COGNITIVE-BEHAVIOR THERAPY

(A Focus on Faulty Thoughts and Beliefs) The mind is its own place, and in itself can make a Heavn of Hell, a Hell of Heavn -JohnMilton

INTRODUCTION
The maladaptive thinking patterns lay at the heart of psychological disorders, and counselings proper goal should be to modify these patterns . Illogical thoughts and beliefs lie at the heart of psychological disorders, the psychotherapies that focus on thought and beliefs of the clients are called cognitive therapies. Cognitive treatment approaches teach people to think in more adaptive ways by changing their dysfunctional cognitions about the world and themselves. Unlike behavior therapists, who focus on modifying external behavior, cognitive therapists attempt to change the way people think as well as their behavior. Cognitive therapy emerged from the theories of psychodynamic therapies aiming at the thought processes that make our belief system which in turn play a vital role in human behavior. We are continuously responding to various stimuli we receive from the environment. Suppose, if you are not invited to a party hosted by your best friend and all other friends are invited, how do you feel? Do you ignore the situation or feel terribly insulted? These responses are sometimes called emotions. We take decisions every moment that are totally based on the belief system we have learned. During the several studies by different therapists, it is found that there was a thinking disorder at the core of the psychiatric syndromes such as depression and anxiety. This is due to the fact that bias interpretation of particular experiences. Kalat(2008), says Your emotions depend not just on the events of life but also on how you interpret them. Some therapists focus on the thoughts and beliefs that underlie emotional reactions. Unlike psychotherapists, these therapists are more concerned about what their clients are thinking right now than about the early experiences that led to those thoughts. Of all the negative feelings, feelings of jealous are most uncontrollable; especially the person you love is friendly with someone else. In these kinds of situations the problem is believed to be originated in cognition. Many of the psychological disorders-depression, anxiety, and other behavior disorders, can stem from how clients think about themselves and the world. These thoughts are very dangerous may affect ones behavior. It is believed that illogical and erroneous thoughts and beliefs lie at the heart of the psychological disorders, and the answer is a dose of therapy aimed at both cognition and behavior is essential.

Cognitive therapy seeks to improve peoples psychological well-being by changing their thoughts and beliefs-their cognitions. A cognitive therapist identifies distressing thoughts and encourages the client to explore the evidence behind them. Usually, the client discovers that the beliefs are unjustified. Cognitive therapy also encourages people to monitor their daily activities and determine which one provides opportunities for pleasure or a sense of accomplishment. Therapists have accepted and practiced cognitive therapy from diverse theoretical and philosophical positions, ranging from psychoanalytic to behavioral. Psychodynamic therapist found cognitive therapy very dynamic where the therapy involves working to alter tacit beliefs and interpersonal schemas. Behavioral therapists have found cognitive therapy a psycho educational model of psychotherapy that is empirically based and has its goal direct behavioral change. Cognitive behavior therapy, which combines both cognitive and behavioral principles and methods in a short-term treatment approach, based largely on empirical research. All of the cognitive behavioral approaches share the same basic characteristics and assumptions of traditional behavior therapy. Traditional behavior therapy, the cognitive behavioral approaches are quite diverse, but they do share these attributes: (1) a collaborative relationship between client and therapist, (2) the premise that psychological distress is largely a function of disturbances in cognitive processes, (3) a focus on changing cognitions to produce desired changes in affect and behavior, and (4) a generally time-limited and educational treatment focusing on specific and structured target problems.

Cognitive therapy treatment approaches teach people think in more adaptive ways by changing their dysfunctional cognitions about the world or themselves (Feldman 2011). Behavioral therapist aims at modifying the behavior of clients, while cognitive therapist treats the clients to change the way they think as well as their behavior. Cognitive therapy focuses primarily on the thoughts and emotions that lead to certain behaviors. On the other hand behavioral therapy deals with changing and eliminating those unwanted behaviors. However, some therapists practice a type of psychotherapy that focuses on both thoughts and behavior. This type of treatment is called cognitive-behavioral therapy (CBT). Another reason for calling cognitive therapy as cognitive-behavior therapy is that modification in behavior therapy also involves learning theories. Cognitive-

behavior therapy (CBT) believes that anxiety, depression, and negative emotions develop from maladaptive thinking. Hence, the CBT therapists teach clients to challenge their assumptions and adopt new approaches to old problems. The CBT relies on learning principles to help clients change the way they think. CBT combines a cognitive emphasis on thought and attitude with behavioral strategies. This dual approach assumes that an irrational self statement often under lie maladaptive behavior (Zimbardo 2012) Example; A client suffers intense anxiety in social situation, despite having excellent social skill. In this situation, instead of social skill training, the therapist helps the client identify the recurring thought (such as I should not draw attention to myself) that get in the way of self expression and create discomfort. Once the obstacle is identified the therapist encourages the client to develop and practice- new and more adaptive ways of thinking. The merging of cognitive therapy and behavior therapy has become more the rule than the exception (Kimberly Dienes 2011). Behavior therapy concerns about the clients learned behavior that arises from responses to an individuals environment and treats the clients to unlearn the problematic behavior. Cognitive therapy concerns about the clients individual beliefs about the self, the world, and the future and treats clients thoughts and maladaptive cognitions. Many therapists combine important features of both behavior therapy and cognitive therapy to form cognitive-behavior therapy (CBT). Cognitive-behavior therapists set explicit goals for changing peoples behavior, but they place more emphasis than most behavior therapists do on changing peoples interpretation of their situation. The task of CBT therapist is to make the client to identify distressing and selfdefeating thoughts and beliefs and encourage the client to explore the evidence behind them and make them develop better social skills, and take a more active role in life. This makes the client to recognize those thoughts and see how they can cause problems. The therapist use modeling, encouragement, and logic to help the client replace them with thoughts that are more realistic. CBT therapists help clients to think and act in more adaptive ways that aim at replacing thoughts with alternative thinking pattern. This is called Cognitive restructuring.

