I. Overview of cognitive-behavioral therapy
(A) Cognitive behavioral therapy is a group of short course psychotherapy methods to change the bad cognitive structure by changing the thinking and behavior to achieve the elimination of bad emotion and behavior. Its main generations are A. Ellis’ Rational Emotive Behavior Therapy (REBT), A.T. Baker and Remy’s Cognitive Therapy (CT), and Donald Mackenbaum’s Cognitive Behavior Therapy (CBT). Mackenbaum’s Cognitive Behavioral Therapy (CBT). This study focuses on the analysis of treatment based on Baker and Remy’s cognitive therapy.
(II) History of cognitive-behavioral therapy
Cognitive-behavioral therapy emerged in the United States in the 1950s and 1960s, and matured and attracted widespread attention in the 1970s. the application of cognitive psychology in medical treatment, which emerged in the mid-1950s, contributed to the rise of cognitive therapy, and cognitive-behavioral therapy emerged from the combination of cognitive therapy and behavioral therapy.
In the 1950s, Albert Ellis founded Rational Emotive Therapy (RET) in the United States, which was called a cognitive-behavioral therapy because it also used some of the methods of behavioral therapy. It was later fused and developed into Rational Emotive Behavior Therapy (REBT). From 1955, A. Eris began to publish articles about rational emotion therapy, and in 1962, he summarized his views and methods and published the book “Reason and Emotion in Psychotherapy”, and then rational emotion therapy formally entered the stage of psychotherapy.
In the early 1960s, Aaron T. Beck created cognitive therapy at the University of Pennsylvania as a stereotypical, short-term treatment for depression that directly addressed the presenting problem and modified dysfunctional thoughts and behaviors. A.T. Beck and others introduced cognitive behavioral therapy (CBT) in 1979, which advocated that behavioral modification should be combined with cognitive modification, and Judith Beck, A.T. Beck’s daughter, inherited and developed the cognitive therapy advocated by her father.
Other major cognitive-behavioral theorists also established different forms of cognitive-behavioral therapy during this period, with Arnold Lazarus proposing multimodal therapy in 1976. Donald Meichenbaum Donald Meichenbaum proposed cognitive-behavioral therapy (CBT) in 1977, arguing that one’s self-representation can influence one’s behavior as much as the representations of others, and that cognitive structure is the organizing aspect of thinking that oversees and guides the choice of ideas. Behavior change requires a number of mediating processes, including the interaction of internal speech, cognitive structure and behavior, and the ensuing consequences. V.C. Raimy has been involved in cognitive therapy research and practice since 1978, when he proposed the “center-edge” model.
Since 1977, when the prognostic study of cognitive-behavioral therapy was first published, cognitive therapy has received a great deal of confirmation. Nowadays, cognitive-behavioral therapy has been refined and systematized by drawing on a variety of psychotherapeutic theories and techniques. Possessions-Burns and Poirot have found that cognitive-behavioral therapy is effective for clients of all ages with different levels of education, income, and experience.
(C) Theoretical basis and framework of cognitive behavioral therapy
1.Theoretical basis.
Baker’s cognitive therapy believes that the tool people use to solve daily life problems is common feelings, which often appear in the form of problem solving, including the process of obtaining information from the outside world, combining existing experience, formulating questions and hypotheses, reasoning, drawing conclusions and verifying them, which is the process of perception and thinking. If people do not use common perceptions correctly and do not interpret and evaluate external information appropriately, it will cause cognitive distortion, which will lead to misconceptions and eventually cause maladaptive behavior. When people use common feelings, they often ignore many cognitive processes, so that many judgments, reasoning and thinking appear vague and jumpy, like an automatic response, the so-called “automatic thinking”. Some misconceptions in the thinking process are also ignored because individuals do not pay attention to them, and they form fixed thinking habits that are preserved, so that individuals themselves cannot reflect on and criticize these misconceptions. Individuals follow certain rules in their lives, which are the rules of behavior acquired during the process of growth. The individual evaluates the past, anticipates the future, and guides the present behavior based on them. However, if the individual does not take into account the objective conditions and acts excessively according to the rules, his behavior will not be in harmony with the real environment, resulting in emotional distress and maladaptive behavior. The most direct way to change maladaptive emotions and behaviors is to modify incorrect and dysfunctional thinking. It is the first task of the counselor to assist the client in mobilizing and utilizing his or her potential to reflect on his or her cognitive processes and to use other normal cognitive functions to solve problems. According to Beck, cognitive distortions occur in people’s cognitive processes that lead to emotional and behavioral disorders. Cognitive distortions can be categorized into the following forms.
