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As cognitive-behavior therapy (CBT) has proven to be an evidence-based intervention for many mental health problems, the requirement for training programs has increased. Although there is promising data on the skills outcomes of such programs, trainees’ affective/behavioral changes mechanisms and in their faulty thinking patterns during the personal development of such training are unknown. The aim of this study is to investigate which are the most common irrational/dysfunctional beliefs of trainees during a cognitive-behavioral intervention training and their maladaptive consequences, as well as the methods of restructuring that they prefer to change these beliefs into rational/functional ones and achieve more adaptive consequences. 94 participants in a cognitive-behavioral interventions training program filled out 340 ABC, forms related to negative events at work and in personal life, as part of the personal development component in the training program. The obtained qualitative data was coded by three trained ratters in accordance to the current cognitive model of CBT. Contingencies analysis showed that demandingness, awfulizing and global evaluation (GE) are most frequently associated with anxiety, while low frustration tolerance is associated with anger. Comfort, affiliation, achievement themes were most frequently associated with anxiety, while fairness was most frequently associated with anger. Pragmatic cognitive restructuring was the most frequently used by trainees. We found evidence that confirmed many of the theoretical predictions form the cognitive model of CBT in respect to the associations between irrational/dysfunctional cognitions and dysfunctional emotions as well as some particularities for this specific population.
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Cognitive-Behavioral Processes Based on Using
the ABC Analysis by Trainees’ for Their Personal
Development
Oana A. David Silviu A. Matu Sebastian Pintea
Carmen D. Cotet Diana Nagy
Published online: 22 April 2014
ÓSpringer Science+Business Media New York 2014
Abstract As cognitive-behavior therapy (CBT) has proven to be an evidence-
based intervention for many mental health problems, the requirement for training
programs has increased. Although there is promising data on the skills outcomes of
such programs, trainees’ affective/behavioral changes mechanisms and in their
faulty thinking patterns during the personal development of such training are
unknown. The aim of this study is to investigate which are the most common
irrational/dysfunctional beliefs of trainees during a cognitive-behavioral interven-
tion training and their maladaptive consequences, as well as the methods of
restructuring that they prefer to change these beliefs into rational/functional ones
and achieve more adaptive consequences. 94 participants in a cognitive-behavioral
interventions training program filled out 340 ABC, forms related to negative events
at work and in personal life, as part of the personal development component in the
training program. The obtained qualitative data was coded by three trained ratters in
accordance to the current cognitive model of CBT. Contingencies analysis showed
that demandingness, awfulizing and global evaluation (GE) are most frequently
associated with anxiety, while low frustration tolerance is associated with anger.
Comfort, affiliation, achievement themes were most frequently associated with
anxiety, while fairness was most frequently associated with anger. Pragmatic cog-
nitive restructuring was the most frequently used by trainees. We found evidence
that confirmed many of the theoretical predictions form the cognitive model of CBT
in respect to the associations between irrational/dysfunctional cognitions and dys-
functional emotions as well as some particularities for this specific population.
Keywords Personal development Rational emotive behavior therapy
ABC model
O. A. David (&)S. A. Matu S. Pintea C. D. Cotet D. Nagy
Department of Clinical Psychology and Psychotherapy, Babes¸-Bolyai University, No. 37 Republicii
Street, 400015 Cluj–Napoca, Romania
e-mail: oanadavid@psychology.ro
123
J Rat-Emo Cognitive-Behav Ther (2014) 32:198–215
DOI 10.1007/s10942-014-0189-0
Introduction
Cognitive-Behavioral interventions are comprised of strategies mostly based on
cognitive and/or behavioral techniques used on clinical and non-clinical
populations, aiming to treat or prevent specific emotional or behavioral disorders
or symptoms (Ellis 1962). Cognitive-Behavioral Therapy (CBT) encompasses a
plethora of cognitive and behavioral approaches, such as Rational Emotive
Behavior Therapy (REBT—Ellis 1962), Cognitive Therapy (CT—Beck 1976).
All these different approaches have common assumptions, based on the cognitive
model (Dobson and Dozois 2010): (a) cognitions (cognitive processes) underpin
emotional and behavioral outcomes, (b) cognitions (cognitive processes) can be
identified and if necessary modified, and (c) emotional and behavioral
outcomes can be modified by altering these determining cognitions (cognitive
processes).
Training in Cognitive-Behavioral Interventions: Effectiveness and Mechanisms
of Change
As CBT is supported by scientific evidence, demand seems to have increased for
developing valid training programs in CBT (Rakovshik and McManus 2010;
Bennett-Levy et al. 2009). There are promising incipient data about the
effectiveness of the existing training programs in CBT (Myles and Milne 2004;
Westbrook et al. 2008). Rakovshik and McManus (2010) reviewed 37 training
programs in terms of training, therapist competence and patient outcome, and
concluded that CBT training programs which are more extensive lead to higher
therapists’ competence, which in turn correlates with better patient outcome.
Different aspects of CBT training have been considered (Bennett-Levy et al.
2009) to be effective in developing different skill sets, such as: (a) reading,
lectures/talks and modeling most useful in acquiring declarative knowledge,
(b) role-play, self-experiential work, modeling and reflective practice—most
useful in developing procedural knowledge, and (c) self-experiential work and
reflective practice—most useful in improving reflective capability and interper-
sonal skills.
