CBT approaches
Initially a controversial alternative to traditional behavior therapy
Cognitive techniques incompatible with behavioral principles
Behaviorism proposed as radical alternative to mentalistic approaches of the day
Early term: Cognitive-Behavioral Modification
Often a hybrid of cognitive and behaviorism
Some start with behavioral techniques and add cognitive techniques, others start with cognitive interventions (i.e. There is no one way to do CBT)
3 fundamental principles of CBT
- Cognitive activity affects behavior
Strong evidence that mental appraisals of events can affect responses to those events - Cognitive activity may be monitored and altered
Assume we can gain access to mental events - Behavior change may be effected through cognitive change
Recognize that overt contingencies (rewards/punishments) can alter bx, more likely to emphasize other alternatives to bx change
factors in development of CBT
Behavioral perspective is limited as an explanation for bx (i.e. Vicarious learning)
Rejection of alternative perspective – psychoanalysis (Beck, Ellis)
Clinical problems are more extensive than bx. Non-behavioral components of problems were untreated.
Mediational concepts were being studied in experimental psychology (Information-processing model of cognition). Application of mediational models to clinical constructs.
There is something between the stimulus and the responses (organism) S-O-R
Several key and significant theorists/therapists emerged who identified themselves with a cognitive-behavioral orientation
Publication of studies finding CBT as effective as BT at treating certain disorders
commonalities among CBT’s
- Time-limited nature
- Problem-focused nature; designed for a specific problem/disorder
- “Clients are the architects of their own misfortune” and have control over their thoughts and actions
- Psychoeducational component – teaching of therapeutic model, presenting problem, and rationale for interventions
cognitive therapy
Aaron Beck – trained as a psychoanalyst
Initially developed approach with depressives, focused on content of negative thinking as well as cognitive biases and distortions.
Began teaching clients to examine and test their negative ideas.
cognitive theory
Deep cognitive structures (schemas) that process information and interpret experiences
Symptoms (emotions, cognitions, behaviors) develop when pathological schemas are activated by stressful events.
Different disorders have different cognitive content – cognitive specific hypothesis
Changes in thoughts and behavior are expected to lead to changes in emotion
cognitive triad
view of self, view of world/others, view of future. Developed in terms of depression.
schemata
underlying structures that organize a patient’s experience and form the basis for biases and distortions. Represent the core of the cognitive disturbance – “core beliefs”
cognitive errors/distortions
– people engage in different types of thinking errors
Overgeneralization – if it’s true in one situation, it’s true for every situation.
Selective abstraction – the only events that matter are the failures, which is the only measure of myself (catastrophizing).
Dichotomous thinking – everything is either one extreme or another (black and white).
automatic thoughts
– actual words and images that go through one’s mind (may include cognitive distortions)
Are situation-specific
Most superficial level of cognition
Example: reading assignment —- this is hard, I’ll never understand this —- sadness, close the book
Beck – 3 levels of cognitive framework
Core beliefs – most fundamental level of beliefs – global, rigid, and overgeneralized
Intermediate beliefs – attitudes, rules, assumptions – “If I work as hard as I can, I may be able to learn this”. Should statements
Automatic thoughts –
J. Persons – automatic thoughts
- Maladaptive thoughts – appear accurate and realistic, but can promote negative mood, impair behavior, impede productive thinking
“I’m not prepared for the exam. I might fail it.” - Derivative of underlying beliefs (core beliefs, schemas) – close restatements of client’s core beliefs
- Distorted thoughts – unrealistic thinking, illogical reasoning (cognitive distortions)
principles of beck’s cognitive therapy
Requires a sound therapeutic alliance
Emphasizes collaboration and active involvement
Goal-oriented and problem-focused. Identify problems in specific terms and set specific goals
Initial emphasis on the present
Schemas develop naturally as a mechanism to make sense of the world and experience
Schemas lie relatively dormant until primed or activated by a relevant situation
“Silent schemas” and diathesis stress model:
Schemas represent a diathesis or vulnerability toward distress, but only when activated by a relevant stressor.
Once schema activated, the situational information appraised
While appraisals can be positive, most of the focus in CT is on more negative appraisals
These appraisals (automatic thoughts) are often made without conscious effort, they can be brought to awareness and evaluated
Once a schema is activated and automatic thoughts are generated, negative emotions and behaviors are expected
These outcomes have feedback implications
Emotions and behaviors can lead to further negative cognitions
Example – avoidant behaviors can lead to additional negative thoughts about undesirability
Cognitive Conceptualization
What is the patient’s diagnosis?
Current problems? How were they developed?
Thoughts and beliefs assoc with the problems? Reactions?
Etc
Alternative methods to help evaluate AT’s
- Use alternative questions
- Identify cognitive distortions
- Use self disclosure
Types of thinking errors
- All or nothing thinking
- Catastrophizing (fortune telling)
- Disqualifying or discounting the positive
- Emotional reasoning
- Labeling
- Magnification/minimization
- Mental filter (selective abstraction)
- Mind reading
- Over generalization
- Personalization
- Should and must statements (imperatives)
- Tunnel vision
What to do when AT’s are true
- Focus on problem solving
- Investigate invalid conclusions
- Work towards acceptance
