational or irrational, that people use to process activating events in life
o Consequences, emotional and behavioral
we can avoid emotional disturbance if we base our lives on logic and empiricism to test our
assumptions and develop a more effective construction of reality
we must realize that the world is not always fair, and that unfortunate events will occur
hedonism = immediate gratification at the expense of lessening our aliveness

REBT THEORY OF PSYCHOPATHOLOGY

psychopathology occurs when a rational beliefs cause emotional consequences


ABC model of human functioning = in emotional disturbances, activating events are always
processed or some irrational belief, such as:
o I believe I need something which in fact, I only prefer
o I cannot tolerate certain events
o my worth as a person is determined by my successes/failures/traits
o I must maintain the approval of authority figures
o the world should treat me fairly and conform to my wishes
o certain people are we kidding and should be punished
o it is terrible when things do not turn out the way I want them to
o harmful things such as cigarettes or drugs can add happiness to my one
o happiness is externally caused; I have little/no ability to control my feelings
o my past history is all-important in determining present behavior
o police learned in childhood can serve as adequate guides for adulthood, even if they are
prejudice/myth

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Systems of Psychotherapy COGNITIVE THERAPIES

common to all irrational beliefs childish/demanding/absolute mode of thinking


irrational beliefs (ibs) or dysfunctional attitudes (DAs) = self-disturbing philosophies
o rigid/dogmatic/powerful demands, usually expressed w/ must, should, ought to, had to, etc.
o musturbatory thinking = I absolutely must have.
o catastrophizing = highly unrealistic/overgeneralized attributions; If I cant have____, I cant
bear it, Im worthless, Ill never get what I want
emotions frequently interfere with performance
when anxietymore anxiety, or depressionmore depression, the original, inappropriate
consequence itself becomes an activating event

REBT THERAPEUTIC PROCESSES

the proper route to changing distressing consequences lies in directly modifying beliefs
ABCDE:
o Activating events, such as rejection or failure
o Beliefs, rational or irrational, that people use to process activating events in life
o Consequences, emotional and behavioral
o Disputing of irrational beliefs
o Effective New Philosophy = sound, rational set preferential believes

CONSCIOUSNESS-RAISING

Clients work = student; become aware of irrational thinking patterns, believe that they have
the human potential to be rational
Therapists work = use a variety of cognitive/emotive/behavioral techniques (interpretation,
confrontations, etc.)to teach clients to distinguish between mature, logical and careful thought
and irrational, unreasonable foolishness
o refutation = point out inherent contradictions between beliefs and actions
o counter conditioning = replace irrational thinking with rational thinking

CONTINGENCY MANAGEMENT

contingency management = rearranging reinforcements to support behavior change

COUNTERCONDITIONING

counterconditioning = inhibiting unhealthy behaviors; embracing rational beliefs interferes with


holding irrational believes
PYA (push your ass) = one of REBTs main rules

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Systems of Psychotherapy COGNITIVE THERAPIES

REBT THERAPEUTIC CONTENT

INTRAPERSONAL CONFLICTS

anxiety = an inappropriate consequence of irrational beliefs; cannot be extinguished by


desensitization, but by disputing irrational thoughts client has about stimulus events. (306)
defense mechanisms = examples of human irrational propensities that must be challenged
self-esteem: we can never prove our worth as human beings
o unconditional self acceptance = the key to being a natural, logical member of our own team
o self-acceptance = by contrast, is a logical/justifiable state; when we finally accept ourselves
unconditionally, we can give up the elusive search for self-esteem and free up energy for the
meaningful question of how we can most enjoy life
responsibility = you are responsible for how you allow the past to impact the present
o tyranny of the should = example: blaming others; You shouldnt have been so ____

INTERPERSONAL CONFLICTS

intimacy and sexuality: love and intimacy are desirable but not necessary for human existence;
as soon as we define love as an absolute necessity, we become anxious, demanding, dependent
communication: most communication problems are really thinking problems
hostility = the irrational consequence of
o an inborn, biological tendency to become aggressive
o some unpleasant or frustrating event
o a tendency to think crookedly about the event and the persistent refusal to work against
this crooked tendency
control: desire to control others is an expression of the irrational demand that the world
conform to my wishes

