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Block 2 Unit 2 Cognitive Behaviour Therapies Including Rational Emotive Therapy

1) What does A, B, C represent in the ABC model used to explain the role of cognitions?

‘A’ represents an event or experience, ‘B’ represents the beliefs about the A, and ‘C’ represents the emotions and behaviours that follow from those beliefs.

2) What are the two main ways in which human beings disturb themselves?

The human beings defeat or ‘disturb’ themselves in two main ways: by holding irrational beliefs about their ‘self’ (ego disturbance) and by holding irrational beliefs about their emotional or physical comfort (discomfort disturbance).

3) What are core beliefs?

Core beliefs are the underlying, general assumptions and rules that guide how people react to events and circumstances in their lives.

4) Name the main components of CBT intervention?

The main components of CBT are engaging the client; assessing the problem, person and situation; preparing the client for therapy; implementing the treatment program; evaluating progress and lastly preparing the client for termination.

5) Explain the technique playing “Devil’s advocate’?

Devil’s advocate is a useful and effective technique designed to get the client arguing against their own dysfunctional belief. The therapist role-plays adopting the client’s belief and vigorously argues for it; while the client tries to ‘convince’ the therapist that the belief is dysfunctional.

6) Discuss the history and theory of Cognitive behaviour therapy?

Cognitive Behaviour Therapy (CBT) has its origins in the mid-1950s with the work of Albert Ellis, who developed Rational Emotive Behaviour Therapy (REBT). Ellis, who originally trained in psychoanalysis, became disillusioned with the slow progress of his clients and observed that they improved when they changed their thinking. He reasoned that therapy would be more efficient if it focused directly on the client’s beliefs.

• Aaron Beck developed the second major cognitive psychotherapy, Cognitive Therapy (CT) in the 1960s. Beck, like Ellis, was a former psychoanalyst.
• Initially, the approaches of Ellis, Beck, and others were grouped under ‘Cognitive Psychotherapies’.
• The term ‘Cognitive Behaviour Therapy’ emerged in the early 1990s, initially used by behaviourists to describe behaviour therapy with a cognitive aspect.
• CBT has evolved into a generic term encompassing a range of cognitively oriented psychotherapies.

CBT theory proposes a 'biopsychosocial' model, suggesting that biological, psychological, and social factors influence how people feel and act. The core premise of CBT is that most human emotions and behaviours are a result of thoughts, assumptions, or beliefs about oneself, others, and the world. It is what people believe about situations, rather than the situations themselves, that determine their feelings and behaviours.

7) Discuss in detail dysfunctional thinking with examples?

Dysfunctional thinking is a central concept in CBT. Different types of CBT focus on different aspects of this thinking, although there is overlap in terminology and concepts.

• CBT acknowledges that there are different levels of thinking. These include:
  • Automatic Thoughts: spontaneous thoughts that occur in response to a situation.
  • Underlying Assumptions or Rules: the intermediate level between automatic thoughts and core beliefs.
  • Core Beliefs: the deepest level of thinking, the fundamental, general assumptions and rules that guide how people react to events.
• There are two types of disturbance:
  • Evaluative Thinking: REBT emphasises evaluative thinking, focusing on the logic behind beliefs rather than their empirical validity.
  • Inferences: CT focuses on underlying core beliefs.

Seven inferential distortions are identified by cognitive therapists:

1. Arbitrary Inference: Drawing conclusions without evidence. 
2. Selective Abstraction: Focusing on detail while ignoring important context.
3. Overgeneralization: Drawing sweeping conclusions based on a single incident.
4. Magnification and Minimization: Exaggerating the negative and downplaying the positive.
5. Personalization: Taking responsibility or blame when not appropriate.
6. Labelling and Mislabeling: Assigning global and inflexible labels to oneself and others.
7. Dichotomous Thinking: Seeing things in black and white terms.

An example of dysfunctional thinking might be someone who fails a test and then engages in overgeneralization and labeling, thinking, "I fail at everything and I am a total failure", instead of acknowledging they performed poorly on one exam.

8) Describe the steps and process of cognitive behaviour therapy?

The process of CBT involves several key steps:

• Engaging the client: Build a relationship with the client using empathy, warmth and respect and demonstrating that change is possible.
• Assessing the Problem, Person, and Situation: Gather information on the client’s view of the problem, related clinical disorders, personal and social history, severity of the problem, personality factors, any secondary disturbances, and non-psychological causative factors.
• Preparing the client for therapy: Clarify treatment goals, assess motivation to change, introduce the basics of CBT, and develop a contract.
• Implementing the Treatment Program: Use activities such as analysing specific episodes, changing beliefs and developing homework assignments, behavioural assignments, and other strategies.
• Evaluating Progress: Checking if improvements are due to changes in thinking or other factors.
• Preparing the Client for Termination: Ensure the client has the tools for self-observation and change.

CBT emphasises teaching clients to be their own therapists. A useful technique to aid this is Rational Self-Analysis, which involves writing down an emotional episode in a structured fashion.

9) What are the treatment principles of CBT?

The treatment principles of CBT are:

• Empowering clients to choose their emotions, behaviours, and lifestyle.
• Aiming for realistic thoughts, emotions and behaviours that are in proportion to the circumstances rather than ‘positive thinking’.
• Being educative and collaborative: clients learn the therapy and how to apply it themselves.
• Emphasising a therapeutic relationship: the therapist shows empathy, acceptance, and encouragement, but avoids dependency.
• Being brief and time-limited, generally involving 5-30 sessions.
• Being task-oriented, focusing on present problem-solving rather than the past.
• Treating emotions and behaviours as functional or dysfunctional, rather than as good or evil.
• Being based on research, logic and empiricism.
• Focusing on profound and lasting change in the underlying belief system.

10) Describe in detail the various cognitive and behavioural techniques in CBT?

CBT uses a variety of cognitive and behavioural techniques:

• Cognitive Techniques
  • Self-monitoring: Clients observe and record their own reactions.
  • Rational analysis: Clients analyze specific episodes to uncover and dispute irrational beliefs.
  • Double-standard dispute: Asking if they would rate others the same way.
  • Devil’s advocate: the therapist argues for the client's dysfunctional belief while the client argues against it.
• Imagery Techniques
  • Using mental imagery to address fears or practice new behaviours.
• Behavioural Techniques
  • Role-playing to rehearse new behaviour.
  • Postponing gratification: Deliberately delaying impulses.
• Other Strategies:
  • Problem solving, activity scheduling, skills training, reading, and tape recording sessions.
• Homework is a key element, involving reading, self-help exercises, and experiential activities.

11) Write about the applications and limitations of CBT?

CBT has a wide range of applications:

• Typical clinical applications include:
  • Depression, anxiety disorders, eating disorders, addictions, hypochondriasis, sexual dysfunction, antisocial behavior, jealousy, sexual abuse recovery, personality disorders, and adjustment to chronic health problems, physical disability, or mental disorder.
  • Also used in pain management, general stress management, child or adolescent behaviour disorders, and relationship and family problems.
• CBT is often used with individual clients, in group work, with couples and increasingly with families.

Limitations and Contraindications of CBT:

• Low patient motivation can hinder progress.
• Patients who have positive beliefs about dysfunctional aspects of their disorder require special interventions.
• Cultural differences may impact effectiveness if therapists do not tailor the therapy appropriately. Therapists need to understand how cultural differences may affect the therapeutic alliance and how cultural beliefs affect thinking and reactions.
• The limits of cognitive therapy have yet to be empirically established.