Cognitive Therapy Central Constructs – Flashcards
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The cognitive model is the foundation of CT, and it proposes that our emotions and behavior are the product of our perceptions of situations. From PP (The cognitive model of development): As we develop, we think about our world and ourselves in different ways. Our beliefs and assumptions about people, events, and ourselves are cognitive schemas. We have automatic thoughts that are derived from these beliefs that they are not aware of. How individuals shift from adaptive beliefs to distorted beliefs is referred to as cognitive shifts in Beck's system.
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EXPLAIN THE COGNITIVE MODEL
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It means both the process and content of thinking, or how you think and what you think.
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WHAT DOES COGNITION MEAN IN CT'S COGNITIVE MODEL?
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1. AUTOMATIC 2. CONSCIOUS 3. METACOGNITIVE
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WHAT ARE THE 3 LEVELS OF COGNITIVE PROCESSING SEEN IN HUMANS?
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Consists of thoughts and other cognitive organizations that are based in survival processes (modes) that are largely out of awareness.
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AUTOMATIC LEVEL OF COGNITIVE PROCESSING
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What we normally think of as thinking
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CONSCIOUS LEVEL OF COGNITIVE PROCESSING
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refers to our ability to think about our thought processes
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METACOGNITIVE LEVEL OF PROCESSING
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Cognitive structures that organize the barrage of info with which we w=are constantly confronted. They help us create meaning out of what otherwise would be a bewildering array of stimuli, both internal and external.
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SCHEMAS
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They are theoretically critical elements that can only be indirectly observed.
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Explain how Beck compares schemas to electrons
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"Schemas are relatively enduring internal structures of stored generic or prototypical features of stimuli, ideas, or experience that are used to organize new info in a meaningful way, thereby determining how phenomena are perceived and conceptualized."
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FORMAL DEFINITION OF SCHEMAS BY CLARK AND BECK
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When you simply think of the word "librarian," you almost instantly come up with a set of images or words associated with the term. You expect a person who is a librarian to display certain qualities--your "librarian schema is activated and is influencing how you respond to info.
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EXPLAIN HOW SCHEMAS CAN BE DORMANT OR ACTIVE
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They influence the selection, encoding, and retrieval of info in the cognitive system.
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EXPLAIN THE INFLUENCE OF SCHEMAS IN THE COGNITIVE SYSTEM
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general knowledge, core beliefs, and emotional elements relevant to a particular domain of experience. If your librarian schema is activated, you are likely to observe features of someone that are consistent with you librarian schema, and you may have great difficulty recalling features that are inconsistent with the schema. You might also feel some emotion stemming from your past experience with librarians.
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WHAT DO SCHEMAS CONTAIN?
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they are broader, have more elements, and apply to more situations (aka are more complex)
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WHY ARE SOME SCHEMAS MORE EASILY ACTIVATED?
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Important components of schema, Judith Beck distinguished between two kinds of cognitions that are important in CT: 1. core beliefs 2. assumptions, roles and attitudes (OR INTERMEDIATE BELIEFS!).
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BELIEFS (two types of cognitions)
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The most basic, ingrained beliefs that we hold, and are thought to be the hardest to modify. They tend to be overgeneralized and absolute, and are usually self referent.
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CORE BELIEFS
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Assumptions, rules and attitudes that are situated between core beliefs and automatic thoughts. These beliefs include should and must beliefs as well as conditional beliefs that are influential in creating meaning from experience. These are more under the surface but influence the direction our automatic thoughts go in.
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INTERMEDIATE BELIEFS
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"If I don't get an A in my Theories of Counseling course, then I am dumb."
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GIVE AN EXAMPLE OF AN ASSUMPTION
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These coping strategies are largely automatic and can be clearly distinguished from other forms of problem solving or coping responses. For example, and individual could hold the core belief : I am a failure" which is connected to the rule "I must get all As." A coping strategy would be, "I will achieve perfection in all of my coursework so that I get As."
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DISCUSS THE RULES OR COPING STRATEGIES USED BY INDIVIDUALS IN REACTION TO OTHER BELIEFS THAT ARE INCLUDED IN INTERMEDIATE BELIEFS
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The most specific form of schema dealing with physical objects or very distinct, simple ideas, such as dogs, books, computers, etc.
