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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
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
J Rat-Emo Cognitive-Behav Ther (2014) 32:198–215
DOI 10.1007/s10942-014-0189-0
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
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
CBT Mechanisms Involved in Personal Development 199
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.
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
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
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.
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
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.
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
psychological constructs in the personal development of trainees in cognitive-
behavioral interventions.
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.
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.
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.
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
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.
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
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-
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
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
(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
(3, N=109) =0.49, p=0.921. More specific, even if
208 O. A. David et al.
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,
(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
(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
The statistical analysis proved there is no significant association between the
content and the type of disputation, v
(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
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.
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
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.
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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CBT Mechanisms Involved in Personal Development 215
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... Consequently, the (C) can be an activating agent (A) that generates secondary beliefs or metabeliefs (B) which in turn underpin secondary consequences or meta-consequences (C) (David et al., 2014;Sánchez et al., 2019). ...
... After documenting the ABC framework, the fundamental aim of REBT is restructuring the irrational belief with the dispute(D) to generate new effect or efficient(E) alternative rational beliefs which then reduces the negative emotions such as fear, anger, anxiety, and depression in turn generating to facilitate (F) functional consequences (David et al., 2014;Turner, Slater, & Barker, 2014). The methods commonly applied during the disputation of beliefs are pragmatic (unhelpful or helpful), empirical (false or true), and logical (unhelpful or helpful). ...
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... Though Albert Ellis formulated the ABC model for Rational Emotive Behavior Therapy yet ABC model and its basic premise can be used in various other forms of psychotherapeutic interventions [15][16][17]. In the ABC model, (A) is activating events (or adversity) which individuals face, (B) stands for beliefs individuals have about the events, and (C) stands for emotional, behavioral, and cognitive consequences generated by belief about the adversity [17][18][19]. The (C) (e.g. ...
... The (C) (e.g. fear) can further act as an activating agent (A) that generates meta-beliefs or secondary beliefs (B) which in turn underpin meta-consequences or secondary consequences (C) [17,18]. ...
... However, it is essential to understand cognition. The description and inference of the situation by individuals are cold cognitions which act as adversity(A) [18]. Whereas the hot cognitions are the evaluation of the situation and represent either irrational or rational beliefs(B) [18]. ...
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... Additionally, the CBT Children's booklet includes a pictured ABC model with an example. The ABC model aids the therapist to propose an alternative perspective to the client regarding the origin of their disorder (David, Matu, Pintea, Cotet, & Nagy, 2014). Moreover, as employed in Bekirogullari and Olkanli (2019), the ABC model can be used by therapists to illustrate the relationship between the incident, thoughts and emotions. ...
... Psycho-education was also administered to the parents to facilitate the behavior modification methods required to teach the client the consequences of his behavior, to eliminate his dysfunctional behavior at home. On top of that, the pictured ABC model was believed to trigger in the client alternative thoughts and functional reactions to anger (David et al., 2014). ...
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... Aspects captured by ethnographic observations of psychiatric nurses and mental health practitioners are conduct, behaviours, skills, and actions that conform to local regulations. The classical ABC model states that when people are engaged in some events (A), they mature a series of beliefs about these events (B), which regulate their psychological and behavioural response to them (C) 10,11 . The ABC observation is vital in confirming that behavioural skills are appropriately applied to psychiatric wards by nurses and doctors, such as observation levels, interviews, and assessments 9 . ...
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Introduction: Despite numerous techniques for assessing mental health nursing abilities and accomplishments, most practice in psychiatric wards is based on observable clinical behaviours and actions. VOSviewer can perform bibliographic network analysis (BNA), extracting all central topics that identify core behavioural skills in mental health nursing and essential elements in interprofessional practice (IPP). Aim: The current study captures the critical concepts in mental health nursing assessment by performing a BNA of essential topics on ethnography, social network analysis, and interprofessional care. Methods: A qualitative BNA with a VOSviewer extracted relevant topics from a total of 542 articles obtained from Microsoft API. A subsequent confirmatory quantitative analysis with NVIVO weighed the percentages of the relevant issues and words extracted by the VOSviewer. Boolean keywords searched were 'ethnography,' 'social network analysis,' 'interprofessional', 'psychiatry' and 'hospital'. Results: Major themes identified in ethnography, IPP, and social network analysis for nursing assessment were those of 'communication' (11.63%), 'whole' (9.29%), 'knowledge' (7.66%), 'person' (7.52%), 'activity' (6.31%) and 'collaboration' (6.10%). Discussion: The current study has proven the value of BNA in extracting relevant topics in target literature. VOSviewer captured salient issues in mental health nursing assessment, including ethnographic observations, social network analysis, and IPP. The results confirmed the value of focusing on collaborative care, reciprocity, knowledge management, and information sharing in assessing mental health nursing performances.
... To provide support to trainees, stress management workshops were developed and conducted using a cognitive behavior therapy (CBT) approach. This approach has been used in trainees for self-improvement (10) and is an effective intervention for various kinds of psychological trauma (11). Group CBT has also been shown to be effective in this area (12). ...
