CBT and REBT

Cognitive –Behavioral and Rational Emotive Therapies: Beck and Ellis
Key Terms:
Schema Cognitive Shift Cognitive Vulnerability
Primal Mode Conscious Mode Collaborative Empiricism
Guided Discovery Cognitive Model Core Belief
Intermediate Belief Automatic Thoughts Cognitive Triad
Cognitive Distortions Arbitrary Inference Selective Abstraction
Overgeneralization Magnification/Minimization Personalization
Dichotomous Thinking
Innate Suggestibility Innate Irrationality Demanding/Desiring
Emotional Disturbance Activating Event Belief
Consequence Grandiosity Perfectionism
Musturbating Awfulizing Shoulding
rB iB


Thought Questions:
1. What are the implications regarding morality/agency given these forms of causality and epistemology?
2. Is there tension in the theory regarding determinism (the formation of schemata) and the “non-determined determiner” of the therapist?
3. Does the therapist know better than the client?
4. When the therapist is indoctrinating the client, who’s philosophy is being taught?
5. Can things actually be terrible, awful, horrible in a rational way?
6. Are there times when we (or our clients) should be ashamed? Is shame always bad?
7. Can people change their irrational beliefs without a therapist?
8. What assumptions do you see in this theory in terms of causality?
9. What assumptions do you see in this theory in terms of epistemology?
10. What assumptions do you see in terms of morality?

CBT
Schema - A schema is a cognitive, behavioral, affective and motivational structures stored in the brain. Schemas are caused by evolution, development, genetics, and experience. These schemas control our perception of ourselves, others, and our world in every temporal dimension, past, present, and future. Schemas, ultimately, are only changed by the environment. Cognitive theorists posit that we can change our schemas, but when we ask them how, they respond that “something in your environment caused you to change your schema in that way.” So, what we think and what we do is determined by our schemas, which in turn are determined by evolution (genetics) and past experience (personal history). So, although CBT looks like a panacea (it is an excellent and consistent theory), it is just as deterministic as behaviorism, only the determinism applies to the mind as well as empirically observed behavior.
Cognitive Shift - Sometimes, people have schemas that cause them to interpret the world in a consistently skewed fashion because of experiences they have had. They might perceive others as hostile or the world as a hopeless unsafe place. Their whole way of thinking has shifted in one direction.
Cognitive Vulnerability - Cognitive vulnerabilities are those problems in thinking which leave us prone to cognitive shifts. If we can’t handle loss, or if we’re desperately terrified of death, we overreact to the vicissitudes of life. Such reactions can become characteristic cognitive shifts. What causes people to have cognitive vulnerabilities? You guessed it: genetics and past experience.
Primal Mode - A network of cognitive, affective, motivational and behavioral schemas that are universal and tied to survival. These modes are stimulus-response modes that occurred due to evolution to help our species survive. These are genetically pre-programmed and cause our responses in a hard sense. These are “unconscious” in a sense, in that they are not in our awareness but influence our behavior greatly.
Conscious Mode - A network of cognitive, affective, motivational and behavioral schemas that are part of our everyday conscious life. When we put ideas together that we read or hear, when we daydream to ourselves as we walk across campus. What causes these thoughts when we’re in conscious mode? The interplay of various schemas, each caused by evolution or past experience.
Collaborative Empiricism - The assumption that both the counselor and the client are empirical scientists, in other words, that the only “real” reality is what can be seen objectively. They work together collaboratively to find out where the mis-perceptions lie. Intuition, wisdom, compassion, are all epiphenomenal to the real curative agent: getting in touch with “objective” reality.
Guided Discovery - Both client and counselor weave a narrative together that articulates the patterns of a client’s beliefs that are hurting them. Much more interpretive and engaged, but contradicts the assumptions above. How can we “weave a narrative” if our interplay of schemas are determined?



Big Question: How can we re-work CBT to fit with such cherished ideas as agency, morality, meaning, or spirituality?


Beck Handout

Cognitive Model involves examining core beliefs, intermediate beliefs, automatic thoughts
and the emotional consequences to those thoughts. In a nutshell: “The situation itself does not directly determine how they feel; their emotional response is mediated by their perception of the situation” (Beck, 1995).

Core Belief: These are the most basic and fundamental beliefs that people have. These beliefs
Become problematic when they are global, rigid, and over-generalized.

Automatic Thoughts: What people think when they’re actually in the situation, they’re very context-specific and involve words and images regarding the situation they’re in. Beck considers this to be the most superficial level of cognition, what “pops to mind” without analytic or careful thought.

Intermediate Belief (also known as conditional assumptions): Intermediate beliefs are those beliefs that mediate between the core belief and the automatic thought. These generally take the form of rules, attitudes, and assumptions that the patient has about matters of import, usually about parts of the cognitive triad. These usually take the forms of shoulds, musts, oughts, or catastrophizing statements.
Cognitive Triad: This consists of people’s core beliefs about themselves, their world and their future. If any of these become rigid and over-generalized, problems may occur.