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SIMPLE SCHEMA
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A normal feature of our cognitive process--swift, evaluative statements or images that exist alongside our more conscious thoughts. They are the result of our core and intermediate beliefs, occurring in shorthand rather than in full sentence form and often seem to just pop up out of nowhere. Depending on their content these thoughts can be functional or distressing, but in either case, they tend to be reasonable to the thinker. Usually, we are not particularly aware of these thoughts, but more likely to be aware of the emotion associated with them. They are thought to be easier to change than intermediate or core beliefs
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AUTOMATIC THOUGHTS
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Distorted, accurate (but with a distorted conclusion), and accurate but dysfunctional.
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WHAT ARE THE 3 GENERAL TYPES OF AUTOMATIC THOUGHTS?
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thoughts that are contrary to available objective evidence: "I never do anything right!" MOST ATs ARE THIS TYPE.
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DISTORTED THOUGHTS
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I UPSET MY BOYFRIEND. NOW HE'LL NEVER LOVE ME AGAIN!
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ACCURATE THOUGHT/DISTORTED CONCLUSION
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This kind of thought either contributes to a reluctance to approach a task or increases anxiety so that focus and concentration are disrupted. "It's going to take a long time to finish this book!" This thought is true, but it may decrease my motivation to write, or it may distract me from my current writing activity because it definitely increases my anxiety.
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ACCURATE BUT DYSFUNCTIONAL
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Networks of cognitive, affective, motivational, and behavioral schemas that compose personality and interpret ongoing situations.
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MODES
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It is largely automatic and global, that is, schema-driven, particularly in the primal modes described later. Like schemas, modes are either active or dorman; when activated, modes tend to dominate behavior in a rather automatic way.
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DESCRIBE MODAL INFORMATION PROCESSING
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It can override modal processing. This system is responsible for metacognition and intentional behavior, such as that based on personal goals and values. Logical reasoning and long term planning are also products of the conscious control system.
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The CONSCIOUS CONTROL SYSTEM
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Primal, constructive, and minor
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WHAT ARE THE 3 MAJOR MODE CATEGORIES?
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The most basic kinds of operation, and function to meet the evolutionary goals of survival: procreation and sociability. Because they are so basic to survival, they operate rapidly and automatically. Thinking in the primal modes is distorted and rigid. Four types are: Threat, Loss, Victim, and self-enhancement
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PRIMAL MODES (4)
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Developed primarily through life experience and serve to increase the life resources available to the individual. They are associated with positive emotions and adaptive characteristics and include: a.) the capacity for intimacy, b.)personal mastery, c.) creativity, and d.) independence
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CONSTRUCTIVE MODES
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The third category of thinking and tend to be under more conscious control than the other modes. They tend to be narrowly focused on situations and include everyday activities such as reading, writing, social interaction, and athletic or recreational activities.
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MINOR MODES
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As the product of learning and genetics: certain personality tendencies (ex: sensitivity to rejection) can be genetic in origin. As kids, we strive to make sense of our environments, and we organize info into schemata. Based on the amounts of positive and negative experiences we have, we develop corresponding views of ouselves and the world. A kid who is praised a lot will develop a positive set of schemata about himself, and the world, and will therefore be less likely to develop faulty cognitive processes.
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THEORY OF THE PERSON AND DEVELOPMENT OF THE INDIVIDUAL: HOW DO CT THEORISTS CONCEPTUALIZE HUMAN FUNCTIONING?
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MODAL THEORY replaces the construct of schemas with that of protoschemas, which are innate patterns that interact with experience to develop the modes.
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THEORY OF THE PERSON AND DEVELOPMENT OF THE INDIVIDUAL: WHAT ARE PROTOSCHEMAS?
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Individuals who are high in sociotrophy find their self worth in relations with others. Autonomous individuals emphasize mastery and independence and build self-esteem through achievement and control.
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EXPLAIN AUTONOMY AND SOCIOTROPY
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Under normal circumstances we operate via simple schematic processing and with our conscious control system. Occasionally (or often if you are dysfunctional), info is present that matches an orienting schema that is linked to a primal mode. When a match is made, the primal mode is activated--the affective, behavioral, and physiological systems or schemas are energized and primary modal processing is seen. The way things play out depends on whether the primary mode activated is one of the constructive modes or one of the defensive or protective modes.