In 1960s Aaron T. Beck was a fully trained psychoanalyst searching for an order in psychoanalysis to be accepted by the medical community. Aaron felt the theories of psychoanalysis are needed to be demonstrated as empirically valid. `The results from his series of experiments led him to search for other explanation for depression. He identified distorted, negative cognition (primarily thoughts and beliefs) as a primary feature of depression and developed a short-term treatment, one of whose primary targets was the reality testing of patients depressed thinking (Beck Judith S, 2011). The underlying theory of CBT by Aaron Beck states that all the psychological disturbances are resulted from the dysfunctional thinking. This dysfunctional thinking influences patients mood and behavior. In this connection, Beck has incorporated two critical elements: 1. One element is Cognitive structures (Schemas and automatic thoughts). 2. The second element is Cognitive mechanism (Cognitive distortions). These two elements are responsible for clients sustained faulty information processing, where by clients distorted and filtered external environmental stimuli. The clients through CBT therapy when they learn to evaluate their thinking in a more realistic and adaptive way, they experience improvement in their emotional state and in their behavior. Modification of their underlying dysfunctional beliefs produces more enduring change (Beck Judith S, 2011). Aaron Beck believed that certain psychological disorders-especially those involving depression and anxiety can be traced to errors in logic, or what he calls cognitive distortions. Cognitive therapy is active, structured problemsolving approach. In cognitive therapy, the therapist helps clients to identify the distorted thought and beliefs that precede anxiety, depression etc.,. As therapy progresses, clients become more skilled at recognizing, and then correcting the cognitive distortions related to their problem (Bernstein 2008). This therapy was found to be successful when adapted to diverse set of populations with wide range of disorders and problems. The treatment is aimed at producing cognitive change-modification in the clients thinking and belief system-to bring about enduring emotional and behavior change. Cognitive behavior therapy is a way of talking about how we think about ourselves, the world and other people and how our behavior affects our thoughts and feelings. This approach will help us to change how we think (Cognitive) and what we do (Behavior). These changes can help us to feel better. Cognitive behavior therapy focuses on the present problems and difficulties. Cognitive behavior therapy does not focus on the causes of distress or symptoms in the past; it looks for ways to improve our state of mind now.

Cognitive behavior therapy has been shown to help with many different types of problems. These include: anxiety, depression, panic, phobias, stress, obsessive compulsive disorder, post-traumatic stress disorder, bipolar disorder and psychosis. This therapy will also help if you have difficulties with anger, a low opinion of ourselves or physical health problems, like pain or fatigue. There are a number of forms of cognitive-behavior therapy that share characteristics of Becks cognitive therapy. 1. 2. 3. 4. 5. 6. 7. 8. Rational-emotive behavior therapy (REBT) by ELLIS Dialectical behavior therapy by LINEHAN Problem-solving therapy by DZURILLA & NEZU Acceptance and commitment therapy by HAYES,FOLLETTE,& LINEHAN Exposure therapy by FOA &ROTHBAUM Cognitive processing therapy by RESICK & SCHNICKE Cognitive Behavior analysis system of psychotherapy by Mc CULLOUGH Cognitive modification by MEICHENBAUM

A BRIEF HISTORY OF COGNITIVE-BEHAVIOR THERAPY

What upsets people is not things themselves but their judgments about the things. Commented stoic philosopher Epictetus. Basing on Epictetus comments, the cognitive therapists believed that individuals are proactive and develop systems of personal meaning to organize their interactions with the world. This is called psychological constructivism. In the history of CBT, the influence of psychodynamic theory is very clearly observed. Freud, in psychodynamic theory divided the psyche into the conscious, pre-conscious, and unconscious domains. Freud believed that individuals behavior primarily motivated by unconscious drives. And cognitive therapists divided cognitive processes into automatic thoughts, assumptions and Schemas. Further to psychodynamic theory of Freud, Beck, Ellis, and Goldfried incorporated cognitive meditational constructs with behavioral theory. They focused on the role of social learning processes in the development of emotional problems and on the use of cognitive restructuring, the development of social problem-solving capacities; and the acquisition of behavioral skills in resolving them(Dienes Kimberly 2011).

BASIC PREMISES OF CBT Though there have been a number of cognitive behavior techniques developed, a set of basic principles and assumptions underlie these techniques. 1. The first premise is that psychological dysfunction is understood in terms of mechanisms of learning and information processing. Cognitive research has shown that distortions in processing information about oneself and the environment are integral to many behavioral and psychological problems. 2. The second premise is that the cognitive-behavior approach treatment believes and guided by principle that behavior is seen as a function of the specific environmental and internal conditions surrounding it. And behavior is viewed as adaptive and subject to change. The central feature of CBT is that once the central feature (responsible feature for disorder) is identified, targeted in treatment, and changed, the resulting maladaptive thoughts, symptoms, and behaviors will also change. 3. The third premise is that change is effected through new learning experience that over power previous forms of maladaptive learning and information processing. CBT sometimes teaches new coping skills for more effective response to environmental situation. As a result of the problem-focused approach, CBT treatments are typically brief and time limited in nature. Many CBT treatments lead to significant clinical improvement and symptom reduction relative to other forms of psychotherapies, in as few as 10-20 sessions (Hazleh-Stevens2002).

THEORIES OF COGNITIVE-BEHAVIOR THERAPY

Cognitive model is based on a concept that dysfunctional thinking which influences the clients mood and behavior is base of all psychological disturbances. When people learn to evaluate their thinking in a more realistic and adaptive way, they experience improvement in their emotional state and in their behavior (Beck Judith s 2011).Therapeutic treatments of their underlying dysfunctional beliefs (about themselves, their world, and other people) produce more enduring change.

