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COGNITIVE THERAPY

COGNITIVE THERAPY. Slides created by Barbara A. Cubic, Ph.D. Professor Eastern Virginia Medical School To accompany Current Psychotherapies 10. Learning Objectives. This presentation will focus on: Principles of learning and cognitive theory relevant to psychotherapy

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COGNITIVE THERAPY

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  1. COGNITIVE THERAPY Slides created by Barbara A. Cubic, Ph.D.Professor Eastern Virginia Medical School To accompany Current Psychotherapies 10

  2. Learning Objectives • This presentation will focus on: • Principles of learning and cognitive theory relevant to psychotherapy • History of cognitive therapy • Overview of cognitive therapy • Commonly used CT techniques • Creative applications of CT

  3. Basic Concepts of CT

  4. Basic Concepts • Cognitive therapy focuses primarily on how information is processed. • Behavioral techniques and cognitive restructuring techniques are utilized to elicit change.

  5. Cognitive Model • Processing of information is vital for survival. • Survival systems are: • Cognitive • Behavioral • Affective • Motivational • Each system is comprised of structures. • Schemas

  6. Modes • Information is processed through networks of cognitive, affective, motivational, and behavioral schemas. • Primal modes are evolutionary-based, universal, tied to survival (e.g. anxiety) and operational almost continuously in some cases (e.g. personality disorders) while other modes are minor and under conscious control. • Primal modes include primal thinking, which is rigid, absolute, automatic, and biased. • Conscious intentions can override primal thinking.

  7. Cognitive Model Behaviors Situation Automatic ThoughtsEmotions Physiological Response • Automatic thoughts influence not only one’s emotional response, but also one’s behavioral and physiological responses.

  8. Cognitive Model • In other words, the relationship is bi-directional (all systems act together as a mode). • Thoughts influence biological, affective, behavioral (and motivational) processes. • Simultaneously biology, emotions, behavior (and motivation) influence thoughts. • Therefore biological treatments can change thoughts and CBT can change biological processes.

  9. Cognitive Model • We all have cognitive vulnerabilities (i.e. core beliefs) which predispose us to interpret information in a certain way. • These vulnerabilities are developed early. • When these beliefs are rigid, negative, and ingrained we are predisposed to pathology. • Core beliefs give rise to conditional assumptions (i.e. rules for living) as we mature.

  10. Cognitive Model Behaviors Situation Automatic Thoughts Emotions Underlying Physiological Beliefs Response • Automatic thoughts are influenced by these underlying core beliefs and conditional assumptions

  11. Cognitive Model Withdrawal Relationship Breakup He doesn’t want me Depressed I’m worthless SNS Reaction I’m unlovable Poor Sleep

  12. Cognitive Shifts • In various types of psychopathology, there is a systematic bias toward selectively interpreting information in a certain manner.

  13. Characteristics of CT • Practical • Symptom-focused • Empirically-derived techniques • Requires patient collaboration. • Acknowledges underlying precursors of symptoms (schemas), but present-oriented. • Case conceptualization drives treatment.

  14. Roles of the CT Therapist • Conceptualize the patient in cognitive terms. • Structure the sessions. • Use collaborative empiricism and guided discovery to: • Specify problems and set goals. • Teach the patient CT techniques.

  15. CT Strategies • Collaborative empiricism • Guided discovery • Deactivation of dysfunctional modes: • Deactivate them. • Modify their content and structure. • Construct more adaptive modes to neutralize them.

  16. Comparing CT to Other Therapies

  17. Compared with Psychoanalysis • Both assume behavior influenced by beliefs outside awareness. • CT focuses on: • Linkages among symptoms, conscious beliefs and current experiences. • Little concern with unconscious feelings or repressed emotions. • Minimal focus on childhood issues except in terms of assessment or when addressing core beliefs. • CT is highly structured and short-term (12-16 weeks) whereas psychoanalysis is long-term and unstructured. • CT therapist actively collaborates with patient.

  18. CT Compared with REBT

  19. Compared to Behavior Therapy • CT is very different from applied behavioral analysis. • CT is the most commonly practiced form of cognitive behavior therapy (CBT). • CBT: An overarching term to represent therapies that integrate cognitive and behavioral theories and techniques. • CT sees the individual as more active rather than passive in change process. • CT stresses expectations, interpretations and reactions.

  20. History of Cognitive Therapy

  21. Cognitive Therapy • Developed by Aaron T. Beck, M.D. • Investigated “anger turned inward” psychoanalytic concept in 1960s and found evidence for negative cognitions. • Bandura, Ellis, Mahoney, and Meichenbaum were all influential and developing their approaches simultaneously.

  22. History of Cognitive Therapy Major influences were: • Phenomenological approaches • Structural theory and depth psychology • Cognitive psychology

  23. Current Status of CT

  24. Research on the Cognitive Model • Cognitive specificity hypothesis (i.e., distinct cognitive profile for each disorder) supported for many disorders. • Negatively biased interpretations have been found in all forms of depression. • Support for cognitive triad, negatively biased cognitive processing of stimuli and identifiable dysfunctional beliefs in depression. • Danger-related bias demonstrated in anxiety disorders.