The Personal Development Component in Therapy and CBT Training
Personal development has been underlined as an important part of the training
process in CBT/C (Beck 1995; Padesky 1996), when trainees use the cognitive-
behavioral techniques on themselves as a learning strategy for understanding the
therapeutic process. Bennett-Levy et al. (2001) found the self-practice based on the
structured self-reflective component, using the cognitive model of a CBT training to
be effective in enhancing therapist skills and therapist self-concept. However, the
extent in which trainees reported benefits from the personal development
component of the CBT training varied consistently, with some of them (Bennett-
Levy et al. 2001) considering it life changing and others failing to engage in the
process.
CBT Mechanisms Involved in Personal Development 199
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The ABC Model: The Process of Personal Development and Change in CBT
Thought record procedures in cognitive-behavioral interventions are using the
cognitive ABC (or ABCDE) model of Ellis (1956,1991; DiGiuseppe et al. 2014;
Dryden 2012), based on the Rational Emotive and Behavioral Therapy (REBT),
offering the major advantage of its framework simplicity. The ABC model revised
(Dryden 2012; Ellis and Dryden 2007) states that when individuals are faced with
certain activating events (A), they have certain beliefs (B) about these events, which
largely mediate the emotional or behavioral consequences (C) of these events. If
their beliefs (B) are rational/functional, then their emotional and behavioral
consequences (C) will be adaptive (or functional); however, if their beliefs (B) are
irrational/dysfunctional, their emotional and behavioral consequences (C) will be
maladaptive (or dysfunctional) (David 2003). It was proposed (David and
Szentagotai 2006) that once generated, a consequence (C; emotion or behavior)
can become an (A), about which the individual could hold other beliefs (B; meta-
beliefs), which in turn are generating secondary emotions (or meta-emotions).
Based on Ellis’s (1994; David et al. 2005a) binary model of distress, there are
functional (e.g., sad, concerned/worried, annoyed, remorseful) and dysfunctional
(e.g., depressed mood, anxious/panicked, furious, guilty) negative emotions, which
are not quantitatively but qualitatively different, and yet interrelated. The difference
between the two types of emotions is judged (Ellis and DiGiuseppe 1993) based on
(1) on their subjective experiences, (2) their subsequent adaptive/maladaptive
behaviors/behavioral tendencies, and (3) their underlying IBs versus RBs. Defined
this way, dysfunctional emotions correspond to clinical problems, while functional
emotions are expressing the normal distress experienced when people are facing
adverse situations (David et al. 2002). Irrational/dysfunctional beliefs (IBs) are
therefore considered most important cognitive etiopathogenetic mechanisms of
emotional disorders and symptoms in both clinical and nonclinical samples (David
et al. 2005b).
A common distinction between different levels of cognitions involved in
generating emotional and behavioral outcomes posits (David and Szentagotai 2006)
that there are ‘‘cold’’ cognitions (descriptions of and inferences about activating
events) and ‘‘hot’’ cognitions (evaluations of said descriptions and inferences).
Cognitive therapy (CT; Beck 1976) approaches these faulty thinking processes
(arbitrary thinking, overgeneralization, negative filtering, personalization, discount-
ing the positives) in order to approach dysfunctional emotions. REBT research has
shown however that the effect of ‘‘cold’’ cognitions on emotions and behaviors is
mediated by the ‘‘hot’’ or evaluative cognitions (David et al. 2002; Szentagotai and
Freeman 2007). Beliefs are thus conceptualized as evaluative (or ‘‘hot’’) cognitions
(IBs/RBs) which can be of four distinct types (Dryden et al. 2010), and each of them
can be in turn irrational or rational:
1. The first irrational, absolutistic belief is demandingness (DEM), and its rational,
flexible counterpart is full preference (PREF). DEM refers to the rigid demand
that a wish or desire regarding the self, the others or the world must be met just
because the individual wants it to (e.g. ‘‘The world must be a fair place.’’).
200 O. A. David et al.
123
Preference, on the other hand, acknowledges the individual’s wish or desire, but
posits that it need not happen (e.g. ‘‘I would very much want the world to be
fair, but it doesn’t have to be that way just because I want it to.’’).
2. The second irrational, rigid belief is awfulizing (AWF). It refers to the appraisal
of a specific situation or event as being catastrophic or more than 100 % bad
(e.g. ‘‘Having to hold that presentation in front of all those people is awful!’’).
Its rational counterpart, non-awfulizing/badness (BAD), refers to the acknowl-
edgement of the negativity of the same situation or event, but without deeming
it the worst thing that could happen (e.g. ‘‘It’s bad for me that I have to hold that
presentation in front of all those people, but it’s not a catastrophe.’’).
3. The third irrational, rigid belief is low frustration tolerance or frustration
intolerance (LFT). It refers to the inability to tolerate a particular situation or
event (or rather the belief thereof) (e.g. ‘‘I can’t stand this work pressure
anymore!’’). The rational version of this is high frustration tolerance (HFT),in
other words the belief that one can tolerate the same particular situation or
event, although it is not an easy or pleasurable thing to do (e.g. ‘‘It’s hard for me
to stand this work pressure, but I can still endure it.’’).
4. The fourth irrational, rigid belief is global evaluation of human worth or life
(GE; of self, others, or life) or depreciation (DEP). It refers to the tendency to
deem the self (self-downing; SD), others (other-downing; OD) or the life (life-
downing; LD) as being either entirely negative/bad or globally positive/good
(e.g. ‘‘I am an incapable person because I messed up the interview.’’).
