Cognitive Therapy Learning Guide

Immanuel Kant and Theoretical Underpinnings

Phenomenological approach to psychology

• Structural theory and depth psychology

Cognitive Psychology

• Kelly (1955) —> Emphasizes role of beliefs in behavior change

• Lazarus (1984) —> Cognitive theories of emotion

Emotions are intertwined in the ways we think. and the way we think about our emotions can drastically affect the way we view the world

Aaron Beck

Observes consistent biases in cognitive processing

• Like a filter that thoughts and perceptions flow through, if your filter has a grey tinge everything will look gray

Develops theory of emotional disorders and cognitive model of depression

Temperament Schemas

The predisposition to how you handle things

Cognitive Schemas

Beliefs about yourself or others or the world which leads to expectations

Clusters of Abilities vs Styles of Respnding

Styles of Responding

• We will each have our own typical way of how we handle things

Clusters of Abilities

Heuristics vs Assumptions

Heuristics

• Set of rules that help us make decisions

Assumptions

• Predictions or statements of fact that are made without any evidence

Psychological Distress: Perceived Threat

Do I think this thing is threatening to me

• Anything that makes us fearful

  • Ex: Criticism

Psychological Distress: Maladaptive Interpretations

When you interpret the experience, you interpret it in a negative or maladaptive way rather than positive adaptively

Systematic Bias in Information Processing

The way in which we take in information from the world around us into ourselves will go through a systematic filter, how the same information is interpretated from one person to another will have different interpretations based on that individuals systematic bias in processing information

• These biases become more solidified over time as they get reinforced

Catastrophizing

The tendency to blow circumstances out of proportions by making problems larger than life

Personalization

The tendency to take blame for absolutely everything that goes wrong in your life

• If you have a tendency to take responsibility for everything, that will be very exhausting

Overgeneralizing

The tendency to make broad generalizations based upon a single event and minimal evidence

Emotional Resoning

The tendency to interpret your experience based upon how your feeling in the moment

• You interpret the situation based on your current emotions, not the facts themselves

• Ex: Students will interpret feedback on a paper as negative and bad because they are upset about their grade even if the feedback is useful for them

Shoulding and Musting

Musterbation, the tendency to make unrealistic and unreasonable demands on yourself or others

Magnification and Minimization

The tendency to magnify the positive attributes of another, while minimizing your own

Cognitive Triad of Depression

Self

• Low self esteem, lack of effort, low self regard

Future

World

• Pessimistic, behave self destructively, irritability, small tasks of daily living seem impossible

Three Components of Anxiety

1. Exaggerated perception of danger

2. Difficulty recognizing cues of safety

3. Minimize ability to cope

Anxiety in OCD

Obsessions

• Uncertainty of safety

Compulsions

• Sense of responsibility to take action

Theory of Personality: Core Beliefs

Foundation of maladaptive schemas

• Bottom of pyramid

Theory of Personality: Underlying Assumptions

Give rise to automatic thoughts, shapes perception, provided interpretation and meaning

• If you have a negative core belief, if someone walks past you without saying hi, you would assume they don’t like you and ignore you on purpose, if you have a positive core belief, you would assume that they just didn’t see you and it was an accident

Theory of Personality: Automatic Thoughts

Spontaneous and triggered by circumstances

• Stimulus —> automatic thought —> emotion and behavior

The automatic thought could be the assumption, usually it reflects the assumption

• Ex: Assuming they hate you is the assumption —> thought is “omg they hate me”

Theory of Personality: Voluntary Thoughts

Top of pyramid

• Most accessible and stable thoughts

Goal of Cognitive Therapy

1. Correct faulty information processing

2. Not simply substitution of positive beliefs for negative ones

3. Treat thoughts as testable hypothesis

Therapeutic Relationship in Cognitive Therapy

Collaborative

• Therapist as a guide and catalyst for change BUT the change has to come from the client themselves

• Therapist can provide the tools but they can NOT do the work for you

Warmth, empathy, genuineness, curiosity

Emphasizes patient responsibility (

Collaborative Empiricism

We take a stance of “we are all scientists, lets collect data”

• refers to NOT making assumptions based on little to no evidence but rather being methodical in how we draw conclusions

Alternative Explanations

• Ex: What are other reasons for why they may have ignored you, what evidence do we have

Socratic Dialogue

Asking Questions

Guided Discovery

A collaborative conversation where the therapist uses a series of open-ended, Socratic questions to help a client actively explore their own thoughts, feelings, and beliefs

Where Change Occurs in Cognitive Therapy

The real work comes in modifying the core beliefs but you must stop from the top and work your way down the pyramid

Structure of Treatment: Initial Phase

Assessment and Contract

• Get an understanding of what their background is, a diagnosis gets a sense of what the maladaptive ways of thinking are

Skills Education

• Using Socratic dialogue, it is important to educate patients on why you are doing what your doing

Structure of Treatment: Middle/Late and Ending treatment Phases

Middle and Later Sessions

• Identify themes in automatic thoughts

• Challenge core beliefs

Ending Treatment

• Relapse Prevention

  • Recognition that there might be times in the future that may cause a relapse

Different Parts of the Sessions (in order)

1. Set the Agenda

   1. Therapist comes in with agenda of their own, with skills and information they want to teach (collaborative)

2. Review Previous Material

3. Review Homework

   1. Homework is a priority and crucial, if they don’t go over the homework it signs that it isn’t important

4. Cover New Material

5. Summarize and Assign Homework

6. Elicit Feedback

Three Components of Psychoeducation

Thoughts, behaviors and feelings are all interconnected

Self Monitoring

First skill and homework that will be taught and assigned to client

We need someone to begin to recognize and observe the patterns in thoughts during daily life so we can look for these themes (underlying assumptions + core beliefs)

Decastrophizing

The process of trying to turn back the dial on catastrophic thoughts

• Take that “what if” scenario all the way to the end, catastrophizing lives in that vague

• Get specific with everything (how likely it is, should I be worried)

Reattribution

Ask people to consider alternative causes, dealing with thoughts that are negative and people aim those thoughts towards something else

Redefining

Redefining the problem is concrete terns, and in things that are within the patients control

• Ex: Train doesn’t run, the problem isnt that the train isnt running, problem is you have to find another way home

Decentering

Challenging the idea that people are always upset at or watching us

• Usually they arent

People walk around constantly feeling judged even if there is no judgment taking place

Incorporating Behavioral Techniques

Through Homework, hypothesis testing, exposure therapy, behavioral rehearsal or role play, activity scheduling

Mechanisms of Cognitive Therapy

Modification of dysfunctional core beliefs and assumptions lead to effective change

• This will lead to a change in emotion and behavior

Core beliefs must be accessible to be modified

• Therapy allows patients to experience emotion and reality testing simultaneously

Large vs Medium effects of Cognitive Therapy

Large Effects For

• Depression, GAD, panic disorder, social phobia

• Works with children for depression and anxiety

Medium Effects

• Marital Distress, anger, chronic pain, childhood somatic disorders

Cultural Considerations

Develop flexibility and reconcile beliefs with environmental constraints