Study Guide - Chapter 10

A. Theory – Cognitive Behavioral Therapy

B. Key Figures and Major Focus
a. Key Figures -
i. Albert Ellis – REBT
ii. Aaron & Judith Beck – CT
iii. Christine Padesky & Judith Mooney’s - SB-CBT
iv. Donald Meichenbaum – Cognitive behavioral modification
b. Major Focus
i. “Traditional Cognitive Therapy has broadened, over time, toward CBT
ii. Cognitive Therapy and Cognitive Behavioral Therapy both maintain the
assumption that beliefs, behaviors, emotions and physical reactions are
all interconnected and affect one another
1. If you change one, you change the others” (French, 2023, slide 4).
C. Basic Assumptions
a. “The various cognitive behavioral approaches share the following attributes:
i. A collaborative relationship between client and therapist
ii. The premise that psychological distress is often maintained by cognitive
processes
iii. A focus on changing cognitions to produce desired changes in affect and
behavior” (Corey, 2021, slide 3)
iv. “A present-centered, time-limited focus
v. An active and directive stance by the therapist
vi. An educational treatment focusing on specific and structured target
problems” (Corey, 2021, slide 4)
vii. “Additionally: both CT and CBT take a psychoeducational approach, use
homework, place responsibility on client to take active part in Tx,
emphasize a strong therapeutic alliance, and draw from cognitive and
behavioral strategies to help facilitate change
1. Clients are encouraged to explore their understandings of self and
the world and to try out new behaviors” (French, 2023, slide 3).
D. REBT
a. Key Concepts
i. “1st behavioral therapy - still a major CBT approach
ii. Believes that clients contribute to their own psychological problems and
to the symptoms they experience b/c of the rigid, irrational, or extreme
beliefs they hold
iii. REBT maintains a cause-effect view of cognitions, emotions, and
behaviors
1. Each is seen to significantly influence the other
 iv. Our emotions are mainly created from our beliefs, which influence the
evaluations and interpretations we make and fuel the reactions we have
to life situations
v. Clients are taught to identify irrational or extreme beliefs, dispute them,
and replace them with rational cognitions
vi. Through this process, clients’ emotions and behaviors are assumed
to change
vii. Therapy is largely seen to be an educational process; the therapist is a
‘teacher’ who collaborates with the client, assigns homework,
teaches/introduces new ways of thinking” (French, 2023, slide 5).
viii. “After learning irrational beliefs in childhood (from significant others), we
repeat these beliefs through auto-suggestion and the reinforcement of
self-defeating thoughts leads to self-defeating behaviors
ix. Ellis maintained that blame is central to many emotional issues—blaming
self and/or blaming others, thus he proposed that we must
unconditionally accept ourselves despite our imperfections
x. Assumption that we have a strong tendency to turn our desires into
‘should,’ ‘musts,’ and ‘oughts;’ demands and commands.
1. When feeling emotionally distressed, we are to evaluate our
absolutist ‘musts’ and ‘shoulds’” (French, 2023, slide 6).
xi. 3 Basic Musts (irrational beliefs)
1. “I must do well and be loved and approved by others
2. Other people must treat me fairly, kindly, and well
3. The world and my living conditions must be comfortable,
gratifying, and just, providing me with all that I want in life”
(French, 2023, slide 7).
xii. ABC (DE) Framework
1. “The ABC framework is central to REBT practice and theory
A = ACTIVATING EVENT
B = BELIEFS ABOUT ’A’
C = CONSEQUENCES (EMOTIONAL/BEHAVIORAL)
a. The client’s beliefs about an event largely create the
consequences seen in C
D = DISPUTING (discrimination of self-helping beliefs from
self-defeating beliefs;
detect the self-defeating beliefs and debate them
vigorously
E = EFFECTIVE NEW BELIEF” (French, 2023, slide 8).
b. Therapeutic Goals
 i. “In the most basic of terms—the goal is to teach clients how to change
defeating and dysfunctional thoughts and behaviors into healthier ones
ii. To minimize emotional disturbances and self-defeating behaviors in
clients so that they can adopt a more compassionate and realistic
philosophy of life
iii. Also, REBT aims to cultivate unconditional self-acceptance, unconditional
other-acceptance, and unconditional life-acceptance” (French, 2023, slide