Alternatively, non-global evaluation, and more specifically unconditional
acceptance (UA) refers to the specific, contextual evaluation of the self (USA),
others (UOA), or life (ULA) and the acceptance of human fallibility and
imperfection of the world (e.g. ‘‘I am a person with successful and unsuccessful
behaviors, and my performance at the interview was just one of the latter.’’).
Thus, all IBs generally reflect a rigid thinking style (musts, should, ought), lack
logical consistency, objective empirical support, and are not pragmatic, while RBs
are formulated flexibly and logically, have objective empirical support, and are
pragmatic (David et al. 2005a). Ellis conceptualized IBs as having a higher
biological basis than RBs, and thus not being at opposite ends of the same
continuum (Bernard 2009). The main IBs and RBs processes presented are built
around need domains named content areas (Bernard 1998; DiGiuseppe et al. 1988;
Shaw 1989), such as approval, achievement, comfort, and fairness, and may refer to
ourselves, others, or life in general (Ellis and Harper 1961; David et al. 2005a).
Currently, there is some agreement in terms of relationships among the different
processes/contents of IBs/RBs and their negative dysfunctional/functional/or
positive consequences based on empirical findings (David et al. 2010; DiGiuseppe
et al. 2014), but also different opinions, which we will briefly present.
Relationships Between IBs Processes
In terms of the relationship between the IBs processes, Ellis and MacLaren (2005)
conceptualized DEM as core IBs, while the other processes functioning as derivates,
CBT Mechanisms Involved in Personal Development 201
123
based on the appraisal theory of emotions (Lazarus 1991; Smith et al. 1993). This
perspective has been supported by research (David et al. 2002; DiLorenzo et al.
2007; Hyland et al. in press), using diverse designs, suggesting that DEM functions
as primary appraisal mechanism, while the AWF, LFT and GE are secondary
appraisals/reappraisals. Beck (1976) adopted a different view, proposing that DEM
is mediating the effects of the other processes on emotional consequences. This
stance has received some empirical support in the literature (David et al. 2005a).
Other research data suggests (Bernard 1998; Gavita et al. 2011) however, based on
factor analyses of the existing measures, that DEM, LFT, and AWF were found to
load on one factor, while GE loads on a different factor. There are some other
studies suggesting that DEM and GE/SD are more central schemas, while AWF and
LFT function like appraisals (Szentagotai et al. 2005).
Relationships Between IBs Processes and Cs
Emotions It was shown (David et al. 2002; David and Cramer 2010) that high levels
of IBs generate dysfunctional emotions (e.g., anxiety), whereas low levels of IBs
(and high RBs) generate functional emotions (e.g., concern). In terms of the
association between processes of IBs and types of emotional consequences, it was
shown (David et al. 2002; Smith et al. 1993) that both high levels of DEM as
primary appraisal process and AWF as secondary appraisals are significant
predictors of high anxiety; depression was predicted by DEM (primary appraisal)
and SD (secondary appraisal), while Bernard (1998) found highest correlation of SD
with depression; for anger the best prediction model was having DEM as primary
appraisal process, and LFT as a secondary appraisal processes; guilt was found to
have DEM and secondary SD as appraisal mechanisms.
In terms of the contents of IBs, Bernard (1998) has obtained the strongest
correlations between the (1) need for achievement and anger both as state and as
trait, (2) need for approval and anxiety, respectively anger in; (3) need for comfort
and depression, and trait anxiety; and (4) need for fairness and ager expression and
trait.
Behaviors For behavioral reactions, self-related DEM for achievement has been
related with maladaptive behaviors, such as emotional eating, medication usage
(Harrington 2005), relational problems, social avoidance and isolation (Watson
et al. 1998), lower performance in social context (Silverman and DiGiuseppe 2001),
and increased anger expression (e.g. Bernard 1998). DEM for comfort and fairness
were associated with behavioral avoidance (Bridges and Roig 1997), self-harming
(Harrington 2005), comfort eating (Bernard 1998), overspending, procrastination,
anger expression and low anger control, respectively relational difficulties (Addis
and Bernard 2002). DEM for comfort were related to a hostile dominant
interpersonal style (Goldberg 1990). In terms of the IB derivative processes, (1)
AWF was both associated with externalized behaviors, like submissive interper-
sonal style and social isolation (Watson et al. 1998; Martin and Dahlen 2004), anger
suppression but also with externalized anger expression (Silverman and DiGiuseppe
2001); (2) LFT was related to aggressive behavior tendencies, like increased anger
expression and decreased control of anger (Jones and Trower 2004), but also with
202 O. A. David et al.
123
behavioral avoidance, social isolation, marital problems, procrastination, comfort
eating, medication use, procrastination or self-harm (Harrington 2005); (3) GE was
correlated with defensiveness to negative feedback (Chamberlain and Haaga 2001),
anger suppression and expression, and marital problems (Silverman and DiGiuseppe
2001).
While there are some results in the literature for IBs processes, much less is
currently known for the RBs processes. This could be due to the fact that most
measures operationalized RBs as low IBs levels. When are measured as distinct
constructs, low but significant converse correlations are found between IBs and RBs
(Bernard 1998). Also, RBs are correlating with life satisfaction and conversely with
dysfunctional negative feelings (depression, anxiety, anger; Bernard 1998), thus
being conceptualized in REBT as resiliency factors and their development being a
goal of the ABC(DE) framework.
