认知疗法29930

1、Theory and Practice of Counseling and PsychotherapyPsych422Chapter10: Cognitive Behavior TherapyRational Emotive Behavioral Therapy (REBT)nStresses thinking, judging, deciding, analyzing, and doingnAssumes that cognitions, emotions, and behaviors interact and have a reciprocal cause-and-effect relat

2、ionshipnIs highly didactic, very directive, and concerned as much with thinking as with feelingnTeaches that our emotions stem mainly from our beliefs, evaluations, interpretations, and reactions to life situationsView of Human NaturenWe are born with a potential for both rational and irrational thi

3、nkingnWe are self-talking, self-evaluating, and self-sustaining. nWe have an inborn tendency toward growth and actualizationnWe learn and invent disturbing beliefs and keep ourselves disturbed through our self-talknWe have the capacity to change our cognitive, emotive, and behavioral processesView o

4、f Emotional DisturbancenWe learn irrational belief from significant other during childhoodnTeach clients to feel undepressed even when they are unaccepted and unloved by significant others. nBlame is at the core of most emotional disturbancesnIrrational idea (e.g., I must be loved by everyone) inter

5、nalize self-defeating nWe have a tendency to make ourselves emotionally disturbed by internalizing self-defeating beliefsThe A-B-C theory of personalityCase discussion 1nTom, a college sophomore, want to overcomes his shyness around women. He doe not date and even des his best to keep away from wome

6、n because he is afraid they will reject him. But he want to change this pattern. nUsing A-B-C-D-E-F to analyze and help TomCase discussion 2nMary would like to take a course in creative writing, but she fears that she has no talent. She is afraid of failing, afraid of being told that she is dumb, an

7、d afraid of follow through with taking the course. nUsing A-B-C-D-E-F to analyze and help MaryCase discussion 3nEach week John comes to his sessions with a new excuse for why he has not succeeded in following through with his homework assignments. Either he forgets, gets too busy, gets scared. Or pu

8、ts it offanything but actually doing something to change what he says he wants to change. Instead of really doing much of anything, he whines each week about how rotten he feels and how he so much would like to change but just doesnt know how.nWhat are the possible irrational beliefs, which keep Joh

9、n from taking actions nWhat homework assignment might you suggest?Case discussion 4 nBrent feels that he must win everyones approval. He has become a “super nice guy” who goes out of his way to please everyone. Rarely does he assert himself, for fear that he might displease someone who then would no

10、t like him.nWhat are the possible irrational beliefs? nHow do you help Brent?nIf Brent is Asian American, what cultural components you might take into account? Irrational IdeasnIrrational ideas lead to self-defeating behaviornSome examples:n“I must have love or approval from all the significant peop

11、le in my life.”n“I must perform important tasks competently and perfectly.”n“If I dont get what I want, its terrible, and I cant stand it.”The Therapeutic ProcessnTherapy is seen as an educational processnClients learnnTo identify and dispute irrational beliefs nTo replace ineffective ways of thinki

12、ng with effective and rational cognitionsnTo stop absolutistic thinking, blaming, and repeating false beliefsTherapeutic GoalsnA basic goal is to teach clients how to change their dysfunctional emotions and behaviors into health ones. nTwo main goals of REBT are to assist clients to achieving uncond

13、itional self-acceptance and unconditional other acceptance.nAs clients become more able to accept themselves, they are more likely to unconditionally accept others. Therapists function and Role n1. Encouraging clients to discover their irrational beliefs and ideasn2. Making connection of how these i

14、rrational beliefs lead to emotional disturbancesn3. Challenging clients to modify or abandon their irrational beliefs.n4. Dispute the irrational beliefs and substitute rational beliefs and behaviors. Clients Experience in TherapynA learner-learn how to apply logical thoughts, experiential exercises,

15、 and behavioral homework to problem solving and emotional change. nFocus on here-and-now experiencesnNot spend much time to exploring clients early history and connecting present and pastnExpect to actively work outside the therapy sessions. Relationship Between Therapist and ClientnIntensive therap

16、eutic relationship is not required. But, REBT unconditionally accept all clients and teach them to unconditionally accept others and themselves. (accept them as persons but confront their faulty thinking and self-destructive behaviors) nEllis believes that too much warmth and understanding can be co

17、unter-productive, fostering dependence for approval.nTherapists shows great faith in their clients ability to change themselves. nOpen and direct in disclosing their own beliefs and valuesnTransference is not encouraged, when it occur, the therapist is likely to confront it (e.g., clients believe th

18、at they must be liked and loved by their therapists.)Therapeutic techniques and proceduresnCognitive methodsnDisputing irrational beliefsnIf I dont get what I want, it is not at the end of the world nDoing cognitive homeworknApplying ABC theory in daily lifes problemsnPut themselves in risk-taking s