(1) Subjective inference, which refers to making arbitrary conclusions without sufficient and relevant evidence.
(2) Selective generalization, in which conclusions are formed based on only some of the details of the whole event, regardless of the significance of the whole context.
(3) Overgeneralization, when an extreme idea is drawn from a contingent event and is inappropriately applied to unlike events and situations.
(iv) Exaggeration or reduction, which refers to overemphasizing or downplaying the importance of an event or situation.
⑤ Extreme thinking, which refers to thinking or interpreting in an all-or-nothing way, a black-or-white way, or an “either …… or ……” way. extreme categorization.
(6) Individuation is the tendency of individuals to associate some external events with themselves without any basis.
(7) Labeling and mislabeling refers to the tendency to describe and define the nature of a person based on shortcomings and previous mistakes.
According to Remy, misconceptions are mainly incorrect or inappropriate evaluations of the individual’s self, that is, false self-concepts. These misconceptions do not exist independently, but are expressed in clusters, with each cluster of misconceptions corresponding to a particular type of emotional disorder. For these misconceptions, Raimi proposed the “center-edge” model. He argues that for each cluster of misconceptions, there is a primary, basic one, which dominates the lesser ones. Visitors may easily abandon a misconception, but until the basic misconception is eliminated, maladaptive behaviors and emotions will remain unchanged. Only after addressing the superficial peripheral misconceptions can the basic misconceptions at the center be revealed gradually. Therefore, the treatment should start from the peripheral, superficial misconceptions, gradually approach the center, the main basic deep misconceptions will be excavated to correct, so as to change the uncomfortable behavior and emotions. This therapy emphasizes the significance of the core misconceptions, focuses on the cognitive process of the misconceptions and the misconceptions that arise in the process, and is concerned with the state of existence of these misconceptions, i.e., in what order and in what way they are expressed and acted upon.
In summary, the basic principle of cognitive-behavioral therapy is that faulty cognitive processes and perceptions are the root cause of emotional and behavioral problems; cognitive processes determine the generation of behavior; and changes in behavior can also cause changes in cognition. In the counseling process, the counselor plays the dual role of diagnostician and educator, and the visitor is the learner; the counselor uses active and directive counseling measures, and the visitor uses active relearning measures. Therefore, the key point of counseling is that the counselor values the potential of the helper, guides the visitor to fully mobilize and develop it, teaches the helper to confirm irrational beliefs, and teaches the helper to identify, observe, and monitor his or her thoughts and assumptions, especially those negative automatic thoughts. The client learns to reflect on their own cognitive processes, to distinguish their thoughts from the events that occur in reality, and to initiate changes to the identified problems so that a virtuous cycle of cognition and behavior can be established.
2.Treatment steps of cognitive-behavioral therapy
According to the basic principles of cognitive-behavioral therapy, the goal of this therapy is to discover and correct the misconceptions and the cognitive processes on which they are formed, and to change to the correct cognitive way; to use detailed cognitive analysis techniques, behavior modification and other techniques to change the irrational concepts and behaviors of the visitors, to help the visitors reduce or eliminate their existing emotional and behavioral disorders, and to gain a more tolerant and rational attitude toward life. The first step is to establish a good rapport with the client.
First, establish a good counseling relationship with the client.
Second, identify counseling goals. Let the client understand the basic principles of cognitive-behavioral therapy. Make sure the client understands that his or her problems are caused by his or her perceptions of certain things, and that in order to solve these problems, the cognitive processes and perceptions must first be analyzed. Specific goals are set to help the client identify the specific manifestations of his or her behavioral discomfort and emotional distress and the triggering events that correspond to these reactions, and to conduct a preliminary analysis of irrational perceptions.
Third, through the techniques of questioning and self-review, visitors are helped to experience and reflect on specific problems and facts to further clarify their irrational ideas. The visitor is asked to clarify the relationship between his or her irrational ideas and his or her current problems. They can recognize the unreasonableness of their perceptions, and then abandon them to establish reasonable ones.
