Reporting Outline:

BEHAVIORAL THERAPY
1. Overview of the Behavioral and Cognitive Behavioral Theory and Introduction of BT and CBT and Key Concepts (Maricon)
Behavior Therapy
Key Figures
B.F. Skinner (1904-1990)
- Brought up in a warm, stable family environment
- Prominent spokesperson for behaviorism
- Can be considered as the father of the behavioral approach to psychology
- Championed radical behaviorism (which places primary emphasis on the effects of environment on the behavior)
- Determinist (he did not believe that humans had free choice)
- He acknowledged that feelings and thoughts exist, but he denied that they caused our actions.
- Stressed the cause-and-effect links between objective, observable, environmental conditions and behavior.
- Believed that science and technology held the promise for a better future
Albert Bandura (b.1925)
- Spent his elementary and highschool years in the one school in town which was short of teachers and resources
- Learned the skills of self-directedness sue to meager educational resources
- Bandura and his colleagues pioneered social modeling
- Explored social learning theory and the prominent role of observational learning and social modeling in human motivation,
thought, and action.
- mid-1980s : renamed his approach social cognitive theory (which shed light on how we function as self-organizing, proactive,
self-reflective, and self-regulating things)
- Broadened the scope of behavior therapy by exploring the inner cognitive-affective forces that motivate human behavior
- Concentrated on four areas of research
- Power of psycholofical modeling in shaping thought, emotion, and action
- Mechanisms of human agency, or the ways people influence their own motivation and behavior through choice
- People’s perceptions of their efficacy to exercise influence over the events that affect their lives,
- How stress reactions aand depressions are caused
Introduction
- Practitioners focus on
- directly observable behavior
 - current determinants of behavior
- learning experiences that promote change
- Tailoring treatment strategies to individual clients, and
- rigorous assessment and evaluation
- Used to treat a wide range of psychological disorders with specific client populations.
- Anxiety disorders
- Depression
- Posttraumatic stress disorder
- Substance abuse
- Eating and weight disorders
- Sexual problems
- Pain management
- Hypertension
Historical Background
- 1950s and early 1960s
- A radical departure from the dominant psychoanalytic perspective
- Field has grown, become more complex, and is marked by a diversity of views.
- Contemporary behavior therapy is no longer limited to treatments based on traditional learning theory and it
increasingly overlaps with other theoretical approaches
- Behavior Therapists now use a variety of evidence-based techniques in their practices, including cognitive therapy,
social skills training, relaxation training, and mindfulness strategies-all discussed in this chapter
Traditional Behavior Therapy
- Arose simultaneously in US, South Africa, Great Britain (1950s)
- Survived in spite of harsh criticism and resistance from psychoanalytic therapists
- Focus was on demonstrating that behavioral conditioning techniques were effective and were a viable alternative to
psychoanalytic therapy
1960s
- Bandura developed Social Learning Theory which combined classical and operant conditioning with observational learning.
- cognition= a legitimate focus dor behavior therapy
- Cognitive behavioral approaches focused on cognitive representations of the environment rather than on characteristics of
the objective environment
1970s
 - Contemporary behavior therapy
- Had a significant impact on education, psychology, psychotherapy, psychiatry, and social work
- Techniques ere expanded to provide solutions for business, industy, and child-rearing problems as well
- BT techniques were viewed as the treatment of choice for many psychological problems
1980s
- Search for new horizons in concepts and methods that wen beyond traditional learning theory
- Behavior Therapists continued to suvject their methods to empirical scrutiny and to consider the impact of the practice of
therapy on both their clients and the larger society
- Increased attention was given to the role of emotions in therapeutic change, as well as to the role of biological factors in
psychological disorders
2 significant developments
1. Continued emergence of CBT as a major force
2. The application of behavioral techniques to the prevention and treatment of health-related disorders
Late 1990s
- Association for Behavioral and Cognitive Therapies (ABCT) claimed a membership of about 4,500,
Early 2000s
- Behavioral tradition had broadened considerably
- 3rd wave of Behavior therapy
➢ Dialectical Behavior Thereapy (DBT)
➢ Mindfulness-based stress reduction (MBSR)
➢ Mindfulness-based cognitive therapy (MBCT)
➢ Acceptance and Commitment Therapy (ACT)
- Behavior therapies are among the most widely used treatment interventions for psychological and behavioral problems today
Four Areas of Development
1. Classical Conditioning
2. Operant Conditioning
3. Social-Cognitive Theory
4. Cognitive Behavior Therapy
Cognitive Behavior Therapy
Albert Ellis (1913-2007)
- Lived an unusually robust, active, and energetic life for 93 years despite his many physical challenges (hospitalized 9 times
as a child, mainly with nephritis, developed renal glycosuria at 19, had diabetes at 40.)
 - Became a psychologist after realizing that he could counsel people skillfully and that he greatly enjoyed doing so.
- Believed psychoanalysis was the deepest form of psychotherapy.
- He was analyzed and supervised by a training analyst.
- Became disillusioned with his clients’ slow progress on psychoanalytically oriented psychotherapy
- Observed that his clients improved more quile once they changed their ways of thinking about themselves and their problems
- 1955: He developed an approach to psychotherapy called rational therapy, later rational emotive therapy, and which is now
known as Rational Emotive Behavior Therapy (REBT)
- Grandfather of cognitive behavior therapy
- Approach was developed as a method of dealing with his own problems during his youth
- By applying rational and behavioral methods, he managed to conquer some of his greatest emotional blocks

