Cognitive Therapy has increased in popularity since the 1980s.
Developed by Aaron Beck and Albert Ellis.
Both were dissatisfied with psychodynamic therapy and behavior therapy.
Strikes a balance between other therapeutic options.
Goal: Logical thinking.
Cognitive therapists believe that the way we think about events determines the way we will respond.
An illogical interpretation of a situation can cause mental health difficulties.
Psychological wellness stems from logical cognitions.
The role of the therapist is to fix faulty thinking.
The Importance of Cognition
Cognitive therapists tend to use terms like thoughts, beliefs, interpretations, and assumptions interchangeably.
Often overlook the importance of thoughts in our day-to-day lives.
We often point to a recent event that made us happy when asked why we're happy.
We tend to view our emotional experiences as a two-step model:
An event happens and that event directly influences our feelings.
Event -> Feeling
Mood is directly influenced.
Cognitive Three-Step Model
Endorse a three-step model:
An event happens, we interpret the event, and the interpretations directly influence our feelings.
Events don’t make us happy or sad—the way we think about the event does.
Event -> Cognition (An interpretation of the events) -> Feeling (Our interpretation influences our mood).
Example of the Three-Step Model
Event: Your boss asks if they can speak to you tomorrow.
Cognition: “I’ve been doing well lately—maybe they’re giving me a promotion!”
Feeling: Happy!
Cognition: “I’ve been struggling recently at work—maybe I’m getting fired.”
Feeling: Anxious!
Revising Cognitions
Therapist ensures that the thoughts of the client about a particular event rationally and logically correspond to the event itself.
If thoughts don’t correspond in a logical way with a particular event, this can cause unnecessary and unpleasant feelings.
E.g., the employee who has an unexpected meeting with a boss.
Revising or restructuring cognitions typically occurs in a three-step process:
Identifying illogical cognitions
Automatic thoughts—take place in an instant without any deliberation.
Challenging illogical cognitions
Replacing illogical cognitions with more logical cognitions
Cognitive Therapy as a Tool
Teaching is used as a therapy tool.
Cognitive therapists provide education about the role cognitions play in emotion.
Homework
Cognitive therapists strongly believe that much of the work of therapy is conducted between sessions.
Brief, structured, focused approach.
Typically fewer than 15 sessions.
Cognitive therapists often set an agenda at the beginning of session.
Cognitive Therapy: Structure
Typical Structure of a Session:
Check on client’s mood or emotional status and solicit brief updates on recent events.
Set and confirm the agenda for the current session.
Establish a link to the previous session, often by reviewing previous homework assignment.
Progress through the body of the current session, proceeding step-by-step through the agenda.
Develop and assign new homework assignment.
Summarize current session; solicit client feedback
Two Traditional Approaches
Two traditional approaches to cognitive therapy:
Rational Emotive Behavior Therapy
Developed by Albert Ellis
Cognitive therapy
Developed by Aaron Beck
Rational Emotive Behavior Therapy
Ellis argued that if we can make our beliefs less irrational, we can live happier lives.
Ellis thought that irrational beliefs are toxic because they function as rigid, dogmatic demands that we apply to ourselves.
We also tend to couple these demands with an overestimation of the consequences of failure.
The ABCDE model:
(A)ctivating Event
(B)elief
Emotional (C)onsequence
(D)ispute
(E)ffective new belief
Often clients are asked to complete ABCDE worksheets between sessions
Ellis’s ABCDE Model Example
A (Activating Event): My significant other broke up with me
B (Belief): “I’m a failure at romantic relationships. I guess I’ll be alone forever.”
C (Consequence - emotional): Depression
D (Dispute): “Just because a person has had unsuccessful relationships doesn’t mean that they won’t find a happy one in the future. Most people go through several break-ups during their lives—it doesn’t mean that they’re all failures. And, aren’t many single individuals happy?”
E (Effective new belief): “I’m understandably upset right now and I’d prefer to find a stable relationship, but I know that I will feel better eventually. I can be happy on my own, but I have a lot of desirable qualities and would make a good romantic partner for someone.”
Aaron Beck
Similar to Ellis in that the goal is to increase the extent to which the client thinks logically.
Argued for a cognitive triad—three particular types of cognitions contribute to our mental health:
Beliefs about the self, the external world, and the future
When all three aspects of the cognitive triad are negative, Beck argued individuals are likely to develop depression.
Clients are often asked to complete a written Dysfunctional Thought Record to help clients organize their thoughts and experiences.
Includes:
Brief description of the event/situation
Automatic thoughts about the event/situation
Emotions (and intensity of emotions)
An adaptive response
Outcome (emotions after the adaptive response has been identified and the extent to which the client still believes the dysfunctional thought)
Common Thought Distortions
Essential step is to discredit illogical automatic thoughts by labeling them.
Beck and colleagues identified a list of common thought distortions.
Examples:
All-or-nothing thinking: irrationally evaluating everything as either wonderful or terrible, with no middle ground or “gray area.”
