Chapter 10 Cognitive therapy – Flashcards

Early childhood experiences—> Development of schemas, basic beliefs, and conditional beliefs—> Critical incidents—> Activation of schemas, basic beliefs, and conditional beliefs——> Automatic thoughts: Emotions,Behaviors, Physiologic responses.

How patients think about their world and their important beliefs and assumptions about people, events, and the environment constitute cognitive schemas. Early childhood -> Beliefs about self/world • Beliefs grouped into schemas - mental framework • Schemas can be adaptive or maladaptive • Common schemas identified & categorized into 5 groups...

They are inaccurate perceptions of self/world. Its the major focus of therapy.

You see things in black or white categories. Example- A student who says, "Unless I get an A on the exam, I have failed" is engaging in all-or-nothing thinking. Grades of A- and B then become failures and are seen as unsatisfactory.

You see a single negative event as a never ending pattern of defeat. Example: "Because I do poorly in math, I am not a good student." Another example would be the person who thinks because "Alfred and Bertha were angry at me, my friends won't like me, and won't want to have anything to do with me."

You pick out a single negative detail and dwell on it exclusively so that your vision of all reality becomes darkened like the drop of ink that discolors the entire beaker of water.

You reject positive experience by insisting they don't count for some reason or other. In this way you can maintain negative belief that is contradiction by your everyday experiences.

You make a negative interpretation even though there are no definite facts that convincingly support your conclusions. e.g. a Mind Reading and B. The Fortune Teller Error. Example- Boyfriend comes home late and right away thinking he was doing something he shouldn't be.

You exaggerate the importance of things (such as your goof-up or someone else achievement). or you inappropriately shrink things until they appear tiny (your own desirable qualities or the other fellow's imperfections). This is also called the "binocular trick" Example- "I know when I meet the regional manager, I'm going to say something stupid that will jeopardize my job. I know I will say something that will make her not want to consider me for advancement" turns an important meeting into a possible catastrophe.

You assume that your negative emotions necessarily reflect the way things really are: I feel it, therefore it must be true.

-You try to motivate yourself with should's and shouldnt's as if you had to whipped and punished before you could be expected to do anything. Example-I should workout or be skinny because of society.

This is an extreme form of over generalization. Instead of describing your error, you attach a negative label to yourself: " Im a loser." When someone else's behavior rubs on you the wrong way, you attach a negative label to him: "He's a louse." Mislabeling involves describing an even with language that is highly colored and emotionally loaded.

You see yourself as the cause of some negative external event which in fact you were not primarily responsible for. Example- My son got into a car accident so its my fault because if i dint let him go it wouldn't of happened.

Its scientific in such that in which both therapist and client test new assumptions. In this process, the therapist may use listening skills that focus on the client's feelings, somewhat similar to the approach of Carl Rogers, to further understand the client's concerns and to develop the relationship. The client also takes responsibility for progress by completing assigned homework outside of the office. Although the cognitive therapist is open to the feedback, suggestions, and concerns of the client, the process of therapy is specific and goal oriented.

More so than many other theories of therapy, cognitive therapy is structured in its approach. The initial session or sessions deal with assessment of the problem, development of a collaborative relationship. Assess client's current mood and problems since last session. Collaborate to make agenda based on recent events. ◦ Review homework. Client provides feedback about session

guided discovery approach is used to help clients learn about their inaccurate thinking. Other important aspects of the therapeutic process are methods to identify automatic thoughts and the assignment of homework, which is done throughout therapy. A specific form of the Socratic method, the three- question technique consists of a series of three questions designed to help clients revise negative thinking.1. What is the evidence for the belief? • 2. How else can you interpret the situation? 3. If it is true, what are the implications? An important early intervention is to ask the client to discuss and to record negative thoughts. Specifying thoughts using the Dysfunctional Thought Record and bringing them into the next session can be helpful for work in future sessions.

Remove cognitive distortions ◦ Thoughts and Schemas • Goals are specific ◦ E.g. Reduce self-doubt and depressive thoughts • Change thought -> and reduce ↓ maladaptive emotions and behaviors

clients record thoughts outside of session

Another method for obtaining information about cognitions. Having a tone sound at a random interval at home and then recording thoughts is one way to get a sample of cognitive patterns. Clients may then record their thoughts in a tape recorder or notebook. Thought sampling can be useful in getting data that is related to specific situations, such as work and school.

Specific assignments are given to help the client collect data, test cognitive and behavior changes, and work on material developed in previous sessions.

Challenging absolutes. Clients often present their distress through making extreme statements such as "Everyone at work is smarter than I am." Such statements use words like everyone, always, never, no one, and all the time. Example- [Client:] Everyone at work is smarter than me. [Therapist:] Everyone? Every single person at work is smarter than you? [Client:] Well, maybe not. There are a lot of people at work I don't know well at all. But my boss seems smarter; she seems to really know what's going on. [Therapist:] Notice how we went from everyone at work being smarter than you to just your boss. [Client:] I guess it is just my boss. She's had a lot of experience in my field and seems to know just what to do.

Using the technique of reattribution, therapists help clients fairly distribute responsibility for an event. Example- [Client:] If it hadn't been for me, my girlfriend wouldn't have left me. • [Therapist:] Often when there is a problem in a relationship, both people contribute to it. Let's see if it is all your fault, or if Beatrice may also have played a role in this.

Labeling such distortions can be helpful to clients in categorizing automatic thoughts that interfere with their reasoning. For example, a client who believes that her mother always criticizes her might be asked to question whether this is a distortion and whether she is "overgeneralizing" about her mother's behavior.

- Clients may be very afraid of an outcome that is unlikely to happen. A technique that often works with this fear is the "what-if" technique. It is particularly appropriate when clients overreact to a possible outcome.

Sometimes clients describe things as all or nothing or as all black or all white.

Mindfulness-based cognitive therapy is a specific method of group training used with individuals with depression n (usually major depression) to prevent relapse

Behaviors, thoughts and emotions

Thoughts and feelings -> behavior Thus, we should understand thoughts and feelings • Learn to identify maladaptive thought patterns •Cognitive and REBT often considered subsets of CBT.

•Thoughts cause behaviors and feelings . Its Brief and time-limited. Strong therapeutic relationship necessary, but not focus. Collaborative Guided discovery is used. Inductive process of testing hypotheses. Homework is given.

Combines cognitive and behavioral theories. • Includes behavioral components, such as exposure therapy, relaxation training, and in vivo exposure.