Module 9 Therapeutic Approaches in Social Work Interventions Cognitive Behaviour Therapy (CBT) and Rational Emotive Behaviour Therapy (REBT) Component 1A Role Name Affiliation Principal Investigator Dr. Geeta Balakrishnan College of Social Work, Nirmala Niketan, Mumbai Paper Coordinator Prof. Xavier Kanickairaj National Institute of Social Work and Social Sciences, Bhubaneswar Content Writer Prof. Kirubakaran Loyola College, Chennai Content Reviewer Dr. Yamini Suvarna College of Social Work, Nirmala Niketan, Mumbai Language Editor Ms. Marianne Claudia Rayer Research Scholar, Pondicherry University, Pondicherry Component 1B Description of Module Subject Name Social Work Education Paper Name Working with Individuals and Families Module Name Therapeutic Approaches in Social Case Work Interventions(contd.) – Cognitive Behavioural Therapy (CBT) and Rational Emotive Behaviour Therapy (REBT) Module ID SW/SCW/9 Pre Requisites Not applicable Objectives To know the origin of CBT and REBT To understand the basic concepts in CBT and REBT including evaluations of facts, theory of causation, concept of thinking, etc To become familiar with the steps involved and the process of CBT To gain knowledge about the techniques used in the Cognitive psychotherapies Key words Irrational beliefs, Demandingness, Awfulising, Discomfort intolerance, People Rating, Inferences, Evaluations, Core beliefs, Rational Self-Analysis. Quadrant 1 1. Introduction Cognitive behaviour therapy (CBT) and Rational Emotive Behaviour Therapy (REBT) are psychotherapeutic treatment approaches that help clients to understand the thoughts and feelings that influence their own behaviour. Both the psychotherapies are based on the theory that emotions and behaviours result primarily from cognitive processes and it is possible for human beings to modify such processes to achieve different ways of feeling and behaving. Cognition or thinking is a key determining factor in how human beings feel and behave, and that modifying cognition through the use of cognitive and behavioural techniques can lead to productive change in dysfunctional emotions and behaviours. Cognitive and behavioural psychotherapies are a range of therapies based on concepts and principles derived from psychological models of human emotion and behaviour. They include a wide range of treatment approaches for emotional disorders, along a continuum from structured individual psychotherapy to self help material. There are a number of different approaches to CBT that are regularly used by mental health professionals. These types include Rational Emotive Therapy, Cognitive Therapy and Multimodal Therapy. Though the various versions or ‘brands’ of cognitive behavioural therapy (CBT) can be distinguished in terms of certain aspects of the client therapist relationship, the cognitive target for change, the assessment of change, the degree of emphasis placed on the client’s self-control, and the degree to which cognitive or behavioural change is the focus, treatment principles common to all cognitive behavioural therapies can be identified. This module enables the learners to become acquainted with the following: 1. Origin of CBT and REBT 2. Basic concepts in CBT and REBT including evaluations of facts, theory of causation, concept of thinking, etc 3. Step involved and the process of CBT 4. Techniques used in the Cognitive psychotherapies 5. Limitations and contraindications in the therapy. 2. The beginnings In 1950 Albert Ellis developed ‘rational therapy,’ which he changed to ‘rational-emotive therapy.’ In 1993 he once again changed the name and called it ‘rational emotive behaviour therapy’ (REBT) since his approach stressed the reciprocal interactions among cognition, emotion and behaviour.We contribute to our own psychological problems, as well as specific symptoms, by the way we interpret events and situations in our life. Therefore, a reorganization of one’s self-statements will result in a corresponding reorganization of one’s behaviour. a. Albert Ellis (1913-2007): Rational Emotive Behavior Therapy (REBT) In the mid 1950’s with the work of Albert Ellis, a clinical psychologist originally trained in psychoanalysis, but became disillusioned with the slow progress of his clients. He observed that they tended to get better when they changed their ways of thinking about themselves, their problems, and the world. Ellis reasoned that therapy would progress faster if the focus was directly on the client’s beliefs, and developed a method now known as Rational Emotive Behaviour Therapy (REBT). REBT argues that a person’s biology also affects their feelings and behaviours which is an important point, as it is a reminder to the therapist that there are some limitations on how far a person can change. REBT lays emphasis on dealing with evaluative type thinking. Let’s say that an individual holds the idea: ‘For me to be happy, my life must be predictable, safe and sound.’ Such an idea or belief will direct them to be oversensitive to any possibility of threat and expect too much of the likelihood of things going erroneous. Suppose they hear a noise in the night. Their sensitivity to threat leads them to assume that there is an intruder in the house. They then evaluate this possibility as disastrous and agonizing, which creates feelings such as severe anxiety. When helping clients explore their thinking, REBT practitioners would tend to use strategies that examine the logic behind beliefs (rather than query their empirical validity). b. A-B-C theory of personality Albert Ellis did not believe in focusing on past history and activating events, or overemphasizing the effort to have clients recognize, express, and ventilate feelings, or urge clients to relive early events and feelings in the present, instead, he would want the client and the therapist dispute the irrational beliefs that are causing disturbed emotional consequences. A stands for activating event, B for belief and C for emotional and behavioural consequence. A (the activating event) does not cause C (the emotional consequence). Instead, B, which is the person’s belief about A, largely causes C, the emotional reaction. For example, the mistakes committed by an individual in public speaking does not cause his depression but it is how he interprets his mistakes or his beliefs about his being a failure that causes depression. One mainly feels the way one thinks. Therefore, disturbed emotional reactions like depression and anxiety are initiated and perpetuated by the self-defeating belief system that is based on irrational ideas one has incorporated and invented. The following example using the ABC model shows how it works: A. Your friend call up over phone and asks if you will accompany her for shopping the rest of the day. Meanwhile you had already planned to catch up with some gardening. B. You infer that: ‘If I say no, she will think badly of me.’ You evaluate your inference: ‘I couldn’t stand to have her disapprove of me and see me as selfish.’ Your inference and the evaluation that follows are the result of holding the underlying belief: ‘To feel OK about myself, I need to be liked, so I must avoid disapproval from any source.’ C. You feel apprehensive and say yes. To change such irrational beliefs, Albert Ellis suggests a disputing process that comprises detecting, debating, and discriminating. By detecting one identifies one’s irrational beliefs, particularly one’s absolutistic “shoulds” and “musts,” one’s “awfulizing,” and one’s “self-downing.” By debating one empirically and logically questions the dysfunctional beliefs and finally learns to discriminate irrational (self-defeating) beliefs from rational (self-helping) beliefs. REBT attempts to help people to distinguish or discriminate the appropriate feelings from the inappropriate and to intensify the former and minimize the latter. What we conventionally label “emotions” and “feelings of emotional disturbances” are largely but not exclusively the direct concomitants of people’s thoughts, ideas, or constructs. 3. Evaluations As well as making inferences about things that happen, we go beyond the ‘facts’ to evaluate them in terms of what they mean to us. Evaluations are sometimes conscious, sometimes beneath awareness. According to REBT, irrational evaluations consist of one or more of the following four types: i) Demandingness ii) Awfulising iii) Discomfort Intolerance iv) People rating These four are discussed below: i) Demandingness: Described colourfully by Ellis as ‘musturbation’, demandingness refers to the way people use unconditional should and absolutistic musts, believing that certain things must or must not happen, and that certain conditions (for example success, love, or approval) are absolute necessities. Demandingness implies certain ‘Laws of the Universe’ that must be adhered to. Demands can be directed either toward oneself or others. Some REBT theorists see demandingness as the ‘core’ type of irrational thinking, suggesting that the other three types derive from it. ii) Awfulising: Exaggerating the consequences of past, present or future events; seeing something as awful, terrible, horrible, that is the worst that could happen. iii) Discomfort intolerance: This is often referred to as ‘can’t-stand-it-itis’: This is based on the idea that one cannot bear some circumstance or event. It often follows awfulising, and leads to demands that certain things do not happen. iv) People Rating: People rating refers to the process of evaluating one’s entire self (or someone else’s). In other words,