Cognitive Psychotherapy and Mindfulness-Based Therapies

Cognitive Therapy Prevails

• Among todays clinical psychologists, cognitive therapy prevails

• More contemporary psychology’s endorse cognitive therapy as their primary orientation than any other single -school approach

Why is cognitive therapy so popular?

• strikes a balance among other therapies (behavioral, psychodynamic)

• Represents a reaction to both behavioral and psychodynamic approaches

• Strict applications of behavior therapy didn’t always work — behavioral therapists began to recognize that cognitions plays an important role

Goal of Cognitive Therapy

The goal is logical thinking

• the way we think about events determine the way we respond

• Psychological problems arise from illogical cognitions

• Psychological wellness stems from logical cognitions

• Cognitive therapists fix faulty thinking

Cognitions

Thoughts, beliefs, interpretations, judgements, evaluations, assumptions, etc

Two-step model

Things happen and those things directly influence out feelings

• model is flawed according to cognitive therapists

Three-step model

Things happen, we interpret those things, and those interpretations directly influence our feelings

• events don’t make us happy or sad, the way we think about those events does

Revising Cognitions

• Goal: to ensure the thoughts rationally correspond to the event itself

• Steps

  1. Identifying illogical thoughts

  2. Challenging illogical thought

  3. Revising illogical thoughts

Automatic thoughts

Cognitions that atleast place instantly and without deliberation

• goal of cognitive therapists is to assist the fluent in identifying these cognitions

Teaching as a therapy tool

Cognitive therapists explicitly educate clients about the cognitive approach

• might use a combination of mini lecture, handouts, and readings used to describe the cognitive model

  • The relationship between feelings, thoughts, and behaviors and the difference between the two-step and three-step models

Homework

Cognitive therapists strongly believe that much of the work of therapy is conducted between sessions

• can be written or behavioral and is always discussed in the following session

Brief, Structured, Focused Approach

• cognitive therapists strive to reach a positive out come quickly — typically in fewer than 15 sessions

• Outpatient therapy is typically once per week and tapers off as client improves

• Focuses on clients current problems; purposeful and deal oriented focus on clearly identifiable symptoms; structured

Humanistic vs Cognitive Approaches

Cognitive is brief, structured, and goal oriented, and humanistic is free flowing and spontaneous

Aaron Beck and Albert Ellis

• 2 pioneers of cognitive therapy who influenced each other but evolved independently for the most part

• Both emphasize improving clients’ symptoms via correcting illogical thinking

• Differ in terminology and sometimes technique

Albert Ellis

• initially called his approach Rational Emotive Therapy (RET) but altered the name to Rational Emotive Behavior Therapy (REBT)

• REBT emphasizes a connection between rationality and emotion and argues that we cal live happier lives if we can make our beliefs less irrational

ABCBE Model

• one of Ellis’ most enduring and clinically useful contributions

• Frames the essential aspects of cognitive therapy into an accessible acronym — enabling use by thousands of therapists and clients

ABCDE Model - parts

• A (activating event), B (Belief), C (Emotional Consequence) — represents the three step model

• Ellis - irrational beliefs are toxic and we tend to couple these demands with overestimations of consequence of failure; this is flawed logic

• D (Dispute) - irrational belief of the target of the dispute

• E (Effective New Belief)

Aaron Beck

• always used the term cognitive therapy to describe his technique

  • Originally developed to conceptualize and treat depression but has been broadly applied shortly after its inception

• Judy Beck has spearheaded its application to many new problems

Cognitive Triad

Beck argues that three particular cognitions contribute to our mental health and when these beliefs are neatuve the produce depression

• thoughts about

  1. The self

  2. The external world

  3. The future

Essence of Beck’s Approach

• To increase the extent to which the client thinks logically

• Like Ellis, incorporates a way of organizing experiences into columns on a written page (ABCDE approach) — Dysfunctional Thought Record

Dysfunctional Thought Record

Columns include

• brief description of the event/situation

• Automatic thoughts about the event/situation and the extent to which the client believes them

• Emotions

• An adaptive response — identifying the distortion in the automatic thought and challenging it

• Outcome — emotions after identifying the adaptive response and the extent to which the client still believes the automatic thoughts

All or nothing thinking

Irrationally evaluating everything as wither wonderful or terrible with no middle ground/grey area

Catastrophsiing

Expecting the worst in the future when realistically its unlikely to occur

Magnification/minimization

For negative events “making a mountain out of a molehill”; for positive events, playing down their importance

Personalization

Assuming excessive personal responsibility for negative events

Over generalization

Applying lessons learned from negative experiences more broadly than is warranted

Mental filtering

Ignoring positive events while focusing exclusively on negative events

Mind reading

Presuming to know that others are thinking critically or disapprovingly, when what they think is in fact, impossible

Common Thought Distortions

• essential step in cognitive therapy is to discredit illogical automatic thoughts by labeling them

• The illogical thoughts grow weaker when clients label them as thighs distortions — allowing client to dismiss them and replace them with more logical thoughts

  • This ultimately decreases the clients distress