The model:

Core Belief
l
V
Intermediate Belief
l
V
Situation  Automatic Thought  Emotion

Cognitive Distortions

Arbitrary Inference: ------------- Drawing a specific conclusion without supporting evidence or even in the face of contradictory evidence. An example of this is the working mother who concludes after a particularly busy day, “I’m a terrible mother.”

Selective Abstraction: ------------ Conceptualizing a situation on the basis of a detail taken out of context, ignoring other information. An example is a man who becomes jealous upon seeing his girlfriend tilt her head towards another man to hear him better at a noisy party.

Overgeneralization: -------------- Abstracting a general rule from one or a few isolated incidents and applying it too broadly and to unrelated situations. After a discouraging date, a woman concluded, “All men are alike. I’ll always be rejected.”

Magnification/Minimization: -- Seeing something as far more significant or less significant than it actually is. A student catastrophized, “If I appear the lease bit nervous in class it will mean disaster.” Another person, rather than facing the fact that his mother is terminally ill, decides that she will soon recover from her “cold.”

Personalization: ------------------ Attributing external events to oneself without evidence supporting a causal connection. A man waved to an acquaintance across a busy street. After not greeting him in return, he concluded, “I must have done something to offend him.”

Dichotomous Thinking: -------- Categorizing experiences in one of two extremes; for example, as a complete success or a total failure. A doctoral student stated, “Unless I write the best exam they’ve ever seen, I’m a failure as a student.”
Rational-Emotive Therapies
RET = Rational Emotive Thinking
REBT (Rational Emotive Behavior Therapy) is a much later adaptation, even though the theory remains the same.

Fundamental human process:
1. Perception
2. Emotion
3. Action
4. Reasoning
a. The example of an odd brown object
All of these processes are always happening. Ellis does not fall into Bandura’s trap of linearizing them, instead, they happen concurrently. They are also always inextricably intertwined. A change to one of them affects the other three concurrently.

Interestingly, due to the legacy of modernity (technologism, spiritual distancing, etc.) human beings have less need for perception and action (which was incredibly important 2000 years ago when we were competing against animals for survival) and instead have become increasingly disabled in terms of emotion and reason, which is where Ellis sought to intervene.

Ellis described how people live emotionally troubled lives in our modern times, and proceeded to describe how it is that emotions (in general) occur.
1. Biologically (hypothalamus, autonomic nervous system)
2. Perception and motion (sensorimotor systems)
3. Desiring and thinking (conation and cognition)
a. Interesting implications for intervention. You could (as Ellis describes) intervene at any of these three levels at any time.
i. Chemicals, electricity, physical contact
ii. Exercise, ecological and aesthetic variables
iii. Psychological intervention (later spiritual, bizarrely enough)
A. Seen as superior – creates independence
B. The sources of feelings are not “unconscious” in a Freudian sense but “preconscious” in a Freudian sense. We can backtrack our own thinking to clarify our “preconscious” thoughts.
C. Emotions and thoughts go together. “Emotion is not unthinking, and thinking is not unemotional”. However, by clarifying your thinking while you’re emotional you can reach a better outcome than refusing to think while you’re emotional
1. Small spot of mold on the bread and you’re hungry. What to do?
D. Emotion is a motivating force, but it is coupled with survival.
1. They assume that everybody wants to survive. Everyone makes goals in the act of surviving, and feelings can motivate us to survive and feel happy or unhappy while surviving.
2. Emotion is defined as “(1) a certain kind of forceful thinking – a kind of strongly slanted or biased by previous perceptions or experiences; (2) intense bodily responses, such as feelings of pleasure or nausea; and (3) tendencies toward positive or negative action in regard to the events that seem to cause the strong thinking and its emotional concamitants” (Ellis, 1962, p. 24).
3. Emotion, if spontaneous, is natural and can exist without thought. Thinking, however, can often exacerbate, deflect, extend or even make emotion problematic.
E. There are such things as good feelings and bad feelings
1. Feelings that help us survive and feel happy = appropriate feelings
2. Feelings that serve to block basic goals (living and happiness) = inappropriate feelings
F. Likewise, rational thinking “assists you (1) to survive and (2) to achieve the goals or values you select to make your survival pleasurable, enjoyable, or worthwhile” (Ellis, 1962 p. 23)
1. How we think is up to us.
i. “Men feel disturbed not by things, but by the views which they take of them.” Epictetus
ii. “There [exists] nothing either good or bad but thinking makes it so” Shakespeare, Hamlet
G. “The main barriers to effective thinking and emoting include these: (1) Some people have too much stupidity to think clearly. Or (2) They possess sufficient intelligence to think straight, but just do not know how to do so. Or (3) they have enough intelligence and education to think clearly but act too disturbedly or neurotically to put their intelligence or knowledge to good use . . . [N]eurosis essentially consists of stupid behavior by nonstupid people” (Ellis, 1962, p. 37).
H. Big assumption here is that rationality leads to happiness, and that what makes an individual happy is their goal in life
i. Individualism and moral relativism