Introduction
- Rational Emotive Behavior Therapy
- Was the first of the cognitive behavior therapies (and today it continues to be a major cognitive behavioral approach.
- Has a great deal in common with the therapies that are oriented toward cognition and behavior. (as it also emphasizes
thinking, assessing, deciding, analyzing, and doing.)
- Basic assumption: people contribute to their own psychological problems, as well as to specific synptomps, by the
rigid and extreme beliefs they hold about events and situations.
- Based on the assumption that cognitions, emotions, and behaviors interact significantly and have a reciprocal
cause-and-effect relationship .
- Holistic and integrative approach (Has consistently emphasized all three (cognitions, emotions, behaviors) of these
and modalities and interactions)
- Alfred Adler was given credit as an influential precursor of REBT
- Karen Horney’s ideas on the “tyranny of the shoulds” aare apparent in the conceptual framework of REBT
- Eastern Philosophies and the ancient Greek: Stoic philosopher Epictetus (Said over 2000 years ago): “People are
disturbed not by events, but by the views which they take of them”
- Ellis’s reformulation of Epictetus’s dictum can be stated as, “People disturb themselves as a result of the rigid and
extreme beliefs they hold about events more than the events themselves.”
- Basic hypothesis: our emotions are mainly created from our beliefs which influence the evaluations and interpretations
we make and fuel the reactions we have to life situations.
-
 BT and CBT’s Basic Characteristics and Assumptions: (Similarities)
1. A collaborative Relationship between client and therapist
2. Premise that psychological distress is often maintained by cognitive processses
3. Focus on changing cognitions to produce desired changes in affect and behavior
4. A present-centered, time-limited focus
5. An active and directive stance by the therapist
6. An educational treatment focusing on specific and structured target problems

Behavior Therapy Cognitive Behavior Therapy

Key Concepts Current Trend View of Emotional Disturbance

- Aims to increase people’s skills so they have more - Blame
options for responding - Core of many emotional
- No debilitating behaviors= individual freedom disturbances
Basic Characteristics and Assumptions Three basic musts (irrational beliefs)
7 key characteristics 1. “I must do well and be loved and approved
1. Behavior therapy is based on the principles and by others”
procedures of the scientific method 2. “Other people must treat me fairly, kindly
2. Behavior is something that can operationally and well”
defined 3. “The world and my living conditions must be
3. Behavior therapy recognizes the importance of the comfortable, gratifying, and just, providing
individual, the individual’s environment, and the me with all that I want in life.”
interaction between the person and the A-B-C Framework
environment in facilitating change. A= activating event
4. An action-oriented and an educational approach B= belief about A that largely creates
and learning is viewed as being at the core of C= consequence (emotional and behavioral)
therapy. After A B and C
5. assumes that change can take place without D= Disputing
insight into underlying dynamics and without
understanding the origins of a psychological
problem.
6. careful assessment and evaluation of the
interventions used to determine whether the
behavior change resulted from the procedure.
 7. interventions are individually tailored to specific
problems experienced by the client.

2. The Therapeutic Process of BT and CBT (Clarence)

i. Therapeutic goals
ii. Therapist’s Function and Role
iii. Client’s experience
iv. Relationship between the therapist and the client

Behavior Therapy Cognitive Behavioral Theory

Therapeutic goals ● To increase personal choice Rational Emotive Behavior Therapy REBT)
● To create new conditions for learning. ● Lead toward the destination of clients minimizing their
○ Formulate Measurable Goals. emotional disturbances and self-defeating behaviors
■ Goals must be clear by acquiring a more realistic, workable, and
■ Concrete compassionate philosophy of life.
■ Understood
● To teach clients how to change their dysfunctional
■ Agreed on by client
emotions and behaviors into healthy ones
● to assist clients in the process of achieving
unconditional self-acceptance (USA), unconditional
other-acceptance (UOA), and unconditional
life-acceptance (ULA).
*Ellis (A. Ellis & Ellis, 2011) is: “Life has inevitable
suffering as well as pleasure. By realistically thinking,
feeling, and acting to enjoy what you can, and unangrily
and unwhiningly accepting painful aspects that cannot
be changed, you open yourself to much joy”

Aaron Beck's Cognitive Therapy

 ● To identify and alter our distorted or negative
beliefs in order to improve our behaviors and
lives.
● Provides symptoms of relief
● Assisting clients in resolving their most pressing
problems
● Changing beliefs and behaviors that maintain
problems
● Teach clients skills that serve as relapse
prevention strategies.

Strengths-Based Cognitive Behavioral Therapy

● To build positive qualities on people. It posits
that there are many pathways to positive
qualities and that each person can construct a
personal model to build a desired quality,
drawing on strengths already in evidence.

Meichenbaum’s cognitive behavior modification

(CBM)
● To change a person's self-described narrative or
life story from negative to positive.
● Helping clients become aware of their self-talk
and the stories they tell about themselves.