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Background: Healthcare professionals have experienced a wide range of psychological problems during the COVID-19 pandemic. Frontline workers and trainees are particularly vulnerable to such effects. This study aimed to share the experience of Cognitive Restructuring workshops for COVID-19 induced Stress in Post-graduate Trainees, highlighting their stress levels and effect of cognitive behavior therapy intervention in processing and managing stress. Methods: Workshops based on a Cognitive Behavior Therapy model were introduced to trainees at the Aga Khan University Hospital to self-assess stress and identify coping mechanisms. We collected data from the stress scale and workshop responses along with a focus group discussion. We performed item analysis of the stress scale and a documentary analysis of participant responses to assess the effectiveness of this intervention. Results: The majority of the participants had moderate stress. A statistically significant relationship was observed between stress level and perceived helplessness (p value 0.002). The feedback of the workshop was largely positive based on sharing of adverse experiences, developing a different perspective and a newer way of processing feelings; about 10% of the participants did not find this workshop useful. In the focus group discussion, the participants described stress scale to be helpful for stress quantification, ABC tool to be useful with repeated practice and reframing technique to reduce stress over time. Conclusion: The COVID-19 pandemic has caused stress in healthcare workers and impacted professional and personal lives. Interventions like group cognitive behavior therapy can be useful in recognizing and managing stress in trainees and can be incorporated in training programs to build resilience for similar events.
... These findings are consistent with previous studies indicating that primary irrational cognitive process contributed to anxiety symptoms, and anxious affect via evaluative irrational cognitive process, AWF (Turner et al., 2019) and LFT (Buschmann et al., 2017), and provide additional empirical evidence for REBT theory that DEM beliefs represents primary irrational cognitive process, while AWF, LFT and GES represent secondary irrational cognitive process in the development of psychological distress. This finding is also in line with prior research findings indicating that LFT (Chang & D'Zurilla, 1996) and AWF (David et al., 2014;David et al., 2002;Deffenbacher et al., 1986) are a predictor of higher anxiety. ...
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As soon as they are admitted to a university, most students become responsible for their own finances, but because of a lack of parental supervision, they are more inclined to spend than to manage their money. A study of first-year undergraduate accounting students was conducted to examine the effects of rational emotive behavior therapy-based coaching (REBT-based coaching) intervention on their financial literacy and money attitudes. Thirty first-year undergraduates studying accounting at Nigerian public universities participated in this two-group randomized trial. About 15 first-year undergraduate accounting students participated in the online REBT-based coaching group, while 15 first-year undergraduate accounting students participated in the face-to-face control group. A repeated measures analysis of variance was performed on the study data at .05 probability level. The study found that the online REBT-based coaching intervention significantly improved the financial literacy and money attitudes of first-year undergraduate accounting students in a similar way to face-to-face REBT-based coaching intervention. The follow-up results for the online REBT-based coaching intervention 1 month later showed a similar trend of increasing students’ financial literacy and money attitude scores similar to what was observed in the face-to-face coaching group. There was no significant difference between students in the online and face-to-face modes regarding satisfaction with REBT-based coaching interventions they received. As a result of the findings, the researchers propose developing coaching approaches that can help students gain insight into their financial actions and knowledge, which will likely improve financial literacy and money attitudes in the future.
This online third edition of A Practitioner's Guide to Rational-Emotive Behavior Therapy reviews the philosophy, theory, and clinical practice of Rational Emotive Behavior Therapy (REBT). This model is based on the work of Albert Ellis, who had an enormous influence on the field of psychotherapy over his 50 years of practice and scholarly writing. Designed for both therapists-in-training and seasoned professionals, this practical treatment guide introduces the basic principles of rational-emotive behavior therapy, explains general therapeutic strategies, and offers many illustrative dialogues between therapist and patient. It breaks down each stage of therapy to present the exact procedures and skills therapists need, and numerous case studies illustrate how to use these skills. It describes both technical and specific strategic interventions, and stresses taking an integrative approach. The importance of building a therapeutic alliance and the use of cognitive, emotive, evocative, imaginal, and behavioral interventions serves as the unifying theme of the approach. Intervention models are presented for the treatment of anxiety, depression, trauma, anger, personality disorders, and addictions.
In this book leading scholars, researchers, and practitioners of rational emotive behavior therapy (REBT) and other cognitive-behavioral therapies (CBTs) share their perspectives and empirical findings on the nature of rational and irrational beliefs, the role of beliefs as mediators of functional and dysfunctional emotions and behaviors, and clinical approaches to modifying irrational beliefs, enhancing rational beliefs, and adaptive coping in the face of stressful life events. Offering a cohesive approach to understanding REBT/CBT and its central constructs of rational and irrational beliefs, contributors review a steadily accumulating empirical literature indicating that irrational beliefs are associated with a wide range of problems in living and that exposure to rational self-statements can decrease anxiety and other psychological symptoms, and play a valuable role in health promotion and disease prevention. Contributors also identify new frontiers of research and theory, including the link between irrational beliefs and other cognitive processes such as memory, psychophysiological responses, and evolutionary and cultural determinants of rational and irrational beliefs.
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.