Psych 3501 Exam 3: Cognitive Therapy

Philosophical Origins

Stoicism: emphasis on developing self-control as a way to overcome destructive emotions

Goal: to become an unbiased thinker

“Men are disturbed not by things but by the view which they take of them”

Taoism, Buddhism: emphasize that human emotions are based on ideas

Control of intense feelings can be achieved by changing ideas

Phenomenological movement: Heidegger, Kant

We interpret our activities by contextual relations to the world

Alfred Adler: emphasize that it’s important to understand the client from their own conscious experiences to see how they are perceiving the world

We are self-determined by the meaning we give to our experiences

Overall: How we interpret events and experiences will drive our feelings and reactions

Assumptions of cognitive therapy

Cognition represents a synthesis of internal and external stimuli

Appraisal of a situation is evident in cognition

Cognitions constitute a "phenomenal field" which is made up of one's view of self, world, past, and future

Content of cognition affect emotion and behavior

Cognitive theory of depression

Cognitive therapy is developed in the context of depression

Built on four components:

1. The cognitive triad

2. Schemas

3. Automatic negative thoughts

4. Negative attributional style

The cognitive triad

Depressed patients tend to have negative views about the world, oneself, and the future

Self: attributing negative events to own defects

World: viewed as hostile, unfair, prevent me from achieving my goals

Future: current difficulties is going to go on forever; expectation of failure

Schemas

Cognitive shortcuts to make navigation quicker, more efficient

Cognitive structure of stored information and memories that forms basis of core beliefs

Constitute basis for screening, differentiating, coding stimuli experienced in a given situation

Determines experience of and response to a situation

Adaptive for efficient information processing

Problematic if negatively biased, rigid, self-perpetuating

Automatic thoughts

Stream of positive and negative thoughts that runs through our minds independent of direct or conscious effort

Automatic, fast, out of voluntary control

Output of negative schemas

event/situation -> schema -> automatic negative thought

Similar to psychoanalysis: events happening without conscious awareness; but not deeply buried

Cognitive biases/distortions

Magnification and minimization

Emotional reasoning

Overgeneralization

Magical thinking

Disqualifying the positive

All-or-nothing thinking

Magnification and minimization

exaggerating or minimizing the importance of events

E.g., believe that own achievements are unimportant or mistakes are excessively important

Emotional reasoning

the assumption that emotions reflect the way things really are

E.g., I feel like a bad friend, therefore I must be a bad friend

Overgeneralization

making broad interpretations from a single or few events

E.g., I felt awkward during my job interview. I'm always so awkward.

Magical thinking

the belief that thoughts, actions, or emotions influence unrelated situations

E.g., Ig I hadn't hoped something bad would happen to him, he wouldn't have gotten into an accident

Common for anxiety disorders (OCD: If I don't washing my hands 7 times, my dog will die)

Disqualifying the positive

recognizing only the negative aspects of a situation while ignoring the positive

E.g., you might receive many compliments on an evaluation, but focus on the single piece of negative feedback

All-or-nothing thinking

thinking in absolutes such as "always", "never", or "every"

E.g., I never do a good enough job on anything

Negative attributional style

Tendency to explain events in way that perpetuates depression

Internal: myself caused the situation

Stable: something that is permanently true, fixed, unchangeable

Global: spread, far-reaching effects

More adaptive attributions: external, unstable, specific

Goals of cognitive therapy

Reduce symptoms by identifying, evaluating, and changing client’s maladaptive cognitions

3 hypotheses:

1. Access hypothesis: client can become aware of their thoughts with training and motivation

2. Mediation hypothesis: thoughts influence emotion and behavior

3. Change hypothesis: thoughts can be modified to improve function

Step 1: help clients develop more awareness of their thoughts - Thought record

Instruct the client to identify the situation, notice emotions, and then identifying thoughts

The columns are structured under the assumptions that thoughts influence emotions

Step 2: Cognitive restructuring: changing thoughts

Once clients are aware of their thoughts, then try to change their thoughts

Process of generating more balanced and adaptive alternative ways of thinking

Four techniques:

- Downward arrow

- Socratic questioning

- Thought records

- Continuum technique

Downward arrow

Technique to identify core beliefs

Core beliefs: underlying negative, broad beliefs that generate specific thoughts

E.g., I’m worthless

Asking about the meaning of an automatic thought until a core belief is discovered

- If that’s true, so what?

- What’s so bad about…?

- What’s the worst part about…?

- What does that mean about you?

Socratic questioning

Asking questions to help reveal patterns in client’s thinking that are maintaining symptoms

Draw attention to information that they filtered out/ignored

Ask with open, genuine curiosity; not arguing with the client/telling them they are wrong/giving advices

- What is the evidence? What is the evidence on the other side?

- Is there an alternative way of viewing the situation?

- What is the worst that could happen? How could you cope with it if it did happen? What is the best outcome? What is the most realistic outcome?

- What is the effect of believing the automatic thought? What could be the effect of changing your thinking?

- What advice would you give if a friend were in the same situation and had the same automatic thought?

Thought records

Structured way for clients to identify automatic thoughts and generate more balanced alternative thoughts and their effect on emotions

Continuum technique

Help clients recognize extreme thinking and generate a new, more balanced thought or belief

Efficacy of cognitive therapy for depression vs. medication

Antidepressant medication vs. cognitive therapy

Panel A: data from UPenn; Panel B: data from Vanderbilt

Y axis: Hamilton Depression Rating Scale: depression severity

Result: patients who receive antidepressants & cognitive therapy both have significant decreases in depression symptoms pre- to post-treatment, and there is no significant differences

Efficacy of cognitive therapy for depression if combine antidepressant medication and cognitive therapy

Panel A: All three group significantly improved, and there is no significant differences between groups

Panel B: no differences between treatment groups

No benefits from combining antidepressant medication and cognitive therapy

Enduring effects of cognitive therapy for depression

16 weeks of cognitive therapy/antidepressant medication

1 year after treatment termination, followed for another 12 months

Result: those received cognitive therapy previous are less likely to experience depression again over time

Better enduring effects of cognitive therapy compared to antidepressants

Concerns about combined treatment

Blue line: combined cognitive therapy + antidepressant medication

Red line: antidepressant alone

Result: for those who received combined treatment, the gains from the treatment tend to be lost once the medication is drawn

If you add medication to cognitive therapy, it might limit the enduring effects

No additional efficacy, and may reduce enduring effects over time

Criticisms of cognitive therapy

Limited view of emotion

- Emotion as outcome

Ignores interpersonal factors

Insufficient attention to therapist-client relationship

Requires insight, intellectual engagement

Summary