Fourthly, we help visitors learn to test the surface misconceptions by separating the real events from their original ideas through suggestions, demonstrations, and imitations. This allows visitors to experience different situations, directly experience their emotions, and test whether their ideas are reasonable.
Fifth, the core misconceptions are corrected through semantic analysis techniques. Deep misconceptions are often expressed as propositions related to abstract self-concepts that do not correspond to concrete events and behaviors, and are difficult to experience through concrete situations. Therefore, they need to be corrected using techniques that are more logical and abstract. We help the client to see the unrealistic nature of his or her thinking, so that he or she can make more objective and realistic attributions to events, learn to use thinking tools correctly instead of illogical cognition, use the evaluation of concrete events instead of the overall evaluation of the self, and use more objective criteria to view his or her problems.
Sixth, in the above process, the counselor can design some special behavioral patterns or situations to help the visitor produce some emotional experiences that he usually ignores, which is important for the change of the visitor’s cognitive perception. Reinforce the positive performance of the client and urge him to reflect on the reinforced emotional experience, so that he can have a happy mood and perform more positive behaviors. The client experiences positive emotions and successful behaviors, learns how to acquire positive emotions and behaviors, and applies these methods in daily life situations.
Seventh, the consolidation phase, in which visitors are given certain tasks in the form of homework assignments or by having them read materials about cognitive therapy. This part of the work can be considered as a further extension of the above counseling steps in real life, and therefore can be done at the same time as the above counseling steps. Cognitive-behavioral therapy attaches special importance to the potential of the client, so the client is guided to continuously reflect on his or her cognitive processes, identify problems and correct them, use cognitive review to consolidate what he or she has learned, and continuously develop his or her inner potential.
3.The main techniques of cognitive-behavioral therapy
In the treatment process of cognitive therapy, the commonly used techniques are questioning and self-censorship, suggestion, demonstration, imitation, semantic analysis, behavior modification, homework, etc.
Baker proposed five specific cognitive therapy techniques: 1. Identifying automatic thoughts, i.e., using techniques that include asking questions, guiding the visitor to self-representation or imitation to help the visitor learn to discover and identify automatic thoughts; 2. Identifying cognitive errors, i.e., the counselor records the automatic thoughts in different situations and problems of the visitor, and asks the visitor to generalize and find commonalities. 3. This is the core of cognitive therapy. This is the core of cognitive therapy.4. Decentering, many visitors always feel that they are the center of attention and that their words and actions are judged by others. By changing what they say and do, they can verify their thoughts by recording whether others pay attention to them or not, and then change their original centrality. 5. Monitoring of depression or anxiety level, most depressed and anxious visitors tend to believe that their bad mood will continue unchanged, so they are encouraged to monitor their depressed or anxious mood and recognize the fluctuating characteristics of the beginning, peak and end of the mood, so as to This will increase confidence in treatment.
There are also other techniques that can be used as a supplement, such as relaxation training, self-management techniques, determination training, social skills training, and problem solving training.
Case Study
(A) Counseling case
Li Mou, female, 17 years old, a sophomore in high school, dressed cleanly and elegantly, came to the counseling room to seek help because of her study problems. Complaint: In the past three months, she has been nervous in class, feeling that someone is watching her, and she cannot concentrate. When I lie down at night, I think back on the day’s study and gain very little, and I feel very ashamed. I thought that if I continued like this, I would not be able to get into a university. I felt worried and disappointed about my current situation. At the beginning of this semester, the 80 students in the two experimental classes were equally assigned to 20 science classes, and since the students in the experimental classes were all top students, my position as the top student in the class for one year was threatened, The teachers did not care about me as much as before. I made up my mind to fight for myself in the second monthly exam, and I would definitely take back the first position. I felt that my classmates and teachers around me began to despise me, and I felt that nothing was going well for me, so I became depressed and irritable. But after that, the monthly exam results often hovered around the tenth place and never entered the top five. Now that the final exams were approaching, I felt that this was a great opportunity to prove myself. Therefore, he came to the counseling office to seek help, hoping to get guidance from the counselor, so that he could quickly regain his status and take back his first place.