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DISCUSS ORIENTING SCHEMA
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Information processing that allows the individual to meet his/her goals of survival, reproduction, and sociability. People don't rely on primary modes (automatic, distorted, rigid thinking). The constructive modes of processing are more in evidence, and the healthy person probably has fairly good problem solving skills.
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WHAT CONSTITUTES HEALTHY FUNCTIONING?
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Psychological distress is ultimately caused by many innate, biological, developmental and environmental factors interacting with one another,and so there is no single cause of psychopathology. Cognitive distortions lay at the heart of dysfunction, though. The cognitivist assumes that the individual's primary problem has to do with his construction of reality. The remedy lies in modifying the cognitive set.
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WHAT CONSTITUTES DYSFUNCTION?
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cognitive problems that are characteristic of depressed individuals
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WHAT ARE COGNITIVE DISTORTIONS?
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The depressive's negative view of the self, the world, and the future.
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WHAT IS THE COGNITIVE TRIAD?
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faulty schemas and their associated core beliefs.
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WHAT IS DISTORTED THINKING THE RESULT OF?
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These cognitive structures develop very early in life as a result of interactions with the surrounding environment, most notably those with significant others. After the schema is created, it can be activated by environmental or internal events, and information processing becomes selective--info that is consistent with the schema is admitted into awareness, whereas inconsistent info is distorted or rejected. In this way the maladaptive schema is maintained. These schemas are resistant to change, connected to significant emotional responses, and if examined by the client, perceived as absolute truths.
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WHAT ARE EARLY MALADAPTIVE SCHEMAS AND HOW ARE THEY MAINTAINED?
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A person would be totally convinced that he can't do anything right and that others hate him. Beck identifies 3 broad categories of negative core self-beliefs that would be seen in a rotten person schema: helplessness, unlovability, and worthlessness.
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ROTTEN PERSON SCHEMA EXAMPLE
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Specific ways of thinking and perceiving that are characteristic of various psychological dysfunctions. In anxiety disorders, for example, the individual is hypervigilant, focused on signs of danger or threat--automatic thoughts of threat and harm come easily and often for them. Other examples of dysfunction-specific beliefs are seen in drug-abusing clients who harbor "need" beliefs such as, "I can't stand the boredom without my drug."
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WHAT IS THE COGNITIVE SPECIFICITY PRINCIPLE?
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Overactive primal modes. We are all born with the protoschemas for primal modes. Through experience, the primal modes are constructed and endowed with energy, or charged. A series of experiences relevant to a specific mode will result in the mode being fully activated and operative. "A particular mode is generally silent or latent at first, but through successive relevant experiences can receive incremental charges until it reaches the threshold for full activation. In some psychopathological conditions, recurrent depression for example, the mode is chronically but subliminally charged so that it can become fully activated after a comparatively minor stressful event.
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WHERE DOES THE REVISION OF CT PROPOSED BY BECK LOCATE THE SOURCE OF PSYCHOLOGICAL DYSFUNCTION?
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According to Beck, the various categories of psychological dysfuntion, as classified inthe DSM-IV, can be understood in terms of the specific primal mode involved and the characteristic "goal" of the mode. For example, in depression, the cognitive feature of loss threatens the orgnnism's livelihood, and the behavioral inactivation so common to depression represents a means of preserving the organism.
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MODES AND DIAGNOSTIC CATEGORIES
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congnitive therapists view the development of Axis II disorders as the result of an interaction between individuals' genetic predispositions toward certian personality traits and their early experiences.
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CT ON PERSONALITY DISORDERS
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Both formal and informal assessment is used in CT. The ultimate goal of the assessment is a structured cognitive case conceptualization.
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NATURE OF THERAPY: ASSESSMENT
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1. To fully understand the psychological picture of the client 2. to determine if any organic syndrome is involved 3. to assess the need for medication or hospitalization
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FOR WHAT 3 REASONS IS A FORMAL COMPREHENSIVE DIAGNOSTIC EVALUATION ENCOURAGED?
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Using standardized self-report inventories such as the Beck Depression Inventory, Beck Anxiety Inventory, Automatic Thought Questionnaire, or the dysfunctional attitude scale, which mesures schema related corebeliefs and assumptions. The latest of these tools seems to be the Beck Cognitive Insight Scale.
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WHAT DOES FORMAL ASSESSMENT IN CT INVOLVE?
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Thoughts--duh. The simplest way to make this assessment is to simply ask, "what was going through your mind?"