INDIVIDUO-SOCIAL CONFLICTS

adjustment v. transcendence = fighting inevitable hypertension, anxiety, anger, depression


impulse control: impulses can turn desires to self-destructive demands

BEYOND CONFLICT TO FULFILLMENT

meaning in life: we cannot find absolute meaning in life; no absolutes except those we create
ideal individual: the scientist is an excellent ideal because scientists are committed to a rational
life, to applying logic/criticism to solving problems
ask yourself: which is most important to change? thoughts, feelings, or beliefs?

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REBT THERAPEUTIC RELATIONSHIP

therapeutic relationship = seen primarily as a precondition for effective treatment, education


therapist provides unconditional support
full acceptance of the client as a human being does not mean that the therapist must
demonstrate warmth or liking
self-disclosure is common; REBT therapists are more willing than most to reveal their own in
order to dispute the clients irrational belief that anyone can be more than human
Ellis: forceful, debating style is often necessary

A SKETCH OF AARON BECK

Aaron Beck (1921 - ) pioneered cognitive therapy from psychoanalytic origins


taught patience to examine and test their negative ideas
Cognitive Therapy (CT) = Becks system of psychotherapy, heavily rooted in empiricism
developed Beck Depression Inventory, Beck Anxiety Inventory, Scale for Suicide Ideation
developed cognitive therapy independent from Ellis, but with many similarities:
o both originally trained in psychoanalysis, emigrated to cognitive psychotherapy
o help clients
become conscious of maladaptive cognitions
recognize disruptive impact of such cognitions
replace maladaptive cognitions with more appropriate, adaptive thought patterns
o eclectic in technique selection
o imperical in theory revision
o problem oriented, directive, psychoeducational
o view homework as a central/indispensable feature of treatment
o committed to bringing self-help resources to clients and public
CT compared to REBT
o emphasizes more empiricism
o relies more on evidence than philosophy
o more structured
o less confrontational

COGNITIVE THEORY OF PSYCHOPATHOLOGY

Beck/Ellis vocabulary differs


o Ellis: irrational beliefs
o Beck: maladaptive cognitions, dysfunctional attitudes, depressogenic assumptions
Becks cognitive therapy (primary focus) = (313) Beck and Ellis share the goal of helping clients
to become conscious of maladaptive cognitions, recognize the disruptive impact of such
cognitions, and to replace them with more appropriate and adaptive thought patterns.

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Systems of Psychotherapy COGNITIVE THERAPIES

Depressogenic (depression-causing) Assumptions: (Beck) (314, Table 10.1)


o Dichotomous Thinking = (314) Everything is either one extreme or another (black or white,
good or bad). Ex: Its all hopeless, there is nothing salvageable from the business.
o Selective Abstraction = (313) The only events that matter are the failures, which are the
sole measures of myself. Ex: All I can think about is this failure. What else is there to life?
o Overgeneralizing = (313) If its true in one situation, it applies to any situation that is even
remotely similar. Ex: Ill never be able to run a successful company.
o Self-Referencing = (314) I am at the center of everyones attention, particularly when I fail at
something. Ex: All our friends know I screwed up; theyre laughing at me behind my back.
o Excessive Responsibility = (313) I am responsible for all bad things, rotten events, and life
failures. Ex: Its all my fault. I should have worked harder, not taken those two weeks of
vacation that year, never purchased that expensive computer.
psychopathology originates in the client preconscious or pre-attentive constructions of reality
schemas = underlying cognitive organization
dysfunctional beliefs are not irrational, per se, but too absolute or broad
content specificity hypothesis = underlying cognitions are assumed to very specifically with
behavioral disorders; each disorder has a specific cognitive content
Cognitive Triad = (314) (Beck) depression has three themes:
o events are interpreted negatively
o depressed individuals dislike themselves
o the future is viewed negatively