Through communication with the student’s parents and teachers, we learned that the student has been doing very well in her studies from elementary school to now, and has a docile personality, and is favored by her parents at home, and by her teachers at school, and praised by neighbors and parents of her classmates when she goes out. She was not able to get into the high school pilot class because she was not feeling well in the middle school exams, but she was gifted, and after she came to the high school, she kept the first place in the class with her solid learning foundation and her own efforts. Recently, however, she has been distracted in class, her academic performance has dropped, she is not active in answering questions, she is reluctant to participate in group activities, and she has become silent and unhappy.
(2) Explanation and analysis of Li’s psychological problems using cognitive behavioral therapy
After two exchanges and analysis, it was found that Li’s main problem was anxiety caused by the realistic stimulus of declining test scores, which was generalized and lasted for more than three months, and it was difficult to be relieved by natural development or non-professional interventions, which affected his life and study to a certain extent. According to Professor Xu’s discussion on the diagnosis of neurosis, this problem does not belong to the category of neurosis, and the diagnosis of this problem should be a serious psychological problem.
Using cognitive-behavioral therapy to analyze Li’s symptoms, we can see that most of the problems are due to her own reasons or her inherent perceptions, such as her relatively smooth upbringing and her excellent grades have made the student form some unreasonable perceptions, such as, she should always be the best, there is no doubt about this; failure to get the first place in the examination is a failure; her grades (ranking) will be looked down upon by her classmates and teachers if they fall. etc.; bad academic performance, everything is bad; good learning, everything is good. Similar unreasonable ideas are deeply rooted in Li Mou’s mind, so when he finds himself not as good as others, he cannot accept it reasonably, and his bad mood affects his normal life and learning, which makes his learning performance continue to be low, so his bad mood and learning performance and unreasonable ideas are cyclical and affect each other, making Li Mou sink in the whirlpool of depression and irritation and distress.
The overgeneralized, absolute requirements and the unreasonable notions of the worst, make Li unable to cope with life events reasonably and lead to maladaptive emotions and behaviors. Therefore, the goal of the counseling was to change Li’s unreasonable perceptions using cognitive behavioral therapy and to establish reasonable perceptions and appropriate behaviors together with Li through cognitive behavioral techniques.
(C) Using the above counseling techniques to solve psychological problems
We analyzed Li’s problems and their causes together and determined the goal of the counseling: to change the unreasonable concepts in his heart, to establish adaptive concepts and behaviors, to improve his academic performance, and to promote his personality improvement.
At the beginning of the counseling, Li did not have a clear understanding of his problems, but through the joint efforts of the counselor and the visitor, Li gradually realized that there were irrationalities in his own perceptions and that these irrationalities had a profound impact on his life. The following is a selection of counseling sessions to show the counseling process.
Counselor: I just thought in my mind that you must feel frustrated, angry and dissatisfied when your academic performance dropped from the first place to the current situation. I understand how you feel right now.
Interviewer: Yes, I can’t stand how things are like this. How am I going to get into the university I want to go to if this goes on?
Counselor: Yes, getting into a good college is the main reason we come to high school. Now you can think about what made the ideal grades become what they are now.
Visitor: I’ve thought about why this is the case, but I can’t find the reason, so I came to you for counseling.
As you can see, you need to help the client identify the goal of the consultation together, recognize the irrational ideas, provide a starting point for the consultation, and then use questioning and self-censorship techniques to gradually identify the client’s specific problems and draw attention to previously overlooked experiences and experiences during the consultation process,
The client is enabled to discover his or her own irrational ideas. By examining marginal misconceptions, using suggestions, demonstrations, and imitations to experience and evaluate oneself more objectively, and correcting core misconceptions, the client achieves reattribution and cognitive reconstruction.
Client: I feel that if I don’t get the first place in my class, my classmates and teachers will laugh at me, and I won’t have any face to face my parents, teachers, classmates and neighbors. It makes me feel bad to think about it.
Counselor: It is indeed a happy thing to get the first place in the examination. But let’s think about this: When you were first in the exam, none of the other students in the class were happy. Is it true that second place is not a good student?
Interviewee: Well, in the eyes of others, second place is not bad. But I ……… (silent) always felt that people would look down on me if I didn’t come first. I just failed.