PSYCHOLOGICAL HEALTH AND PATHOLOGY Human behavior is based on rules and tacit beliefs that are elaborated and consolidated over the course of an individuals life. A belief system is developed from the knowledge processed by cognitive processing system. This belief system in turn expressed as a behavior called emotional response. Hence, cognitive processes play a central role in organizing our responses. These cognitive processes, emotional responses, and also behavioral skills are adaptive. The difference between a healthy personality and the individuals with psychopathology is the distinction between adaptive cognitions and maladaptive cognitions. Aaron Beck has identified three variables that play a central role in the formation and maintenance of common psychological disorders. 1. COGNITIVE TRIAD 2. SCHEMAS 3. COGNITIVE DISTORTIONS

1. COGNITIVE TRIAD. This was proposed by Aaron Beck to describe negativistic thoughts of depressed clients. The characteristic feature of a depressive personality is developing highly negative views of self, the world, and the future. The cognitive triad is 1. The clients view of self 2. His world 3. Thoughts of future 2. SCHEMAS. A schema describes any of several concepts including:

An organized pattern of thought or behavior. A structured cluster of pre-conceived ideas. A mental structure that represents some aspect of the world. A specific knowledge structure or cognitive representation of the self. A mental framework centering on a specific theme, which helps us to organize social information. Structures that organize our knowledge and assumptions about something and are used for interpreting and processing information.

The following are the schemas maintained by highly depressed persons. Im defective (impaired autonomy and performance) and people are unreliable (disconnection and rejection). Highly angry individuals, in contrast, may or may not believe they are flawed or defective. They do, however, tend to believe that the world is dangerous (over vigilance/inhibition), and that people are malicious (disconnection and rejection). Although not present in these individuals daily thoughts, these beliefs strongly influence their behavioral and emotional reactions. A schema plays an important role in cognitive models of emotional and behavioral problems. These are developed over the course of an individuals infancy and childhood. Schemas are early maladaptive experiences. They develop into beliefs and serve as the wellspring of the various cognitive distortions. As thoughts about personal weakness, hopelessness, and unremitting disappointment gain predominance, individuals become less active and socially engaged, and their mood becomes increasingly depressed and hopeless (Dienes Kimberly 2011). These schemas become tacit beliefs and are activated by events that are similar to early experiences. The early maladaptive schemas are presumed to occur in FIVE main domains (Dienes Kimberly 2011). 1. Disconnection and rejection, in which an individual perceives instability in interpersonal connections. 2. Impaired autonomy and performance, in which one has difficulty functioning independently and successfully differentiating self from others. 3. Impaired limits in regard to reciprocity and self-discipline. 4. Other directedness that focuses on the needs of others while neglecting ones own needs. 5. Over vigilance and inhibition that involve suppression of ones own impulses and feelings, and internalization o rigid rules about ones functioning. Automatic Thoughts As mentioned previously, the automatic thought is a key concept in Becks cognitive psychotherapy. Such thoughts occur spontaneously, without effort or choice. In psychological disorders, automatic thoughts are often distorted, extreme, or otherwise inaccurate. For example, Nancy put off applying to department stores for a job as an assistant buyer. Unhappy with her job as a sales clerk, she had such thoughts as Im too busy now, When the holiday season is over, I will apply for a job, and I cannot get time off to go to other stores to get job applications. Recognizing these thoughts as excuses, Nancy,

with the help of her therapist, identified automatic thoughts related to job seeking, such as I wont present myself well and Other people will be better than me. By talking with Nancy about her thought processes, the therapist was able to generate several automatic thoughts. By organizing these automatic thoughts, the therapist was able to articulate a set of core beliefs or schemas. 3. COGNITIVE DISTORTIONS We are in our daily life exposed to infinite amount of information through our five senses. We receive the information selectively that are important to our adaptation and survival. Information is necessary for our survival. But our senses have limitations in capacity and abilities to processes the information. That is the reason that some events or information is examined, recalled, and reflected on; others are overlooked, ignored, and forgotten as unimportant or uninteresting. Because of limitations in the processing of information, an individuals perceptions, memories, and thoughts can become distorted in a variety of adaptive and maladaptive ways. Distortions represent maladaptive ways of processing information and may become emblematic of a particular style of behaving or of certain clinical syndromes (Dienes Kimberly 2011). Typical distortions and examples of the common clinical correlates include the following: (Dienes Kimberly 2011).

1. Dichotomous thinking. Things are black or white; Youre with me or against me. This tendency toward all-or-nothing thinking is encountered in borderline personality and obsessivecompulsive disorders. 2. Mind reading. They probably think that Im incompetent; I just know that they will disapprove. This processing style is common in avoidant and paranoid personality disorders. 3. Emotional reasoning. I feel inadequate, so I must be inadequate; Im feeling upset, so there must be something wrong. This distortion is common among individuals suffering from anxiety disorders. 4. Personalization. That comment wasnt just random, I know it was directed toward me. At the extreme, this is common in avoidant and paranoid personality disorders. This is also called self-referencing. In this kind, the clients take everything personally. If someone doesnt say hello, they conclude that its their fault. 5. Overgeneralization. Everything I do turns out wrong; It doesnt matter what my choices are, they always fall flat. This distortion occurs when an individual generalizes and comes to a strong conclusion on the basis of a single or small number of incidents. When overgeneralization occurs,

the conclusion may be unwarranted. It is like when individuals magnify imperfections or minimize good points. 6. Catastrophizing. If I go to the party, there will be terrible consequences; It would be devastating if I failed this exam; My hearts beating faster, its got to be a heart attack. This distortion is characteristic of anxiety disorders, especially social anxiety, social phobia, and panic. 7. Should statements. I should visit my family every time they want me to; They should do what I say because it is right. This is common in obsessivecompulsive disorders and among individuals who feel excessive guilt. 8. Selective abstraction Ive got to focus on the negative details; the positive things that have happened dont count. At the extreme, this is common in depression. This is a kind of distortion where most relevant information about a situation is ignored while one minor detail provides the basis for a negative conclusion. This is like focusing selectively on negative events. 9. Arbitrary Inference. This distortion is like jumping to conclusion without any supporting or relevant evidence that the worst possible outcome will happen. 10. Labeling and Mislabeling. All humans use labels to describe themselves and others. A negative view of oneself is created by selflabeling based on some errors or mistakes. A person who has had some awkward incidents with acquaintances might conclude, Im unpopular. Im a loser rather than I felt awkward talking to Harriet. In labeling and mislabeling in this way, individuals can create an inaccurate sense of themselves or their identity. Basically, labeling or mislabeling is an example of over generalizing to such a degree that ones view of oneself is affected. If they occur frequently, such cognitive distortions can lead to psychological distress or disorders. Making inferences and drawing conclusions from a behavior are important parts of human functioning. Individuals must monitor what they do and assess the likelihood of outcomes to make plans about their social lives, romantic lives, and careers. When cognitive distortions are frequent, individuals can no longer do this successfully and may experience depression, anxiety, or other disturbances. Cognitive therapists look for cognitive distortions and help their patients understand their mistakes and make changes in their thinking.

