Cognitive Behavior Therapy

Cognitive Behavior Therapies

  • built on behavior therapy

  • built to be studied - works very well if conducted exactly as it was in each study, clinicians doing the exact same things

  • focus shifts from behaviors to client cognition

    • schemas learned in childhood influence the ways that we interpret circumstances

    • negative automatic thoughts arise, often outside of our awareness, and influence our emotions and behaviors

  • “top-down” approaches that begin with present thoughts

    • good CBT includes a subsequent focus on deeper beliefs and associated emotions

  • wide range of approaches

    • we’ll focus on REBT and CT

  • effective in treating a range of issues, including anxiety, depression, substance use disorder, etc.

    • less effective with those with less cognitive capacity

  • criticized for being overly mechanized and directive and ignoring emotion and depth (“gimmicks” or “band-aids”)

Rational Emotive Behavior Therapy (REBT)

  • the guy: Ellis, eccentric

    • musterbation: client says ‘must’ too much → recognize it is not actually a need

    • other extreme thoughts

  • twist on behavior therapy

  • focus on thought above all else

    • thoughts may include judgements, decisions, analysis

  • reciprocal causal relationship among cognition, emotions, and behaviors

    • what does this mean?

  • cognitive states are fundamental components of personality

    • emotions stem from beliefs and interpretations about life situations

View of Human Nature

  • humans are born with the potential for both rationality and irrationality

  • humans are predisposed to skewed thinking and therefore needlessly disturb themselves

    • we learn disturbed thinking/beliefs early in our lives from biology and culture and then repeat these incorrect beliefs as we age

  • we have the potential to change these processes with concerted effort

The REBT Therapeutic Process

  • highly directive and educational

  • therapist is as much as trainer as a counselor

  • clients receive psychoeducation

    • to identify the interplay of their thoughts, feelings, and behaviors

    • to stop absolutistic thinking, blaming, and repeating of false beliefs

    • to identify and disrupt irrational ideas

  • therapists work with clients to upend irrational ideas

Modifying Irrational Ideas Example

  • irrational belief: “I must have love/approval from those significant to me and must avoid disapproval from any source”

  • alternative belief: “love/approval from any particular person is nice but not necessary”

ABC Theory of Personality

  • AKA a twist on the functional assessment of behavior with some potential for action

  • more elaborate system to help modify irrational ideas

  • A-B-C

    • activating event - belief - consequence

      • how is this different from the FAB from behavior therapy?

    • D-E-F

      • disputing intervention - effective philosophy - new feeling

Cognitive Therapy

  • developed by Aaron Beck

    • extrapolated on by Judith Beck

  • initially described to decrease depressive symptoms

    • later reinterpreted for a host of different illnesses, disorders, and issues

  • manualized, highly technical approach

  • seeks to bring about both insight and action

  • three bases that Beck believed caused depression

    • cognitive triad

    • negative self-schemata

    • errors in logic

      • cognitive distortions

Cognitive Triad

  • negative views of self

    • “I am a terrible person.”

  • negative views of the world

    • selective abstraction

    • client interprets life events through a negative filter

    • “the world is a crappy place”

  • negative views of the future

    • “bad things will happen to me”

  • interaction of these three elements leads to a self-reinforcing negative thought pattern

Schemata

  • schemata are interpretations/assumptions used to help make sense of experience

    • can be functional or dysfunctional

  • negative self-schemata specifically are major contributors to depression

    • are equivalent neuroscientifically to stereotypes

    • more common in people prone to depression

Examples of Cognitive Distortions

  • arbitrary inferences: conclusions drawn without supporting evidence

    • eg., catastrophizing

  • selective abstraction: forming conclusions based on an isolated detail of an event while ignoring other information

  • overgeneralization: holding extreme beliefs on the basis of a single incident and applying them inappropriately to dissimilar events or settings

  • filtering

    • magnification & minimization: perceiving a case or situation in a greater or lesser light than it truly deserves

  • jumping to conclusions

  • should-ing

    • all over ourselves

  • catastrophizing

  • splitting

    • black-and-white thinking

    • polarized thinking

  • overgeneralizing

    • labeling & mislabeling

  • fallacies

    • change

    • control

    • fairness

Similarities & Differences

  • REBT

    • therapist is teacher, therapeutic relationship not stressed

    • more directive and confrontational

    • techniques dependent on client personality

    • evidence-based practice

  • CT

    • greater focus on therapeutic relationship

    • client must discover distortions on own

    • techniques dependent on disorder

    • tends to be more “Socratic”

    • evidence-based practice

Cognitive Behavior Therapy

  • focus on the present moment

  • employs a multitude of different techniques to help increase a client’s awareness of their thoughts

    • help them learn the ways their thoughts impact behaviors, emotions, and other thoughts

  • specifically focuses on automatic thoughts, to help clients register how they are negatively evaluating themselves

    • “what words are/were going through your head?”

    • E.g., “I’m going to fail this test because I couldn’t get myself to study hard enough”

Cognitive Model

  • situation →

  • automatic thought(s) →

  • reaction →

  • emotion, behavior, physiological response

Cognitive Behavior Therapy (Cont.)

  • automatic thoughts arise from deeper belief systems, which tend to be distorted in consistent ways

    • e.g., “I didn’t study hard enough because I’m disciplined”

    • then… “I’m undisciplined and I’m helpless to fix it”

    • and finally… “I’m helpless”

  • after clients become aware of their thoughts and their beliefs, they learn to be better prepared for them and to challenge them as they arise

    • for both increasing awareness and challenging thoughts, the ‘right’ techniques to use are the ones that resonate for the client

  • long-term goal to have the client apply the techniques on their own, in novel situations

  • REPETITION - work & practice, work & practice

Therapeutic Techniques

  • psychoeducation

  • collaborative empiricism

  • stress inoculation

  • cognitive modeling

    • modeling self-talk aloud

  • covert conditioning

    • imagined engagement in new, more positive behaviors

  • thought stopping

    • interruption of unwanted thoughts

  • cognitive restructuring

    • replacement of irrational, maladaptive thoughts/schemas with more rational, adaptive

    • highlighting of cognitive distortions

  • homework

Thought Records

  • an exercise used to encourage clients to consider how their responses to particular circumstances reflect internal processes

  • highlights the cognitive elements

  • can be tailored to your client’s unique issues

    • can focus on emotions

    • can highlight cognitive distortions

  • used in session or as homework

    • pertinent to do it with the client first, and then assess buy-in

Effectiveness

  • addiction & substance use disorders

  • smoking cessation

  • positive symptoms of schizophrenia

  • depression

    • in comparison to no-treatment conditions

  • eating disorders

  • bipolar

    • small effect sizes, otherwise good at preventing relapse

  • anxiety disorders

    • sleep dysfunction

    • PTSD

    • specific phobias

  • somatoform disorders

Limitation

  • mechanisms that underlie cognitive processes not yet fully understood

  • highly directive approach

  • often rejected by critical theorists for its implicit espousing of White, male worldviews as adaptive or “right”

  • extensive training for successful implementation

    • therapist must be trained in both cognitive techniques but also behavior and learning theory

    • therapist must be highly disciplined