Ellis holds that people are fundamentally biological creatures with the innate abilities to construe themselves and to construct their world in a meaningful way. This sounds wonderfully agentic and creative, but quickly we see a potential problem. Ellis holds that we, as children, have innate suggestibility, meaning that we quickly learn and adopt (and take as “real”) the beliefs of others who are important to us. Because of this (in part) we are also innately irrational, meaning that we hold irrational (or illogical beliefs) and that we are as much self-defeating as self-actualizing. These self-defeating behaviors come from several sources. One is our confusing desires with demands (“I want this” versus “I have to have this” or “I would like to be this way” versus “I have to be this way”). The greater the demand, the greater the emotional disturbance, or emotional upset, that results.

It happens like this: Something happens in our lives, an activating event (he called “A”). We have certain beliefs about “A”, and he called these beliefs “B”. These beliefs about “A” have certain emotional and behavioral consequences, called “C”. B is the problem in this chain. Problematic beliefs occur when people are taught values which they then make rigid. This rigidity leads to fragile feelings of grandiosity, or the feeling that they are wonderful, godlike, or that they should be wonderful and godlike. This is also accompanied with feelings of perfectionism, or the feeling that perfection is demanded of us, that we must always be the best in everything. Because of this grandiosity and tendency towards perfectionism, people tend to musturbate, awfulize, and should all over the place. Such statements as “I must get a good grade in this course” or “It would be awful and unbearable if she broke up with me” or “I should be perfect at all times” are examples of these statements.

From Ellis’ perspective, people upset themselves by the way they talk to themselves about point B, their beliefs about a particular event. If they are perfectly rational about that event, then they will not feel the level of emotional upset that they would otherwise. An intriguing notion in early RET is that we can be rational in our misery (a perspective emphasized by R. Harper, a student of Ellis and early co-author), but that rational misery is not as intense or overwhelming as irrational misery.
1. Grief at the loss of a loved one
a. Neurotic response
b. Rational response
2. Loss of a job
a. Neurotic response
b. Rational response
3. We can diagnose our own thoughts in terms of rational beliefs and irrational beliefs
a. “I hope I do well on this exam, I’d better study and do my best because I would like a good grade”
i. This is an example of an rB, a rational belief
b. “I hope I do well on this exam. But the material is so hard and complex I don’t know if I can stand it. I’ll probably flunk this test. I’m such a loser”
ii. This is an example of an iB, an irrational belief
4. As counselors, we can help dispute irrational beliefs
a. A useful exercise would be to write down the iB’s as they surface or become clear
i. A woman who felt terrible after having gotten a divorce from a miserable marriage
A. “Married people should stay married”
B. Who says so? Objective laws of nature? God? Your mother? (Direct questioning is a primary technique in RET)
1. If the client did say that one of these entities said so, a follow-up question might be, “Who says that your mother is always right?”
5. Once the iB’s are acknowledged, disputation must continue, but some clients are too stupid to get it. The therapist is required to try until it would be irrational to continue.
6. Often, however, clients obtain a degree of insight. Ellis identified three types of insight.
a. Insight 1: “the fairly conventional kind of understanding first clearly postulated by Freud: knowledge by the individual that he or she has a problem and that certain antecedents cause this problem” (Ellis, 1962, p. 40).
b. Insight 2: “consists of seeing clearly that the irrational ideas we create and acquire in our early lives still continue, and that they argely continue because we keep indoctrinating ourselves with these ideas – consciously and unconsciously work fairly hard to perpetuate them” (p. 41)
c. Insight 3: “Now that I have discovered Insights No. 1 and 2, and fully acknowledge the self-creation and continue reinforcement with which I keep making myself believe the irrational ideas that I have believed for so long, I will most probably find no way of eliminating my disturbances than by steadily, persistently, and vigorously working to change these ideas” (ibid).

Ellis, however, in his early writings offers a window to change that few therapists of his time would: people can become rational on their own. He acknowledges that some people do need help, but it does not always hold true. “. . . [I]mprovement can occur as long as a troubled person somehow undergoes significant life experiences, or learns about others’ experiences, or sits down and thinks for himself, or talks to a therapist who helps him reconstruct his basic attitudes toward himself and others” (Ellis, 1962 p. 5 emphasis in original).

It is up to the therapist to actively challenge these irrational tendencies. Ellis went so far, in fact, as to state that without therapy it is impossible for people to become rational, contradicting his earlier writing. It is up to the rational therapist, who himself has been through therapy, to make others rational as well. In other words, it is up to the therapist to teach the client how to think rationally, and such rationality is defined by the therapist. Although the latter part of this (rationality determined by the therapist) is consistent, the earlier part (people needing therapy) is contradicted by his own theory.