9)
c. Therapeutic Relationship
i. Therapist's Function & Role
1. “Show clients how they have incorporated many irrational and
absolutist “should”, “oughts”, and “musts”; dispute these beliefs
and help clients engage in activities that will dispute and counter
these rigid beliefs with preferences
2. Demonstrate to clients how they are keeping their emotional
distress active through unrealistic and illogical thinking
3. Help clients change their thinking and minimize irrational beliefs
a. Help client identify the irrational belief, demonstrate how
they continue to indoctrinate themselves, and remind
them that change is possible with continued effort
4. Encourage clients to develop a realistic and rational philosophy of
life” (French, 2023, slide 10).
ii. Client’s Experience
1. Present-focused (French, 2023, slide 11)
2. Free association/dream work/dealing with transference – not
valued
3. “Homework is a cornerstone to REBT; clients are regularly asked
to do work outside of session to become skilled at minimizing
irrational beliefs and disturbances in thinking/behaving” (French,
2023, slide 11).
iii. Relationship Between Therapist and Client
1. “A warm relationship between REBT therapist and client is not
required, but the relationship should be respectful; REBT
therapists are more directive” (French, 2023, slide 10).
d. Techniques and Procedures
i. “Cognitive Techniques
1. Therapists practicing REBT use these:
a. Disputing irrational beliefs
b. Doing cognitive homework
c. Bibliotherapy
d. Changing one’s language
 e. Psychoeducational methods” (Corey, 2021, slide 12)
ii. “Emotive techniques
1. Therapists practicing REBT use these:
a. Rational emotive imagery
b. Using humor
c. Role playing
d. Shame-attacking exercises
e. Standard behavior therapy procedures” (Corey, 2021, slide
13)
E. Cognitive Therapy
a. Key Concepts
i. “Developed at the same time Ellis was developing REBT (but developed
independently of each other)
ii. Beck wanted to create an evidence-based approach for depression; his
empirical approach was adopted by many around the world
1. Empirically validated CT approaches were developed for many
mental health issues: eating disorders, panic disorder, PTSD, anger
issues, etc.
iii. Beck found that depressed clients had negative bias in their
interpretation of certain life events, which resulted from active processes
of cognitive distortion. Thus, Beck saw the importance of developing a
therapeutic approach that would help clients address negative thinking
1. Beck did not believe that depression was caused by negative
thinking, alone (contrary to Ellis); neurobiological, genetic, or
situational/environmental changes and stressors could impact
development of depression” (French, 2023, slide 13)
iv. Negative Cognitive triad - “Once people became depressed, Beck
suggested that the negative cognitive triad is what was evidenced in their
thinking and what maintained depression:
1. Negative views of self (self-criticism)
2. Negative view of the world (pessimism)
3. Negative view of the future (hopelessness)” (French, 2023, slide
14).
v. Generic Cognitive Model
1. “It provides a comprehensive framework for understanding
psychological distress.
2. Psychological distress can be thought of as an exaggeration of
normal adaptive human functioning.
 3. Faulty information processing is a prime cause of exaggerations in
adaptive emotional and behavioral reactions” (Corey, 2021, slide
17).
4. Seven Cognitive Distortions
a. “Arbitrary inferences
b. Selective abstraction
c. Overgeneralization
d. Magnification and minimization
e. Personalization
f. Labeling and mislabeling
g. Dichotomous thinking” (Corey, 2021, slide 18).
5. “Our beliefs significantly influence what type of psychological/
emotional distress we will experience
6. Changes in beliefs lead to changes in emotions and behaviors
7. If beliefs are not modified, conditions will reoccur
8. Thus, the primary focus of CT is to help clients recognize
maladaptive beliefs and change them, and to help them
understand the link between their thoughts-emotions-behaviors
a. Clients learn to ‘put their thoughts on trial’ (i.e., identify
cognitive distortions and dysfunctional thinking, examine
them, weigh evidence for or against the thoughts, and
forming alternate interpretations/beliefs
9. The primary goal is to help clients learn practical skills to make