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WHAT ARE CT COUNSELORS MOST INTERESTED IN ASSESSING?
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A formal treatment plan. After assessment, in the first session of CT, the client is asked to establish specific and concrete goals.
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WHAT DOES COGNITIVE ASSESSMENT LEAD TO?
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CT is structured, active, collaborative, and psychoeducational, and is characterized by a collaborative relationship between client and counselor. Cognitive therapists emphasize armth, genuineness, trust, and respect, like person centered, but also are open to modifications based on the client.
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THERAPUTIC ATMOSPHERE
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CT relationship is seen as different from other counseling relationships because it emphasizes this scientific approach. Client and counselor are co-investigators in the scientific study of the client's difficulties. The client's schemas, beliefs, and automatic thoughts are treated as hypotheses to be tested by the two scientists. Evidence is gathered and experients are designed and conducted to test the hypotheses.
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WHAT IS COLLABORATIVE EMPIRICISM?
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In terms of interpersonal support, the client is not to become passive in the relationship. Support in CT means support of the efforts of the client to learn and implement the CT model in his life. The therapist makes genuine efforts to understand the client and accepts the client in the sense that all client cognitions, feelings, and behaviors are openly examined for their advantages and disadvantages However, the cognitive therapist does not accept certain client actions and goals when they are considered antisocial.
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WHAT DOES "RESPONSIBLE DEPENDENCY" MEAN IN THE THERAPEUTIC ATMOSPHERE?
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it simply helps the client apply problem solving techniques that he has used in the past ot correct the current faulty thought processes. CT is typically a short term intervention, ranging from 10 to 20 sessions.
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WHAT DID BECK MEAN BY CT BEING A "COMMON SENSE THERAPY?"
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Counselor is an expert who teaches the client about cognitive theory--resembles doctor patient relationship. The client is a student who becomes an expert on how CT applies to him. Cog therapists ask their clients a lot of questions and are very likely to assign tasks related to the clients' identified problems. Client starts out as student working hard to learn the CT ways and do the homework. The client is simultaneously a collaborator in the counseling process, whose direct input is always solicited. As therapy progresses, client is expected to take more and more responsibility for what occurs in sessions.
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ROLES OF CLIENT AND COUNSELOR
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To identify and change faulty info processing and to modify beliefs that support psychological dysfunction to ones that are more adaptive. Through addressing automatic thoughts, basic beliefs or schemas are sometimes accessed, but significant change in these deeper structures may require longer term therapy than is typical in CT. A broader goal of CT is to teach clients problem solving strategies. The idea is to get the individual to operate based on REFLECTIVE, CONSTRUCTIVE PROCESSES THROUGH THE USE OF THE CONSCIOUS CONTROL SYSTEM, OR METACOGNITION, RATHER THAN PRIMITIVE SCHEMAS. The dysfunctional modes need to be deactivated, and more adaptive modes built. MODIFYING THE CONTENT OF THE MODES IS YET ANOTHER WAY TO ACHIEVE MORE ADAPTIVE BEHAVIOR, WHICH IS ACHIEVED THROUGH ADDRESSING CORE BELIEFS AND SCHEMAS.
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GOALS OF TC
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Moves through 3 general stages: 1. Behavioral activation in early sessions 2. specific automatic thoughts and their relationship to emotion and behavior 3. complex level of schematic processing--some clients never get here
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PROCESS OF THERAPY
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1. ESTABLISHING THE WORKING RELATIONSHIP 2. GOAL SETTING 3. SOCIALIZING THE CLIENT it is also beneficial to provide some initial quick symptom relief
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WHAT ARE THE 3 CRITICAL GOALS OF THE FIRST SESSION?
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Directly teaching the cognitive model. each session is partitioned into 7 segments: 1. brief update, 2. bridge from the previous session, 3. setting the agenda, 4. review of homework, 5. discussion of the issues, 6. devising new homework, and 6. summary and feedback
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WHAT DOES SOCIALIZATION INVOLVE?
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the process of CT where the therapist has an idea (based on her cognitive conceptualization) about where she wants the client to end up, and through her questioning helps the client to get there. "The goal here is for the patient to discover the answers she needs, guided by the therapist. ULTIMATELY THE AIM OF THE COGNITIVE THERAPIST IS TO HELP THE CLIENT BECOME HIS OWN COUNSELOR
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WHAT IS GUIDED DISCOVERY?