Cognitive Restructuring/Disputation (D)
If beliefs are found to be irrational, the goal of REBT/CBT is to restructure/dispute
(D) the irrational constructions of reality and acquire more efficient (E) rational/
functional beliefs, which in turn will facilitate (F) functional consequences.
Disputation of the irrational beliefs can be carried out in several ways, the most
common three ways being (Walen et al. 1992): (a) Logical disputation—by asking
whether or not the belief held by the individual is logical; (b) Empirical
disputation—by corroborating the belief with empirical evidence; and
(c) Pragmatic/functional disputation—by questioning whether or not the belief
held by the individual is helpful. Among them, it is considered that pragmatic
disputing can be the most effective (DiGiuseppe et al. 2014), in that is helping the
person acquire rational beliefs in favor of their goals, although this assumption lacks
empirical data. Another actual dilemma is concerned to which of the IB processes
are to be approached first in RE&CBT in order to be most effective. Questions are:
is it enough to dispute derivative IBs in order to obtain long lasting change, or the
core DEM should be also addressed? Which of the two should be addressed first?
By restructuring the core DEM, is the person changing also the derivative IBs? We
found recommendations about disputing the central DEM and at least an IB
derivative (DiGiuseppe et al. 2014) but no research data is available in this regard.
Objectives
The current study examines the frequencies and associations of the key cognitive-
behavioral components in healthy adults. We examined the psychological constructs
based on their integration in the ABC form that trainees’ were assigned to fill-in
based on their personal development component of their training in cognitive-
behavioral interventions. We were interested in the types of emotional and
behavioral difficulties, the types of cognitions they identified and the types of
disputing they choose to use more frequently. This is the first study to our
knowledge with an exploratory approach towards identifying the key relevant
CBT Mechanisms Involved in Personal Development 203
123
psychological constructs in the personal development of trainees in cognitive-
behavioral interventions.
Method
Participants
An initial number of 102 participants (19.8 % males) registered for a post-graduate
academic course in cognitive-behavioral interventions for personal and professional
development, organized by the Babes-Bolyai University. This group was included
as participants in another study (in preparation) on the efficacy of the course in
reducing emotional distress of the participants and improving their performance.
The mean age of the group was 36.34 years (SD =7.48), ranging from 25 to
59 years. Course participants had at least a college degree and had heterogeneous
licenses: 20.6 % of the participants were clinical psychologists, 22.5 % were school
psychologists, 9.8 % were industrial psychologists, 12.7 % were teachers, 13.7 %
were managers, 5.9 % were economists, 6.9 % were working in the human
resources field, and the rest of 7.8 % were lawyers, medical doctors, engineers,
social workers, assistant managers and translators.
Only 94 participants that completed the course requirements and provided data
for the personal development component of the course were included in this study.
In terms of thought recording requirements, 18.1 % of the participants filled in 5
forms, 50 % of the participants filled 4 forms, 18.1 % of the participants filled 3
forms and 4.3 % filled 2 forms, while 9.6 % filled only 1 ABC form. In total, we had
340 ABC forms for content analyses.
Procedure
Participants were registered for a one semester post-graduate course in cognitive-
behavioral interventions called Cognitive-behavioral coaching and consultation for
professional and personal development, during September 2011–March 2012. Prior to
the initiation of the course and after its ending, participants completed online a specific
set of questionnaires which are part of another effectiveness study in preparation.
The course had three modules: theoretical background of the cognitive-behavioral
approach, specific techniques used in CBT, and supervised practicum using on role-
plays on applying the ABC model. After the modules, requirement for graduating the
course was to fill five weekly ABC forms as part of their personal development
component, and to submit a project with a case study base on cognitive-behavioral
interventions. The ABC forms were accessed online, whenever the participants
experienced emotional or behavioral difficulties.We used a strict protocol of directions
regarding the ethical handling of the data, approved by university Institutional Review
Board. Respondents received information on the purpose of the study and details were
provided regarding the data handling procedures, including their right to refuse to
participate or to withdraw at any time. Moreover, it was clearly announced in advance
that the personal development component is a requirement of the course.
204 O. A. David et al.
123
The ABC(DE) forms (see Fig. 1) were based on the Ellis’s model, and included
the cognitive errors of Beck: A-the activating event, B-irrational/dysfunctional
cognitions; C-dysfunctional reactions (emotions or/and behaviors); D-disputing/
restructuring; E-effective beliefs; and F-alternative functional reactions (emotions
or/and behaviors).
All forms were collected by the first author and were analyzed and coded
blindly by three independent coders (S.M., C.C., & D.N., all clinical psychol-
ogists, certified by the National Board of Psychologists). The coding sheet was
derived from current models of CBT (Dryden 2012; Fig. 2). In addition to the
categories described above, for C’s behaviors we used the categories adaptive or
maladaptive behaviors/action tendencies (Dryden 2012; Dryden and Branch 2008)
oriented towards self or others and externalized versus internalized. Externalized
behavior or action tendencies to express distress outwards, while internalizing
behavior refers to the tendencies to express distress inwards (Krueger et al. 2001).
Only responses that were coded in a similar manner by at least two of the coders
were initially included in the analysis. In the rest of the cases, responses were
discussed and introduced after agreement.
The categories having the same interpretation in two or all three of the coders’
analysis were taken into consideration for further analyses (the calculation of
frequencies). When disagreements were noted between the coders, they were
discussed and the correct interpretation was agreed.
