Beck, Ellis, and the cognitive therapies: how the exam separates them.
Cognitive distortions versus irrational beliefs, collaborative empiricism versus disputation, and Meichenbaum and Glasser at the edges.
By Dr. Andrew Wichterman · September 15, 2026 · 5 min read · Updated October 4, 2026
Cognitive approaches account for a large share of theory items, and the writers know that Beck and Ellis are hard to tell apart. Here is the separation the exam relies on.
Ellis: REBT
Rational emotive behavior therapy. The ABC model: an activating event, a belief about it, and the emotional consequence. Disturbance comes from irrational beliefs, especially rigid demands ("musts" and "shoulds," which Ellis called musturbation) and catastrophizing. The therapist is active, directive and often confrontational, disputing beliefs directly. Unconditional self-acceptance is a goal. Homework and shame-attacking exercises are techniques. Ellis is the origin point; REBT dates to 1955.
Beck: cognitive therapy
Automatic thoughts, cognitive distortions and underlying schemas. Distortions include all-or-nothing thinking, overgeneralization, mental filter, catastrophizing, personalization, mind reading, should statements and labeling. The therapist uses collaborative empiricism and Socratic questioning, treating thoughts as hypotheses to test rather than beliefs to attack. The cognitive triad of depression: negative view of self, world and future. Thought records and behavioral experiments are techniques. Beck developed the Beck Depression Inventory.
A session in each
An REBT session moves through the letters. The counselor identifies the activating event and the emotional and behavioral consequence, then hunts for the belief between them, usually a demand: "I must be approved of by everyone." D is disputation, which is active and can be blunt: where is the evidence that you must? What happens if you are not? E is the effective new belief, a preference rather than a demand: "I would prefer to be liked, and I can stand it when I am not." Homework is designed to test the new belief in the world, including shame-attacking exercises that deliberately risk disapproval.
A Beck session has a structure: a brief mood check, often with a standardized measure; setting an agenda together; reviewing homework; working through one or two agenda items, typically with a thought record that captures the situation, the automatic thought, the emotion, the evidence for and against, and a balanced alternative; designing a behavioral experiment; and assigning new homework, with a summary and feedback from the client at the end. The tone is collaborative and curious. If the stem describes a counselor asking "what is the evidence?" in a Socratic way, it is Beck; if it describes a counselor arguing that a belief is irrational, it is Ellis.
Where the exam puts the third wave
Textbooks describe behavior therapy as the first wave, cognitive therapy as the second and the acceptance and mindfulness-based approaches as the third. The exam tests the third wave at the level of recognition, and the distinguishing feature is the relationship to thought content. Beck and Ellis change what the client thinks. ACT, DBT and mindfulness-based cognitive therapy change the client's relationship to the thought, treating it as a passing event to be observed rather than a claim to be disputed.
Mindfulness-based cognitive therapy, from Segal, Williams and Teasdale, was built for relapse prevention in recurrent depression and combines Kabat-Zinn's mindfulness-based stress reduction with cognitive therapy. DBT adds dialectics, the balance of acceptance and change, with validation as the acceptance strategy and skills training as the change strategy, delivered in individual sessions, a skills group, phone coaching and a consultation team. ACT's six processes, acceptance, defusion, present-moment contact, self-as-context, values and committed action, form what Hayes calls psychological flexibility. An item about a counselor asking a client to notice a thought and let it pass is third wave, not Beck.
Two items, worked
A client says his presentation went badly because two people left early. The counselor asks him how many people stayed, what feedback he received, and whether there are other explanations for why two people left, then asks him to write down a more balanced conclusion. Beck: Socratic questioning of an automatic thought, examining the evidence, generating an alternative. The distortions in play are overgeneralization and a mental filter, and the exam may ask for them by name.
A client says she cannot stand it when her supervisor criticizes her and that it proves she is incompetent. The counselor asks where it is written that she must never be criticized, points out that she has in fact stood it every time, and suggests she deliberately ask the supervisor for critical feedback this week. Ellis: disputing a demand and a low-frustration-tolerance belief, then a shame-attacking homework. If the counselor had instead asked her to notice the thought "I am incompetent" as a thought and return attention to what she values about the work, that would be ACT.
The exam's tell
- If the item says "irrational beliefs," "musts," "ABC" or describes a confrontational therapist, it is Ellis.
- If it says "automatic thoughts," "cognitive distortions," "schemas," "collaborative" or "Socratic," it is Beck.
- If it describes teaching the client to talk to themselves differently, self-instructional training or stress inoculation, it is Meichenbaum.
Neighbors
- Glasser, reality therapy and choice theory: five basic needs (survival, love and belonging, power, freedom, fun), the WDEP system (wants, doing, evaluation, planning), no excuses and no punishment. Behavior is chosen. Often mistaken for cognitive therapy; it is closer to a behavioral, present-focused approach.
- Lazarus, multimodal therapy: the BASIC ID assessment (behavior, affect, sensation, imagery, cognition, interpersonal, drugs and biology). Technical eclecticism.
- Linehan, DBT: dialectics, mindfulness, distress tolerance, emotion regulation, interpersonal effectiveness. Originally for borderline personality disorder.
- Hayes, ACT: acceptance, cognitive defusion, values, committed action; psychological flexibility. Does not try to change thought content.
Practice this. The flashcards and practice tests on this site are sorted by content area, so you can drill this one until it holds.
Ellis disputes beliefs. Beck tests thoughts. Everything else in the family is a variation you can place once those two are fixed.