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CT Therapists recognize the existence of transference. The goal in CT is to keep these reactins to a minimum through the use of COLLABORATIVE EMPIRICISM. if client transference appears, it is treated lide any other hypothesis--client and therapist explore the cognitive process around it and the evidence that supports or refutes it. The cognitive construct of schema activation is similar to the psychodynamic construct of transference in that there are times when the client behaves in ways similar to tose he employs outside of therapy. In this case the therapist hould not elaborate or deepen things, but just facilitate awareness and change.
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TRANSFERENCE IN CT
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Problems in collaboration, client and therapist dysfunctional beliefs match, poor socialization of the client (he isn't on the CT train), mistiming of interventions, and unclear/unrealistic therapy goals.
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WHAT IS CLIENT RESISTANCE DUE TO?
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Any Flexible eclectic techniques that attack dysfunctional thought can be used if client and counselor agree to its use. Both cognitive and behavioral (used in the interest of behavioral activation) techniques are used. COGNITIVE RESTRUCTURING: ANYTHING THAT CHANGES CLIENT COGNITIVE STRUCTURES--TO MODIFY OR ELIMINATE SCHEMAS, CORE BELIEFS, AND AUTOMATIC THOUGHTS.
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THERAPEUTIC TECHNIQUES
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1. The methods are consistent with cognitive therapy principles and are ligically related to the theory of therapeutic change. 2. the choice of techniques is based on a comprehensive case conceptualization that takes into account the patient's characteristics (introspective capacity ex). 3. Collaborative empiricism and guided discovery are employed 4. the standard interview structure is followed.
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WHAT ARE THE CT CRITERIA FOR TECHNIQUES?
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ANYTHING THAT CHANGES CLIENT COGNITIVE STRUCTURE
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WHAT IS THE FORMAL DEFINITION OF COGNITIVE RESTRUCTURING?
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Considered essential in CT, and many of the techniques can be transformed into homework assignments.
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HOMEWORK
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1. Deactivate them 2. modify their content and structure 3. construct more adaptive modes to neutralize them
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3 WAYS TO DEAL WITH DYSFUNCTIONAL MODES (I.E. MODIFY OR ELIMINATE SCHEMAS, CORE BELIEFS, AND AUTOMATIC THOUGHTS)
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One of the most basic interventions in CT is to ask the client, "What was going through your mind right now?" when the counselor notices a change in the client's affective state. The idea is that emotions are good indicators of the presence of automatic thoughts.
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THERAPEUTIC TECHNIQUE OF QUESTIONING
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Refers to the strategy of asking leading questions so that the client comes to the cognitive therapy conclusion. A favorite question of cog therapist is, "Where is the evidence for this thought/belief?" IT IS THE COUNSELORS JOB TO DEVISE QUESTIONS THAT HELP CLIENTS ALTER THEIR CURRENT VIEWS TO "A STATE OF INQUISITIVENESS AND CURIOSITY."
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SOCRATIC QUESTIONING (BOLD TERM)
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1. What is the evidence? 2. Is there an alternative explanation? 3. What is the worst that could happen, and could i live through it? What is the best that could happen? What is the most realistic outcome? 4. What's the effect of my believing the automatic thought? What could be the effect of changing my thinking? 5. What should I do about it? 6. What would I tell a friend if he or she was in the same situation?
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WHAT ARE THE 6 TYPES OF QUESTIONS CONSIDERED EFFECTIVE IN HELPING CLIENTS TEST AUTOMATIC THOUGHTS?
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Technique used to identify core beliefs. It is so-named because the therapist starts by examining thoughts realatively close to the "surface" and proceeds downward to core beliefs. First, a key automatic thought is identified that the counselor thinks is related to a core belief. The counselor then asks the client what this thought means, assuming it is true. Repeating this question for each client response will eventually lead to the core belief. Judith Beck noted that asking the client what the thought means to the client often leads to an intermediate belief, whereas asking what the thought means about the client leads to a core belief.
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WHAT IS THE DOWNWARD ARROW?
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A commonly used instrument is the Dysfunctional Thoughts Record, which the counselor asks the client to take home and record various occurrences of ATs between counseling sessions. Counselor and client review the DTR at next session.