FORMS OF PRINCIPLES

COGNITIVE

THEORY,

THERAPY

AND

THEORITICAL

Cognitive therapy is divided into THREE types basing on the doctrines they are built upon. 1. Rational (Rational-Semantic cognitive therapy behavior therapy REBT) 2. Empirical (Collaborative-Empirical therapies) 3. Philosophical- Constructivist Cognitive therapy or Rational-Emotive

Rational-Emotive behavior therapy (REBT) (Overcoming Irrational Beliefs) View of Human Nature Corey says Rational emotive behavior therapy is based on the assumption that human beings are born with a potential for both rational, or straight, thinking and irrational, or crooked, thinking. People have predispositions for self preservation, happiness, thinking and verbalizing, loving, communion with others, and growth and self-actualization. They also have propensities for selfdestruction, avoidance of thought, procrastination, endless repetition of mistakes, superstition, intolerance, perfectionism and self-blame, and avoidance of actualizing growth potentials. Taking for granted that humans are fallible, REBT attempts to help them accept themselves as creatures who will continue to make mistakes yet at the same time learn to live more at peace with themselves. View of Emotional Disturbance Corey writes REBT is based on the premise that although we originally learn irrational beliefs from significant others during childhood, we create irrational dogmas by ourselves. We do this by actively reinforcing self-defeating beliefs by the processes of autosuggestion and self-repetition and by behaving as if they are useful. Hence, it is largely our own repetition of early-indoctrinated irrational thoughts, rather than a parents repetition, that keeps dysfunctional attitudes alive and operative within us. This leads to personality disorder and Ellis blames emotional disturbances for this situation. He says that it is important to learn to fully accept ourselves despite our imperfections. Although REBT encourages people to experience healthy feelings of sadness over being unaccepted, it attempts to help them find ways of overcoming unhealthy feelings of depression, anxiety, hurt, loss of self-worth, and hatred. A-B-C Framework

The A-B-C framework is central to REBT theory and practice. This model provides a useful tool for understanding the clients feelings, thoughts, events, and behavior . A is the existence of a fact, an activating event, or the behavior or attitude of an individual. C is the emotional and behavioral consequence or reaction of the individual; the reaction can be either healthy or unhealthy. A (the activating event) does not cause C (the emotional consequence). Instead, B, which is the persons belief about A, largely causes C, the emotional reaction. The interaction of the various components can be diagrammed like this: A (activating event) B (belief) C (emotional and behavioral consequence) D (disputing intervention) E (effect) F (new feeling) If a person experiences depression after a divorce, for example, it may not be the divorce itself that causes the depressive reaction but the persons beliefs about being a failure, being rejected, or losing a mate. Ellis would maintain that the beliefs about the rejection and failure (at point B) are what mainly cause the depression (at point C)not the actual event of the divorce (at point A). Disturbed emotional reactions such as depression and anxiety are initiated and perpetuated by clients self-defeating belief systems, which are based on irrational ideas clients have incorporated and invented. Philosophical restructuring to change our dysfunctional personality involves these steps: (1) fully acknowledging that we are largely responsible for creating our own emotional problems; (2) accepting the notion that we have the ability to change these disturbances significantly; (3) recognizing that our emotional problems largely stem from irrational beliefs; (4) clearly perceiving these beliefs; (5) seeing the value of disputing such self-defeating beliefs; (6) accepting the fact that if we expect to change we had better work hard in emotive and behavioral ways to counteract our beliefs and the dysfunctional feelings and actions that follow; and (7) practicing REBT methods of uprooting or changing disturbed consequences for the rest of our life Philosophical view points Early in 1955 Ellis developed rational emotive behavior therapy (REBT). Ellis has rightly been called the grandfather of cognitive behavior therapy. By applying cognitive behavioral methods, one can manage to conquer some of the strongest emotional blocks. He has drawn few philosophical doctrines to explain REBT.

Responsible Hedonism Hedonism refers to the concept of seeking pleasure and avoiding pain. Ellis is particular about responsible hedonism concerning long term pleasure over short-term pleasure that may lead to pain, such as drug abuse and alcohol addiction. Although REBT does not tell people what to enjoy, its practitioners believe that enjoyment is a major goal in life. This point of view does not lead to irresponsible behavior because individuals with a responsible attitude toward hedonism think through the consequences of their behavior on others as well as on themselves. Manipulating and exploiting others is not in the long-range interest of individuals. Humanism. Practitioners of REBT view human beings as holistic, goal-directed organisms who are important because they are alive. They should accept that they make mistakes, that they have worth, and that some of their own assets and qualities are stronger than other assets that they or others possess. Rationality. Rationality refers to people using efficient, flexible, logical, and scientific ways of attempting to achieve their values and goals, not to the absence of feelings or emotions. Therapy with REBT shows individuals how they can get more of what they want from life by being rational (efficient, logical, and flexible). This modern rational approach has been developed and promoted by Albert Ellis. This approach is the result when he felt that the theories of psychoanalysis are ineffective. According to Ellis, outside events do not cause us to have feelings. We feel as we do because of our irrational beliefs ( Huffman Karen 2010). Ellis in his theory says that humans are neither inherently good nor inherently bad; they are potentially capable of thinking both rationally and irrationally. Unfortunately, humans have a strong tendency to think in crooked, mistaken, and irrational ways and this is the primary source of human misery (Flanagan John Summers 2004). In REBT, psychopathology is a direct function of irrational beliefs. And sometimes it is offensive. Ellis has identified THREE basic irrational beliefs. Example: A few unrealistic ideas or irrational beliefs are mentioned below 1. I must do well and win the approval of others for my performances or else I am no good.

