Foundations of Treatment 129
requires mediation through the patient’s belief.) The therapist helps the patient (D)
dispute any irrational beliefs by highlighting their destructive or illogical quality. A
successful dispute leads to (E) an effect or an effective new philosophy, a new idea
or a new pattern of emotion or behavior. Finally, the patient can fortify the effect
through (F) further action.
Each REBT session is devoted to one aspect of the patient’s overall problem.The patient and therapist often start a session by agreeing on the desired ef-
fect of the session’s intervention. In Leon’s case, the desired effect for a session
might be to modify enough of his beliefs about being laughed at that he feels able
to say hello to a coworker the next day. A main intervention during the dispute
step involves helping the patient distinguish between a belief that something is
necessary (a “must,” such as “When I talk to someone, I must be suave and bril-
liant”) and a belief that something is simply preferred (“When I talk to someone,
I’d like them to think of me as suave and brilliant”). Sometimes the therapist ar-
gues with the patient as part of the dispute process. The therapist might also use
role-playing to help patients develop new patterns of thinking and acting (Ellis &
MacLaren, 1998).
Beck’s Cognitive Restructuring
Beck’s approach to cognitive therapy, like Ellis’s, builds on the premise that
psychological problems result from faulty automatic thoughts. Such thoughts are
negative and pop into awareness without effort. For example, consider the situa-
tion of a young man, Yoshi, who, as a child, was accused by his parents of being
selfi sh in relation to his younger brother; he grew up believing that he is a selfi sh
person. Whenever he expresses a preference (“I’d like to see this movie tonight,
not that one”), Yoshi feels that he is being selfi sh and feels bad about himself.
Yoshi may live his life trying to avoid seeming selfi sh, and so strive to be totally
fl exible, never expressing preferences or desires that might confl ict with those of
others. His automatic thought, then, is that he is selfi sh; it pops into his awareness
without effort.
Beck proposed that such negative thoughts arise from systematic cognitivedistortions, which create a cognitive vulnerability—a diathesis, to use the term
introduced in Chapter 1—for particular disorders (Beck, 2005). Table 4.4 shows
several common cognitive distortions that lead to negative automatic thoughts.
Beck proposes that the problems created by negative automatic thoughts can di-minish as the patient tests these thoughts (and discovers they are faulty) and adopts
more rational and realistic thoughts. Beck developed methods to identify and reduce
cognitive distortions and thereby modify automatic negative thoughts. Whereas
REBT depends on the therapist’s efforts to persuade patients that their beliefs are
irrational, Beck’s approach to cognitive therapy encourages patients to see their be-
liefs and automatic negative thoughts as testable hypotheses, about which they col-
lect data. Both patient and therapist then examine the data to determine whether
the patient’s hypotheses are supported (or, as more often occurs, refuted). From this
point of view, interactions in the world are opportunities for real-life “experiments”
that can confi rm, modify, or challenge the patient’s beliefs (Hollon & Beck, 1994,
2004). Beck and his colleagues have developed this treatment scientifi cally, assess-
ing depression, anxiety, and other problems before and after treatment; they have
obtained this information in order to evaluate the degree to which the treatment
works for each kind of problem, and to determine which elements cause the most
positive change (Beck, 2005; Beck, Emery, & Greenberg, 2005; Beck, Freeman, &
Davis, 2004; Newman et al., 2002).
This kind of cognitive therapy often relies on a patient’s written self-reportof each day’s dysfunctional thoughts (see Figure 4.4, which shows a completed
log for Leon). Patients are instructed to identify the context in which each
automatic thought occurred, rate their emotional state at the time, and record
the thought itself. Then they are asked to record their rational response to the
automatic thought (which is like the dispute step in REBT) and a new rating of