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TECHNIQUE OF THOUGHT RECORDING
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These experiments are assignments that are tailored to a specific belief. The therapist and client design a task or activity that challenges a faulty cognition.
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TECHNIQUE OF BEHAVIORAL EXPERIMENTS
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AKA "mastery and pleasure therapy, and involves the client and therapist making structured and planned activities on a daily schedule of sorts. Client can simply keep a record, or rate the activities for pleasure and mastery.
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TECHNIQUE OF ACTIVITY SCHEDULING
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When a client faces what seems to be an overwhelming task, the counselor and client can work to make it less intimidating by breaking it down into smaller steps. Concrete steps are formulated to reach the agreed upon goal, and the client then works on the steps one at a time. First steps should be really easy so as to build confidence in their ability to achieve.
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TECHNIQUE OF GRADED TASK ASSIGNMENT
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Teaching clients skills that support their rights without violating the rights of others. Role play is often involved.
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TECHNIQUE OF ASSERTIVENESS TRAINING
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Identifying and clarifying the problem, generating alternatives, evaluating the alternatives, implementing and alternative, and then assessing the utility of the new approach--this approach is often used to evaluate dysfunctional beliefs.
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PROBLEM SOLVING
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When a client is having difficulty identifying automatic thoughts, the counselor can resort to using imagery or role playing to vividly conjure up the problem situation. These activities are likely to evoke the emotions associated with the problematic situations, so they should help the client identify cognitions associated with the feelings. THE TURN OFF TECHNIQUE can be used to help clients learn that they can control images. In this technique, the therapist and client think up a way to sharply disrupt the image, such as clapping his hands or blowing a whistle.
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IMAGERY/TURN OFF TECHNIQUE (BOLD TERM)
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AKA BEHAVIORAL REHEARSAL, this can be used to help the client practice behaviors useful in social situations. Graded exposure is also used in CT
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ROLE PLAYING
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Lots of early criticism by behaviorists and psychoanalysts. Relatively simple to use, but some say too simple. Criticized for ignoring client's history and environmental aspects. A strength of TC is that Beck et al have contiually evaluated, modified, and advanced the theory--lots of supporting outcome research.
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EVALUATION OF THE THEORY
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Precision and testability: Treatment manuals created by Beck make the testing of CT outcome easier and more valid. Some say though, that CT constructs are hard to test--slippery and indeterminate...some say that the standard measures of cognitive dysfunction might just be assessing general psychological distortion rather than distorted thinking. Effectiveness for a variety of client problems: CT is perhaps the most well-researched counseling approach in existence, with a lot of empirical support for its effectiveness with lots of client problems. Evidence for the theoretical assumptions is not so strong.
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QUALITIES OF THE THEORY
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Outcome studies have uniformly supported CT Effective with a wide variety of dysfunctions: depression, anxiety, suicide, ocd
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RESEARCH SUPPORT
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SUPPORT FOR THE VALIDITY OF CT THEORY IS MIXED, mostly on the issue of its model of depression--the cognitive triad is very specific in its assertions.
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THEORY TESTING
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HOFFMAN SUGGESTS THAT INDVIDUALS FROM NON-WESTERN CULTURE ARE MORE LIKELY TO ACCEPT CONTRADICTORY THOUGHTS OR IDEEAS THAN ARE WESTERNERS--NON-WESTERN CLIENTS MIGHT BE MUCH MORE COMFORTABLE IN HOLDING TWO EXPLANATIONS OF ANXIETY SIMULTANEOUSLY. CT assumes that the individual is largely responsible for his own fate; this individualistic outlook may clash with collectivistic values such as those found in some asian, hispanic, or american indian cultures. Highly spiritual people may not respond well to the notions of individual choice. Asian culture viewed CT as more credible than time-limited psychodynamic therapy Collaborative nature works well with female clients IN GENERAL, THE NEGLECT OF ENVIRONMENTAL FACTORS AND INFLUENCES IN CT THEORY MAY BE PROBLEMATIC, BECAUSE PEOPLE WHO HAVE EXPERIENCED PREJUDICE, DISCRIMINATION, AND OPPRESSION MIGHT HAVE MORE DIFFICULTY LOCATING THE SOURCES OF THEIR DISCOMFORT SOLELY IN THEIR COGNITIVE PROCESSES.
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INDIVIDUAL AND CULTURAL DIVERSITY
