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Cognitive Therapy (CT) developed by

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Aaron Beck

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Term Cognitive Therapy is often used as

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a general label for several systems that emphasize the role of cognition in dysfunction and intervention

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If you follow the writing of the Becks

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very clear, you will see that there is a very clear, pure version of CT, which is what I present in this chapter.

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Beck turned his attention to

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psychiatry and was classically trained as a psychoanalyst

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Beck's clinical work informed

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his theoretical development, he began to notice that his clients had thoughts during free association that they did not report. Most of these thoughts had to with the analytic relationship (what the therapist that about the client - transference) and they were associated with the client's current emotional state

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Human nature

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neutral position, humans are organisms who adapt to the environment

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CT theory as constructivist because

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it recognizes that a critical aspect of human existence is the creation of meaning from experiences

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Beck saw his theory as

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the great integrator - "one" psychological theory that can explain all others

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Roots of the theory lie in both

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behavioral and psychoanalytic approaches

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CT is mostly a theory of

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psychology dysfunction, because it originated as a theory of depression

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The Cognitive Model

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our emotions and behavior are the product of our perception or situations - the way you think affects the way you feel

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Cognition means

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the process and the content of thinking, or how you think and what you think

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Three levels of cognitive process

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1. automatic or preconscious - consists of thoughts and other cognitive organizations that are based in survival processes that are largely out of awareness 2. conscious - what we normally think of as thinking 3. metacognitive - ability to think about our thought process

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Schemas

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are cognitive structures that organize the barrage of information with which we are constantly confronted

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Like REBT this is very important in CT

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Beliefs

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Beliefs are

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important components of schema and , as critical targets of CT

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Two types of beliefs

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1. Core beliefs - schemas contain our core beliefs, which are the most basic beliefs we hold and are thought to be the hardest to modify 2. Assumptions, rules , and attitudes - also known as intermediate beliefs, 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

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Automatic Thoughts (ATs)

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normal feature of our cognitive process, they are swift, evaluative statements or images that exist alongside our more conscious thoughts, they tend to occur in shorthand, rather than in full sentence form, and often seem to just pop up out of nowhere

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Modes

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networks of cognitive, affective, motivational, and behavioral schemas that compose personality and interpret ongoing situations

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Three types of Modes

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1. Primal - most basic kinds of operation and function to meet the evolutionary goals of survival, procreation, and sociability, because they are so basic they operate rapidly and automatically, the four primal modes are - threat, loss or deprivation, victim, and self-enhancement (see book for more details on page 323) 2. Constructive - 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 such as: A. the capacity for intimacy B. personal mastery C. creativity D. independence 3. Minor (most important) - 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 interactions, and athletic or recreational activities

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CT theorist conceptualize

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human functioning as the product of learning and genetics

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As children we

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strive to make sense of our environments (including ourselves and others) and organize this information into "schemata"

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Earliest versions of CT theory

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did not elaborate a theory of personality

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Two general dispositions

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1. autonomy - emphasize mastery and independence and build self-esteem through achievement and control 2. sociotropy - find their self-worth in relations with others

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CT versions of health would include

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information processing that allows the individual to meet his goals of survival, reproduction, and sociability

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Healthy people

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do not rely on a lot of primary mode processing and do not show a lot distorted thinking, they have fairly good problem-solving skills

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Regarding dysfunction

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there is no single "cause" of psychopathology

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CT is best characterized as

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adaptive theory, it draws on evolutionary theory to locate the motivation for human behavior in two major evolutionary goals: 1. survival 2. reproduction

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Basic needs or humans are

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preservation reproduction dominance sociability

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Focus in most of CT theory is

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predictably, cognition

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Cognitive distortions

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remain important theoretical constructs in CT theory (see page 327 for complete list)

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Cognitive triad

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the depressive's negative views of the self, the world, and the future

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Distorted thinking results from

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faulty schemas and their associated core beliefs

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Formal assessment

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involves using standardized self-report inventories such as the "Beck Depression Inventory, Automatic Though Questionnaire, Dysfunctional Attitude Scale", however Beck Cognitive Insight Scale is the latest

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Informal assessment

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also used

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CT counselors are most interested in

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assessing their clients' thoughts, and they do this continually throughout therapy - "What was going through your mind?"