changes in these thoughts, emotions, and behaviors that will
sustain change over time
a. Therapy is psychoeducational, directive, present-focused,
and interactive” (French, 2033, slide 18).
b. Therapeutic Goals
i. “The therapy goals include providing symptom relief, assisting clients in
resolving their most pressing problems, and teaching clients relapse
prevention strategies” (Corey, 2005, p. 286).
ii. Present-centered focus & typically brief
iii. “More recently, increasing attention has been placed on the unconscious,
affective, and even existential components of cognitive therapy
treatment” (Corey, 2005, p. 286).
c. Therapeutic Relationship
i. Therapist's Function & Role
1. “Cognitive therapy places more emphasis on helping clients
discover their misconceptions for themselves and generally
applies more structure than REBT. Through this reflective
 questioning process, the cognitive therapist attempts to
collaborate with clients in testing the validity of their cognitions, a
process termed collaborative empiricism. Therapeutic change is
the result of clients confronting faulty beliefs with contradictory
evidence that they have gathered and evaluated” (Corey, 2005, p.
287).
2. “The therapist functions as a catalyst and a guide who helps
clients understand how their beliefs and attitudes influence the
way they feel and act” (Corey, 2005, p. 287).
3. “Therapists promote corrective experiences that lead to cognitive
change and acquiring new skills” (Corey, 2005, p. 287).
ii. Client’s Experience
1. “Cognitive therapists encourage clients to take an active role in
the therapy process. Clients are expected to bring up topics to
explore, identify the distortions in their thinking, summarize
important points in the session, and collaboratively devise
homework and assignments that they agree to carry out” (Corey,
2005, p. 287).
2. “Beck places more weight on the client's role in self-discovery
(Corey, 2005, p. 287).
iii. Relationship Between Therapist and Client
1. “Cognitive therapists are continuously active and deliberately
interactive with client; They also strive to engage client's active
participation and collaboration throughout all phases of therapy.
The therapist and client worked together to frame the client's
conclusions in the form of a testable hypothesis” (Corey, 2005, p.
287).
2. “Beck conceptualizes a partnership to devise personally
meaningful evaluations of the client's negative assumptions, as
opposed to the therapist directly suggesting alternative
cognitions” (Corey, 2005, p. 287).
d. Techniques and Procedures
i. “Thought logs = having clients log ‘automatic thoughts’ to test them;
when the evidence is against the thought, clients learn how to generate
alternative explanations that are more reasonable
1. If evidence is in support of the automatic thought, the therapist
helps the client to create an action plan to solve the problem vs.
ruminating on it
ii. Examining thoughts, Socratic dialogue with the therapist, homework
assignments, behavioral experiments, gathering data on assumptions
made, forming alternative interpretations
 iii. Problem-solving and coping skills are taught and learned from the
beginning of therapy
1. Through guided discovery, the client learns the
interconnectedness of their thoughts, feelings, and behaviors”
(French, 2033, slide 19).
F. Strengths-Based CBT
a. Key Concepts
i. “Developed by Christine Padesky and Kathleen Mooney, S-B CBT is a
variant of Aaron Beck’s cognitive therapy.
ii. It involves identifying and integrating client strengths at each phase of
therapy.
iii. Active incorporation of client strengths encourages clients to engage
more fully in therapy and often provides avenues for change that
otherwise would be missed” (Corey, 2021, slide 23).
iv. “SB-CBT is empirically based.
1. Therapists should be knowledgeable about evidence-
based approaches pertaining to client issues discussed in therapy.
2. Clients are asked to make observations and describe the details of
their life experiences, so what is developed in therapy is based in
the real data of clients’ lives.
3. Therapists and clients collaborate in testing beliefs and
experimenting with new behaviors to see if they help achieve
desired goals” (Corey, 2021, slide 24).
G. Cognitive Behavior Modification
a. Key Concepts
i. “Focus: Client’s self-statements or self-talk
