COGNITIVE-BEHAVIORAL FAMILY THERAPY (CBFT)
BETH MUGNO, MA November 30, 2009
Behavior therapy for individuals
Behavior therapy for couples
1930’s – 1960’s
Adding a cognitive component as a supplement to behavioral couples therapy Integrating and emphasizing the cognitive component of behavioral couples therapy
Applying a CB approach to families
late 1980’s - early 1990’s
behavioral approach as applied to individuals
Developed classical conditioning (1932)
First described notion of systematic desensitization (1948)
Developed principles of operant conditioning*
behavioral approach as applied to couples/families
Pioneered the use of behavioral parent training to help parents control the behavior of aggressive children (1971)
Applied an operant framework to family problems
Introduced concepts of role rehearsal and modeling (1970)
Developed the notion of contingency contracting with reciprocal reinforcement (1969)
adding a cognitive component to couples therapy
Rational Emotive Therapy (RET):
Ellis adapted his model of Rational Emotive Therapy to couples in conflict (1955)
Proposed that relationship distress occurs when one partner:
Holds irrational or unrealistic beliefs about the other or about the relationship Makes extreme negative evaluations when either the partner and/or the relationship do not live up to high expectations
Developed his A-B-C model to illustrate the interconnectedness
of cognitions, emotions, and behavior.
Taught the members of a couple to challenge their irrational thinking.
Ellis’ A-B-C Model
Beliefs about Event
He is such a loser!
Disputing Self-Defeating Beliefs
Effect of Consequences
adding a cognitive component to family therapy
Emphasizes each individual’s perception and interpretation of events that occurs in the family environment (i.e., family members create their own world by the view they take on what happens to them)
Therapy focuses on how particular problems of the family members affect their functioning and well-being as a unit
A-B-C theory: maintains that family members blame their problems on certain activating events in the family environment (A). In family therapy, individuals are taught to probe for irrational beliefs (B), which are then logically challenged by each member and finally debated and disputed.
Ellis later renamed his approach Rational Emotive Behavior Therapy (REBT) in order to more fully acknowledge the role of behavioral responses in an individual’s interpersonal problems
RET vs CBT
RET is devoid of any systems application whereas CBT is highly consistent with a family systems perspective
CBT is a more expansive and inclusive approach than RET in that it focuses in greater depth on family interaction patterns
(Beck, 1976; Ellis, 1978)
cognitive behavioral approach
An individual’s emotional and behavioral reactions to life
events are shaped by his/her particular interpretations of these events (cognitive appraisals), rather than solely by the events themselves
THOUGHTS cause feelings and behaviors (i.e., your feelings
come from your thinking)
In a family, relationships, cognitions, emotions, & behavior
mutually influence one another (consistent w/systems theory)
If negative patterns of behavior develop, they are often
unknowingly maintained through reciprocal reinforcement.
Social Learning Theory: Behavior is maintained by its
Reinforcements: consequences that affect the rate of behavior Reinforcers (+ & -): behavior Punishers: behavior Extinction: behavior (behavior stops when reinforcement fails to follow a response)
Theory of social exchange (Thibaut & Kelley, 1959): In relationships, individuals strive to maximize rewards while minimizing costs.
3 most important elements of a successful relationship or marriage: Communication* (Wills, Weiss, & Isaac, 1978) Affection Child care
Other significant elements: High positive affect (Wills, Weiss, & Patterson, 1974) Low negative affect (Gottman et al., 1977) Good conflict resolution skills (Jacobson, 1981) Use of a high rate of varied reinforcers
Good relationships Learned coping behavior Need to develop good relationship skills
Symptoms are a result of learned responses
Emphasis on the symptoms themselves
Search for reinforcers
Maintenance of Disordered Behavior is often the result of:
E.g., Inconsistency in reinforcers, delay in reinforcing, ineffective use of punishment, etc.
Aversive Control Techniques
Attempt to control through the use of name-calling, crying, withdrawal, nagging, etc. Aversive behavior is often reciprocated (reciprocal reinforcement), leading to a cycle of negative behavior.
7 types of cognitive distortions
A conclusion is drawn from an event in the absence of supporting substantiating evidence.
Information is perceived out of context. An isolated incident or two is allowed to serve as a representation of similar situations, whether or not they are truly related. A case or circumstance is perceived as having greater or lesser significance than is appropriate.
Magnification and minimization
7 types of cognitive distortions (cont.)
A form of arbitrary inference in which external events are attributed to oneself when insufficient evidence exists to render a conclusion.
Experiences are classified as either all or nothing – as complete successes or total failures.
Labeling and mislabeling
Behaviors such as mistakes made in the past are generalized to traits to define oneself or another family member.
goals of CBFT
Primary Behavior Change
Increasing positive behavior and extinguishing maladaptive behavior
*Behavior change better achieved through pos behavior than negative behavior
Secondary Cognitive Change
Facilitating the family's ability to recognize and challenge distorted thinking
Tertiary Education (skill-building)
Teach skills in regard to communication (expressive & listening skills), negotiation, and problem-solving (i.e., teach families how to heal themselves in the future)
logistics of CBFT
structured goal-oriented time-limited (10-20 sessions typically; weekly basis) sequentially delivered core components Collaborative relationship with therapist highly individualized treatment plan present-focused therapy
Session structure: mood check-in, homework review, agenda
setting, processing session content, homework assignment, feedback/summaries
process of behavior change
To achieve behavior change, alter the contingencies of reinforcement.
Identify behavioral goals Conduct a functional analysis Employ learning theory techniques to achieve goals Use social reinforcers to facilitate and maintain change Train significant others to use contingency management techniques to influence family members and provide appropriate consequences for behavior
process of cognitive change
To achieve cognitive change: Identify dysfunctional cognitions of individual family members as well as distorted family schemas (i.e., jointly held beliefs among family members). Teach family members to challenge these dysfunctional cognitions/schemas.
specific therapeutic techniques
1) Parent Management Training
teach parenting skills (e.g., ways to make requests to increase child compliance) & behavioral principles (e.g., differential attention, counter-conditioning, material and social reinforcements, modeling) via therapist-guided practice, role-play, feedback, and coaching
2) Cognitive Restructuring
identifying and challenging distorted cognitions via Socratic questioning, reframing, and reality testing, e.g.
rise of CBFT
1980’s & 1990’s Rapid expansion of literature on CBFT
AAMF National Survey (2002)
N = 292 randomly selected MFT’s Asked to report their primary treatment modality in a word or two
27 different models were identified modality (most frequently mentioned tx)
27.3% of therapists identified CBFT as their primary
factors leading to the adoption of CBFT by MFT’s
Research evidence supports its efficacy (coupled with a much greater emphasis on evidence-based therapies by consumers and insurers)
This type of therapy seems to appeal to clients
Clients value the proactive approach to problem-solving and skill-building that the family can use to help solve future problems as well
Easily integrated with other treatment approaches (very flexible)
Patients in chronic pain Suicidal adolescents Children with medical disorders Children going through a highconflict divorce Children with anxiety disorders Caregivers of patients with Alzheimer’s disease Schizophrenics Children with brain injury
(Khoadyarifard et al., 2006) (Piacentini et al., 2009) (Mazzone et al., 2009)
(Suveg et al., 2009)
(Marriott, Tarrier, & Burns, 2001)
(Sellwood et al., 2006) (Wade et al., 2006)
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