Results
Descriptive Analyses
Activating Event (A)
The analysis revealed that most events recorded were present events, 303 cases
(89.4 %), followed by future events, 27 cases (8.0 %) and past events, 9 cases
(2.7 %). Second, the analysis for the locus of the activating events shows that the
great majority were external events, 318 cases (93.8 %) while only 21 events
(6.2 %) were internal events.
In terms of the content of the events, the analysis showed that the work related
events were predominant, 184 cases (54.8 %), while the life events were slightly
less frequent, 152 cases (45.2 %). Beyond the general content, a more specific
analysis revealed that, from the work category, the most frequent events were
related to work performance (65 cases), colleagues (35 cases) and boss (25 cases),
while from the life category, the most frequent were related to family and children
(39 cases), health/well-being (22 cases) and friends (15 cases).
Consequences (Cs)
Emotions From a total of 340 cases, 214 (63 %) reported feeling dysfunctional
emotional consequences. From the emotions reported, the most frequent was anger,
CBT Mechanisms Involved in Personal Development 205
123
present in 119 cases (55.6 %), followed by anxiety, 103 cases (48.1 %) and
depression, 19 cases (8.8 %). In 26 cases (12.1 %) the emotions were reported in
combinations of two, 25 cases (11.6 %) or three emotions, 1 case (0.4 %).
Maladaptive behaviors Maladaptive behaviors were reported in 163 out of 340
cases (48 %). From the total of maladaptive behaviors reported, 135 were
externalized behaviors (82.8 %) and 28 were internalized behaviors (17.1 %). As
the orientation of these behaviors is concerned, in 81 cases (49.6 %) were oriented
toward self, while in 91 cases (55.8 %) were oriented toward others.
Fig. 1 The ABC monitoring form (Ellis 1956,1991)
Fig. 2 The coding sheet for the ABC form contents registered by participants (Ellis and Dryden 2007;
Dryden 2012)
206 O. A. David et al.
123
Beliefs (Bs)
Beck’s model The dysfunctional inferences were present in 77 cases (22.6 %) and
absent in 263 cases (77.4 %). When trainees recorded dysfunctional inferential
cognitions, the most frequent was labeling (28.5 %), followed by arbitrary
inferences (27.2 %), overgeneralization (24.6 %), and personalization (14.2 %).
Ellis’s model From the total cases analyzed, 244 (71.8 %) reported irrational
beliefs. From these cases, taking into account both single appearance and
combinations with other beliefs, the most frequent was LFT, present in 138 cases,
(56.5 %), followed by DEM, 115 cases (47.1 %), AWF, 86 cases (35.2 %) and GE,
42 cases (17.2 %). Also, the most frequent combination was DEM ?LFT (23
cases) and AWF ?LFT (19 cases). Where present, the most frequent content of the
cognitions was achievement, 70 cases (29.4 %), followed by affiliation, 65 cases
(27.3 %), fairness, 63 cases (26.5 %) and comfort, 40 cases (16.8 %).
Disputing/Restructuring (D)
The disputation was present in 209 of the cases (61.4 %). From the total disputation
cases reported, the most frequent was the pragmatic disputation, with 125 cases
(59.8 %), followed by empirical disputation, 114 cases (54.5 %) and logical
disputation, 22 cases (10.5 %). There is also relevant to mention that in 48 cases
(22.9 %) were reported combinations of types of disputation, the most frequent
combination being the empirical and pragmatic one, 33 cases (15.7 %).
The New Effective Beliefs (Es)
Beliefs After the disputation, only one subject reported irrational beliefs (0.2 %).
Also, from 176 cases RBs that were reported (51.7 %), the most frequent was BAD
with 48 cases (27.2 %), HFT with 44 cases (25 %), PREF with 27 cases (5.3 %) and
UA with 6 cases (3.4 %). Also, in 51 cases (29 %) the RBs were reported in
combinations of two or more beliefs. As the content of these beliefs is concerned,
this was reported in only 31 cases (9.1 %), with the predominance of achievement,
14 cases (45.1 %), followed by comfort, 10 cases (32 %), affiliation, 6 cases
(19.3 %) and fairness, 1 case (3.2 %).
The New Adaptive Consequences (Fs)
Emotions Emotions post-disputation were reported in only 159 of cases (46.7 %).
The most frequent were: concern, 71 cases (44.6 %), followed by sadness, 53 cases
(33.3 %), annoyance 15 cases (9.4 %) and positive emotions, 6 cases (3.7 %). Also,
in 14 cases (8.8 %) there was reported more than one functional negative emotion.
Adaptive Behaviors Adaptive behaviors following disputation were reported in
185 cases (54.4 %). In 181 of cases (97.8 %) they were externalized behaviors,
while 1 case (0.5 %) was of internalized behavior. Also, in 175 cases (94.5 %) the
orientation of the behavior was reported, with 67 cases (38.2 %) when behavior was
oriented toward self, and in 108 cases (61.8 %) toward others.
CBT Mechanisms Involved in Personal Development 207
123
Inferential Analyses
We further analyzed the associations between the categories where sufficient cases
were available. Thus, we were not able to further analyse the cognition categories
based on Beck’s model due to their low frequency and high number of sub-
categories.