ii. Premise: As a prerequisite to behavior change, clients must notice how
they think, feel, and behave, and what impact they have on others.
iii. Basic assumption: Distressing emotions are typically the result of
maladaptive thoughts” (Corey, 2021, slide 27).
iv. “Self-instructional therapy focus:
1. Trains clients to modify the instructions they give to themselves
so that they can cope more effectively.
2. Emphasis is on acquiring practical coping skills.
v. Cognitive structure:
1. The organizing aspect of thinking, which seems to monitor and
direct the choice of thoughts
2. The executive processor” (Corey, 2021, slide 28).
vi. Behavior Change (3 phases)
1. “Self observation
2. Starting a new internal dialogue
 3. Learning new skills” (Corey, 2021, slide 29)
vii. Coping Skills Program
1. Stress Inoculation Training (3 stages)
a. “The conceptual-educational phase
b. Skills acquisition and skills consolidation phase
c. Application and follow-through phase” (Corey, 2021, slide
30)
viii. A Cognitive Narrative Approach to CBT
1. “It focuses on the plots, characters, and themes in the stories
people tell about themselves and others.
2. Meichenbaum claims that we are all story tellers.
3. In therapy, clients learn how they construct reality, examine the
implications and conclusions they draw from their stories, and
develop resilient-engendering behaviors” (Corey, 2021, slide 31).
H. Applications
a. Three Applications of SB-CBT
i. “An add-on for classic CBT
ii. A four-step model to build resilience and other positive qualities (1.
Search, 2. Construct, 3. Apply, 4. Practice)
iii. The NEW paradigm for chronic difficulties and personality disorders”
(Corey, 2021, slide 25).
b. Applications of Cognitive Therapy
i. “The length and course of CT varies greatly and is determined by the
therapy protocols used for specific diagnoses.
1. Examples:
2. CT for depression: lasts 16 to 20 sessions and begins with
behavioral activation
3. CT for panic disorder: lasts 6 to 12 sessions and targets
catastrophic beliefs about internal physical and mental
sensations” (Corey, 2021, slide 22).
I. Multicultural Perspectives
a. “CBT uses the individual’s belief system, or worldview, as part of the method of
self-exploration.
b. Emphasis on cognition, action, and relationship issues appeals to clients from
diverse backgrounds.
c. CBT and multicultural therapy share common assumptions that make integration
possible” (Corey, 2021, slide 32).
J. Contributions to the profession
a. “Both Ellis’s REBT and Beck’s CT represent the most systematic applications of
CBT.
 b. The approaches are relatively brief and structured treatments that are cost
effective.
c. The cognitive behavioral theorists have demystified the therapy process” (Corey,
2021, slide 35).
d. “The credibility of this model grows out of the fact that many of its propositions
have been empirically tested.
e. All cognitive behavioral approaches place emphasis on practicing new skills both
in therapy and in daily life, and homework is a key part of the learning process”
(Corey, 2021, slide 36).
K. Spiritual Implications
a. In Romans 12, Paul writes, “Do not conform to the pattern of this world, but be
transformed by the renewing of your mind. Then you will be able to test and
approve what God’s will is—his good, pleasing and perfect will” (Holy Bible New
International Version, 2011, Romans 12:2). For this spiritual implication, we will
focus on the portion about how we must not be conformed to the patterns of
this world but be transformed by the renewing of our minds. I couldn’t think of a
more applicable scripture that applies to cognitive behavioral therapy as we are
transformed by the renewing of our minds when we recognize faulty,
maladaptive cognitions or irrational beliefs and replace them with healthy,
adaptive cognitions and beliefs.

References

Corey, G. (2005). Theory and practice of counseling and psychotherapy (7th ed.). Brooks/Cole-

Thomson Learning, Inc.

Corey, G. (2021). Theory and practice of counseling and psychotherapy: Chapter 10

cognitive behavior therapy [PowerPoint slides]. D2L.

https://d2l.oru.edu/d2l/le/content/860652/viewContent/4132658/View

French, H. R. (2023). Cognitive behavioral therapy [PowerPoint slides]. D2L.

https://d2l.oru.edu/d2l/le/content/860652/viewContent/4138468/View

Holy Bible New International Version. (2011). Biblica, Inc. www.biblegateway.com