2. Other people must treat me considerately, fairly, kindly, and in exactly the way I want them to treat me. If they dont, they are no good and they deserve to be condemned and punished. 3. I must get what I want, when I want it; and I must not get what I dont want. If I dont get what I want, its terrible, and I cant stand it. These irrational beliefs trigger negative emotions, which in turn support the irrational beliefs and lead to a self-defeating cycle (Feldman 2011). This theory is based on the following FIVE components. In this statement Ellis efficiently summarizes five bedrock components of his theory of therapy: 1. People dogmatically adhere to irrational ideas and personal philosophies. 2. These irrational ideas cause people great distress and misery. 3. These ideas can be boiled down to a few basic categories. 4. Therapists can find these irrational categories rather easily in their clients reasoning. 5. Therapists can successfully teach clients how to give up their miserycausing irrational beliefs. The cognitive therapy treatment is based on a theory that the reason for unhappiness is the fact that the people who suffer with unhappiness harbor irrational, unrealistic ideas. The treatment into restructure a persons belief system into more realistic, relational and logical set of views. REBT approach believes that thought leads to emotions, and when these emotions become unpleasant emotions interpret past events, current concern and future possibilities. CBT set explicit goals for changing peoples behavior, but they place more emphasis than most behavior therapists do on changing peoples interpretation of their situation (Kalat James 2008). REBT in this situation help clients eliminate maladaptive thought and beliefs and adopt more effective training. As a rationalist model, REBT encourages therapists to actively identify and label thoughts that cause clients distress and misery as irrational thoughts.

Factors Basic to the Rational Emotive Behavior Theory of Personality Ellis has recognized a number of factors that contribute to an individuals personality development and personality disturbances, including strong biological and social aspects that present a challenge to the therapist to help change.
1.

Biological factors. 2. Social factors. 3. Vulnerability to disturbance

Biological factors Ellis believed in the power of biological factors in determining human personality. He also believed that humans have a strong biological tendency to needlessly and severely disturb themselves, and they also powerfully predisposed to unconsciously and habitually prolong their mental dysfunction. He believes that certain severe mental disturbances are partly inherited and have strong biological components. Social factors. Interpersonal relationships in families, peer groups, schools, and other social groups have an impact on the expectations that individuals have of themselves and others . They are likely to define themselves as good or worthwhile, depending on how they see others reacting to them. If they feel accepted by others, they are likely to feel good about themselves. Individuals receiving criticism from parents, teachers, or peers are likely to view themselves as bad or worthless or in other negative ways. From a rational emotive behavior perspective, individuals who feel worthless or bad about themselves are often caring too much about the views and values of others. Vulnerability to disturbance. Depending on social and biological factors, individuals vary as to how vulnerable they are to psychological disturbance. They often have goals to enjoy themselves when alone or in social groups, to enjoy an intimate sexual relationship with another, to enjoy productive work, and to enjoy a variety of recreational activities.

Therapeutic Techniques and Procedures

(The Practice of Rational Emotive Behavior Therapy) Cognitive restructuring is a central technique of cognitive therapy that teaches people how to improve themselves by replacing faulty cognitions with constructive beliefs. Overcoming Irrational Misconceptions Albert Ellis believes that most people require the help of a therapist to allow them to see through their defenses and force them to challenge their selfdefeating thoughts. However, you may be able to improve some of your own irrational beliefs and responses with the following suggestions: 1. Identify your belief system. Identify your irrational beliefs by asking yourself why you feel the particular emotions you do. Ellis believes that, by confronting your thoughts and feelings, you can discover the irrational assumptions that are creating the problem consequences.
2.

Evaluate the consequences. Emotions such as anger, anxiety, and depression often seem natural. But they dont have to happen. Rather than perpetuating negative emotions by assuming they must be experienced, focus on whether your reactions make you more effective and enable you to solve your problems. Dispute the self-defeating beliefs. Once you have identified an overly demanding or irrational belief, argue against it. For example, it is gratifying when people you cherish love you in return, but if they do not, continuing to pursue them or insisting that they must love you will only be self defeating.

3.

4.

Practice effective ways of thinking. Continue to examine your emotional reactions to events and situations in order to create opportunities to dispute irrational beliefs and substitute realistic perceptions. Practice behaviors that are more effective by rehearsing them at home and imagining outcomes that are more successful.

REBT generally starts with clients distorted feelings and intensely explores these feelings in connection with thoughts and behaviors. REBT practitioners tend to use a number of different modalities (cognitive, imagery, emotive, behavioral, and interpersonal). They are flexible and creative in their use of

methods, making sure to tailor the techniques to the unique needs of each client. They are 1. Cognitive methods 2.Emotive techniques 3. Behavioral techniques COGNITIVE METHODS REBT practitioners usually incorporate a forceful cognitive methodology in the therapeutic process. REBT relies heavily on thinking, disputing, debating, challenging, interpreting, explaining, and teaching. The most efficient way to bring about lasting emotional and behavioral change is for clients to change their way of thinking. The following are some cognitive techniques available to the therapist.
a. Disputing irrational beliefs b. doing cognitive homework c. changing ones language d. Psycho educational methods.