Processes of Cognitions 9Emotions
From a total of 513 cases, in 323 cases (63 %) there were at least one IBs process
and one dysfunctional emotion mentioned. In Table 1we present the contingency of
cognitions and emotions.
The analysis using the Chi square procedure, proves that there is a statistically
significant association between the IBs processes and dysfunctional emotions, v
2
(6,
N=323) =24.35, p=0.001. Such as, DEM is most frequently associated with
anxiety (52.2 %), followed by anger (42 %) and depression (6.8 %). AWF is most
frequently associated with anxiety (57.3 %), followed by anger (33 %) and
depression (9.7 %). LFT is most frequently associated with anger (60.2 %),
followed by anxiety (35.6 %) and depression (4.2 %). Finally, GE is most
frequently related to anxiety (45.7 %), followed by anger (34.3 %) and depression
(20 %).
Content of Cognitions 9Emotions
A similar analysis was developed for the contingency between content of IBs and
dysfunctional emotions. From 335 cases, in 181 (54 %) were present at least one
IBs content and one emotion. The results from this group of cases are presented in
Table 2.
The analysis proved a statistically significant association between IBs content
and dysfunctional emotions, v
2
(6, N=181) =22.41, p=0.001. More specific, the
comfort content was most frequently associated with anxiety (65.5 %), followed by
anger (31 %) and depression (3.4 %). The affiliation content was most frequently
associated with anxiety (44.4 %), followed by anger (42.5 %) and depression
(12.5 %). The fairness content was most frequently associated with anger (72.5 %),
followed by anxiety (19.6 %) and depression (7.8 %). Finally, the achievement
content was most frequently associated with anxiety (53.2 %), followed by anger
(40.4 %) and depression (6.4 %).
Content of Cognitions 9Type of Maladaptive Behaviors
In the contingency of IBs content and maladaptive behaviors, we found a total of
109 cases where there was at least one content and one maladaptive behavior
reported. The bivariate distribution is presented in Table 3.
The contingency analysis revealed no significant association between content and
maladaptive behavior, v
2
(3, N=109) =0.49, p=0.921. More specific, even if
208 O. A. David et al.
123
the externalized type of maladaptive behavior is predominant, there is no significant
variation from one content to another.
Content of Cognitions 9Orientation of Maladaptive Behaviors
A similar analysis was performed on the contingency between IB contents and the
orientation of the maladaptive behaviors. The results are presented in Table 3.
The statistical analysis performed on the bivariate distribution of contents and
orientation of maladaptive behavior proved a statistically significant relationship,
v
2
(3, N=121) =13.94, p=0.003. More specific, the maladaptive behavior
oriented towards self was predominantly for the comfort (76.2 %) and achievement
contents (60 %), while the maladaptive behavior oriented towards others was
predominantly for the affiliation (67.6 %) and fairness contents (64.5 %).
Content of Cognitions 9Type of Disputation
A total of 195 cases of at least one type of content and one type of disputation were
identified. In Table 4there is the bivariate distribution of all pairs.
Statistical analyses failed to show any significant association between the content
and the type of disputation, v
2
(6, N=195) =0.77, p=0.992.
Processes of Cognition 9Type of Disputation
The type of disputation was also analyzed related to the type of IB processes. For
this analysis, 368 cases were identified, where at least one IB process and one type
of disputation were reported. The bivariate distribution is presented in Table 5.
Table 1 The contingency of cognition processes and emotions
IB/emotion Depression Anxiety Anger Total
DEM 6 46 36 88
AWF 8 47 27 82
LFT 5 42 71 118
GE 7 16 12 35
Total 26 151 146 323
Table 2 The contingency of contents and emotions
IBs content/emotion Depression Anxiety Anger Total
Comfort 1 19 9 29
Affiliation 7 24 23 54
Fairness 4 10 37 51
Achievement 3 25 19 47
Total 15 78 88 181
CBT Mechanisms Involved in Personal Development 209
123
The statistical analysis proved there is no significant association between the
content and the type of disputation, v
2
(6, N=195) =6.50, p=0.369.
Discussion and Conclusions
In this study we aimed to explore the content of personal development component of
a one semester university based course in CBT, based on the Ellis’s ABC(DE)
model. We found that trainees’ filled most of the forms about distressing events (As)
experienced at work, which were presenting current external events (as opposed to
reacting to own emotions/thoughts or past/future events). In terms of content, most
frequently they felt distress over performance related situations, while in the life
area they referred to child related distress. This result might be due to the fact that
the group was composed mainly by young working population and the course focus
on applying CBT to work settings.
Table 3 The contingency of contents and type of maladaptive behaviors
Content/maladaptive
behavior
Externalized Internalized Total Self Others Total
Comfort 16 4 20 16 5 21
Affiliation 27 4 31 11 23 34
Fairness 24 5 29 11 20 31
Achievement 24 5 29 21 14 35
Total 91 18 109 59 62 121
Table 4 The contingency of contents and type of disputation
Content/disputation Logical Empirical Pragmatic Total
Comfort 4 21 25 50
Affiliation 4 16 19 39
Fairness 4 22 21 47
Achievement 5 28 26 59
Total 17 87 91 195
Table 5 The contingency of IB process and type of disputation
Content/disputation Logical Empirical Pragmatic Total
DEM 9 46 56 111
AWF 6 49 39 94
LFT 12 49 61 122
GE 4 23 14 41
Total 31 167 170 368
210 O. A. David et al.
123
In terms of dysfunctional consequences recorded (Cs), most frequently they
reported feeling anger, shortly followed by anxiety. Depression was reported less
frequently, which might be due to the fact that is less socially desirable in this
young, highly functional and competitive population. Externalized maladaptive
behaviors reported were oriented both towards others and self, with similar
frequencies. The same pattern of both externalized and internalized maladaptive
behaviors associated with dysfunctional emotions was found in other studies
(Harrington 2005).
