Cognitive Behavior and Reality Therapy

Cognitive Behavior Therapy

Key Figures:

 A.T. Beck (1921) founder which gives a primary role to thinking as it influences behavior.

Judith Beck (1954) continues to develop Cognitive Behavior Therapy.

Donald Meichenbaum (1940) is a prominent contributor tho the development of Cognitive Behavior Therapy.

Albert Ellis (1913 - 2007), founded rational emotive behavior therapy, a highly didactic, cognitive, action-oriented model of therapy that stresses the role of thinking and belief systems as the root of all personal problems.

Albert Ellis's Rational Emotive Behavior Therapy (REBT)

1. Basic Philosophy:

• REBT was the first cognitive behavior therapies, and today it continues to be a major cognitive behavioral approach. 
• REBT has a lot in common with the therapies that are oriented toward cognition and behavior as it also stresses thinking, judging,, deciding, analyzing and doing.
• The basic assumption of REBT is that people contribute to their own psychological problems, as well as to specific symptoms, by the rigid and extreme beliefs they hold about events and situations.
• REBT is based on the assumption that cognition's, emotions, and behaviors interact significantly and have a cause and effect relationship.
• REBT has consistently emphasized all three of these modalities and their interactions, thus qualifying it as an integrative approach.

   2. Key Concepts

               View of Human Nature

• REBT is based on the assumption that human beings are born with a potential for both rational and irrational thinking.
• People have the predisposition for self-preservation, happiness, thinking and verbalizing, loving, communication with others, and growth and self actualization.
• They also have propensities for self-destruction, avoidance of thought, procrastination, endless repetition of mistakes, superstition, intolerance, perfectionism and self-blame, and avoidance of actualizing growth potentials.
• REBT encourages people to accept themselves even though they will make mistakes.

View of Emotional Disturbance

REBT is based on the premise that we learn irrational beliefs from significant others during childhood and then re-create these irrational beliefs throughout our lifetime.

• Ellis insists that blame is at the core of most emotional disturbances. If we want to become psychologically healthy, we had better stop blaming ourselves and others and learn to fully and unconditionally accept ourselves despite our imperfections.
• Ellis hypothesizes that we have strong tendencies to transform our desires and preferences into dogmatic "shoulds," "musts," and "oughts," demands, and commands.
• When we are disturbed, it is a good idea to look to our hidden "musts" and "shoulds".  Such demands underpin disruptive feelings and dysfunctional behaviors.

Examples of "musts"

1.  "I must do well and win the approval of others for my performances or else I am no good"
2. "Other people must treat me considerately, fairly, 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 or punished."
3. "I must get what I want, when I want it; and I must not get what I don't want.  If I don't get what I want, it's terrible, I can't stand it, and life is no good for depriving me of what I must have."

A-B-C Framework:

It is central to REBT theory and practice.  This model provides a useful tool for understanding the client's feelings, thoughts, events and behavior.

A (Activating event) << B (belief) >> C (emotional and behavioral consequence)

                                                              ^

                                                              ^

D (disputing intervention) >> E (effect) >> F (new feeling)

Cognitive Restructuring: a central technique of cognitive therapy that teaches people how to improve themselves by replacing irrational beliefs with rational ones.

Restructuring to change our dysfunctional personality involves these steps:

1. fully acknowledging that we are largely responsible for crating our own emotional problems
2. accepting the notion that we have the ability to change these disturbances significantly
3. recognizing that our emotional problems are largely stem from irrational beliefs
4. clearly perceiving these beliefs
5. seeing the value of disputing such self-defeating beliefs
6. accepting the fact that if we expect to change we had better work hard in emotive and behavioral ways to counteract our beliefs and the dysfunctional feelings and actions that follow
7. understanding what the irrational alternative to these irrational beliefs are
8. practicing REBT methods of uprooting or changing disturbed consequences and practicing their healthy alternatives for the rest of our lives

3.  Therapeutic Process:

• We have a strong tendency not only to rate our acts and behaviors as good or bad, worthy or unworthy, but also to rate ourselves as a total person on the basis of our performances.
• The goals of REBT are to assist clients in the process of achieving unconditional self-acceptance and unconditional other acceptance and to see how these are interrelated.  as clients become more able to accept themselves, they are more likely to unconditionally accept others.