a. Disputing irrational beliefs The most common cognitive method of REBT consists of the therapist actively disputing clients irrational beliefs and teaching them how to do this challenging on their own. Clients go over a particular must, should, or ought until they no longer hold that irrational belief, or at least until it is diminished in strength. Here are some examples of questions or statements clients learn to tell themselves: Why must people treat me fairly? How do I become a total flop if I dont succeed at important tasks I try? If I dont get the job I want, it may be disappointing, but I can certainly stand it. If life doesnt always go the way I would like it to, it isnt awful, just inconvenient. b. Doing cognitive homework REBT clients are expected to make lists of their problems, look for their absolutist beliefs, and dispute these beliefs. They often fill out the REBT SelfHelp. They can bring this form to their therapy sessions and critically evaluate the disputation of some of their beliefs. Homework assignments are a way of tracking down the absolutist shoulds and musts that are part of their internalized self messages. Part of this homework consists of applying the A-BC model to many of the problems clients encounter in daily life. In carrying out homework, clients are encouraged to put themselves in risk taking situations that will allow them to challenge their self-limiting beliefs. For example, a client with a talent for acting who is afraid to act in front of an audience because of fear of failure may be asked to take a small part in a stage play. The client is instructed to replace negative self-statements such as I will fail, I will look foolish, or No one will like me with more positive messages such as Even if I do behave foolishly at times, this does not make me a foolish

person. I can act. I will do the best I can. Its nice to be liked, but not everybody will like me, and that isnt the end of the world. Making changes is hard work, and doing work outside the sessions is of real value in revising clients thinking, feeling, and behaving. c. Changing ones language REBT contends that imprecise language is one of the causes of distorted thinking processes. Clients learn that musts, oughts, and shoulds can be replaced by preferences. Instead of saying It would be absolutely awful if . . . they learn to say It would be inconvenient if . . .. Clients who use language patterns that reflect helplessness and self-condemnation can learn to employ new self-statements, which help them think and behave differently. As a consequence, they also begin to feel differently.
d. Psycho educational methods.

Therapists educate clients about the nature of their problems and how treatment is likely to proceed. They ask clients how particular concepts apply to them. Clients are more likely to cooperate with a treatment program if they understand how the therapy process works and if they understand why particular techniques are being used. EMOTIVE TECHNIQUES REBT practitioners use a variety of emotive procedures, including unconditional acceptance, rational emotive role playing, modeling, rational emotive imagery, and shame-attacking exercises. Clients are taught the value of unconditional self-acceptance. Even though their behavior may be difficult to accept, they can decide to see themselves as worthwhile persons. Clients are taught how destructive it is to engage in putting oneself down for perceived deficiencies. Some of the emotive therapeutic techniques are a. Rational emotive imagery b. using humor. c. Role playing. d. Shameattacking exercises.
a. Rational emotive imagery

This technique is a form of intense mental practice designed to establish new emotional patterns. Clients imagine themselves thinking, feeling, and behaving exactly the way they would like to think, feel, and behave in real life. They can also how to feel unhealthily upset about this situation, how to intensely experience their feelings, and then how to change the experience to a healthy negative feeling. As clients change their feelings about adversities, they stand a

better chance of changing their behavior in the situation. Such a technique can be usefully applied to interpersonal and other situations that are problematic for the individual. Ellis has observed practicing rational emotive imagery several times a week for a few weeks; we can reach the point that we no longer feel upset over negative events.
b. Using humor

One appealing aspects of REBT is that it fosters the development of a better sense of humor and helps put life into perspective. Humor has both cognitive and emotional benefits in bringing about change. Humor shows the absurdity of certain ideas that clients steadfastly maintain, and it can be of value in helping clients take themselves much less seriously. In his workshops and therapy sessions, Ellis typically uses humorous songs, and he encourages people to sing to themselves or in groups when they feel depressed or anxious. c. Role playing Role playing has emotive, cognitive, and behavioral components, and the therapist often interrupts to show clients what they are telling themselves to create their disturbances and what they can do to change their unhealthy feelings to healthy ones. The focus is on working through the underlying irrational beliefs that are related to unpleasant feelings. d. Shame-attacking exercises Ellis developed exercises to help people reduce shame over behaving in certain ways. The exercises are aimed at increasing self-acceptance and mature responsibility, as well as helping clients see that much of what they think of as being shameful has to do with the way they define reality for themselves. Clients may accept a homework assignment to take the risk of doing something that they are ordinarily afraid to do because of what others might think. In these exercises the clients are asked to do the acts deliberately which they thought are foolish. Example: like singing at the top of their lungs, asking silly questions, wearing a dress designed to attract attention, etc. By carrying out such assignments, clients are likely to find out that other people are not really that interested in their behavior. They continue practicing these exercises until they realize that their feelings of shame are self-created and until they are able to behave in less inhibited ways.

In sum, philosophical restructuring to change our dysfunctional personality involves these steps: (1) fully acknowledging that we are largely responsible for creating our own emotional problems; (2) accepting the notion that we have the ability to change these disturbances signify cantly; (3) recognizing that our emotional problems largely stem from irrational beliefs; (4) clearly perceiving these beliefs; (5) seeing the value of disputing such self-defeating beliefs; (6) accepting the fact that if we expect to change we had better work hard in emotive and behavioral ways to counteract our beliefs and the dysfunctional feelings and actions that follow; and (7) practicing REBT methods of uprooting or changing disturbed consequences for the rest of our life. BEHAVIORAL TECHNIQUES REBT practitioners use most of the standard behavior therapy procedures, especially operant conditioning, self-management principles, systematic desensitization, relaxation techniques, and modeling. Behavioral homework assignments to be carried out in real-life situations are particularly important. Doing homework may involve desensitization and live exposure in daily life situations. Clients can be encouraged to desensitize themselves gradually but also, at times, to perform the very things they dread doing implosively. For example, a person with a fear of elevators may decrease this fear by going up and down in an elevator 20 or 30 times in a day. Three behavioral methods frequently used by rational emotive behavior therapists are activity homework, reinforcements and penalties, and skill training AARON BECK AND COGNITIVE THERAPY (EMPIRICAL) In addition to Freudian analytic theory, Beck concluded that other stream of consciousness was much more valuable to clients than the usual free association. Becks observations of depressed clients revealed that they had a negative bias in their interpretation of certain life events, which contributed to their cognitive distortions. Cognitive therapy perceives psychological problems as stemming from commonplace processes such as faulty thinking, making

