Kathryn Hibbert (Student Ref 5) – 30.11.10 – towards Assessment 2.

Evaluate the underlying assumptions, key approaches and

main goals of cognitive behavioural therapy.

In the 1950’s, Albert Ellis developed ‘Rational Emotive Therapy.’ He

had been influenced by the Stoic Greek philosophers such as
Epictetus who is attributed with the following statements:
“Men are disturbed not by things, but by the view which they take
of them.”
“It's not what happens to you, but how you react to it that matters.”
“First say to yourself what you would be; and then do what you
have to do.”
“Know, first, who you are, and then adorn yourself accordingly.”
“Practice yourself, for heaven's sake in little things, and then
proceed to greater.”

Part of Ellis’ approach included the ABC model of emotions.

A = something happens
B = you have a (core) belief about the situation
C = you have an emotional reaction to that belief

A does not cause C. B causes C. Our core beliefs are absolute and
consistent and are about ourselves, others and the world around us.

Albert Ellis at the American Psychological Association, 108th

Convention in Washington DC, August 4-8, in 2000 said,

1. People don't just get disturbed by events, but by the

*perception*. A+B.
2. No matter when you developed your belief, you still believe it.
3. There is no way but work and practice the rest of your damn
life!

Ellis concluded in terms of dysfunctional beliefs: "Everything boils

down to 3 things":

1. I must do well
2. You must treat me well
3. The world must be easy.

During the 1960’s Aaron Beck, influenced by Ellis, developed his

theory of Cognitive Therapy. He came to the conclusion that the
most important changes in ‘beliefs’ had to come from the patient.

Source:http://www.brainyquote.com/quotes/authors/e/epictetus_3.html
Source http://www.fenichel.com/Beck-Ellis.shtml
Source http://www.davidbonham-carter.com
Source http://www.docstoc.com/docs/55717745/Overview-of-cognitive-work-in-CBT
Kathryn Hibbert (Student Ref 5) – 30.11.10 – towards Assessment 2.1

At the same 108th convention as above, Beck said, “If beliefs do not
change, there is no improvement. If beliefs change, symptoms
change. Beliefs function as little operational units". (Beck is very
excited about new studies which demonstrate the effectiveness of
persuading patients to abandon self-destructive beliefs which serve
to maintain dependent and avoidant behaviour in particular, even
among what are typically seen as very difficult disorders.) Today,
Beck’s approach has developed into Cognitive Behavioural Therapy.
(CBT)

As CBT is based on the assumption that most reactions are ‘learned’

- these reactions can also be ‘unlearned.’ Therefore the goal of
therapy is to help clients to replace their old behaviours and beliefs
with new ones. When people are able to do this, they are helping
themselves to get well. This can lead to positive long-term results
because the person essentially continues his/her own therapy into
future life.

CBT has proved to be a useful model, effective in treating conditions

such as:

• Stress/Anxiety disorders
• Depression
• Phobias
• Anger management
• Changing habits (because of vicious cycles)

CBT works in the ‘here and now. David Bonham-Carter, a practicing

CBT therapist, said, “I work in a pragmatic way, helping clients to
move forward, focusing primarily on how to create a brighter future
for you, rather than delving into painful past or difficult emotions.”

The key approaches of CBT are:

Identify (distorted) thought patterns/ core beliefs

Some recognised cognitive distortions are:

• arbitrary inference – “jumping to conclusions”

• selective abstraction – “blowing things out of proportion”
• overgeneralisation – “forming a view based on a single
detail”
• dichotomous thinking – “all or nothing view to life”

Source:http://www.brainyquote.com/quotes/authors/e/epictetus_3.html
Source http://www.fenichel.com/Beck-Ellis.shtml
Source http://www.davidbonham-carter.com
Source http://www.docstoc.com/docs/55717745/Overview-of-cognitive-work-in-CBT
Kathryn Hibbert (Student Ref 5) – 30.11.10 – towards Assessment 2.1

• magnification/ minimisation – “making judgements based

on ‘ over or under’ emphasising
a detail”
• personalisation – “judging other’s treatment of you
internally with no ref to fact”
• catastrophizing – “believing a worst case scenario for
everything that happens”
• disqualifying/discounting – “not accepting positive details
as good/having value”
• mind reading – “feeling what others are thinking about you
as being true fact”
• labelling – “fitting into a perception of oneself that may not
be true”
• emotional reasoning – “believing something to be true
because one ‘feels’ it.

A vicious cycle can arise as a result of automatic negative thoughts,

often leading to depression.. (See assess criteria 2.2) It is important
to identify the distorted behaviour/beliefs in order to deal with the
situation.

Examine evidence to support/disprove any distorted behaviour/core

beliefs

The next stage is to examine these thought processes/core beliefs.

There are various ways to do this. The following records can be very
helpful, as is the following web site.
http://www.getselfhelp.co.uk/freedownloads.htm

• Thought record sheet (critical voice)

• Social situations record
• Managing perceived threat record
• Trigger situations record
• Core beliefs & Outcomes record
• Experimenting with Healthier Beliefs record
• Realistic Thinking record

Goals are formulated with client to achieve desired outcome

Source:http://www.brainyquote.com/quotes/authors/e/epictetus_3.html
Source http://www.fenichel.com/Beck-Ellis.shtml
Source http://www.davidbonham-carter.com
Source http://www.docstoc.com/docs/55717745/Overview-of-cognitive-work-in-CBT
Kathryn Hibbert (Student Ref 5) – 30.11.10 – towards Assessment 2.1

In an article on CBT by L C Melton, he states, “By changing thinking,

behaviour and emotional responses, therapists assist clients in
overcoming challenges and difficulties.” Within the CBT counselling
relationship, the counsellor takes on the role of tutor.

Once the problem has been identified and examined, then practical
and structured measures are used to achieve changed
behaviour/beliefs. (E.g. as in a driving phobia – see assess criteria
2.3) Goals should be realistic, measurable and achievable. To help
achieve goals, homework is usually included in CBT. It can also
include methods such as Exposure (graded or internal.)

CBT, although very successful in meeting its goals as a problem

solving therapy is not suitable for everyone. It is not a ‘fix all.’ If a
person is very depressed, they may not find the motivation to take
on CBT. Also if a person is not able to relate to such a scientific
approach he/she might find it very difficult. And, also if a person is
more introspective by nature, he/she won’t find CBT suitable. There
are some situations, such as bereavement, where CBT could do
more harm than good.

However, CBT can fit very well into an eclectic approach of

counselling. For example, alongside person centred counselling and
during stage 2 of Egan’s helping model.

Source:http://www.brainyquote.com/quotes/authors/e/epictetus_3.html
Source http://www.fenichel.com/Beck-Ellis.shtml
Source http://www.davidbonham-carter.com
Source http://www.docstoc.com/docs/55717745/Overview-of-cognitive-work-in-CBT