Chapter 19:Cognitive therapy – Flashcards

The foundation on which cognitive therapy is established can be identified by the statement, *"Men are disturbed not by things but by the views which they take of them."*

Lazarus's and Folkman's concept of personal appraisal of an event by an individual has also contributed to the cognitive therapy approach Cognitive therapy is aimed at modifying distorted cognitions about a situation.

Depression Panic disorder Generalized anxiety disorder Social phobia Obsessive-compulsive disorder Posttraumatic stress disorder Eating disorders Substance use disorders Personality disorders Schizophrenia Couple's problems Bipolar disorder Illness anxiety disorder Somatic symptom disorder *Cant be acute psychotic, or psychosis, first has to be stabilized* Can be neurotic, but not psychotic. Need to be educated! Explain! What is cognitive therapy?.. Whats it for, ?

The goal of cognitive therapy is for clients to learn to identify and alter the dysfunctional beliefs that predispose them to distort experiences. Cognitive therapy is highly structured and short-term, lasting 12 to 16 weeks.

Is based on an ever-evolving formulation of the client and his or her problems in cognitive terms Requires a sound therapeutic alliance Emphasizes collaboration and active participation Is goal oriented and problem focused Initially emphasizes the present Is educative, aims to teach clients to be their own therapist, and emphasizes relapse prevention Aims to be time limited Uses structured therapy sessions Teaches clients to identify, evaluate, and respond to their dysfunctional thoughts and beliefs Uses a variety of techniques to change thinking, mood, and behavior

Automatic thoughts: are thoughts that occur rapidly in response to a situation and without rational analysis; sometimes called cognitive errors Some examples are: Arbitrary inference: individual automatically comes to a conclusion about an incident without supporting facts. Overgeneralization: generalize everything. All female are mean. Dichotomous thinking: Yes or no Selective abstraction: Focus only on negative. Magnification: Exaggerate the negative thinking. Minimization: Minimize the positive. Catastrophic thinking: Thinking worse care scenario. Personalization: Always my fault. *(There are triggers that cause these thoughts.)* Schemas (core beliefs): "Cognitive structures that consist of the individual's fundamental beliefs and assumptions, which develop early in life from personal experiences and identification with significant others. These concepts are reinforced by further learning experiences and, in turn, influence the formation of other beliefs, values, and attitudes." Schemas may be adaptive or maladaptive, general or specific, and positive or negative.

*A. Arbitrary inference* B. Overgeneralization (absolute thinking) C. Dichotomous thinking D. Personalization This client statement indicates the use of arbitrary inference. When arbitrary inference is used, the individual automatically comes to a conclusion about an incident without supporting facts.

A. Arbitrary influence B. Minimization *C. Catastrophic thinking* D. Personalization Catastrophic thinking involves always thinking that the worst will occur without considering the possibility of more likely positive outcomes. By stating "...when my parents find out they are going to disown me. They'll hate me and never forgive me for this," the client is expressing the automatic thought of catastrophic thinking.

Didactic (Educational) Aspects: --->Clients must be prepared to become their own therapist. --->The therapist provides information about cognitive therapy and provides assignments to reinforce learning. --->A full explanation about the correlation between distorted thinking and clients' mental illness is provided.

Recognizing Automatic Thoughts and Schemas --->Socratic questioning ---> Imagery ---> Role play ---> Thought recording (Table 19-2, 19-3) Modifying Automatic Thoughts and Schemas ---> Generating alternatives ---> Examining the evidence ---> Decatastrophizing ---> Reattribution ---> Daily recording of dysfunctional thoughts ---> Cognitive rehearsal

*A. "First you must decide if this negative thought is valid."* b."Let's really look at that thought pattern. What evidence made you come to that conclusion?" c."When you start to have a negative thought, start visualizing a pleasant experience." D. "Let's explore some other possibilities related to this thinking." This nursing statement could be used during the technique of decatastrophizing. Decatastrophizing assists the client to examine the validity of a negative automatic thought. Even if some validity exists, the client is then encouraged to review ways to cope adaptively, moving beyond the current crisis situation.

---->It is believed that cognitions affect behavior and that behavior influences cognitions. ---->The following procedures are directed toward helping the client learn more adaptive behavioral strategies that will in turn have a more positive effect on cognitions. ----> Activity scheduling ---->Graded task assignments ----> Behavioral rehearsal Distraction Relaxation exercises Assertiveness training Role modeling Social skills training Thought-stopping techniques

Cognitive therapy techniques are within the scope of nursing practice. These concepts are often not a part of basic nursing education. It is important for nurses to understand the basic concepts of cognitive therapy as the scope of nursing practice continues to expand.