Cognitive Behavior Therapies

A Guidebook for Practitioners

Ann Vernon, Kristene Anne Doyle

• Publisher: American Counseling Association
• Year: 2017
• Print ISBN: 9781556203671
• eBook ISBN: 9781119375456
• Edition: 1
• Topic: Education
• Subtopic: Professional Development

This comprehensive book showcases different approaches to cognitive behavior therapy (CBT) and focuses on the implementation of these various theories in real-world practice. Following an overview of cognitive therapy, practitioners and scholars discuss behavior therapy, cognitive therapy, rational emotive behavior therapy, multimodal therapy, acceptance and commitment therapy, dialectical behavior therapy, and mindfulness. Each theory highlighted includes a profile of the theorist(s), an overview of the theory, a discussion of the therapeutic process, an array of targeted interventions, a verbatim case transcript, an analysis of the limitations of the theory, and reflective sidebars to facilitate learning. The final chapter presents a single case study discussed from the perspective of each particular theory.

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Chapter 1
What Is Cognitive Behavior Therapy?

Raymond DiGiuseppe, Rachel Venezia, and Roseanne Gotterbarn

Cognitive behavior therapy (CBT) represents a form of psychotherapy that solves current problems, disturbed emotions, and dysfunctional behavior by acknowledging the role of human learning as well as the effects of the environment, cognitions, and language in disturbance. It has become the overriding, generic term used to describe a wide range of approaches to counseling and psychotherapy that represent three distinct yet overlapping therapeutic approaches: behavior therapy (BT), cognitive therapies, and mindfulness and acceptance therapies. These approaches are similar but conceptualize the mediation of dysfunctional behavior differently.

CBT originated in BT and remains committed to many of its values and traditions. The main organization that represents the professional and scientific advancement of these therapies was originally known as the Association for the Advancement of Behavior Therapy; in 2004 this group added the term Cognitive to its name, thus becoming the Association for Behavioral and Cognitive Therapies.

This chapter provides an overview of CBT and orients you to general concepts that are described more specifically in the chapters of this book. Although there are many varieties of CBT, this book focuses on BT, cognitive therapy (CT), rational emotive behavior therapy (REBT), multimodal therapy (MMT), acceptance and commitment therapy (ACT), dialectical behavior therapy (DBT), and mindfulness. The editors selected these models because they each have good empirical support, are widely accepted, and appear to be growing in popularity.

Variation in CBT

Despite its popularity, CBT does not represent a monolithic paradigm. Some theorists have used the metaphor of three waves to understand the differences among the forms of CBT. The first wave of CBT started with the behavioral tradition, based on the work of B. F. Skinner and Ivan Pavlov and the clinical areas of applied behavior analysis (Martin & Pear, 2015) and pragmatic behavior therapy (Fishman, Rotgers, & Franks, 1988). Learning principles formed the basis of this initial approach, and interventions included relaxation training, exposure, operant interventions, and the rehearsal of new adaptive responses to problems.

The second wave emerged because of some dissatisfaction with the behavioral model. Behavior therapists recognized that human thoughts and language played a more central role in disturbed behavior than the behavioral model recognized. As the cognitive revolution occurred in BT, the number of approaches increased very quickly. This group of therapies included Albert Ellis' s REBT, Aaron Beck' s CT, Don Meichenbaum' s (1993) self-instructional training, and problem-solving skills training (Nezu, Maguth Nezu, & D' Zurilla, 2013).

The third wave included techniques based on mindfulness and a new approach to language and cognition called relational frame theory, which represents a new approach to Skinner' s learning theory applied to language. Relational frame theory differs from previous schools of thought insofar as it does not recommend trying to change the content of a belief or thought but instead attempts to break the connections between thoughts and rigid behavior actions. It relies on teaching acceptance of negative thoughts and training flexible behavioral reactions in response to their occurrence.

The metaphor of the three waves might not be the best way to conceptualize these differences in CBT. Waves come in an order, and new waves overtake previous waves, which recede back to the ocean unnoticed. The three waves of CBT did not occur in three different points in time; each has ancient roots in philosophy and psychology. Also, the first two waves have not run out of energy and fallen back into the undertow of science or clinical practice; they still exist and are going strong. A better metaphor would be three branches on an evolutionary bush, such as three groups of apes: gorillas, chimpanzees, and bonobos. Each model has common ancestors in psychology and philosophy and continues to evolve on its own. None of the models has driven the others into extinction.

Even in these three major groups there continues to be diversification and expansion. As early as 1993, Kuehlwein identified 10 schools of CBT. Since that time, more variants of CBT have appeared. Table 1.1 represents an inexhaustive list of types of CBT theories that we uncovered in a recent search.