incorrect inferences on the basis of inadequate or incorrect information, and failing to distinguish between fantasy and reality. In this therapy he uses a style he refers to as collaborative empiricism, wherein he works together with clients to help them discover for themselves the maladaptive nature of their automatic thoughts. In REBT Ellis forcefully eradicates the irrational thought. In cognitive therapy, Beck collaborates in modification of maladaptive thoughts. According to cognitive theory, behavior is the function of what the individual thinks about its consequences. Hence, the S-R model of behavior is revised as S-O-R model-stimulus-organism-response theory. Cognitive theory believes in the individual organisms processing of environmental stimuli as the driving force determining his or her specific response. Becks cognitive therapy is also similar to Ellis REBT. Both the theories believe in; 1. Cognition is at the core of human suffering 2. The therapists job is to help clients modify distress-producing thoughts. Beck and Ellis both tried to help clients to modify their thoughts by teaching and learning. All of these therapies are active, directive, time-limited, presentcentered, problem-oriented, collaborative, structured, and empirical, make use of homework, and require explicit identification of problems and the situations in which they occur. The basic theory of CT holds that to understand the nature of an emotional episode or disturbance it is essential to focus on the cognitive content of an individuals reaction to the upsetting event or stream of thoughts. The goal is 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. This is done by encouraging clients to gather and weigh the evidence in support of their beliefs. BECK THEORY OF PERSONALTY OR THEORY OF PSYCHOPATHOLOGY Becks theory of personality and psychotherapy includes the following characteristics:
1. In the process of living, individuals are exposed to a variety of specific

life events or situations, some of which trigger automatic, maladaptive thoughts.

2. These maladaptive thoughts are characterized by their faultiness; they

are too narrow, too broad, too extreme, or simply inaccurate.

3. An individuals maladaptive thoughts are usually derived from deeply held maladaptive core beliefs (a.k.a. schemas or dysfunctional attitudes).

4. Individuals generally acquire these core beliefs during childhood. 5. These automatic thoughts, core beliefs, and their associated emotional disturbances, can be modified via cognitive therapya procedure that does not require exploration of a clients past. In comparison Ellis focused on three irrational beliefs in his REBT, on the other hand Beck emphasized the clients cognitive distortions or faulty assumptions and misconceptions. These distortions, triggered by external events produce automatic thoughts, which are often linked to underlying core beliefs or schemas (Flanagan John Summers 2004). Some of the systematic errors in reasoning that lead to faulty assumptions and misconceptions, which are termed cognitive distortions. a. Arbitrary inferences b. Selective abstraction c. Overgeneralization d. Magnification and minimization e. Personalization f. Labeling and mislabeling. a. Arbitrary inferences This refers to making conclusions without supporting and relevant evidence. This includes catastrophizing, or thinking of the absolute worst scenario and outcomes for most situations. This is like taking task thinking that you fail miserably in the execution. b. Selective abstraction This consists of forming conclusions based on an isolated detail of an event. In this process other information is ignored, and the significance of the total context is missed. The assumption is that the events that matter are those dealing with failure and deprivation. When take up job, you might measure your worth by your errors and weaknesses, not by your successes. c. Overgeneralization This is a process of holding extreme beliefs on the basis of a single incident and applying them inappropriately to dissimilar events or settings. Failure in one incident is applied all other unconnected incidents. d. Magnification and minimization

This consist of perceiving a case or situation in a greater or lesser light than it truly deserves. You might make this cognitive error by assuming that even minor mistakes in a job can be devastating. e. Personalization This is a tendency for individuals to relate external events to themselves, even when there is no basis for making this connection. f. Labeling and mislabeling This involve portraying ones identity on the basis of imperfections and mistakes made in the past and allowing them to define ones true identity. The cognitive therapist operates on the assumption that the most direct way to change dysfunctional emotions and behaviors is to modify inaccurate and dysfunctional thinking. The cognitive therapist teaches clients how to identify these distorted and dysfunctional cognitions through a process of evaluation. Through a collaborative effort, clients learn the influence that cognition has on their feelings and behaviors and even on environmental events. In cognitive therapy, clients learn to engage in more realistic thinking, especially if they consistently notice times when they tend to get caught up in catastrophic thinking. SOME DIFFERENCES BETWEEN CT AND REBT In both Becks cognitive therapy and REBT, reality testing is highly organized. Clients come to realize on an experiential level that they have misconstrued situations. Yet there are some important differences between REBT and CT, especially with respect to therapeutic methods and style. REBT is often highly directive, persuasive, and confrontational; it also focuses on the teaching role of the therapist. The therapist models rational thinking and helps clients to identify and dispute irrational beliefs. In contrast, CT uses a Socratic dialogue by posing open-ended questions to clients with the aim of getting clients to reflect on personal issues and arrive at their own conclusions. CT places more emphasis on helping clients discover and identify their misconceptions for themselves than does 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. There are also differences in how Ellis and Beck view faulty thinking. Through a process of rational disputation, Ellis works to persuade clients that certain of

their beliefs are irrational and nonfunctional. Beck (1976) takes exception to REBTs concept of irrational beliefs. Cognitive therapists view dysfunctional beliefs as being problematic because they interfere with normal cognitive processing, not because they are irrational CONSTRUCTIVIST THEORY AND THERAPY Philosophical-constructivism is founded on the premise that humans actively construct their own reality. Constructive theories and therapies place a strong emphasis on helping clients reconstruct or restory their lives in more adaptive and satisfying ways. This emphasis requires that therapy interactions focus primarily on the present and future. In some ways, to explore constructive theories is to dive more deeply into the abyss of as if as introduced to philosophers in the early twentieth century by Hans Vaihinger. Constructivism is philosophically and psychologically compelling, especially within our contemporary multivariate, multidimensional, and multicultural society. As a consequence of this philosophical position, we humans can no longer stake any claim to objectivity. Everything is perspective, and perspective is everything. Each of us views reality through our own particular set of lenses. SPECIFIC THERAPY TECHNIQUES There are numerous, highly accessible, and highly practical cognitive therapy techniques that practitioners can employ. The following techniques are few of them. Generating Alternative Interpretations Generating alternative interpretations is a useful technique with clients who hold onto maladaptive or irrational automatic thoughts despite the fact that other, more reasonable, interpretations or explanations exist. The technique of generating alternative interpretations is explained, with the specific focus being on thoughts or interpretations rather than behaviors. This technique is especially useful with adolescents. In a series of studies, researchers have demonstrated that youths who consistently display aggressive behavior often do so, in part, because they have quickly and incorrectly interpreted the behavior of other youths as hostile. This phenomenon is called misattribution of hostility. For example, if a youth disposed toward aggression is walking through the hall at school and another student inadvertently bumps him, the youth is likely to attribute the bump to an intentional hostile act. Consequently, the potential for retaliation is increased.

