2011 Brooks/Cole, A Division of

Cengage Learning
Chapter 13

Cognitive Behavior
Therapy
Nothing is so terrible as activity without
thought.
Johann Wolfgang von Goethe
2011 Brooks/Cole, A Division of
Cengage Learning
Chapter Objectives
After reading this chapter, you should be able to:
Outline the development of cognitive behavioral
therapy
Explain the theory of cognitive behavioral therapy
Discuss the counseling relationship and goals in
cognitive behavioral therapy
Describe assessment, process, and techniques
Demonstrate some therapeutic techniques
Clarify the effectiveness of cognitive behavioral
therapy
2011 Brooks/Cole, A Division of
Cengage Learning
Aaron Beck
Childhood fears were handled with reasoning
Likely motivated his work with cognitive therapy
focusing on anxiety and depression
Graduated from Brown University and Yale Medical
School
Studied psychiatry and was trained as a
psychoanalyst
eventually his research led him to formulate cognitive
therapy, the focus of his career at the University of
Pennsylvania where the Beck Institute for Cognitive
Therapy and Research is housed
2011 Brooks/Cole, A Division of
Cengage Learning
Aaron Beck
Beck contended that various mental
disorders have particular cognitive
patterns and that the most effective and
lasting therapy involves intervention into
those patterns.
2011 Brooks/Cole, A Division of
Cengage Learning
Beliefs
People are not passive victims of their inborn
tendencies
People are actively creating and moving
toward goals that are vital to them
Distress occurs when people experience a
threat to their interests
The more crucial a person considers the goal
to be, the greater the response.
2011 Brooks/Cole, A Division of
Cengage Learning
Four levels of cognition
automatic thoughts,

intermediate beliefs,

core beliefs, and

schemas.
2011 Brooks/Cole, A Division of
Cengage Learning
Cognitive distortions
Distortions convert incoming information to keep
cognitive schema intact.
They use the assimilation process to maintain
homeostasis.
The information contrary to core belief is cancelled
out by the distortion process, and the person cannot
identify any disconfirming evidence from his
environment.
2011 Brooks/Cole, A Division of
Cengage Learning
Three assumptions
1. Cognitive activity impacts behavior.
2. Cognitive activity can be monitored and
changed.
3. A desired change in behavior can be
accomplished through changing
cognitions.
2011 Brooks/Cole, A Division of
Cengage Learning
Cognitive distortions
associated with distress and
maladaptive behaviors
Catastrophizing: expecting disastrous event
Mental filtering: seeing an entire situation
based on one detail with all else ignored
Blame or assigning internal responsibility
entirely to external events
2011 Brooks/Cole, A Division of
Cengage Learning
Cognitive distortions
associated with distress and
maladaptive behaviors
All-or-nothing thinking: the person thinks in
terms of two opposite categories
Discounting the positive: person says
positives do not count
Overgeneralization: a sweeping negative
conclusion that goes beyond facts
2011 Brooks/Cole, A Division of
Cengage Learning
Counselor
Both a guide to help the client understand how
beliefs and attitudes interact with emotions
and behavior, and a catalyst promoting
corrective experiences, leading to cognitive
change, and building skills.
2011 Brooks/Cole, A Division of
Cengage Learning
Case formation
Dynamic process
Requires the counselor to generate and test
their hypotheses
Five parts:
1. problem list,
2. diagnosis,
3. working hypothesis,
4. strengths and assets, and
5. treatment plan.
2011 Brooks/Cole, A Division of
Cengage Learning
Fundamental concepts
Collaborative empiricism - the cooperative working
relationship of jointly determining goals and seeking
feedback
Socratic dialogue - a type of questioning designed to
promote new learning
Guided discovery - when the counselor coaches the
child in a voyage of self-discovery in which the child
does his or her own thinking and draws his or her own
conclusions
2011 Brooks/Cole, A Division of
Cengage Learning
Session outline
Build an agenda that has meaning for the client
Ascertain and measure the intensity of the persons mood
Identify and review presenting problems
Ask about the clients expectation for counseling
Teach the person about cognitive therapy and the clients
role in it
Give information about the persons difficulties and
diagnosis
Establish goals
Recommend homework
Summarize
Obtain the clients feedback
2011 Brooks/Cole, A Division of
Cengage Learning
Counseling Session Four Steps
1
Review progress bringing counselor and client up to
date. Homework assignments checked for
completion.
Four quadrants for last week
1.List high points
2.Low points
3.How week could have been better
4.Plans for next week
2
Set agenda for current session based on 4 point
quadrant
3
Clarify and set specific behavioral goals for next
week
4
Have client summarize session as bridge to next
week: review new homework, anticipate obstacles,
evaluate session
2011 Brooks/Cole, A Division of
Cengage Learning
Stress inoculation
CBT technique that includes
Self talk
Practice tests
Visualization
Relaxation training
Deep breathing exercises
2011 Brooks/Cole, A Division of
Cengage Learning
Stress inoculation
Michenbaums 4 categories of self-talk
Preparation: what do you have to do
Confrontation: you can handle it
Coping: keep stress manageable
Reinforcing: I did it