Therapist’s Function ● Conduct a thorough Functional assessment Rational Emotive Behavior Therapy (REBT)
and Role ○ ABC Model 4 steps on Therapist Task
■ Antecedents (1) Show clients how they have incorporated many
■ Behavior irrational absolute “shoulds,” “oughts,” and
■ Consequences “musts”.
-Behavioral assessment interview, to identify (2) to demonstrate how clients are keeping their
the particular antecedent and consequent events emotional disturbances active by continuing to
 that influence, or are functionally related to, an think illogically and unrealistically.
individual’s behavior (Cormier, (3) Help clients change their thinking and minimize
Nurius, & Osborn, 2013). their irrational ideas.
● Behaviorally oriented oriented practitioners tend to be active (4) to strongly encourage clients to develop a
and directive and to function as consultants and problem rational philosophy of life so that in the future
solvers. they can avoid hurting themselves again by
believing other irrational beliefs.
● Other functions as well (Miltenberger, 2012; Speigler, 2016): Aaron Beck's Cognitive Therapy
○ Understand the function of client behaviors, ● Helped clients(depressed clients) become
including how certain behaviors originated and aware of and change their negative thinking.
how they are sustained.
● Teach clients to learn how to identify their
○ Uses strategies that have research support for
use with a particular kind of problem. dysfunctional thinking.
○ Evaluates the success of the change plan by Strengths-Based Cognitive Behavioral Therapy
measuring progress toward the goals ● Therapists help clients identify existing
throughout the duration of treatment. strengths that are used to construct a personal
○ Follow-up assessments are conducted to model of resilience.
evaluate whether the changes are durable ● The therapist focuses on the client's
over time.
existing resources, resilience, and
positive qualities in an effort to use these
abilities to improve quality of life and
reduce problematic symptoms.
Meichenbaum’s cognitive behavior modification
(CBM)
● Teach clients to make self-statements and
training clients to modify the instructions they
give to themselves so that they can cope more
effectively with the problems they encounter
● The therapist and the client together play a role
in reflecting the client's problems in his daily life.

Client’s experience ● Therapists and clients have clearly defined roles, and the Rational Emotive Behavior Therapy (REBT)
importance of client awareness and participation in the ● REBT emphasizes here-and-now experiences
therapeutic process is stressed. and clients’ present ability to change the
 ○ a therapist's role is to teach concrete skills patterns of thinking and emoting that they
through the provision of instructions, modeling, constructed earlier.
and performance feedback. ● Does not place much value on free association,
○ Client’s role is to engage in behavioral working with dreams, or dealing with
rehearsal with feedback until skills are well transference phenomena.
learned and generally receive active ● Clients are encouraged to actively work outside
homework assignments (such as self therapy sessions.
monitoring of problem behaviors) to complete ○ Homework- carefully designed and
between therapy sessions. agreed upon and is aimed at getting
● Clients to be motivated to change, and they are expected to clients to carry out productive actions
cooperate in carrying out therapeutic activities that contribute to emotional and
○ Motivational interviewing (see Chapter 7), attitudinal change.
which honors the client’s resistance in such
Aaron Beck's Cognitive Therapy
a way that his or her motivation to change is
increased over time, is a behavioral ● Clients are engage with Socratic questioning
strategy that has considerable empirical ● Clients learned to identify the distortions in their
thinking, summarize important points in the
support (Miller & Roll nick, 2013)
session, and collaboratively devise homework
● Clients are encouraged to experiment for the purpose of
assignments.
enlarging their repertoire of adaptive behaviors
● Client is educated through bibliotherapy,
● Clients are as aware as the therapist is regarding when the
○ Bibliotherapy is which clients complete
goals have been accomplished and when it is appropriate
readings that support and expand their
to terminate treatment.
understanding of cognitive therapy
principles and skills.
● Homeworks-diaries, reflections that prompt
cognitive reappraisal, and meditations

Strengths-Based Cognitive Behavioral Therapy

● a client is the actor or agent of change.
● Clients are able to identify value and
assemble their strengths and capacities.
Meichenbaum’s cognitive behavior modification
(CBM)
 ● Clients undergone processes of
Self-observation. Changing negative self-talk
to positive self-talk. Learning new skills.

Relationship between ● Establishing a collaborative working relationship with Rational Emotive Behavior Therapy REBT)
the therapist and the clients but contend that warmth, empathy, authenticity, ● Warm relationship between therapist and client is
permissiveness, and acceptance is necessary, but not not required.
client
sufficient, for behavior change to occur. ● REBT practitioners strive to unconditionally accept
all clients and to teach them to unconditionally
accept others and themselves.
● REBT practitioners accept their clients (and
themselves!) as imperfect beings

Aaron Beck's Cognitive Therapy

● Combine empathy and sensitivity with technical
competence (A. Beck, 1987
● Therapeutic alliance is a necessary first step in
cognitive therapy, especially in counseling
difficult-to-reach clients.
● A cognitive therapist functions as a catalyst and
a guide who helps clients understand how their
beliefs and attitudes influence the way they feel
and act.
● Therapist realized the clients are more likely to
complete homework

Strengths-Based Cognitive Behavioral Therapy

● Collaborative, active, here and-now focused,
and client-centered
● Encouraging allies of their clients and need to
be genuine, caring, and willing to engage with
 clients as full human beings in both struggles
and successes.
● Therapists do not take an “expert” stance but
instead serve as curious assistants or guides to
their clients’ own discovery and growth.
Meichenbaum’s cognitive behavior modification
(CBM)
● Therapist and client practice the
self-instructions and the desirable behaviors in
role-play situations that simulate problem
situations in the client’s daily life.