Catastrophizing: expecting the worst in the future, when realistically, it is 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 responsibility for negative events
More Common Thought Distortions
Overgeneralization: applying lessons learned from negative experiences more broadly than is warranted
Mind reading: presuming to know that others are thinking critically or disapprovingly, when knowing what they think is, in fact, impossible
Labeling thoughts as illogical allows the client to dismiss them and replace them with more adaptive and logical thoughts
Beliefs as Hypotheses
Beck argued that our beliefs are hypotheses
A good way to expose a belief as illogical is to “put it to the test” in real life
Similar to scientists empirically testing their hypotheses in a laboratory
Cognitive therapy often includes “experiments” in the form of homework
Homework assignments need to be carefully designed so that they effectively refute illogical thoughts. If the assignment confirms their illogical beliefs, this approach could backfire.
Cognition and Emotion
Let’s examine a criticism of the traditional cognitive therapy approach…
Sometimes arguing with negative thoughts gives them power.
Trying not to think negative thoughts (i.e., thought suppression) also tends to backfire
Exercise: For the next few minutes, write down whatever comes to mind, but whatever you do, try not to think about a polar bear
Thought Suppression
Individuals have a very difficult time suppressing their thoughts—when they try to do so, they often end up thinking about the topic even more
So what can we do to address this?
Several things…
Pick an absorbing distractor and focus on that instead
Try to postpone the thought
Mindfulness—involves changing the individual’s relationship to their thoughts rather than trying to change the thoughts themselves
Recent Applications: Mindfulness-Based Therapies
In recent years, third-wave cognitive therapies (e.g., mindfulness) have become increasingly popular
Many of us have the tendency to go on “auto-pilot”
E.g., While driving
Mindfulness is an important component of more recent treatments
Difficult to define “refers to being able to pay attention in the present moment to whatever arises internally or externally, without becoming entangled or ‘hooked’ by judging or wishing things were otherwise” (Roemer & Orsillo, 2009, p. 2)
“Mindfulness means paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally” (Kabat-Zinn)
“The short definition of mindfulness… is (1) awareness, (2) of present experience, (3) with acceptance” (Germer, 2005, p. 7)
Derives from Buddhist traditions, but typically used without explicit religious ties
Mindfulness Aim
Aim is to change a person’s relationship to their thoughts rather than change the thoughts themselves
Clients can learn to understand their thoughts as fleeting suggestions that may not require much of a reaction at all
Mindfulness and acceptance might be the focus of therapy or used to complement other approaches
It takes practice! Our minds tend to wander
Tend to start with shorter mindfulness exercises (that take a few minutes) to longer mindfulness exercises (~20-45 min)
Mindfulness Exercise Script
Open your Awareness with a Hearing Meditation: a practice for open monitoring (Smalley and Winston, 2010, page 167)
Get comfortable in your meditation posture. Take a few deep breaths to help yourself relax a little bit. Now simply listen to the sounds around you. There may be sounds in the room, outside the room, or even inside your body. Try to listen with openness and curiosity. If you pay attention, you will notice that many sounds come and go, while others seem constant. Can you notice the sounds passing through your awareness? Can you also notice the stillness in between sounds? Try to avoid making up a story about the sounds; just listen to them exactly as they are.
Acceptance and Commitment Therapy (ACT)
Steven Hayes is a leading developer of Acceptance and Commitment Therapy
Many people do not accept their internal psychological experiences (i.e., emotions, thoughts, sensations)—avoiding these experiences can lead to greater psychological difficulties
Acceptance means facing one’s internal fears
One acronym coined by Hayes (ACT) explains the core principles of treatment
Accepting one’s own inner experiences for what they are, and nothing more
E.g., Hayes asks us to imagine our thoughts as a parade in which we are spectators, but not participants.
Choosing directions in life based on one’s core values, which will enhance life’s meaning and purpose
Or commitment to one’s own personal values
Taking action in matters large and small that are consistent with one’s own values
Dialectical Behavior Therapy (DBT)
Developed by Marsha Linehan specifically for the treatment of Borderline Personality Disorder (BPD)
Based on the conceptualization that Borderline Personality Disorder is a problem of emotion regulation
Emotion dysregulation is thought to stem from two sources: biological predisposition and environment
An invalidating interpersonal environment
Individuals with BPD often come from families who communicate that the individual’s characteristic responses to events (particularly his or her emotional responses) are incorrect, inappropriate, pathological, or not to be taken seriously
This teaches the individual that only extreme emotional reactions will elicit a response from others
DBT Focus
Therapist focuses on problem-solving, validation, and dialectics
Problem-solving
The therapist helps the client “think through” stressful situations that might evoke an extreme emotional response
Validation
The therapist works to validate the client’s emotions.
Dialectics
Refers to the exchanges between the client and therapist intended to resolve simultaneous, contradictory feelings held by the client
Important skills taught in DBT include:
Emotion regulation
Distress tolerance
Interpersonal effectiveness
Mindfulness skills
How Well Does Cognitive Therapy Work?
Strongly supported by a body of empirical evidence that is enormous and continues to grow
Empirical support for the use of cognitive therapy with many different types of disorders
E.g., Depression, anxiety, bulimia, posttraumatic stress disorder, personality disorders, etc.
Third-wave mindfulness-based cognitive therapies also have strong empirical support