In less than 1/4th of the cases participants identified thinking errors as responsible
for their Cs, while in about 3/4th of the cases they identified irrational beliefs (Bs).
When participants identified thinking errors, these were most frequent labeling
arbitrary inferences, overgeneralization, and less frequently personalization. Of the
IB processes, the most frequently recorded was LFT, followed closely by DEM, and
then AWF and GE. When they reported more than one process, the most frequent
combination was DEM with LFT and AWF with LFT. In terms of the IBs contents,
most frequently IBs recorded were about achievement, followed by affiliation, and
fairness. Again, these findings might be explained by the fact that participants are
healthy working population, competitive, following their career aspirations though
the course. The correspondence between the most frequent emotion being anger and
the most frequent process LFT in the achievement area are in line with other
findings (David et al. 2002).
We found the DEM process to be most frequently recorded for anxiety, followed
by anger. The AWF cognition was most frequently recorded about anxiety, followed
by anger. The LFT was most frequently recorded about anger, while the GE (be it
about self, others or life) has a more equal distribution, being associated more
closely to anxiety, anger and depression. In terms of the IB contents, comfort IBs
were most frequently recorded for anxiety (followed by anger), the affiliation IBs
for anxiety and anger (depression having the higher frequency for affiliation),
fairness IBs was most frequently reported for anger, and achievement IBs for
anxiety, followed by anger. Thus, our results are confirming and nicely extending
different previous findings (Bernard 1998; David et al. 2002) concerning the
relevant processes for dysfunctional negative emotions.
In terms of the IBs contents and maladaptive behavior, no significant variation
was found between content of cognitions, for externalized versus internalized
behaviors. This is in line with a myriad of studies investigating the maladaptive
behaviors of IBs, which have reported both internalizing and externalizing
maladaptive behaviors. However, significant differences in frequencies were
observed for behavior orientation and IBs contents, with maladaptive behavior
oriented towards self being predominantly for the comfort and achievement contents
of IBs, while the maladaptive behavior oriented towards others was predominantly
for the affiliation and fairness contents of IBs.
An adequate disputation (D) of the IBs was used in over 60 % of the cases, with
pragmatic disputation being indeed the most frequent, as expected (DiGiuseppe
et al. 2014) followed closely by the empirical disputation. When trainees chose to
use more disputation types, the empirical and pragmatic disputation types were used
most often together.
CBT Mechanisms Involved in Personal Development 211
123
Almost all of the trainees using disputation were also able to identify correct new
effective beliefs (Es). Surprisingly, BAD was the most frequent of the RB processes,
followed closely by HFT, most of the times maintaining the predominance of
achievement, followed by comfort and affiliation contents. This is an interesting
finding since the frequency of IB and new RB processes at Es do not completely
correspond. Some of the trainees, whom initially reported DEM beliefs, chose to
formulate their RB in the derivative form after the disputing. This could suggest that
they did have also AWF, supporting the idea that DEM is indeed a central cognition,
as proposed by Ellis (David et al. 2002).
We could not find significant associations in the IB processes or contents and the
type of disputation employed by the trainees. More specifically, this result means
that different IB processes or contents were not disputed with significantly different
strategies and that we cannot talk about preferred disputation strategies depending
on the type of IBs identified.
Our results show that only about half of participants were able to replace their
initial Cs with new adaptive consequences (Fs) for their Es; however, half of them
were able to identify both emotions and behaviors. Most frequently they recorded
feeling concern, followed by sadness, and only in about 1/10th of the cases their
emotion was annoyance. Surprisingly, while anger was most frequently reported at
Cs, at Fs most of the participants are recording feeling concern. This is another
unexpected result, since most of the adaptive behaviors recorded were externalized,
oriented closely towards others and self, maintaining the same line from the Cs. It
might be that anxiety is also a less socially desirable emotion and thus it was less
reported although participants experienced it. Or it could be that the binary model of
distress was not fully understood due to the short training/time pressure, which
would be supported by the fact that few of them reported feeling a positive emotion
at the end and other did not report Fs. Another explanation lies in the fact that
emotions can be mixed, and although trainees chose to change a specific one, they
managed to change also another. The fact that about 1/10 of them reported more
than one functional negative emotion would support this.
A limitation of the present study is the fact that since the course was mostly
focused on applying the cognitive-behavioral interventions in the workplace not
only in their life, this could have influenced the type of situations participants
selected to include in their ABC forms. An important strength however is that our
sample is not composed of psychology students but rather heterogeneous sample in
terms of professional backgrounds. Since we investigated also the efficacy of the
course in another study (in preparation) we found that participants registered
significant lower levels of IBs and depression, respectively improved work
performance after the course. We also found that participants who received better
composite scores for the quality of their assignments (the ABC forms) reported
higher improvements in their work performance after the course.
While CBT has been shown to be effective for diverse psychiatric conditions,
less data is available in the literature in terms of the theory of change, and this is the
case especially in healthy population. Our findings bring important insights both
concerning the CBT/REBT/CT theory and in documenting the personal develop-
ment component of the training in cognitive-behavioral interventions.