Table 1.1 Models of CBT and Their Founders

Form of Counseling	Founder and Reference
Acceptance and commitment therapy	Hayes et al. (2011)
Applied behavior analysis	Martin & Pear (2015)
Behavior therapy	Wolpe (1969)
Cognitive therapy	A. T. Beck (1976)
Cognitive analytic therapy	Ryle (2005)
Constructivist cognitive psychotherapy	Neimeyer (2009)
Dialectical behavior therapy	Linehan (1993)
Fixed role therapy	Kelly (1955)
Functional analytic psychotherapy	Kohlenberg & Tsai (1991)
Meta-cognitive therapy	Wells (2008)
Mindfulness cognitive therapy	Sigel, et al. (2013)
Mindfulness-based interventions	Kabat-Zinn (2013)
Multimodal therapy	A. A. Lazarus (1981)
Parent training	Forgatch & Patterson (2010)
Pragmatic behavior therapy	Fishman et al. (1988)
Problem-solving therapy	Nezu et al. (2013)
Rational emotive behavior therapy	Ellis (1962)
Rumination-focused CBT	Watkins et al. (2007)
Schema-focused cognitive therapy	Young et al. (2003)
Self-instructional training	Meichenbaum (1977)
Trauma-focused CBT (TF-CBT)	Cohen (2006)
Trial-based cognitive therapy	de Oliveira (2016)
Wellness therapy	Fava (2016)
Note. CBT = Cognitive behavior therapy.

As noted, this book describes only a few variants of CBT but includes representatives from all three branches or waves. The chapter on BT represents the first branch and includes the basic skills of CBT. The chapters on REBT (Ellis, 1962), CT (A. T. Beck, 1970, 1976), and MMT (A. A. Lazarus, 1981) represent the second branch. The chapters on ACT (Hayes, Villatte, Levin, & Hildebrandt, 2011), DBT (Linehan, 1993), and mindfulness (Kabat-Zinn, 2013) represent the third branch.

Although these models share more similarities than differences, they emphasize different learning, cognitive, and psychological processes as mediating the relationship between environmental stressors and emotional and behavioral disturbances. Furthermore, although they use many different interventions, most of the interventions in each of these models are compatible with the other models. Hofmann, Asmundson, and Beck (2013) described CBT as a theoretically consistent model that focuses on a wide range of clinical problems, each of which might require a different emphasis and intervention. Thus, CBT practitioners might use multiple procedures to accomplish change yet remain theoretically consistent, describing their clients in terms of CBT theoretical constructs that are presented in this book.

Observing a number of professionals delivering CBT sessions might be confusing to the novice because one is likely to see the counselors doing many different things without a consistent pattern. O' Donohue and Fisher (2009) described 74 different CBT interventions. Here is a list of some of the techniques used in CBT:

• Assertiveness training
• Assessing the emotions, thoughts, and behaviors that occurred when the client tried to implement a homework assignment
• Assessing the presence of dysfunctional behaviors or emotions
• Behavioral activation—increasing mastery and pleasuring experiences
• Bibliotherapy
• Challenging the client' s irrational beliefs
• Challenging the client' s negative automatic thoughts
• Changing the client' s underlying schemas
• Decentering
• Defusion
• Diagnostic interviewing
• Distress tolerance
• Exploring the adaptability of the client' s belief system
• Exploring the adaptability of the client' s emotions
  and behaviors
• Flooding
• Graduate exposure
• Habit reversal training
• Harm reduction
• Imaginal exposure
• Mindfulness exercises
• Modeling and role-playing new skills
• Negotiating homework
• Offering alternative rational beliefs or schemas to replace the client' s irrational beliefs or dysfunctional schemas
• Operant strategies
• Opposite action
• Parent training
• Performing a comprehensive multimodal assessment of behaviors, affect, sensations, imagery, cognitions, interpersonal relationships, drugs, or biological influences
• Performing an ABC analysis of thoughts: activating event, beliefs, and emotional consequences
• Performing an ABC functional analysis of behavior: antecedents, behaviors, and consequences
• Relapse prevention
• Relaxation procedures
• Response chaining
• Response prevention and exposure
• Reviewing homework
• Self-control procedures
• Self-instructional training
• Shaping
• Social problem solving
  • Helping the client generate alternative solutions to problems
  • Helping the client evaluate the consequences and effectiveness of alternative solutions
• Social skills training
• Stimulus control procedures
• Teaching the B → C connection
• Teaching the difference between irrational and rational beliefs
• Token economies
• Validating the client' s emotions
• Values and goals clarification

It is important to note that although CBT is eclectic in techniques, it is consistent in its theory. And although many therapists consider themselves eclectic, eclecticism can be a confusing and difficult path to follow. A. A. Lazarus (1967; A. A. Lazarus & Beutler, 1993) pointed out that therapists who practice as theoretically eclectic must inevitably use contradictory ideas, which begs the question of how one chooses or justifies using one theory with one case and a different theoretical approach with another case. However, CBT practitioners can and do use many different interventions while remaining theoretically consistent. A. A. Lazarus (1967) coined the term technical eclecticism to describe clinical practice that remains theoretically consistent yet uses a variety of methods that target the theoretical mechanism identified by one' s orientation.

Assumptions and Core Principles of CBT

Given all of these variations on CBT, you might wonder what they have in common. In this section, we review the common assumptions, principles, and histories that unite CB...

Table of contents

• Cover
• Title Page
• Copyright
• Dedication
• Preface
• About the Editors
• About the Authors
• Chapter 1: What Is Cognitive Behavior Therapy?
• Chapter 2: Behavior Therapy
• Chapter 3: Cognitive Therapy
• Chapter 4: Rational Emotive Behavior Therapy
• Chapter 5: Multimodal Therapy
• Chapter 6: Acceptance and Commitment Therapy
• Chapter 7: Dialectical Behavior Therapy
• Chapter 8: Mindfulness
• Chapter 9: The Case of Marcos from each Theoretical Prespective
• Index
• Technical Support
• End User License Agreement