Cognitive/
Behavioural
Therapies
Psychology 3371F/570
Adam Koenig, M.A., RP, CCC, CT
Brief Overview of Factors
that Influenced CBT
Cognitive Behavioural Therapy
The way in which CBT treatment interventions
are used today has been influenced by
Behaviour Therapy (i.e., Skinner, Pavlov),
Rational Emotive Behaviour Therapy (Albert
Ellis)* and Cognitive Therapy (Aaron Beck).
Central to Cognitive Behavioural Therapy is
having an understanding of the way that our
thoughts effect our emotions and behaviours.
Becoming more aware of our thought
processes, and changing them to be more
adaptive is a key feature in this treatment
approach.
Basics of CBT (Newman, 2013)
Psychological health = Adaptability of
individual’s thinking patterns, behaviours,
and ability to self-regulate
Through observation and experiences
learn adaptive behaviour
But at same time use cognition to
mediate behaviour
Cognitive triad (view of themselves, their
world, their future) impact their
reactions/behaviour to situations
Psychologically healthy individual would
use cognitions to positively mediate
behavioural reactions*
View of Human Nature
(Neukrug, 2018)
Operant conditioning, classical conditioning, and
modeling all play a role in development of
personality and in strategies one can use in helping
clients change
Significant others and cultural influences play an
important role in how individual is conditioned
Genetic and bio factors may play a significant role
in who we become, but does not necessarily
determine person’s way of thinking and acting
View of Human Nature
(Neukrug, 2018)
Behaviours and cognitions play a central role in the
development of normal and abnormal behaviour
Past often plays role in conditioning how a person
thinks, acts, and feels but one only need to focus on
the present for change to occur
Carefully identifying maladaptive cognitions and
behaviours, one can develop strategies to decrease
frequency of them
Identifying adaptive behaviours and cognitions, one
can develop strategies to increase frequency of
them
Change is possible in relatively short amount of time
Behavioural Therapy
Behavioural Therapy
This approach states that psychopathology is
the result of inadequate learning or a skills
deficit
the learning of maladaptive behaviour
Subsequently, psychopathology is treated by
unlearning problematic behaviours and
learning or relearning new ones.
Early research included Classical
Conditioning (Pavlov) and Operant
Conditioning (Thorndike & Skinner)
Behavioural Therapy
Therapeutic strategies include Exposure
Therapy and Aversion Therapy
Other concepts such as modelling, or
flooding are also utilized
The goals of therapy are to change target
behaviours that are clearly defined
Currently, programs like Intensive Behavioural
Intervention or Applied Behavioural Analysis
have been found to be useful for ASD and
other behaviours along the developmental
spectrum
Also Systematic Desensitization
Behavioural Therapy Example:
Systematic Desensitization*
This technique begins with the client using
various relaxation methods
An anxiety hierarchy is created, which
includes a ladder of graded degrees of
anxiety using a rating scale of how
upsetting each event would be
The steps include: relaxing the client,
imagine a neutral scene, presents scenes of
increasing anxiety, relax when client
becomes anxious, return to a less anxious
scene, continue to move slowly up the
hierarchy
Rational Emotive Behaviour
Therapy
Rational Emotive Behaviour
Therapy
At the beginning, Ellis called his approach
Rational Therapy (RT)
By 1961 Ellis called his approach Rational
Emotive Therapy (RET)
Required that the therapist help the client
understand that their personal philosophy
on life contains beliefs that cause emotional
pain.
The past is not emphasized, yet
acknowledges past has influence*
Rational Emotive Behaviour Therapy
The essence of REBT states that an
individual’s psychological problems stem
from misperceptions and mistaken
cognitions about what they perceive, rather
than from the event itself*
Includes emotional overreactions or
underreactions, habitually dysfunctional
behavioural patterns (Neukrug, 2018)
Seven basic principles of
REBT (as cited in Neukrug, 2018)
Cognitions, not events, are the most important
determinant of human emotion
Irrational thinking leads to emotional distress
Distress is best dealt with by addressing irrational
thinking
Genetic and environmental factors are antecedents
to irrational or rational thinking
Strong emotions are a sign that a problem needs to
be addressed
Therapy should focus upon the continued and
ongoing self-indoctrination of irrational thinking, not
historical influences
Although beliefs can be changed, changing one’s
beliefs takes work
Ellis’ Core Irrational Beliefs
Eventually, Ellis condensed his 12 irrational
beliefs into 3 core ones:
1. I must do well and be approved by
significant others and if I don’t then there must
be something rotten about me.
2. All people must treat me considerately and
fairly all the time.
3. All life conditions must be arranged such that
I can conduct my life with ease, and it’s
horrible when those conditions are harsh.
Goals of REBT Therapy
Minimize emotional disturbance
Decrease self-defeating behaviours
Become more self-actualized
Think more rationally
Feel more appropriately
Act more effectively
Deal more effectively with negative
thoughts/feelings
Learn the ABCDEF strategy
The ABCDEF approach of REBT
A ~ activating event separate what happened from
what was perceived to have happened
B ~ beliefs irrational beliefs are the focus of therapy
C ~ consequence is important to discern beliefs from
outcomes
D ~ dispute irrational beliefs by: detecting,
discriminating, debating
E ~ effect having disputed their irrational beliefs, clients
develop an effective philosophy
F ~ feelings new feelings and behaviours that arise from
effective rational beliefs; such interventions promote
change
REBT Cognitive Strategies
Detecting, disputing and modifying irrational
cognitions
Writing to express and explore
thoughts/feelings
Discerning rational and irrational beliefs
Confronting irrational beliefs
Identifying and changing self-talk
Reframing a situation
Listing ways of coping (e.g., the worst situation)
Distraction, visualization, imagery
Promote a focus on happiness
A-FROG (Beck & Emery as cited by Seligman &
Reichenberg, 2010)
Questions to ask related to rational thinking or
not
A = Does it keep me alive?