In general Cognitive Behavior Therapy…

Therapeutic Goals
● Help clients rethink their own perspectives and thinking patterns, allowing them to take more control over their behavior by
separating the actions of others from their own interpretations of the world.
● Develop healthier thought patterns by becoming aware of the negative and often unrealistic thoughts that dampen your
feelings and moods.
Therapist’s Function and Role
● Specifically regarding their relationships, surroundings, and life, so that they can influence those thoughts and behaviors for
the better.
● Directive in treatment, therapist seen as expert. The clinician, as an expert, educates the client about relapse prevention and
helps to empower the client to be his or her own therapist. Empowering the client is vital for effective treatment. Therapy
sessions are highly structured.
Client’s experience
● Clients are given homework and conduct experiments between sessions.
● Clients learn how to identify, question, and replace their negative thoughts and behaviors as they arise.
Relationship between the therapist and the client
● Generic elements of alliance, empathy, expressed positive regard; as well as those elements that are specific to CBT; notably
collaborative empiricism and Socratic dialogue
5. A. Application: Therapeutic Techniques and Procedures of Behavioral Therapy (Nivil)
a. Applied Behavioral Analysis: Operant Conditioning Techniques
- The goal is to increase positive and helpful behaviors and decrease harmful behaviors.

Key Principles:

(1) Positive reinforcement: addition of something of value to the individual as a consequence of certain behavior
(2) Negative Reinforcement: involves the escape or the avoidance of unpleasant stimuli
(3) Extinction: withholding reinforcement from a previously reinforced response.
(4) Positive punishment: an aversive or unpleasant stimulus is added after the behavior to decrease the frequency
of the behavior.
(5) Negative Punishment: reinforcing stimulus is removed after the behavior to decrease the frequency of a target
behavior.

B. Progressive Muscle Relaxation

- Clients are given a set of instructions that teaches them to relax. They assume a passive and relaxed position in a
quiet environment while alternately contracting and relaxing muscles.
- It is used to address problems related to stress and anxiety, which are often manifested in psychosomatic symptoms.

c. Systematic Desensitization

- Clients imagine successively more anxiety-arousing situations at the same time that they engage in a
behavior that competes with anxiety. Gradually, or systematically, clients become less sensitive (desensitized)
to the anxiety-arousing situation.
 - Three Steps:

(1) Relaxation training

(2) Development of anxiety hierarchy

(3) Desensitization

d. In Vivo Exposure and Flooding (Two variations of traditional systematic desensitization)

● In Vivo Exposure

- Clients are exposed to the actual anxiety-evoking events rather than imagining these situations.

● Flooding

- Consists of intense and prolonged exposure to the anxiety-producing stimuli, either in vivo or imagination.

5. Eye Movement Desensitization and Reprocessing

- Entails assessment and preparation, imaginal flooding, and cognitive restructuring in the treatment of
individuals with traumatic memories. It involves the use of rapid, rhythmic eye movements and other bilateral
stimulation to treat clients.

6. Application (Franz)
● Social Skills Training
○ It is used to help clients develop and achieve skills in interpersonal competence.
○ Behavioral Techniques:
■ Psychoeducation
■ Modeling
■ Behavior rehearsal
 ■ Feedback
○ Applicable to:
■ Bullying
■ Social anxiety
■ Emotional and behavioral problems in children
■ Behavioral treatment for couples
■ Depression
■ Anger management

● Self-Management Programs and Self-Directed Behavior

○ Aims at self-change tend to increase involvement and commitment to their treatment.
○ Hope.
○ Self-management Strategies (Kress and Henry, 2015)
■ Teaching clients how to select realistic goals
■ How to translate these goals into target behaviors
■ How to create an action plan for change
■ Ways to self-monitor and evaluate their actions
○ Steps for succeeding in Self-Management Programs (Watson and Tharp, 2014):
■ Selecting Goals
■ Translating Goals into Target Behaviors
■ Self-Monitoring
■ Working out a plan for change
■ Evaluating an Action Plan
○ Applicable to:
■ Coping with panic attacks
■ Reducing perfectionism
■ Helping children to cope with fear of the dark
■ Increasing creative productivity
■ Managing anxiety in social situations

● Multimodal Therapy: Clinical Behavior Therapy

 ○ Therapy is based on the idea that humans function in different ways, and therefore, treatment should be
tailored to address each individual's unique needs.
○ Focusing on different modalities:
■ Behavior
■ Affect
■ Sensation
■ Imagery
■ Cognition
■ Interpersonal Factors
■ Drugs