 4.  Therapeutic Techniques:

• Cognitive Methods:

1. Disputing irrational beliefs
2. Doing cognitive homework
3. Bibliotherapy
4. Changing one's language
5. Psychoeducational methods

• Emotive Techniques:

1. Using humor
2. Role playing
3. Shame-attacking exercises

• Behavioral Techniques :

Counselors use most of the standard behavior therapy procedures, especially operant conditioning, self-managment priciples, systematic desensitization, relaxation techniques, and modeling.

AAron Beck's Cognitive Therapy (CT):

1. Key Concepts

• CT perceives psychological problems as stemming from commonplace processes such as faulty thinking making incorrect inferences on the basis of inadequate or incorrect information, and failing to distinguish between fantasy and reality.
• Like REBT, CT is an insight-focused therapy with a strong psychoeducational component that emphasizes recognizing and changing unrealistic negative thoughts and maladaptive beliefs.
• 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.

      2.  Basic Principles:

• Beck discovered that clients exhibited a negative bias in their interpretation of thinking.
• Individuals tend to maintain their core beliefs about themselves, their world, and their future.
• He contends that people with emotional difficulties tend to commit characteristic logical errors that distort objective reality.



                     Cognitive Distortions:

1. Arbitrary inferences: making conclusions without supporting and relevant evidence.
2. Selective abstraction: consists of forming conclusions based on an isolated detail of an event.
3. Overgeneralization: a process of holding extreme beliefs on the basis of a single incident and applying them inappropriately to dissimilar events or settings.
4. Magnification and minimization: consists of perceiving a case or situation in a greater or lesser light than it truly deserves.
5. Personalization: is a tendency for individuals to relate external events to themselves, even when there is no basis for making this connection.
6. Labeling and mislabeling: involves portraying one's identity on the basis of imperfections and mistakes made in the past and allowing them to define one's true identity.
7. Dichotomous thinking: involves categorizing experiences in either-or extremes

    3.  Therapeutic Process and Techniques

• The aim is to identify specific, measurable goals and to move directly into the areas that are causing the most difficulty for clients.
• Therapist aim to teach clients how to be their own therapist.
• A therapist will educate clients about the nature and cause of their problem, about the process of cognitive therapy, and how much thoughts influence their emotions and behavior.

    4.  Applications of Cognitive Therapy

• treatment of depression
• family therapy

Donald Meichenbaums's Cognitive Behavior Modification (CBM)

1. Key concepts and philosophy:

• focuses on changing the client's self-verbalization.
• combines some of the best elements of behavior therapy and cognitive therapy.
• Self-statements affect a person's behavior in much the same way as statements made by another person.
• The basic premise of CBM is that clients, as a prerequisite to behavior change, must notice how they think feel, and behave and the impact they have on others.
• For change to occur, clients need to interrupt the scripted nature of their behavior so that they can evaluate their behavior in various situations.

      2.  Therapeutic Process - How Behavior Changes and Techniques

• Phase 1.  Self-observation: the beginning step in the change process consists of clients learning how to observe their own behavior
• Phase 2. Starting a new internal dialogue: As a result of early client-therapist contacts, clients learn to notice their maladaptive behaviors, and they begin to see opportunities for adaptive behavioral alternatives
• Phase 3: Learning new skills:  The third phase of the modification process consists of helping clients interrupt the downward spiral of thinking, feeling, and behaving  and teaching them more adaptive ways of coping using the resources they bring to therapy.  Clients learn more effective coping skills, which are practiced in real-life situations.

Stress Inoculation Training: is one application of a coping skills program and teaches clients stress management techniques by way of a strategy known as stress inoculation training (SIT).

• Exposes clients to anxiety-provoking situations by means of role playing and imagery
• Requires clients to evaluate their level of anxiety
• Teaches clients to become aware of the anxiety-provoking cognition's they experience in stressful situations.
• Helps clients examine these thoughts by reevaluating their self-statements.
• Has clients note the level of anxiety following this reevaluation.
• Phases of stress inoculation training:
• conceptual-education phase - the primary focus is on creating a working relationship and therapeutic alliance with clients and guided self-discovery.
• skills acquisition and consolidation phase - the focus is on giving clients a variety of behavioral and cognitive coping skills to apply to stressful situations. This phase involves direct actions.
• How can I prepare for a stressor?
• How can I confront and deal with what is stressing me?
• How can I cope with feeling overwhelmed?
• how can I make reinforcing self-statements?
• application and follow-through phase - the focus is on carefully arranging for transfer and maintenance of change from the therapeutic situation to everyday life.
• Relapse prevention - consits of procedures for dealing with the inevitable setbacks clients are likely to experience as they apply what they are learning to daily life.

