4 Components of Cognitive Behavior Therapy

Learn about the four components of cognitive behavior therapy from anger management expert Dr. J. Ryan Fuller in this Howcast video.


I am Ryan Fuller, I am a clinical psychologist and I practice with clients in New York City. There are basically four components that are critical in doing a cognitive behavioral therapy approach to anger. The first is a cognitive intervention. And this is where we help socialize clients to the idea that there are beliefs, there are thinking in fact influences how they feel and what they end up doing. And so we typically teach them an ABC model, where they begin to recognize triggers as the A, the activating event, beliefs as the B, and this is their thinking about what has occurred, thinking about the terrible wrong the other person has committed and possibly even thinking about what it says about him or herself. And there is the C, the emotional consequence. And then there is a behavioral consequence. And so the emotional consequence is face of anger is obviously anger. But then what a person decides to do, the behavioral consequence, could be they can be very very aggressive. It could be that they can be passive and withdraw or they could assertively communicate about what has happened and actively problem solve. And that´s going to lead into the second component. So, the first component is the cognitive one.

The second one is teaching very clear skills. Problem solving skills and assertive communication. Problem solving is very basic. Most of us in fact have learned it in work settings or in school settings and there are sometimes four-step or five-step models. The first is, I´ve got a problem. And we normalize at first and say "this isn´t that strange. It’s not that out of the ordinary. There’re other people that have experienced this.” And we kind of orient myself.” Okay, this is workable." Second is "I want to clearly define the problem." Third, "I´m going to brainstorm". And this is where no solution or no idea is a bad idea and I’ll list everything imaginable. Finally, I´m going to evaluate which idea I think is the best and set up a time. And this is the one most of us don´t do. Set up a time to revisit how that solution is working for us. And if it´s not working well, we want then to go back and try one of these other solutions. So even though problem solving seems very elementary and basic, I think it´s something that we actually fail to do frequently in our personal lives. Maybe we do very sophisticated modes of this at work. But in our personal life, we’ve problems all the time that we actually are not actively addressing in a methodical way like this. For anger management, problem solving alone in fact has been shown to be very very effective and I´ve seen that with my clients.

Assertive communication is the other skill we want to make sure people develop. So, assertiveness sets distinctly different from being aggressive where I intend harm and when I´m passive and I don´t do anything. Assertive communication has two pieces. The first piece is that I in fact actively communicate to the person what I am feeling or wanting, what my preferences are, something along those lines. The second piece is that after making a request for what I want very concretely, I also prepare myself to accept the fact that the person might say "yes" and say that they are going to carry out my request but they might not. Or they might say "no." The second piece of assertiveness is the one we typically ignore. So assertiveness is communicating what I´m thinking and feeling and what I want very specifically in forms of request and then accepting what comes back. So we have cognitive intervention, problem solving, assertiveness.

And finally relaxation. Because anger management involves anger, which is a high arousal emotion, sympathetic nervous system is very, very, very active. Our heart rate is up. Our blood pressure is up. Pupils are dilated. We want to make sure that people experiencing anger management issues learn very well how to control their nervous system. And so we frequently teach them different forms of relaxation. Breath work is something that I´ve used in studies that I´ve done where they pace the respiration. Basically they slow r down their breathing and they make sure that they exhale longer than they inhale. And there are some very specific ways to go about that. You can certainly find them on various websites. The other is progressive muscle relaxation. This is where we teach clients to first contract muscles very, very tightly and then release them. And over time, they begin to discriminate between what tension feels like and then relaxation. We give them a cue word and by cueing it again and again and again, eventually they can begin to get a relaxation response without having to actively tense the muscles. So we basically have four components in anger management. We have cognitive interventions, we have problem solving, we have assertive communication and finally, relaxation skills.

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