● Mindfulness and Acceptance-Based Approaches

○ 3rd wave of behavior therapy
○ Mindfulness
■ “the awareness that emerges through having attention on purpose, in the present moment, and
nonjudgmentally, to the unfolding of experience moment by moment” (Kabat-Zinn, 2003, p. 145)
■ We are present (Germer, 2005)
■ Treats depression, anxiety disorders, relationship problems, substance abuse, and psychophysiological
disorders (Germer, Siegel, and Fulton, 2013)
○ Acceptance
■ the process involving receiving one’s present experience without judgment or preference, but with
curiosity and kindness, and striving for full awareness of the present moment
○ Four Major Approaches
■ Dialectical Behavioral Therapy.
● geared toward helping clients make changes in their behavior and environment while
communicating acceptance of their current state (Kuo & Fitzpatrick, 2015; Robins & Rosenthal,
2011).
● Zen Teachings - being aware of present, seeing reality, accepting without judgement, letting go
of attachments, and fully present (Robins & Rosenthal, 2011).
○ Interpersonal effectiveness
○ Emotional regulation
○ Distress Tolerance
 ■ Minfulness-Based Stress Reduction
● 8-week structured group program
● People increase their responsibility for their well-being
● Develop inner resources for treating their physical health concerns
● Targeting what? The notion that much of our distress and suffering results from continually
wanting things to be different from how they are
● Approaches
○ Sustained directed attention
○ Emphasis on experiential learning from the process of self-discovery
○ Bringing mindfulness into all of their activities to deepen their focus through a disciplined
practice

■ Mindfulness-Based Cognitive Therapy

● Change clients’ awareness of and relation to their negative thoughts.
● Teach clients to respond in skillful and intentional ways to their automatic negative thought
patterns.
● Essential
○ Kindness
○ Self-Comapassion
● Mindfulness is something that is caught more than something that is taught.
■ Acceptance and Commitment Therapy (Hayes et al., 2005; 2011)
● Psychological intervention that uses acceptance and mindfulness, with commitment to develop
psychological flexibility.
● Goal:
○ become aware of and examine their thoughts.
○ learn how to change their relationship to their thoughts.
○ learn how to accept yet not identify with thoughts and feelings they may have been trying
to deny.
● Process:
○ Commitment to Action
○ Homework and Behavioral Exercises
● Application to Group Counseling
 ○ Goals:
■ Emphasize self-management skills
■ How to restructure thoughts
■ Contol their lives and deal with them effectively
○ Group Leaders’ Responsibilities:
■ Borrows from different theoretical viewpoints
■ Data collection before, during, and after the interventions
○ 4 general approaches to the practice of behavioral groups:
■ Social skills training groups
■ Psychoeducational groups
■ Stress management groups
■ Mindfulness and acceptance-based behavior therapy

7. B. Application: Application: Therapeutic Techniques and Procedures (Toni)

● Aaron Beck’s Cognitive Therapy
- CT was first created by Beck as an evidence-based therapy for depression, eventually through time evidence-supported CT
approaches were developed for disorders other than depression.
- Evidence-based therapy aimed to help clients overcome psychological disorders through recognizing and changing their
unrealisitc thoughts and maladaptive beliefs that lead to negative behavior.
- Negative cognitive triad:
- Negative views of the self (self-criticism)
- Negative views of the world (pessimism)
- Negative views of the future (hopelessness)
- 3 theoretical assumptions of CT:
- People’s thought processes are accessible to introspection.
- People’s beliefs have highly personal meanings.
- People can discover these meanings themselves rather than being taught or having them interpreted by the therapist.
- Generic Cognitive Model
- This model provides a comprehensive framework for understanding psychological distress.
- Principles on which the model is based:
1. Psychological distress can be thought of as an exaggeration of normal adaptive human functioning.
2. Faulty information processing is a prime cause of exaggerations in adaptive emotional and behavioral reactions.
 - Common cognitive distortions:
● Arbitrary inferences
● Selective Abstraction
● Overgeneralization
● Magnification and minimization
● Personalization
● Labeling and mislabeling
● Dichotomous thinking
3. Our beliefs play a major role in determining what type of psychological distress we will experience.
4. Central to cognitive therapy is the empirically supported observation that “changes in beliefs lead to changes in
behaviors and emotions”
5. If beliefs are not modified, clinical conditions are likely to reoccur.
- Basic Principles of CT:
Recognize and change unrealistic thoughts and maladaptive beliefs of clients.
- Main goal of CT:
Help clients learn practical skills that they can use to make changes in their thoughts, behaviors, and emotions and
how to sustain these changes over time.
- How can this goal be achieved?
IEE (Identify, Examine, Employ)
- Some similarities and differences of CT and REBT:

SIMILARITIES DIFFERENCES IN THERAPEUTIC DIFFERENCES IN HOW FAULTY

METHODS AND STYLE THINKING IS VIEWED

Reality testing
REBT is highly directive, persuasive, and Through a process of rational
confrontational and the teaching role disputation, Ellis (REBT) works to
of the therapist is emphasized. persuade clients that certain of their
beliefs are irrational and nonfunctional.
Both are based on the theoretical On the other hand, Beck (CT) views his
rationale that the way people feel and CT uses Socratic dialogue. clients’ distorted beliefs as being the
behave is influenced by how they result of cognitive errors rather than being
perceive and place meaning on their driven solely by irrational beliefs.
experience.

CT places more emphasis on helping

clients identify misconceptions for
themselves rather than being taught.