212 O. A. David et al.
123
Acknowledgments This work was supported by a grant for young researchers awarded to Oana A.
David from the Babes-Bolyai University, project number GTC34060. The work of Silviu A. Matu and
Diana Nagy was supported by the Sectoral Operational Programme for Human Resources Development
2007–2013, cofinanced by the European Social Fund, under the project number POSDRU/107/1.5/S/
76841 with the title ‘‘Modern Doctoral Studies: Internationalization and Interdisciplinarity’’.
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While initially used in the sports field, coaching is currently considered a domain at the intersection of various disciplines (e.g., andragogy, psychology, behavioral sciences, consulting), which is defined by different theories (e.g., adult learning theories, counseling, psychotherapeutic approaches, and positive psychology). Coaching is primarily conceptualized as an adult learning strategy, using focused conversations between a coach and coachee, where the coach acts as a catalyst for the coachee’s learning process in relation to their goal/issue. Change processes are facilitated by the coach through the use of effective questioning – derived from counseling - meant to assist the coachee in order to formulate realistic goals, overcome obstacles and implement effective steps in reaching their goals.
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Keywords: Ethnographic research, dementia care, partnership, Patient-centered care is becoming one of the primary targets in treating people with dementia. The current study aims to explore some of the advantages of conducting ethnographic observational research to investigate staff behaviors in clinical settings treating patients with dementia. Furthermore, one of the significant motors of quality of care for dementia is a successful partnership in multidisciplinary teams and teamwork. However, to create policy paper to regulate group skills and behaviors, standard interviews and quantitative research might not help in discovering target manners, attitudes, and skills especially if there are strict regulations that penalize professional negligence. The same applies for capturing personal accounts on behaviors by using standard interviews. In this case, the actor of targeted actions and skills might not like to disclose personal errors for fear of retaliation. Hence, ethnographic research by a participant observer might be the only viable option in capturing teamwork and organizational behaviors in dementia care. The writer works in dementia wards in a clinical role, therefore, by regular participation into wards and clinical activities he was able to outline the required policies and principles regarding behaviors in patient-centered care.
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Coaching continues to grow both as a professional occupation as well as a domain using a group of techniques for supporting people to achieve specific goals in various areas of their lives (life, leadership, work performance, career, health, parenting, sports). It is considered a personalized and systematic learning process dealing with non-clinical problems and challenges, which has gained much knowledge from psychotherapeutic approaches. The most evidence-based and popular psychotherapeutic approach that has been adapted to coaching is cognitive behavior therapy (CBT) which was adapted into cognitive -behavioral coaching (CBC). In this book, we have positioned Rational Emotive, Cognitive Behavioral Coaching (RE-CBC), based on Albert Ellis’ Rational-Emotive Behavior Therapy (REBT) for the future. We have done this by defining what it is, establishing its scientific respectability as best practice, presenting its robust theory for helping coaches understand their coachees differently from other coaching approaches, illustrating its professional practice as applied to diverse problems and coachees, and how RE-CBC offers a sound theory for both developmental coaching and problem focused coaching.
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Assessment is considered important in RE-CBC not only in the initial phase of coaching but also during the coaching process and at its termination, depending on its function. A comprehensive assessment provides an empirical basis for the case conceptualization and subsequent intervention using specific frameworks. During the coaching process, assessment offers understanding on the progress and potential “stuck points.” Formulation in RE-CBC is considered an essential part of making explicit components relating to the coachee’s view of the self, others and world and their influence on goals and current reactions/performance based on an empirically tested frameworks (e.g., the ABC generic model; Ellis, 1994). The most important criteria for the use the conextual ABC model in the RE-CBC assessment and formulation are related to its evidence-based status (David & Cobeanu, 2016), comprehensiveness (it can explain in a comprehensive manner the change mechanisms relating to coachee’s issues/goals), practical utility, and ease of implementation. As researchers, practitioners, and coaches, it is critical to inform our case formulation and intervention planning through the use of valid and adequate assessment tools.
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Rational Emotive Behaviour Therapy (REBT) encourages the client to focus on their emotional problems in order to understand, challenge and change the irrational beliefs that underpin these problems. REBT can help clients to strengthen conviction in their alternative rational beliefs by acting in ways that are consistent with them and thus encourage a healthier outlook. This accessible and direct guide introduces the reader to REBT while indicating how it is different from other approaches within the broad cognitive behavioural therapy spectrum. Divided into two sections; The Distinctive Theoretical Features of REBT and The Distinctive Practical Features of REBT, this book presents concise, straightforward information in 30 key points derived from the author's own experience in the field. Rational Emotive Behaviour Therapy: Distinctive Features will be invaluable to both experienced clinicians, and those new to the field. It will appeal to psychotherapists and counsellors, together with students and practitioners who are keen to learn how REBT can be differentiated from the other approaches to CBT.
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The present study examined the relationship between irrational beliefs and automatic thoughts in predicting distress (i.e., depressed mood in patients with major depressive disorder). Although both constructs have been hypothesized and found to predict emotional reactions in stressful situations, the relationships between these two types of cognitions in predicting distress has not been sufficiently addressed in empirical studies. Our results show that both irrational beliefs and automatic thoughts are related to distress (i.e., depress ion/depressed mood), and that the effects of irrational beliefs on distress are partially mediated by automatic thoughts.