19、ituations to challenge their self-limiting beliefs.nReplace negative self-statement to positive messagenChanging ones languagenIt would be absolutely awful.It would be inconvenient nUsing humornHumorous songsTherapeutic techniques and proceduresnEmotional TechniquesnRational-emotional imagerynImagin

20、e the worst things that could happen to themnRole playingnShame-attacking exercisesnTake a risk to do something that they are afraid to do because of what others might thinkuntil they realize that their feelings of shame are self-created. nUse of force and vigornFrom intellectual to emotional insigh

21、tnReverse role playingTherapeutic techniques and proceduresnBehavioral TechniquesnUse most of the standard behavioral therapy approaches.nResearch EffortsnMost studies focus only on cognitive methods and do not consider emotive and behavioral methods. Applications of REBTnREBT has been widely applie

22、d to several areas: anxiety, depression, psychotic disorders, problems of sex, love, and marriage, crisis, couple and family therapyAaron Becks Cognitive Therapy (CT) nInsight-focused therapynEmphasizes changing negative thoughts and maladaptive beliefsnTheoretical AssumptionsnPeoples internal commu

23、nication is accessible to introspectionnClients beliefs have highly personal meaningsnThese meanings can be discovered by the client rather than being taught or interpreted by the therapistTheory, Goals & Principles of CTnBasic theory:nTo understand the nature of an emotional episode or disturbance

24、it is essential to focus on the cognitive content of an individuals reaction to the upsetting event or stream of thoughtsnGoals:nTo change the way clients think by using their automatic thoughts to reach the core schemata and begin to introduce the idea of schema restructuringnPrinciples:nObserve au

25、tomatic thoughts, identify cognitive distortions, and ask for evidences for reality testing the cognitive distortionsCTs Cognitive DistortionsnArbitrary inferencesnMaking conclusions without supporting and relevant evidencenSelective abstractionnForming conclusions based on an isolated detail of an

26、eventnOvergeneralizationnBased on one single incident and applying them to dissimilar eventsCTs Cognitive DistortionsnMagnification and minimizationnPerceiving a case or situation in a greater or lesser light than it truly deservesnPersonalizationnRelate external events to themselves even when there

27、 is no basis for the connection.nLabeling and mislabelingnPortraying ones identity on the basis of imperfections or mistakes made in the pastnPolarized thinkingnThinking in all-or-nothing termsThe Client-Therapist RelationshipnTherapeutic relationship is necessary, but not sufficient, to produce the

28、rapeutic effect.nEncourage clients to take an active role in self-discovery. nAim to teach client how to be their own therapist, educate clients about the nature of their problem, about the process of cognitive therapy, and how thoughts influence their emotions and behaviors.nUse homework to test th

29、eir beliefs in daily-life situations CTs Cognitive TriadnPattern that triggers depression:1. Client holds negative view of themselves and blames themselves2. Selective abstraction: Client has tendency to interpret experiences in a negative manner3. Client has a gloomy vision and projections about th

30、e futureApplication of CTnTreatment of depression and anxietynManaging stress, in parent training, and in treating various clinical disordersDonald Meichenbaums Cognitive Behavior Modification (CBM)nFocus:nChanging clients self-verbalizations or self-statementsnPremise:nAs a prerequisite to behavior

31、 change, clients must notice how they think, feel, and behave, and what impact they have on othersnBasic assumption:nDistressing emotions are typically the result of maladaptive thoughtsMeichenbaums CBMnSelf-instructional therapy focus: nTrains clients to modify the instructions they give to themsel

32、ves so that they can copenEmphasis is on acquiring practical coping skillsnCognitive structure: nThe organizing aspect of thinking, which seems to monitor and direct the choice of thoughtsnThe “executive processor,” which “holds the blueprints of thinking” that determine when to continue, interrupt,

33、 or change thinkingHow Behavior Changes? n3 Phases of Behavior Changen1. Self-observationnListen to themselves, realize they contribute to their depression through how they think, and develop new cognitive structuresn2. Starting a new internal dialoguenSee adaptive behavioral alternativesn3. Learnin

34、g new skillsnTeaching more effective coping skillsn Coping Skills ProgramsnCoping skills programs Stress inoculation training (3 phase model)n1. The conceptual phasenCreating a working relationship with clientsn2. Skills acquisition and rehearsal phasenGiving coping skills to apply to stressful situ

35、ationsn3. Application and follow-through phasenTransfer change to real worldFrom a multicultural perspectivenContributionsnDiverse populationsappreciate the emphasis on cognition and actionsnChallenge rigid thinking (e.g., “should”) instead of questioning the valuesnStress the relationship of individuals to the family, community,