Collaborative empiricism

- The Client-Therapist relationship

- Effective therapists must combine empathy and sensitivity with technical competence.
- Therapists must have a cognitive conceptualization of cases, be creative and active, be able to engage clients.
- Continuously active and deliberately interactive with clients.
- Cognitive therapist functions as a catalyst and a guide who helps clients understand how their beliefs and attitudes
influence the way they feel and act.
- Cognitive therapists emphasize the client’s role in self-discovery.
- Cognitive therapists identify specific, measurable goals and move directly into the areas that are causing the most
difficulty for clients.
- Client’s role: Identify the distortions in their thinking, summarize important points in the session, and collaboratively
devise homework assignments that they agree to carry out.
- Homework is often used as a part of cognitive therapy because practicing cognitive behavioral skills in real life
facilitates more rapid and enduring gains.
- Applications of CT:
- Used to treat:
- Depression
- Each of the anxiety disorders
- Cannabis dependence
- Hypochondriasis
 - Body dysmorphic disorder
- Eating disorders
- Anger
- Schizophrenia
- Insomnia
- Chronic pain
- Suicidal behavior
- Borderline personality disorders
- Narcissistic personality disorders
- Schizophrenic disorders
- Personality disorders
- Substance abuse
- Medical illness
- Proven to be helpful in:
- Crisis intervention
- Couples and families therapy
- Child abusers
- Divorce counseling
- Skills training
- Stress management
- With children and adolescents, CT has been shown to be effective in the treatment of depression and anxiety
disorders and more effective than medications for these problems.
- Applying Cognitive techniques:
- The cognitive therapist is mainly interested in applying procedures that will assist individuals in making alternative
interpretations of events in their daily living and behaving in ways that move them closer to their goals and values.
- Examples of behavioral techniques used by cognitive therapists:
- Activity scheduling
- Behavioral experiments
- Skills training
- Role playing
- Behavior rehearsal
- Exposure therapy
- Treatment and Approaches:
- CT makes use of various activities and experiences.
- When applied to the treatment of depression:
- Lasts 16-20 sessions
- Begins with behavioral activation
- Thought Records – automatic thoughts – action plan (mahimo pa kek daw flowchart kinemer)
- When applied to treat panic disorders:
- Lasts 6-12 sessions
- Identify the sensations that trigger a panic attack – identify the catastrophic beliefs linked to these sensations
– Generate an alternative hypotheses that explain the feared sensations.

● Christine Padesky and Kathleen Mooney’s Strengths-Based Cognitive Behavioral Therapy

- The main idea of SB-CBT is that active incorporation of client strengths encourages clients to engage more
fully in therapy and often provides avenues for change that otherwise would be missed.
- Basic Principles of SB-CBT
- Therapists should be knowledgeable about evidence-based approaches pertaining to client issues
discussed in therapy.
- Clients are asked to make observations and describe the details of their life experiences so what is
developed in therapy is based in the real data of clients’ lives.
- Therapists and clients collaborate in testing beliefs and experimenting with new behaviors to see if they
help achieve desired goals.
- SB-CBT therapists help clients develop and construct new positive ways of interacting in the world.
- SB-CBT proposes that it is often easier to construct an entirely new way of doing things than to problem
solve or modify a chronic way of doing things.
- The client-therapist relationship
- SB-CBT therapists are encouraging allies of their clients and need to be genuine, caring, and willing to
engage with clients as full human beings in both struggles and successes.
- SB-CBT therapists only serve as assistants or guides.
- SB-CBT help clients break free of recurring patterns.
- Application of SB-CBT:
 - An add-on for classic CBT.
- A four-step model to build resilience and other positive qualities.
- The four-steps are as follows:
- 1. Search
- 2. Construct
- 3. Apply
- 4. Practice
- The NEW Paradigm for chronic difficulties and personality disorders.
- The four steps of this model:
- 1. Conceptualize the OLD System of operating and help clients understand they do things “for
good reasons.”
- 2. Construct NEW systems of how clients would like to be.
- 3. Strengthen the NEW using behavioral experiments to try on NEW ways of being and edit
them as needed.
- 4. Relapse management

● Donald Meichenbaum’s Cognitive Behavior Modification

- Focuses on changing the client’s self-talk.
- Unlike CT and REBT, CBM believes that it is more effective to change our behavior instead of our thinking
process.
- How behavior changes
- Phase 1: Self-observation
- Phase 2: Starting a new internal dialogue
- Phase 3: Learning new skills
- Stress inoculation training
- A strategy that promotes stress management techniques among clients.
- Collaborative goals are set that nurture hope, direct-action skills, and acceptance-based coping skills.
- Procedures that teach the said coping skills:
- Expose clients to anxiety-provoking situations by means of role playing and imagery.
- Require clients to evaluate their anxiety level.
 - Teach clients to become aware of the anxiety-provoking cognitions they experience in stressful
situations.
- Help clients examine these thoughts by reevaluating their self-statements.
- Have clients note the level of anxiety following this reevaluation.
- Phases of Stress Inoculation Training:
- The conceptual-educational phase.
- The skills acquisition and consolidation phase.
- The application and follow-through phase.
- Relapse Prevention
- Cognitive narrative approach to CBT:
- In this perspective, we are all “storytellers”.
- The ff questions were used for this perspective:
- Are clients now able to tell a new story about themselves and the world?
- Do clients now use more positive metaphors to describe themselves?
- Are clients able to predict high-risk situations and employ coping skills in dealing with emerging
problems?
- Are clients able to take credit for the changes they have been able to bring about?

