Wk 8: behavioural therapy and CBT

  1. Where do emotions come from?
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  2. Difference between positive and helpful thinking
    • Positive thinking can still be delusional or incorrect
    • ▪ Positive thinking can be a form of denial
    • ▪ Positive thinking can sometimes lead to bad outcomes
    • ▪ Positive thinking can sometimes be UNHELPFUL thinking
    • ▪ Positive thinking is pleasurable, but that doesn’t mean it’s good for us

    • Helpful thoughts: are those that are likely to be accurate and allow us to feel and behave in a way we want to
    • Instead using the terminology “positive or negative thoughts”, it is better to use “helpful” and “unhelpful” (though Ellis called them “rational” versus “irrational”)
  3. Behaviour therapy
    • Originated 1950 and 1960w
    • Radical departure from the previous theories.
    • Skinner, Bandura and Lazarus are prominent ‘behaviourists’ and forged the pathway to show that altering our behaviour with specific behavioural techniques was an alternative to psychoanalysis.
    • ▪ Great deal of emphasis on empirical evidence
    • Behaviour is something that can be operationally defined; it includes overt actions as well as internal processes such as cognitions, images, beliefs, and emotions.
    • Change can take place without insight into underlying dynamics and the origins of a psychological problem.
    • Behaviourists ask: “What treatment, by whom, is the most effective for this individual with that specific problem and under which set of circumstances?”
  4. Skinner
    • No emphasis at all on feelings, emotions; rather a heavy emphasis on one’s environment. Denied that they caused behaviour.
    • Emotions like toothache.
    • Focusing on what environmental facts occurred that produced these feelings.
  5. Albert bandura
    • Social learning theory
    • Combining classical and operant conditioning with observational learning.
    • Wrote extensively about 'self-efficacy'- whether the person is an effective person.
    • Bobo doll experiment
    • Gained a lot more cognitive and emotional insight
  6. Classical and Operant conditioning
    BT assumes that behaviour is learnt from the environment and symptoms are acquired through classical conditioning and operant conditioning
  7. BT techniques
    • Flooding
    • – Exposure and response prevention
    • – Systematic desensitization
    • – Virtual reality
    • – Aversion therapy
  8. Third wave of BT
    • Newest developments this century include:
    • ▪ Dialectical Behaviour Therapy (DBT): intensive, long, 
    • ▪ Mindfulness-based stress reduction (MBSR)
    • ▪ Acceptance and Commitment Therapy (ACT)
  9. CBT vs BT
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  10. CBT
    • Distinction is very fine between CBT and BT
    • ▪ CBT is the most widely used type of psychological practice
    • ▪ It’s brief, cost-effective, evidence-based, collaborative, overt, accessible
    • ▪ In reality CBT is a movement that doesn’t distinguish between particular theorists
  11. Albert Ellis (REBT)
    View of human nature
    First influential CBT developer

