3. Cognitive Therapy

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COGNITIVE BEHAVIOURAL APPROACHHONG AN NGUYEN, MSc

PSY302DE01

Your Logo or Name Here

• Although I’d like to have people in my life, I just don’t seem to know how to go about making friends or getting close to people.

• I’d like to turn my life around, but I have no sense of direction.

• I want to make a difference.

• I am afraid of failure.

• I know when I feel alone, scared, and overwhelmed, I drink heavily to

• feel better.

• I am afraid of women.

• Sometimes at night I feel a terrible anxiety and feel as if I’m dying.

• I often feel guilty that I’ve wasted my life, that I’ve failed, and that I’ve let people down. At times like this, I get depressed.

• I like it that I have determination and that I really want to change.

• I’ve never really felt loved or wanted by my parents.

• I’d like to get rid of my self-destructive tendencies and learn to trust people more.

• I put myself down a lot, but I’d like to feel better about myself.

KEY THEMES FROM STAN

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A concensus of CBTs


(1) collaborative relationship (2) psychological distress is largely a function of disturbances

in cognitive processes (3) focus on changing cognitions to produce changes in affect

and behavior(4) a generally time-limited and educational treatment (Arnkoff & Glass, 1992; Weishaar, 1993).

All of the cognitive behavioral therapies are based on: - a structured psychoeducational model- emphasize the role of homework- place responsibility on the client to assume an active role

both during and outside of the therapy sessions,- draw from a variety of cognitive and behavioral strategies to

bring about change.


Beck & Ellis

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Your Logo or Name Here 5

RATIONAL EMOTIVE BEHAVIOUR THERAPYAlbert Ellis

View of Human Nature

- Humans are born with both rational and irrational thinking- help them accept themselves as creatures who will continue

to make mistakes yet at the same time learn to live

- Irrational dogmas are created by socialization and ourselves, through actively reinforcing self-defeating beliefs by autosuggestion and self-repetition and by behaving.

- The therapist teaches clients how to feel undepressed even when they are unaccepted and unloved by significant others

- Blame is at the core. It is important to learn to fully accept ourselves despite our imperfections

- “Tyranny of the SHOULD” or “MUST”

View of Emotional Disturbances3 Basic MUSTs:“I must do well” “Other people must treat me well”“The world must treat me well”

PSY302DE01_Hong An Nguyen



Secondary irrational processes

• Global negative jugdment ofself and others

• Catastrophic thinking• Low tolerance of frustration

Absolute Demand

• self• others• world

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Rational ThoughtsIrrational Thoughts

• Not rigid• Do not cause fear• Assume human can

overcome struggles• Accept self, others,

and life• Have power,

responsibility and ability to change

• Rigid, demanding• Cause fear• Assume human

cannot overcome struggles

• Belittle self, others, and life

• Self criticise, self evaluate



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1. It is a dire necessity for adults to be loved by significant others for almost everything they do

Concentrating on their own self-respect, on winning approval for practical purposes, and on loving rather than on being loved.

2. Certain acts are awful or wicked, and that people who perform such acts should be severely damned

Certain acts are self-defeating or antisocial, and that people who perform such acts are behaving stupidly, ignorantly, or neurotically, and would be better helped to change. People’s poor behaviors do not make them rotten individuals.

3. It is horrible when things are not the way we like them to be

We would better try to change or control bad conditions so that they become more satisfactory, and, if that is not possible, we had better temporarily accept and gracefully lump their existence.

Irrational ThoughtsPSY302DE01_Hong An Nguyen

Rational Thoughts

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6. It is easier to avoid than to face life difficulties and self-responsibilities

So-called easy way is usually much harder in the long run.

8. We should be thoroughly competent, intelligent, and achieving in all possible respects

We would better do rather than always need to do well, and accept ourselves as quite imperfect creatures, who have general human limitations and specific fallibilities.

10. The idea that we must have certain and perfect control over things

Instead of the idea that the world is full of improbability and chance and that we can still enjoy life despite this.

4. Human misery is invariably externally caused and is forced on us by outside people and events

Neurosis is largely caused by the view that we take of unfortunate conditions.

Irrational Thoughts PSY302DE01_Hong An NguyenRational Thoughts



A-B-C Framework

Thất bại trong mốiquan hệ

Tôi luôn phải đượcngười khác yêu thương

Nếu không tôi không cógiá trị

Buồn/ Tức giận/ Lo lắngKhóc/ Chứng tỏ/ Rút lui

Có ai yêu thương tôi?Tôi có thể yêu thương ai?

Giá trị của tôi là gì?