8. Behavior Therapy and Cognitive Behavioral Therapy From a Multicultural Perspective and Limitations and Criticisms (Paula)

Multicultural perspective - Multicultural perspective in psychotherapy is an approach that recognizes and values the diversity
of human experiences and perspectives related to culture, ethnicity, race, gender, sexual orientation, religion, and other
socio-cultural identities
BT CBT

- Cultural and ethnic backgrounds make it possible for Strengths:

clients to hold values that are contrary to the free - it uses the individual’s belief system or worldview as
expression of feelings and the sharing of personal part of the method of self exploration.
 concerns - The basic nature of CBT and the way it is practiced
Strengths: is inherently suited to treat diverse clients
- specificity, task orientation, focus on objectivity, focus (individualized treatment, foucs on the external
on cognition and behavior, action orientation, dealing environment, active nature, emphasis on learning,
with the present more than the past, emphasis on reliance on empirical evidence, concern with present
brief interventions, teaching coping strategies, and behavior, and brevity
problem-solving orientation - Integrating assessment of client beliefs, emotional
- Sensitive to differences (most appropriate for clients responses, and behavioral choices throughout
who are looking for action plans and specific therapy, which communicated respect for clients’
behavioral change) viewpoints regarding their progress
- Focuses on environmental conditions of the client - CBT and Multicultural therapy share common
that contribute to their problem and considers social assumptions that make integration possible:
and political influences > Interventions are tailored to the unique needs and
- Behavior therapy is based on an experimental strengths of the individual.
analysis of behavior in the client’s own social > Clients are empowered by learning specific skills
environment and gives special attention to a number they can apply in daily life (CBT) and by the
of specific conditions: the client’s cultural conception emphasis on cultural influences that contribute to
of problem behaviors, establishing specific clients’ uniqueness (multicultural therapy).
therapeutic goals, arranging conditions to increase > Inner resources and strengths of clients are
the client’s expectation of successful therapeutic activated to bring about change.
outcomes, and employing appropriate social > Clients make changes that minimize stressors,
influence agents (Tanaka-Matsumi, Higginbotham, & increase personal strengths and supports, and
Chang, 2002). establish skills for dealing more effectively with their
Limitations: physical and social (cultural) environments.
- There is a need for behavior therapists to be more Limitations:
responsive to specific issues pertaining to all forms - Clients with long-cherished cultural values pertaining
of diversity to interdependence may not respond favorably to
- It is essential that behavior therapists pay careful forceful methods of persuasion toward
attention to societal factors and address social independence.
justice issues as they arise in the therapy - The emphasis of CBT on assertiveness,
- Therapist tend to concentrate too much on problems independence, verbal ability, rationality, cognition,
within the individual rather than viewing them in the and behavioral change may limit its use in cultures
context of their sociocultural environment that value subtle communication over assertiveness,
(hence this is not beneficial for the client) interdependence over personal independence,
- The behavioral interventions responsible for the listening and observing over talking, and acceptance
success of an individual therapy are not applicable to over behavior change.
 others - Failure to recognize the role of the past in a client’s
What is needed: development since CBT focuses on the present.
- Discuss the complexity inherent in change before - There could be inaccuracy in interpreting the client’s
deciding the goals for behavioral therapy experiences if the therapist is unaware of the client’s
- Conduct a thorough assessment of the interpersonal cultural beliefs.
and cultural dimensions of the problem (functional - Individualistic orientation
analysis of the problem situation which includes the What is needed:
cultural context in which the problem behavior - Draw on the client’s culturally related strengths in
occurs, the consequences both to the client and to developing helpful ways of thinking to replace
the client’s sociocultural environment, the resources unhelpful cognitions.
within the environment that can promote change, and -
the impact that change is likely to have on others in
the client’s social surroundings
- Assessment methods should be chosen based on
the client’s cultural background
- Clients should be helped in assessing the possible
consequences of some of their newly acquired social
skills

Limitations and Criticisms

BT CBT

1. Behavior therapy may change behaviors, but it does 1. Elli’s rebt

not change feelings. 2. Beck’s Cognitive Therapy
2. Behavior therapy does not provide insight. 3. Padesky and Mooney’s Strengths-Based CBT
3. Behavior therapy treats symptoms rather than 4. Meichenbaum’s Cognitive Behavior Modification
causes.
4. Behavior therapy involves control and social
influence by the therapist.

9. (Behavior Therapy Applied to the Case of Stan) (Christine)

 - Applying BT to the case of Stan, a formal assessment should be done to determine behaviors that should be targeted for
change. It is important to identify and determine the areas for change and specific problems to tailor fit the treatment
interventions to the client.
- Interpersonal
- Unassertive, has unsatisfactory relationship with his parents, has few friends, afraid of contact with women and
fears intimacy, feels socially inferior
- Emotional
- Anxiety, panic attacks, depression, fear of criticism and rejection, feeling worthlessness and stupid, feeling
isolated and alienated
- Cognitively
- Worries about death and dying
- Many self-defeating thoughts and beliefs
- Governed by categorical imperatives (shoulds, oughts, musts)
- Engages in fatalistic thinking
- Compares himself negatively with others
- Behaviorally
- Defensive, avoids eye contact, speaks hesitantly, drinks alcohol excessively, has poor sleep pattern, and
displays various avoidance behaviors in social and interpersonal situations.

(-) Changes in behavior can occur prior to or simultaneously with an understanding oneself.