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Cognitive assessment leads to

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a formal treatment plan

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CT is characterized by

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a collaborative relationship between client and counselor

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CT is different from other theories because

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it emphasizes a scientific approach, the relationship is said to be based on "collaborative empiricism" - client and counselor are co-investigators in the scientific study of the client's difficulties

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Length of CT

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short term, 10-20 sessions

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Counselors are

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an expert who teach the client about CT. In this way the relationship resembles that of doctor-patient

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Client is

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a student who is expected to work hard to learn about CT, expected to devote energy to examining his thought process and to complete homework assignments

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The goals of CT are

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identify and change faulty information processing and to modify beliefs that support psychological dysfunction to ones that are more adaptive

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Beck advocates

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the flexible use of techniques, almost any ethical technique that attacks dysfunctional thought is appropriate, counselor and client agree on its use, it could be considered technically eclectic but not theoretically sound because we are gaining after dysfunctional thoughts

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Both cognitive and behavioral

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are used in CT

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Cognitive restructuring

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anything that changes client cognition

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Considered essential in CT

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homework, do not let this go when client does not do homework

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Tech: Questioning

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Ask the client questions such as, "What was going through your mind just now?" Socratic questioning - strategy of asking questions that prompt clients to examine distorted thoughts and dysfunctional beliefs and challenge them (what evidence supports or what evidence does not support this idea), ask when see strange non-verbals (emotional shift)

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Tech: Downward Arrow

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therapist starts by examining thoughts relatively close to the "surface" and proceeds downward to core beliefs

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Tech: Thought recording

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the client writes down and records various occurrences of ATs between counseling sessions, can be done through homework or in session

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Tech: Behavioral experiments

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assignments that are tailored to a specific belief, for example if Mitchell has no fun at the beach he can then try surfing

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Tech: Activity scheduling

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client creates a daily schedule to follow between therapy sessions, client may keep a record of daily activities, rate on a scale of 1 to 10 each activity

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Tech: Graded tasks

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overwhelming task, the counselor and the client break down the task into smaller steps, client works on steps one at a time

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Tech: Social skills training

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borrowed from behaviorism, teaching clients skills that promote harmonious and productive interactions with others, role play is used along with assertiveness training

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Tech: Problem solving

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identifying and clarifying the problem, generating alternatives, evaluating the alternatives, implementing an alternative, and then assessing the utility of the new approach (dysfunctional beliefs)

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Tech: Imagery

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when a client is having difficulty identifying ATs, the counselor can resort to using this or role play to vividly conjure up the problem situation. Turn off technique - clients have the ability to control their images

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Tech: Role playing and other behaviorally oriented techniques

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aka behavioral rehearsal, can be used to help the client practice behaviors useful in social situations. Exposure is also used in CT particularly with clients who present with anxiety-related problems

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Evaluation: It was attacked by

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behaviorists and psychoanalysts

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Evaluation: Behaviorist

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Need to focus on behaviors

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Evaluation: psychoanalysts

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cognitive is to surface level focus

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Evaluation: CT appears

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simple to use, provides clear explanations for the problem and allows the use of a wide variety of techniques

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Evaluation: Negative

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identifying cognitions (particularly ATs) is not as simple as it may seem, also too simple and mechanistic, ignores the client's emotions and history in favor of the client's thinking, relative neglect of environmental factors and influences in CT theory may be problematic when working with culturally and individual diverse individuals

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Evaluation: Positive

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not difficult to research, leads to outcome research, collaborative nature of the CT relationship. appeals to minority clients

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Evaluation: CT assumes

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the individual is largely responsible for his own fate; this individualistic outlook may clash with collectivistic values

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Evaluation: Counselors should

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be careful to incorporate any critical sociocultural factors in their CT case formulation

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