Corey, Gerald (2013). Theory and Practice of Counseling and Psychotherapy (9^thed.). Belmont, CA:Brooks/Cole, Cengage Learning .

Reality Therapy

Founder:  William Glasser

Key Figure:  Robert Wubbolding

Reality Therapy is a short-term approach based on choice theory and focuses on the client assuming responsibility in the present.  Through the therapeutic process, the client is able to learn more effective ways of meeting her or his needs.

1. Key Concepts:

• View of  Human Nature
• Choice Theory states that we are not born blank slates waiting to be externally motivated by forces in the world around us.  Rather, we are born with five genetically encoded needs that drive us all our lives.  Each of us have all five, but they vary in strength.
• Survival or self-preservation
• Love and belonging
• Power or inner control
• Freedom or independence
• Fun or enjoyment
• We store information inside our minds and build a file of wants called our quality world which is the core of our life.
• Our quality life would look like a picture album that we have developed of our wants as well as ways to satisfy those wants.
• Choice Theory Explanation of Behavior
• Choice Theory explains that all we ever do from birth to death is behave and, with rare exceptions, everything we do is chosen.
• Total behavior teaches that all behavior is made up of four inseparable but distinct components.
• acting
• thinking
• feeling
• physiology
• Choice Theory emphasizes thinking and acting, which makes this a general form of cognitive behavior therapy.
• Characteristics of Reality Therapy
• Emphasize choice and responsibility - If we choose all we do, we must be responsible for what we choose.
• Reject transference - By being themselves, therapists can use the relationship to teach clients how to relate to others in their lives.
• Keep the therapy present - Whatever mistakes were made in the past are not pertinent now. To function effectively, people need to live a plan in the present and take steps to create a better future. We can only satisfy our needs in the present.
• Avoid focusing on symptoms - People who have symptoms believe that if they could only be symptom-free they would find happiness.
• Challenging traditional views of mental illness - Choice theory rejects the traditional notion that people with problematic physical and psychological symptoms are mentally ill, but Glasser has warned people to be cautious of psychiatry, which can be hazardous to both one's physical and mental health.
• Therapeutic Goals
• A primary goal of reality therapy is to help clients get connected or reconnected with the people they have chosen to put in their quality world.  And to fulfill this need for love and belonging including  achievement, power or inner control, freedom or independence, and fun.  The basic human needs serve to focus treatment planning and setting both short-and long-term goals.  Reality therapists assist clients in making more effective and responsible choices related to their wants and needs.
• Therapeutic Techniques
• Can be conceptualized as the cycle of counseling
• Creating the counseling environment
• A supportive and challenging environment allows clients to begin making life changes.
• The therapeutic relationship is the foundation for effective practice; if this is lacking, there is little hope that the system can be successfully implemented.
• Implementing specific procedures that lead to changes in behavior
• Reality therapists are convinced that we are motivated to change and that:
• When we are convinced that our present behavior is not meeting our needs
• When we believe we can choose other behaviors that will get us closer to what we want
• Reality therapists begin by asking the client what they want from therapy.
• When clients begin to realize that they can control only their behavior, therapy is under way
• The art of counseling is to weave these components together in ways that lead clients to evaluate their lives and decide to move in more effective directions.
• The "WDEP" System - Wubbolding
• Explores the wants, needs, and perceptions of the client
• The focus is on the present and what they are currently doing and where they what they are doing at the present time.
• Self-evaluation is the cornerstone of reality therapy procedures.
• Planning and action - what are your plans for getting what you want, and what are you going to do.
• In order for all this to work, the therapist must get the client to commit themselves to their plan. It is useful to have the clients put it in writing.


 Corey, Gerald (2013). Theory and Practice of Counseling and Psychotherapy (9^thed.). Belmont, CA:Brooks/Cole, Cengage Learning.