In the beginning of the therapy, Stan was asked to translate his general goals into concrete goals since BT emphasizes behavioral
change so clients are required to do something to bring about change through concrete skills that are taught and facilitated by the
therapist. So it’s not just enough that the client knows they have a problem but they also know how to change it.

One of Stan’s concrete goals was to function without drugs or alcohol, the therapist then suggested that keep a record of when he
drinks and what events made him or lead him to drinking. In BT, clients are expected to take on an active role by engaging in specific
actions to deal with their problems including monitoring their behaviors both during and outside the therapy session. This helps them
keep track of their behaviors and know what specific events or circumstances lead them to do these “bad” behaviors and work
through them.
Another problem Stan was having was him having trouble talking with his boss and so the therapist demonstrated specific
skills which he can use in approaching them more directly and confidently such as modeling, role-playing, and behavior rehearsal. He
then tries more effective behaviors with the therapist who was acting as the boss and then was later given feedback on how strong or
apologetic he seemed. One of the most important roles of a BT is to teach clients concrete skills through the aforementioned
procedures. Clients engage in behavioral rehearsal with feedback until skills are well learned and translated into their daily lives. So
basically, they have to learn how to do it properly during sessions to be applied and practiced in their daily lives.

Another set of techniques used to help with Stan’s fear of failing are imaginal exposure and systematic desensitization wherein Stan
learns relaxation techniques during the sessions and practices them at home. Since BT approach is an action-oriented and
educational approach, learning is considered the core of the therapy. Part of the behavioral approach is that clients carry out
therapeutic tasks in their daily lives or homework assignments for them to learn new and adaptive behaviors. He then lists his specific
fears relating to failure and makes a hierarchy out of them. Systematic desensitization is then done on his hierarchy of fears where
he is repeatedly exposed to items he finds frightening starting from the least feared. Exposure exercises were then practiced in
different situations away from the therapy office. BT emphasizes the importance of not just the individuals, but also the individual’s
environment and interaction with it in facilitating change.(-) BT uses a variety of evidence-based or empirically-based techniques in
their practices such as the systematic desensitization used in Stan’s case that is applied to help clients cope and change their
maladaptive behaviors.

Applying CBT to Stan’s Case

Just like in BT, Stan was also given homework or personal experiments for him to practice coping skills in his daily life. Although the
therapist facilitates the therapeutic process, clients are still aware of their progress and other information related to the sessions.

In addressing Stan’s fear of women, first, he was educated about the importance of examining his automatic thoughts, self-talk, and
many shoulds, the oughts, and musts he has accepted without questioning. Some of his beliefs are “I’m not a man if I show any signs
of weakness,” and “I always have to be strong, tough, and perfect.” This step will help him discover some of his basic thoughts that
influence what he tells himself and how he feels and acts.

Stan will then be assisted in monitoring and evaluating the ways in which he keeps telling himself these self-defeating ideas. This
would help Stan in clarifying specific problems and critically evaluating his thinking.
“You’re not your father. I wonder why you continue telling yourself that you’re just like him. Where is the evidence that your parents
were right in their assessment of you? What is the evidence they were not right in their assessment of you? You say you’re such a
failure and that you feel inferior. Do your present activities support this? If you were not so hard on yourself, how might your life be
different?”

Once Stan fully understands the nature of his self-defeating beliefs and cognitive distortions, cognitive and behavioral techniques
were drawn to help him learn to identify, evaluate, and respond to his beliefs. Socratic questioning, guided discovery, and cognitive
restructuring were used to help Stan examine the evidence that supports or contradicts his core beliefs. Using guided discovery, Stan
learns to evaluate the validity and functionality of his beliefs and conclusions. With cognitive restructuring, he can observe his own
behavior in different situations like he could take note of a particular situation that he finds problematic and he can observe his
automatic thoughts and internal dialogue “What is he telling himself as he approaches a difficult situation?” With these, he is able to
learn to attend to his thoughts and behaviors and may begin to see that his statements have as much impact as what others say
about him. He would then see and become aware of the connection between his thinking and behavioral problems.

Lastly, Stan would then be given homework assignments which he collaboratively worked on with his therapist for him to deal with his
fears. He will learn new coping skills that he can practice in the first session and then in daily life situations. He would be given
homework which will include him approaching a woman for a date. Once he is successful in getting a date, he can think about his
catastrophic expectations of what might happen. For example, he’ll tell himself over and over that he must be approved of and if any
women turns him down and the consequences will be more than what he can bear but with practice, Stan will be able learn to label
his distorted thoughts and will be able to identify his negative thoughts and monitor his cognitive patterns or way of thinking. Through
these strategies, he would be able to gain new info, change his basic beliefs, and implement new and more effective behavior.

Time Table
Date Deadline Tasks Description

Apr 3 (Monday) Assigning Tasks

Apr 4 (Tuesday) Reading of parts. Members should be starting to outline their report.

Apr 5 (Wednesday)

Apr 6 (Thursday) Report on Task Progress/ Powerpoint Input Update on their details report. Start to input on
PowerPoint.

Apr 7 (Friday) Reading of assigned parts Read additional resources.

Apr 8 (Saturday) Assigned Time/ Reporting Distribution per Member The group will assign how much time is spent per
part of the report.

Apr 9 (Sunday) Internal Deadline for Slides

Apr 10 (Monday) Finalize

Apr 11 (Tuesday) Reporting Day