COGNITIVE THERAPEUTIC PROCESSES

stages in correcting faulty cognition: identify problematic schema and remediation


o become aware of thinking o substitute accurate for inaccurate judgments
o recognize the rational thought o decide whether changes are correct
differences between Cognitive Therapy and REBT:
o CT emphasizes empiricism more than REBT; clients encouraged to see beliefs as hypotheses
o CT encourages reliance on evidence to alter believes; REBT philosophical conversion based
on rationality and logic
o CT more structured and precise than REBT; adheres to disorder-specific treatment manuals;
structure encourages problem orientation, discourages wasting time, provides client with
therapeutic rationale/direct you
activity scheduling = specific daily activities selected/evaluated strictly by how effectively they
elevate mood; after symptoms begin to lift, treatment focus shifts to underlying cognitions
cognitive restructuring = modifying the thinking process; natural adjunct to medicine/healing;
three approaches:
o What is the evidence?
o What is another way of looking at it?
o So what if it happens?
dichotomous thinking = all or nothing

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Systems of Psychotherapy COGNITIVE THERAPIES

distancing = learning to deal with that setting thoughts objectively, reevaluating them rather
than automatically accepting them
disattribution technique = clients disabuse themselves of the belief that they are entirely
responsible for their flight

COGNITIVE THERAPEUTIC RELATIONSHIP

Socratic dialogue = clients make personal discoveries by a tactful progression of questions ( in


contrast to Elliss direct confrontational style)
collaborative empiricism = client is active partner; participants share goal of determining from
evidence they gather which thoughts are dysfunctional and which solutions might help
therapist provides support/direction; tries to be empathetic/warm, but does not view empathy
as necessary/sufficient; ideal therapist support engenders responsible dependency in a client

PRACTICALITIES OF COGNITIVE THERAPIES

brief treatment: 1-20 sessions w/most clients; 12-16 sessions spaced further as client recovers
50 minutes (90 for groups) weekly
homework, bibliotherapy expected
training is widely available

MAJOR ALTERNATIVE: MINDFULNESS/ACCEPTANCE THERAPIES

third wave of CT therapy = incorporates mindfulness and acceptance into standard cognitive
behavioral therapies; adds an Eastern or Buddhist twist to Western psychotherapy
Buddhism explains how suffering can be avoided: accept it
instead of relentlessly trying to change we dont like, we can learn to accept
third wave therapists train patients in meditation and mindfulness
Acceptance and Commitment Therapy (ACT) = clients first learned acceptance/mindfulness
skills, then discover/commit to what gives meaning to their life
third wave therapies remain controversy

EFFECTIVENESS OF COGNITIVE THERAPIES

most therapy really takes place outside therapists office

RATIONAL-EMOTIVE BEHAVIORAL THERAPY (REBT)

superior to placebo and to no treatment


equally effective to other cognitive and behavioral treatments

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Systems of Psychotherapy COGNITIVE THERAPIES

COGNITIVE THERAPY (CT)

the most actively researched systems of psychotherapy over the past decade
as effective or more effective than other treatments for depression, anxiety, panic, PTSD, eating
disorders, and chronic pain
depression
o investigator allegiance = researchers tend to be biased in favor of their own views
anxiety disorders
social phobia
panic disorder
o panic control therapy (PCT) = includes elements of cognitive therapy, behavior therapy, and
exposure therapy
posttraumatic stress disorder
eating disorders
o intent-to-treat analysis = patients who started therapy but dropped out
chronic pain
body dysmorphic disorder
personality disorders
psychotic disorders
marital and group therapy
domestic violence
homework assignments: produce greater outcomes than psychotherapy entirely consisting of in-
session work
differential response

FUTURE DIRECTIONS

cognitive behavioral therapies are the fastest-growing, most heavily-researched systems of


psychotherapy
Elliss theories are declining; Becks theories are increasing
cognitive analytic therapy (CAT) = integration of cognitive with psychoanalytic therapy
becoming more applicable to more disabling conditions such as bipolar disorder, schizophrenia,
and personality disorders
it is premature to predict whether the third wave will make a lasting impression

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