Gặp gỡ/ Trân trọng/ Hoà nhãVui/ Hi vọng/ …


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• Mai would like to take a course in statistics, but she fears that she has no talent. She is afraid of failing, afraid of being told that she is dumb, and afraid of follow through with taking the course. • Using A-B-C-D-E-F to analyze and help Mai

Case of Mai



• Hien was bullied by friends. She feels life is unfair and always feels angry because those people never get punished

• Using A-B-C-D-E-F to analyze and help Hien

Case of Hien


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• Take 1 of the irrational thoughts• Imagine in group 1 situation that can illustrate the thought• Give a rational thought that should be placed instead

Imagine your own case



RATIONAL EMOTIVE BEHAVIOUR THERAPYAlbert Ellis - To teach clients how to change their

dysfunctional emotions and behaviors into healthy ones. - Two main goals of REBT are assist clients to

achieving: - unconditional self-acceptance- unconditional other acceptance.

The Therapeutic Goals


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RATIONAL EMOTIVE BEHAVIOUR THERAPYAlbert Ellis 1. Encouraging clients to discover their

irrational beliefs and ideas2. Demonstrate the connection between irrational thinking and emotional disturbances3. Helping clients modify their thinking and minimize their irrational ideas 4. Challenge clients to develop a rational philosophy of life

Therapist’s function and Role



RATIONAL EMOTIVE BEHAVIOUR THERAPYAlbert Ellis - Learn how to apply logical thoughts,

experiential exercises, and behavioral homework to problem solving and emotional change.

- Focus on here-and-now experiences. - Expect to actively work outside the

therapy sessions.

Client’s Experience in Therapy


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- Intensive therapeutic relationship is not required. - unconditionally accept all clients and teach them

to unconditionally accept others and themselves.- Too much warmth and understanding can be

counter-productive, fostering dependence for approval.

- Therapists shows great faith in their clients’ abilityto change themselves.

- Open and direct in disclosing their own beliefs and values

- Transference is not encouraged and needed to be confronted

Relationship Between Therapist and Client



RATIONAL EMOTIVE BEHAVIOUR THERAPYAlbert Ellis Cognitive methods

Disputing irrational beliefs- Functional disputes- Empirical/ Didactic/ Metaphorical disputes - Socratic Methods

Doing cognitive homeworkApplying ABC in daily life’s problemsPut themselves in risk-taking situations to challenge self-limiting beliefs.Replace negative self-statement to positive messageBibliotherapy

Changing one’s languageIt would be absolutely awful à It would be inconvenientReframing

Therapeutic techniques and procedures


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• What do you mean by saying _______?• What is the evidence for this thought? Against it? • Might other people have different interpretations of this same situation?

What are they? • What will you say to someone who said ______?• What is the worst/best outcome of this situation?

Socratic Questioning



• Everyone is happier than me• My life is filled with unhappiness• I am responsible for others• This is the worst things ever

Empirical/ Didactic/ Metaphorical disputes

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• Empirical disputes• Can you give me an example of

someone has worst situation?• Can you give me a happy memory that

you have?• How many percent that you are

responsible for him/her?• How many percent you believe in that

statement?• Can you think of a worse thing than

that?


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• Everyone is happier than me• My life is filled with unhappiness• I am responsible for others• This is the worst things ever


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• Didactic disputes• Everyone can have troubles in their life• This thought is illogical because you may

feel happy in some points of time in your life.

• Should everyone being responsible for their own?




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• Metaphorical disputesClient: I feel like losing him is like losing a floatTherapist: Do you mean that you always need a float to swim?

Client: That fear is like a room. I am afraid of open the door and see a tiger in itTherapist: How do you know there is a tiger in the room without opening the door?


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RATIONAL EMOTIVE BEHAVIOUR THERAPYAlbert Ellis Emotional Techniques

Rational-emotional imageryImagine the best/worst things that could happen to them

Role playing/ RehearseShame-attacking exercises

Take a risk to do something that they are afraid to do because of what others might think…until they realize that their feelings of shame are self-created.

Use of force and vigorFrom intellectual to emotional insightReverse role playing

Behavioral TechniquesUse most of the standard behavioral therapy approaches.

Therapeutic techniques and procedures



Aaron Beck’s Cognitive Therapy (CT)

• Based on working with depressed clients• Insight-focused therapy• Emphasizes changing negative thoughts & maladaptive beliefs• Theoretical Assumptions

• People’s internal communication is accessible to introspection• Clients’ beliefs have highly personal meanings• These meanings can be discovered by the client rather than being taught

or interpreted by therapist


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Theory, Goals & Principles of CT

• Basic theory:• To understand the nature of an emotional episode or disturbance

it is essential to focus on the cognitive content of an individual’s reaction to the upsetting event or stream of thoughts

• Goals:• To change the way clients think by using their automatic thoughts

to reach the core schemata and begin to introduce the idea of schema restructuring

• Principles:• Observe automatic thoughts, identify cognitive distortions, and

ask for evidences for reality testing the cognitive distortionsPSY302DE01_Hong An Nguyen


CT’s Cognitive Distortions

• Arbitrary inferences• Making conclusions without

supporting and relevant evidence

• Selective abstraction• Forming conclusions based on an

isolated detail of an event

• Overgeneralization• Based on one single incident and

applying them to dissimilar eventsOvergeneralisation

Mind Reading

Catastrophizing


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CT’s Cognitive Distortions

• Magnification and minimization• Perceiving a case or situation in a

greater or lesser light than it truly deserves

• Personalization• Relate external events to

themselves even when there is no basis for the connection.