Counselor: You failed the midterm, but didn’t you also do very well in your first year of high school? Did your failure in the midterm affect your academic performance in the first year of high school?
Interviewer: Well, …… (silent) now, it doesn’t seem to have affected much.
Counselor: Your first monthly exam was only 1 point away from the first place, what was the difference between the two places?
Interviewee: One point is just a multiple-choice question, right? The ranking represents the grade, and the difference is of course the difference in the ranking grade.
Counselor: As we can see, grades are the true expression of knowledge mastery, but rankings are not. Imagine that the classmates have high scores, the bottom one can go to Tsinghua, the bottom one is also very powerful; on the contrary, the classmates have very low scores, the first one can not even reach the general line, what is the meaning of this first for our purpose of examination?
Interviewer: Well, the teacher has a point, it’s true. It seems that I used to put too much emphasis on the ranking. In fact, knowledge mastery is the essence, the main thing, the ranking is a superficial, relative thing, right?
With the help of the counselor, the visitor unveils his or her own irrational ideas step by step through techniques such as authenticity testing, decentering, and identifying cognitive errors, revealing the deep-rooted irrational ideas like peeling corn, recognizing their irrationality and harm, and enhancing the visitor’s desire to seek treatment and confidence in solving the current problem. By making full use of demonstration, imitation and homework, the cognitive-behavioral therapy learned by the visitors can be transferred to the real life and applied, so as to fully mobilize the inner potential of the visitors to establish reasonable and effective behavior patterns and cognitive concepts to improve themselves.
(IV) Evaluation of the effectiveness of the consultation
1. Visitors’ comments.
”I don’t feel like someone is watching me in class anymore” “I can basically spend all my time in class on studying” “I feel much more relaxed, and I see things more clearly than before” “As long as I study hard, even if I can’t get the first place in the exam, I can definitely get an ideal university in the college entrance examination.”
2. Objective reality of the change in the visitor’s social adjustment: academic performance has improved; she has become more enthusiastic about her teachers and classmates than before; she has taken the initiative to study.
3.Visitor’s parents’ evaluation: His academic performance has improved, he is more cheerful than before, and he is aware of his petty temperament and intends to change it slowly. Teachers’ and classmates’ evaluation: He is more attentive in class, his academic performance has increased rapidly, and he gets along with others around him better than before.
4.Consultant’s evaluation: I found that the counseling has basically achieved the expected goal; the depressed and irritable mood disappeared, interpersonal relationships recovered well, and the efficiency and effectiveness of learning improved significantly. The whole person became more mature and sensible, and his evaluation of himself was also fair and sensible. The counseling process was more complete and organized.
After the follow-up survey, we found that the visitor was well adjusted to society and her academic performance was among the top three in her class.
III. Personal experience
1. Through the study and application of the theory, I have learned that unreasonable concepts are widely present in our daily life, and usually influence our concepts, emotions and behaviors in a silent way. Therefore, it is very important to further promote the theoretical content and techniques of cognitive behavioral therapy so that more people can benefit from them. During the counseling process, both parties should establish an equal interpersonal relationship, discuss and formulate the counseling plan proposed by the counselor, and adjust the direction and process of counseling according to the counseling summary. The counselor should be good at grasping the key points of the visitor’s psychological turnaround, paying attention to the visitor’s positive psychological factors, developing his or her inner potential, and giving full play to the visitor’s initiative and participation, so that he or she can get rid of obstacles and disturbances and improve his or her personality. At the same time, we deeply believe that the professionalism of the counselor is very important.
2.I feel that the first step in cognitive-behavioral therapy is to determine the goals and specific problems of the counseling. In the process of counseling, making full use of the examination of superficial misconceptions, semantic analysis techniques, and behavior modification techniques can promote effective progress of counseling. Cognitive review and homework are essential for the consolidation of counseling effects. The above techniques require professional training to be used effectively and flexibly to help visitors to the greatest extent possible, and it is necessary to continuously summarize and improve proficiency in their use. With the help of the above techniques, we can fully mobilize the inner potential of the visitors and achieve the purpose of helping people to help themselves. As in the cognitive apprehension therapy by Youbin Zhong, examples and analogies can be used to change the visitor’s inherent cognitive perceptions in a silent and effective way. Concrete language is more effective when used in conjunction with abstract language.