COGNITIVE-BEHAVIORAL THERAPY "Men are disturbed not by things, but by the view which they take of them.

" Epictetus Enchiridion Cognitive-Behavioral Therapies (CBT) are psychotherapies based on the assumption that the primary sources of psychological distress are maladaptive patterns in the way we think and act. The two major psychologists associated with the development of cognitive-behavioral therapy are Dr.s Albert Ellis and Aaron Beck. DR. ALBERT ELLIS and RATIONAL EMOTIVE BEHAVIOR THERAPY Dr. Ellis developed Rational Emotive Behavior Therapy (REBT) in the mid-1950s based on the premise that you largely feel the way you think. Ellis argued that it is not external events but the way in which people interpret these events that causes psychological distress. Ellis uses the ABC model to explain psychological problems. When an Activating event (A) occurs, it is the beliefs (B) that cause emotional consequences (C). Therefore, rather than an external situation (A) causing emotional distress (C), it is the beliefs (B) that are the true sources of distress (C). For example, if your friend does not call you back for a few days (A), this may trigger the interpretation that she is not calling you back because she does not value your friendship which may be connected to the belief that you MUST be loved by EVERYONE in your life or else the are WORTHLESS (B), which in turn leads to feelings of overwhelming sadness (C). Ellis describes peoples interpretations of external events as being influenced by core irrational beliefs. The first step in REBT is for the therapist to help the client recognize specific irrational ideas that are the source of the clients distress. Common Irrational Beliefs (Based on Ellis, 1991) Ellis, A. (1991). Reason and emotion in psychotherapy. New York: Carol. 1. It is an absolute necessity to be loved or approved of by every significant person in one's life. 2. To be worthwhile, a person must be thoroughly competent, adequate, and achieving in all possible respects. 3. Some people are bad, wicked, or villainous and therefore should be blamed and punished. Furthermore, you should be extremely upset over other peoples wrongdoings. 4. It is awful, terrible, and catastrophic if things are not they way you would them to be. 5. Unhappiness is the result of external events, and therefore a person has little or no control over bad feelings and emotions. 6. Something potentially dangerous or harmful should be cause for great concern and should always be kept in mind. 7. Running away from and avoiding difficulties and responsibilities is easier than facing them. Avoiding difficulties is more likely to lead to happiness than facing them. 8. A person must rely on someone stronger than himself/herself. 9. Past history is the most important determinant of present behavior and therefore there is no way to change its effect on present behavior. 10. A person should be extremely upset over other peoples problems and difficulties.

11. There is always a single, right answer to all human problems, and a failure to find this answer is a catastrophe. The second step in REBT is for the therapist to dispute and challenge the irrational beliefs and help the client work towards adopting a more rational point of view. For example, using the previous example of your friend not calling you back, an alternative belief would be, Though it would be great to have everyone love me all the time, that is not a realistic expectation, and it is not necessary to have everyone love me all the time for me to be a worthwhile human being. The goal is not to erase the emotional process but to feel sad or angry or anxious based on rational versus irrational beliefs. The long-term goal of REBT is to teach the client to do challenge his thinking in a wide range of situations. REBT utilizes "homework" assignments to help clients generalize what they learn in the sessions to their day-to-day situations and also incorporates behavioral exercises to help clients to change their behaviors along with their thoughts and beliefs. REBT can be quite empowering in that through the therapy process, the client learns to help himself. For more information on Ellis and REBT, click on the following link: http://www.rebt.org/ DR. AARON BECK and COGNITIVE THERAPY In the 1960s, Dr. Aaron Beck developed his approach called Cognitive Therapy, which became widely known for its effectiveness in the treatment of depression. Rather than speak of irrational beliefs, Beck has identified what he calls cognitive distortions. When depressed, people are more likely to interpret their experiences in a negative way. For example, when depressed, people are more likely to think, I ALWAYS mess up, or NOBODY likes me, or Ill NEVER get better. More recently, Dr. David Burns has comprised a list of common cognitive distortions that lead to psychological distress. From: Burns, David D., MD. 1989. The Feeling Good Handbook. New York: William Morrow and Company, Inc. ALL-OR-NOTHING THINKING: You see things in black-and-white categories. If your performance falls short of perfect, you see yourself as a total failure. OVERGENERALIZATION: You see a single negative event as a never-ending pattern of defeat. MENTAL FILTER: You pick out a single negative detail and dwell on it exclusively so that your vision of all reality becomes darkened, like the drop of ink that discolors the entire beaker of water. DISQUALIFYING THE POSITIVE: You reject positive experiences by insisting they "don't count" for some reason or other. In this way you can maintain a negative belief that is contradicted by your everyday experiences. JUMPING TO CONCLUSIONS: You make a negative interpretation even though there are no definite facts that convincingly support your conclusion. MIND READING: You arbitrarily conclude that someone is reacting negatively to you, and you don't bother to check this out THE FORTUNETELLER ERROR: You anticipate that things will turn out badly, and you feel convinced that your prediction is an already-established fact. MAGNIFICATION (CATASTROPHIZING) OR MINIMIZATION: You exaggerate the importance of things (such as your goof-up or someone else's achievement), or you inappropriately shrink

things until they appear tiny (your own desirable qualities or other fellow's imperfections). This is also called the binocular trick. EMOTIONAL REASONING: You assume that your negative emotions necessarily reflect the way things really are: "I feel it, therefore it must be true." SHOULD STATEMENTS: You try to motivate yourself with should and shouldn't, as if you had to be whipped and punished before you could be expected to do anything. "Musts" and "oughts" are also offenders. The emotional consequences are guilt. When you direct should statements toward others, you feel anger, frustration, and resentment. LABELING AND MISLABELING: This is an extreme form of overgeneralization. Instead of describing your error, you attach a negative label to yourself. "I'm a loser." When someone else's behavior rubs you the wrong way, you attach a negative label to him" "He's a Goddamn louse." Mislabeling involves describing an event with language that is highly colored and emotionally loaded. PERSONALIZATION: You see your self as the cause of some negative external event, which in fact you were not primarily responsible for. The first step in CT is for the client to monitor his automatic thoughts. Automatic thoughts are those thoughts that come to mind without conscious effort or control and have a strong impact on mood. For example, in response to an upcoming test, one possible automatic thought is, I know Im going to fail. I always fail. Once automatic thoughts are identified, the therapist and client work to identify distortions in thinking. In the above example, the client may recognize that the statement I know Im going to fail, is an example of negative FORTUNE-TELLING, while the statement, I always fail, is an example of ALL-OR-NOTHING THINKING and MENTAL FILTER. Once the distortions are recognized, the client can formulate an alternative thought such as, I cant say for sure that Im going to fail. It is not helpful to try to predict the future so negatively. Also, to say that Ive failed in the past is all-or-nothing thinking as I havent failed, I just havent done as well as I wanted to. This is also a mental filter, because although I havent always performed the best, there have been times that I have excelled and have felt good about my performance. Im discounting those positive experiences. A major component in CT is that the therapist and client work together collaboratively to determine the reality of the automatic thoughts. The therapist may encourage the client to challenge his own thinking based on past experiences or on more rational thinking. The therapist may also encourage the client to empirically test the validity of their thoughts. For example, if the client is afraid of running up and down stairs for fear of having a panic attack and passing out, a therapist may have the client run up and down stairs to test out this hypothesis. For more information on Beck and cognitive therapy, click on the following link: http://www.beckinstitute.org/Library/InfoManage/Guide.asp? FolderID=200&SessionID={56CEA49B-8D46-49DA-9D65-85712B44FADF}