  25. Cognitive Therapy and Medication • Studies generally show CT to be equivalent to psychotropic medications for depression, bulimia and some anxiety disorders. • Generally, research suggests the combination of the two approaches is superior to either used in isolation. • CT shows longer efficacy (less relapse) and increased likelihood of continuing gains when treatment is discontinued.

  26. Current Status of CT • Controlled studies shown efficacy of CT with: • Depression • Panic disorder • Social phobia • Generalized anxiety disorder • Substance abuse • Eating disorders • Marital problems • Schizophrenia • OCD • PTSD

  27. CT Assessment Measures • Beck Depression Inventory-II (BDI-II) • Beck Anxiety Inventory • Beck Hopelessness Scale (score of > 9 predictive of eventual suicide) • Beck Scale for Suicidal Ideation • Many others

  28. Resources in CT • Center for Cognitive Therapy (U/Penn) and Beck Institute are the major training sites (both in Philadelphia). • Multiple other training sites in the United States and internationally: • Cognitive Therapy and Research • Journal of Cognitive Psychotherapy • Academy of Cognitive Therapy (www.academyofct.org)

  29. Understanding the Theory Behind CT

  30. Cognitive Case Conceptualization

  31. Personality Dimensions:Styles of Behaving • Sociotropy (social dependence): • Become depressed following disruption of relationship(s). • Organized around closeness, nurturance, and dependence.

  32. Personality Dimensions:Styles of Behaving • Autonomy: • Become depressed after defeat or failure to attain a desired goal. • Organized around independence, goal setting, self-determination, and self-imposed obligations.

  33. Problematic Thinking Problematic thinking is very: • Extreme • Broad • Catastrophic • Negative • Unscientific • Pollyannaish • Idealistic • Demanding • Judgmental • Comfort Seeking • Obsessive • Confusing

  34. Cognitive Distortions • Arbitrary inference:Drawing a conclusion without evidence or in the face of contradictory evidence. • Example: A young woman with anorexia nervosa believes she is fat although she is dying from starvation.

  35. Cognitive Distortions • Selective abstraction:Dwelling on a single negative detail taken out of context. • Example: While on a date, you say one thing you wish you could have said differently and now see the entire evening as a disaster.

  36. Cognitive Distortions • Overgeneralization: A single negative event is viewed as a never-ending pattern of defeat. • Example: Following a job interview, an accountant does not receive the job. He/she begins thinking that they will never find a job position despite their qualifications.

  37. Cognitive Distortions • Magnification and/or minimization:The binocular trick. Things seem bigger or smaller than they are. • Example: An employee believes that a minor mistake will lead to being fired. • Example: An alcoholic believes he/she doesn’t have a problem.

  38. Cognitive Distortions • Personalization: Assuming personal responsibility for something for which you are not responsible. • Often seen in patients who are sexually abused/assaulted.

  39. Cognitive Distortions • Dichotomous thinking: Things are seen as black and white, there is no gray or middle ground. • Things are wonderful or awful, good or bad, perfect or a failure.

  40. Cognitive Distortions • Mind reading: Assuming someone is responding negatively to you without checking it out. • Example: If your husband is in a bad mood, you assume it is your fault and don’t ask what is wrong. • Fortune teller error: Creating a negative self-fulfilling prophecy. • Example: You believe you will fail an exam so you don’t study and fail.

  41. Cognitive Distortions • Emotional reasoning:You assume that your negative feeling results from the fact that things are negative. • Example: If you feel bad, then that means the world or situation is bad. You don’t consider that your feelings are a misrepresentation of the facts.

  42. Cognitive Distortions • Should statements: Use words like should, must, ought rather than “it would be preferred” to guilt self. • Labeling and mislabeling: Name-calling (such as “he’s a jerk”) rather than just criticizing the behavior.

  43. Cognitive Triad of Depression Negative view of

  44. Examples of Cognitive Shifts: Depression vs. Anxiety Negative view of Threatening view of Future Future World World Self Self

  45. Secondary appraisal: “Risk: Resources ratio” Primary appraisal: “Danger” Illustration of the Cognitive Model of Anxiety Reappraisals of danger, risk, resources Stimulus (Environmental Or Internal) Physiological Palpitations,Sweating,Tension, etc. Affect Anxiety, Terror Behavioral inclination (Flight, Freeze, Defend)

  46. Cognitive Profile of Other Psychological Disorders

  47. Cognitive Profile of Other Psychological Disorders

  48. Cognitive Therapy Treatment

  49. Structure of a CBT Session • Mood check • Setting the agenda • Bridging from last session • Today’s agenda items • Homework assignment • Summarizing throughout and at end • Feedback from patient

  50. General Principles of CT • Goal is to correct dysfunctional thinking and help patients modify erroneous assumptions. • Patient is taught to be a scientist who generates and tests hypotheses. • Relationship between patient and therapist is collaborative.

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