    • “People disturb themselves as a result of the rigid and extreme beliefs they hold about events more than the event themselves.”
    • ▪ We are born with a potential for both rational and irrational thinking
    • ▪ We have the biological and cultural tendency to think crookedly and to needlessly disturb ourselves- propensities for self-destruction
    • ▪ We learn and invent disturbing beliefs and keep ourselves disturbed through our self-talk
    • ▪ We have the capacity to change our cognitive, emotive, and behavioural processes
  12. REBT: an educational process
    • Clients learn: 
    • To identify the interplay of their thoughts, feelings and behaviours
    • – To identify and dispute irrational beliefs that are maintained by self-indoctrination
    • – To replace ineffective ways of thinking with effective and rational cognitions
    • – To stop absolutistic thinking, blaming, and repeating false beliefs
  13. REBT
    • Stresses thinking, judging, deciding, analyzing, and doing
    • ▪ Assumes that cognitions, emotions, and behaviors interact and have a reciprocal cause-and-effect relationship
    • ▪ Is highly didactic, very directive, and concerned as much with thinking as with feeling
    • ▪ Teaches that our emotions stem mainly from our beliefs, evaluations, interpretations, and reactions to life situations
  14. ABC theory in REBT
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  15. Beck's cognitive therapy
    • A lot of focus on depression, Beck developed CT at same time as Ellis REBT yet independently
    • Time-limited, directive, present-centred, empirical, structured, problem-oriented, collaborative
    • ▪ Emphasis on homework and explicit detail and identification of specific problems
    • ▪ Strong psych-educational focus
    • Recognising and changing maladaptive beliefs
  16. CT Theoretical assumptions
    • 1. That our internal communication is accessible to introspection
    • 2. That our beliefs are highly personally meaningful
    • 3. These meanings can be discovered by the client and not taught by the therapist
  17. Principles of CT
    • Automatic thoughts- mostly negative and mostly contrary to objective evidence
    • Core beliefs set views about self, world, future
    • Cognitive distortions or errors - distort objective reality e.g. arbitrary inferences - conclusions without support or evidence, or selective abstraction (forming opinion based on an isolated detail of an event) e.g. school report with 8
    • A’s and 1 D…focus on the D!
    • ▪ Magnification (catastrophising)
  18. Maladaptive thought processes/ cognitive distortion
    • They are automatic and not innately true
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  19. Beck's cognitive triad (core beliefs)
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  20. Irrational Belief and the Rational Alternative
    • It’s easier to put off something difficult or unpleasant than it is to face up to it.
    • Facing difficult situations will make me feel bad at the time, but I can cope with that. Putting off problems does not make them any easier, it just gives me longer to worry about them.
  21. Key phrases indicating irrational beliefs
    may follow
    • I must (get what I want)
    • ▪ I should (always be right)
    • ▪ I never (get what I deserve)
    • ▪ I always (get treated badly)
    • ▪ Its not fair (I never win)
    • ▪ Why me (I always lose)
    • ▪ Things are really good/bad (black/white)
  22. CBT for insomnia
    • Based on challenging irrational beliefs about sleep and associated problems:
    • Didactic focus
    • ▪ Paradoxical intention
    • ▪ Cognitive restructuring
  23. CBT overview
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  24. Summary
    • CBT is a present moment, targeted treatment aimed at resolving specific difficulties
    • ▪ CBT aims to change thoughts, because thoughts cause feelings
    • ▪ Helpful thoughts are not just positive thoughts
    • ▪ ACT protects people from painful thoughts, but does not seek to change the thoughts
  25. Donald Meichenbaum’s Cognitive Behavior Modification
    • focuses on changing the client’s self-talk.
    • self-statements affect a person’s behavior in much the same way as statements made by another person.
    • A 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.
    • Meichenbaum suggests that it may be easier and more effective to change our behavior rather than our thinking.
    • The therapeutic process consists of teaching clients to make self-statements and training clients to modify the instructions they give to themselves so that they can cope more effectively with the problems they encounter.
    • He describes cognitive structure as the organizing aspect of thinking, which monitors and directs the choice of thoughts through an “executive processor” that “holds the blueprints of thinking” that determines when to continue, interrupt, or change thinking.
    • The emphasis is on acquiring practical coping skills for problematic situations such as impulsive and aggressive behavior, anxiety in social situations, fear of taking tests, eating problems, and fear of public speaking.
  26. How behaviour changes CBM
    • Phase 1: Self-observation. Clients learning how to observe their own behavior. 
    • must first realize that they are not “victims” of negative thoughts and feelings. Rather, they are actually contributing to their depression through the things they tell themselves.
    • Although self-observation is necessary if change is to occur, it is not sufficient for change.
    • Phase 2: Starting a new internal dialogue. clients learn to notice their maladaptive behaviors, and they begin to see opportunities for adaptive behavioral alternatives.
    • In therapy, clients learn to change their internal dialogue, which serves as a guide to new behavior.
    • Phase 3: Learning new skills. 
    • Clients learn to interrupt the downward spiral of thinking, feeling, and behaving, and the therapist teaches clients more adaptive ways of coping using the resources they bring to therapy
  27. Stress inoculation training
    • A particular application of a coping skills program is teaching clients stress management techniques by way of a strategy known as stress inoculation training (SIT).
    • Individuals are given opportunities to deal with relatively mild stress stimuli in successful ways, and they gradually develop a tolerance for stronger stimuli.
    • This training is based on the assumption that we can affect our ability to cope with stress by modifying our beliefs and self-statements about our performance in stressful situations.
    • Stress inoculation training is a combination of information giving, Socratic discovery-oriented inquiry, cognitive restructuring, problem solving, relaxation training, behavioral rehearsals, self-monitoring, self-instruction, self-reinforcement, and modifying environmental situations.
    • Clients are assisted in generalizing what they have learned so they can use these skills in daily living, and relapse prevention strategies are taught.
    • Clients can acquire more effective strategies in dealing with stressful situations by learning how to modify their cognitive “set,” or core beliefs. 

    • The following procedures are designed to teach these coping skills:
    • Expose clients to anxiety-provoking situations by means of role playing and imageryRequire clients to evaluate their anxiety levelTeach clients to become aware of the anxiety-provoking cognitions they experience in stressful situationsHelp clients examine these thoughts by reevaluating their self-statementsHave clients note the level of anxiety following this reevaluation
  28. The Phases of Stress Inoculation Training
    • Meichenbaum (2007, 2008) has designed a three-stage model for stress inoculation training:
    • (1) the conceptual-educational phase: the primary focus is on creating a therapeutic alliance with clients.
    • Training includes teaching clients to become aware of their own role in creating their stress and their life stories.

    • (2) the skills acquisition and consolidation phase: focus is on giving clients a variety of behavioral and cognitive coping skills to apply to stressful situations.
    • 3) 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 taught at this stage.
    • Clients learn to view any lapses that occur as “learning opportunities” rather than as “catastrophic failures.”

    linical applications of SIT are individually tailored to specific target populations and include anger control, pain control, anxiety management, assertion training, improving creative thinking, treating depression, dealing with health problems, and preparing for surgery. Stress inoculation training has been employed with medical patients and with psychiatric patients
  29. A Cognitive Narrative Approach to Cognitive Behavior Therapy
    • Meichenbaum (2015) has embraced a cognitive narrative perspective
    • which focuses on the plots, characters, and themes in the stories people tell about themselves and others regarding significant events in their lives.
    • He uses a Socratic discovery-oriented approach and the art of questioning to assist clients in reaching their goals.

    In successful therapy clients develop their own voices, take pride in what they have accomplished, and take ownership of the changes they are bringing about. In short, clients become their own therapists and take the therapist’s voice with them.
Card Set
Wk 8: behavioural therapy and CBT
Wk 8: behavioural therapy and CBT ▪ Appreciate that CBT is based on behavioural principles ▪ Know the mechanism by which CBT resolves problems and differentiate it from “positive thinking” ▪ Articulate the therapeutic goals of CBT ▪ Understand Ellis’ REBT and Beck’s cognitive therapy ▪ Contrast CBT with other approaches