F = Do I feel better as a result of this thought?
R = Is this thought based on reality?
O = Does it help me in my relationships with
others?
G = Does it help me achieve my goals?
REBT Behavioural Strategies
Relaxation strategies
Create challenging situations and cope
with them
Role-play or reverse roles
2-chair exercise
Acting as if a person is someone else
Self-help books, tapes
Skill development
Planning pleasurable activities
REBT Affective Strategies
Imagine the worst that could happen
Provide emotionally powerful stories,
metaphors
Use humour
Encourage willpower and determination to
change
Promote unconditional acceptance
RT “REBT” with Gloria
https://www.youtube.com/watch?v=odnoF8V3g6g&t
=528s
Cognitive Therapy
Cognitive Therapy Highlights
Cognitive therapy has become one of the
most empirically validated approaches
A phenomenological model that assists
clients in making meaning of events based
on what they think about them (not how
they feel about them)
Changing thinking leads to changes in
feelings and actions
Treatment is short term, goal oriented,
problem focused, active, structured
Levels of Cognition
Automatic thoughts – stream of cognitions;
mediate between a situation and an
emotion
Intermediate beliefs – extreme and
absolute rules, expectations, assumptions,
and attitudes that shape automatic
thoughts
Core beliefs (sometimes called Schemas) –
central ideas that support many automatic
cognitions and are often reflected in
intermediate beliefs
Schemas – ‘cognitive structures in the
mind’ that contain the core beliefs; also
include thoughts, emotions and actions
Treatment Process
Establish an agenda
Determine and measure intensity of mood
Identify and review presenting problems
Elicit expectations for treatment
Educate client about therapy, role of client
Provide information about
difficulties/diagnosis
Establish goals
Tasks/homework
Summarize session and ask for feedback
Therapeutic Alliance
Clinician communicates support, empathy,
caring, warmth, interest and optimism
Clinician makes effort to know and
understand client
Assume nonjudgmental position
Do not elicit transference, but will address it
if need be
Effective therapy requires a solid alliance
Case Formulation
List of problems and concerns
Hypothesis regarding core beliefs or
schema
Relationship of belief to current problem
Precipitants of current problem
Understanding of background relevant to
formation of underlying beliefs
Anticipated obstacles
Cognitive Distortions
All or nothing thinking
Overgeneralization
Mental filter/selective abstraction
Disqualifying the positive
Jumping to conclusions
Magnification/minimization
Emotional reasoning
‘Should’ and ‘must’ statements
Labeling and mislabeling
Personalization
Mind reading
Tunnel vision
Strategies in CT
Activity scheduling
Mental and emotional imagery
Cognitive rehearsal
Thought stopping
Diversions or distractions
Self-talk
Affirmations
Keeping diaries
Letter writing
Aaron Beck
Contributed a significant amount to our
understanding of depression, anxiety,
panic, suicide, assessment techniques
Published over 500 articles and written/co-
authored 17 books, lectured around the
world
BDI, BAI
Main Differences of CBT from
Other Theoretical Orientations
A de-emphasis on early childhood.
Focus on present, not past.
Use of psychological homework.
Awareness is central, but insight* is not.
Emotions and behaviours are secondary to
thoughts
Strengths-Based CBT
Padesky & Mooney (2012)
These authors wanted to incorporate positive
psychology with CBT to increase happiness
and promote resilience
Goal is to help people build a model in order
to help deal with life’s obstacles
Resilience is a process, not a trait.
Focus is to construct resilient beliefs and
behaviours rather than dismantle beliefs and
behaviours that are roadblocks*.
Strengths-Based CBT
Padesky & Mooney (2012)
1. Search for strengths
2. Construct a personal model
3. Apply the PMR to areas of life
difficulty
4. Practise resilience
Search for Strengths
Padesky & Mooney (2012)
Within positive, sustained activities
Introduce obstacles
Many different types of strengths
Construct PMR
Padesky & Mooney (2012)
Turn strengths into general strategies
Use client’s words
Include images and metaphors
Apply PMR
Padesky & Mooney (2012)
Identify problem areas in need of resilience
Plan which PMR strategies to use
Focus on resilience, not outcome
Practice
Padesky & Mooney (2012)
Design behavioral experiments
Resilience predictions
Many different types of strengths
Highlights of Strengths-Based CBT
There are many pathways and combinations
of strengths that can lead to positive qualities
Often, it is not necessary to teach clients new
skills, but to highlight existing ones and find
ways to utilize them
The approach assumes that people are
already resilient in various aspects of their life
People are often unaware of their strengths
as they can be hidden
Finding strengths in everyday activities can
yield rich information not found in
questionnaires
Highlights of Strengths-Based CBT
Examples of finding strengths that lead to
resilience:
Having a good sense of humour and good
problem solving skills
Strong social ability can result in asking others
for help
In Treatment