Vigorous and Forceful Disputing: This technique stems from Elliss view that an individual can begin to lightly adopt a rational belief (e.g., I want people to like me, but I can live happily if they dont) while at the same time strongly holding onto an opposing irrational belief with more intensity (e.g., But I really absolutely need their approval and have nothing to live for if I dont get it!). To help clients who have this problem, Ellis suggests that you first explain to them that vigorous, forceful, and persistent disputing of irrational beliefs is often needed to actually replace them with rational beliefs. Next, provide clients with the written instructions, encouraging them to partake in this homework assignment to vigorously dispute their irrational beliefs. Elliss prescription of homework assignment essentially amounts to repeated practice at more and more forceful cognitive disputing procedures. This homework assignment flows directly from his therapeutic style: That is, if clients can mount a forceful and rational counterattack against their irrational beliefs, theyll be able to minimize and hopefully eliminate their irrational thinking.
Thinking in Shades of Grey

It involves taking a clients automatic thoughts, assumptions, or conclusions about a specific performance and placing them on a concrete, measurable scale. After focusing on automatic thoughts, the client produces the following written description of himself and his core beliefs or self-schema: I am basically defective. Therefore, to prove Im not defective, I have to do a better, higher quality job on my work than anyone else. Every task I do must be performed flawlessly, or there is just more proof that Im defective. But accomplishing one or two tasks perfectly is not sufficient proof of my adequacy. Therefore, Ive got to keep working. . . or Ive failed, period. Also, my basic assumption is that to fail at one task is to fail altogether. Obviously, the client was suffering from a terrible case of the tyranny of the shoulds, and several cognitive and behavioral procedures are employed in his overall treatment. However, as one entry point for questioning his rigid selfschema, the therapist used the technique of thinking in shades of grey. The clients assignment was to rate himself using a scale and to occasionally double-check his ratings with his supervisors ratings of his performance. To clients surprise, his supervisor always rated the quality of his performance in

the top two categories, and client himself discovered that all of his self-ratings were also in the top two categories. There are many more cognitive techniques available to the cognitive therapist. Most of these techniques focus on using mental strategiesusually verbal, linguistic, or based on visual imageryto manage or eliminate problematic symptoms.
Cognitive-behavior therapies for specific diseases.

Validated therapies that have a particularly strong cognitive emphasis include the following: Cognitive-behavior therapy for Panic Disorder with and without Agoraphobia Cognitive-behavior therapy for Generalized Anxiety Disorder Stress inoculation training for coping with stressors Cognitive therapy for depression Cognitive-behavior therapy for Bulimia Nervosa Multicomponent rheumatic disease cognitive-behavior therapy for pain associated with

Multicomponent cognitive-behavior therapy with relapse prevention for smoking cessation Summary REBT has evolved into a comprehensive and integrative approach that emphasizes thinking, judging, deciding, and doing. This approach is based on the premise of the interconnectedness of thinking, feeling, and behaving. Therapy begins with clients problematic behaviors and emotions and disputes the thoughts that directly create them. To block the self-defeating beliefs that are reinforced by a process of self-indoctrination, REBT therapists employ active and directive techniques such as teaching, suggestion, persuasion, and homework assignments, and they challenge clients to substitute a rational belief system for an irrational one. Therapists demonstrate how and why dysfunctional beliefs lead to negative emotional and behavioral results. They teach clients how to dispute self-defeating beliefs and behaviors that might occur in the future.

Becks key concepts in cognitive therapy share similarities with REBT, but differ in underlying philosophy and the process by which therapy proceeds. Beck developed specific cognitive procedures that are useful in challenging a depressive clients assumptions and beliefs and in providing a new cognitive perspective that can lead to optimism and changed behavior. Cognitive therapists try to get clients to give up their irrational beliefs and unrealistic goals and to replace defeatist thinking with more favorable views of themselves and the world. Many therapists combine features of behavior therapy and cognitive therapy, attempting to change peoples behaviors by altering how they interpret the situation.

References
Beck Judith S, Cognitive behavior therapy: basics and beyond.,
The Guilford Press 2011

Bernstein A. Douglas et.al Psychology, Houghton Mifflin Company 2008 Kalat James W. An Introduction to Psychology, Thomson Wadsworth,2008 Feldman, Robert S. Essentials of understanding psychology, The McGraw-Hill Companies, Inc., 2011 Zimbardo Philip G.et.al , Psychology; core conceptsPearson Education.Inc. 2012 Stanley B. Messer, Alan S. Gurman(Edited), Essential Psychotherapies Theory and Practice , The Guilford Press 2011, Hazleh-Stevens Holly, Brief cognitive-behavior therapy: Definitions and scientific foundations in Hand book of Brief Cognitive-behavior therapies edited by Bond Frank W and Dryden Winds, John Wiley & sons, LTD. 2002 Flanagan -John Sommers and Rita Sommers-Flanagan, Counseling and psychotherapy theories in context and practice: Skills, strategies, and techniques, John Wiley & Sons, Inc. 2004. Huffman Karen, Psychology in Action, John Wiley & sons Inc, 201 Review Questions What are the main differences between Elliss REBT and Becks cognitive therapy? List and describe four of Becks cognitive distortions List and describe the REBT ABCs Describe what Beck means by a self-schema. What are the five bedrock assumptions of Elliss REBT?

THE ABOVE MATERIAL IS PREPARED FOR STUDENTS OF PSYCHOLOGY IN INDIAN UNIVERSITIES.