• Labeling and mislabeling• Portraying one’s identity on the

basis of imperfections or mistakes made in the past

• Polarized thinking• Thinking in all-or-nothing terms

Dichotomous Thinking

Minimization

Labeling

Personalization



Application of CT

• Treatment of depression and anxiety• Managing stress, in parent training,

and in treating various clinical disorders


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CT’s Cognitive Triad

• Pattern 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 the future



Automatic thoughts

• Automatic thoughts, the actual words or images that go through a person’s mind, are situation specific and may be considered the most superficial level of cognition. (Beck, 1964)

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TÌNH HUỐNG VÍ DỤ A.T

Sự kiện bên ngoài Người yêu cúp máy

Dòng suy nghĩ Nghĩ về bài thi

Nhận thức Nghĩ về sự kiệnsang chấn

Cảm xúc Tức giận

Hành vi Ăn quá độ

Hiện tượng thểlý/tinh thần

Nhịp tim nhanh

Sao cô ấy có thể đối xử với tôinhư thế?

Tôi không bao giờ học hết nổi!

Tôi sẽ không bao giờ vượtqua được!Tôi không nên nổi giận, tôilà người tồi tệ

Tôi thật yếu đuối. Tôi khôngkiểm soát được việc ăn uốngcủa mình

Nếu có gì đó không ổnxảy ra với mình thì sao?


• Intermediate belief• attitudes, rules, and assumptions

• Core belief• the most fundamental level of belief; they

are global, rigid, and overgeneralized • Beginning in childhood, certain ideas about

themselves, other people, and their world.

• enduring understandings so fundamental and deep that they often do not articulate them, even to themselves. The person regards these ideas as absolute truths—just the way things “are” (Beck, 1987).

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Activating Events Automatic Thoughts Consequences

Intermediate Beliefs

Core Beliefs

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COGNITIVE CONCEPTUALIZATION


Suy nghĩ, hình ảnhĐiều gì diễn ra trong đầu? Điều gì làm

khó chịu? Điều đó có ý nghĩa gì với thânchủ?

Cảm giác thể lýTôi nhận thấy điều gìnơi cơ thể? Ở vị trí

nào?

Tôi có những cảm xúcgì? Mức độ (%)?

Hành vi, tôi làm hay khônglàm điều gì (tránh né)?

Điều gì giúp tôi đương đầu vàvượt qua? Tôi có những phản

ứng tự động gì? Mọi ngườithấy tôi làm gì?

Tình huốngỞ đâu? Khi nào? Ai tham gia? Điều gì

xảy ra, như thế nào?Padesky (1986)

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Mọi sự đều tuyệt vọngTôi vô dụng/ không đáng giáTất cả là lỗi của tôiThế giới thật tàn nhẫn

Mệt mỏi, kiệt quệKhông tập trung, dễ quên

Thay đổi giấc ngủ/ ăn uống

Mất hứng thúTáo bón

TRẦM CẢM

HÀNH VI

SUY NGHĨ

Giảm hoạt độngThay đổi giấc ngủ/ ăn uống

Tự cách ly, rút luiVùi mình vào suy nghĩ tiêu cực

CƠ THỂ


Tôi đang gặp nguy hiểmĐiều tồi tệ nhất sẽ đến với tôiTôi không thể đối mặt vớiđiều đó

Tim đập mạnhNhịp thở nhanh

Cơ gồng cứng

Đổ mồ hôiGiãn đồng tử

Nôn mửa, khô môi

LO ÂU

HÀNH VI

SUY NGHĨ

Tránh né người/ nơi chốnDi chuyển liên tuc

Hoạt động/ hành vi trấn anTrốn chạy

CƠ THỂ

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Tôi bị đối xử thiếu công bằngTôi không được tôn trọngNgười ta không tuân thủluật lệ

Tôi không chịu đựng nổi

Tim đập mạnhNhịp thở nhanh

Cơ gồng cứng

RunThiếu toan tính

Bồn chồnNghiến răng

GIẬN DỮ

HÀNH VI

SUY NGHĨ

Trừng mắtTư thế hung hăn

Tấn côngCãi vã, la hét

Bỏ điIm lặng, làm lơ

Chì chiết, xem thường

CƠ THỂ

3. Cognitive Therapy

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