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Cognitive Structure

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Schema and automatic thoughts; elaborated a model of automatic thoughts, intermediate assumptions, and core self-schema in explaining the development and course of "depressogenic" thinking.

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Cognitive Mechanisms

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Cognitive distortions: emphasized the influence of faulty schema about self (self-schema), the world, and others, which gave rise to and sustained faulty information processing, whereby clients distorted and filtered external environmental stimuli.

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Ellis

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Suggested that neurotic or manipulative behavior are learned and directly related to irrational belief that people hold about events in their lives

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Ellis's model

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Assumes that by identifying and changing unrealistic or irrational belief, it is possible to alter one's behavior or emotional reactions to events.

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mindfulness

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Nonjudgmental acceptance of cognition and other internal experience rather than cognitive restructuring

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Contextualism

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A focus on emotional appraisal and regulation process

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Acceptance and commitment therapy (ACT)

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Believes that psychopathology arise from a psychological inflexibility, as influence by an overreliance on literal linguistic rules and experiential avoidance that arises because some internal events, such as thoughts and feelings, are perceived as adversve or are evaluated negatively (Feeling anxious is perceived to be "bad" because it is assumed to arise from negative events); individuals should become aware of and examine their thoughts and change the relationship they have with their thoughts. Goals include increased mindfulness, promotion of distancing from one's cognition, observations of cognition and emotions in a nonjudgmental way, and exploration of values and development of commitment to engage actively with the external world and work towards having a meaningful, authentic life; rejects cognitive restructuring because the focus is on addressing the function, not the content, of the cognition.

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Mindfulness-Based Cognitive Therapy (MBCT)

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Developed to threat chronic or long-standing major depressive disorder; builds on Beck's model of cognitive therapy by elaborating on the process by which schema and a client's over-learned, habitual patterns of thinking process may become reactivated and consequently triggered symptoms relapse in vulnerable individuals during times of stress; uses explicit cognitive framework and the major goals of therapy are to reactivate adaptive patterns of thinking through a nonjudgmental awareness of cognition, emotions, and bodily sensations and to develop a decentered stance towards cognition and feeling which are viewed as passing events in the mind.

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Schema-based therapy

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Was developed to address more specifically the needs of individuals with characterological issues, like borderline personalty disorder, and long-standing or relapsing conditions, like chronic depression or anxiety, eating disorder, and long-standing relationship or intimacy problems

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Early maladaptive schemas

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self-defeating emotional and cognitive patterns that begin early on, development and repeat through out life; disconnection and rejection in which a person perceives instability in interpersonal connections (people are unreliable), impaired autonomy and performance (I'm defective), in which one has difficulty functioning independently and successfully differentiating self from other; impaired limits in regard to reciprocity and self-discipline, others directness that focuses on the needs of others wile neglecting one's own needs, overvilgilance and inhibition that involves suppression of one's own impulses and feeling and an internalization of rigid rules about one's functioning (the world is dangerous).

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Schema avoidance

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Individuals cope with these problematic, painful, or distressing early maladaptive schemas; rearranging their lives so that problematic schema are never activated.

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Schema surrender

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Perceptions and behaviors are changed to conform to their schema

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Schema neutralization.overcompensation

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Individual act to neutralize the schema by behaving in a manner opposite to what is predicted by the schema.

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Cognitive techniques

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Used to explore schema to develop a schema formulation with the client and to provide corrective experiences

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Concept of personality

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Although attachment therapy is derived from psychodynamic models of thought, cognitive theory has reformulated the original drive-based conceptualization and posits that an individual's characteristic patterns of viewing the world are shaped throughout development and are know as schema; makes sense of new experiences in terms of what we already believe rather than by changing our preexisting views.

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Schema

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Plays a central role in the formation of an individuals personality; is stored in memory as generalizations from specific experiences and prototypes; provide focus and meaning for incoming information; incorporate emotions or affective valence related to the events; strongly held and are seen as essential for the person's safety, well-being, or existence.

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Cognitive Triad

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Proposed by Beck; views (negative) of self, the world, and the future.; serves as a useful framework for examining the automatic thoughts and tacit assumptions that clients describe.

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Schemas

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Plays an important role in cognitive models of emotional and behavioral problems; are maintained, elaborated, and consolidated through processes of assimilation and are changed through accommodation to novel experiences; tacit beliefs or schemas are activated by events that are similar to early experiences surrounding their development and these tacit, rules, assumptions, and beliefs serves as the wellspring of the various cognitive distortions seen in clients.

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Cognitive distortions

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An individual's perceptions, memories, and thoughts can become distorted in a variety of adaptive and maladative ways, which usually become the focus in therapy; dichotomous thinking (all-or-nothing), mind reading (I just know they'll disapprove), emotional reasoning (I'm feeling upset, so there must be something wrong), personalization (I know that was said for me), overgeneralization (everything i do is wrong), catastrophizing (my heart is beating fast, I must be having a heart attack), "Should" statements (They should do what i say because i'm right), and selective abstraction (the good things that happen don't count)

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Clinical assesement

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Important for evaluating the effectiveness of an intervention and vulnerability factors

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Cognitive therapy sessions

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Emphasis on helping clients to examine the manner in which they understand themselves and their world (cognition) and to experiment with new ways of responding (behavioral); Sessions are structured, active, and problem oriented; time-limited and strategic; psychoeducational; based on constructionist models of thought and behavior; collaborative; don't alleviate emotions but provides client with skills for understanding and managing them giving them a greater sense of control and self-efficacy to effectively deal with life stressors

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Cognitive Therapy in Action

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First establish rapport through emphatic, active listening, promotes the client to talk about their experience, identifies recurrent patterns in client's behaviors and thoughts (pointing our maladative and distortions), review developmental familial, social, cultural, occupational, educational, medical, and psychiatric history; this will establish a problem list, give an idea of where therapy is going, a general time frame, and a means of assessing therapeutic progress.

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Interventions

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Chosen to address distortions, maladaptive beliefs, and hypothesized schema identified in the case formulation that underlie identified problem behaviors and improve medication compliance

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Cognitive techniques

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Interventions that alter a client's perception or beliefs

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Idiosyncratic meaning

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The exploration of meaning attached to the client's words and thoughts

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Questioning the evidence

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systematically examine evidence in support of a belief as well as evidence that is inconsistent so the client may recognize that they overlooked information

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Rational responding

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helping the client to challenge dysfunctional thinking; therapist may inquire as to a situation that engender the emotion and the attendant thought; ascertain the feelings and the situation; and endeavors to determine the thoughts and emotions that precede accompany and follow the event; systematic examination of evidence supporting and refuting the belief, the development of an alternative, more adaptive explanation or belief, decatstrophizing the belief, and identifying specific behavioral steps to cope with the problem

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Examining options and alternative

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Work with the client to generate additional options and evaluate solutions

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Decatastrophizing

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Clients are taught to examine whether they are overestimating the severity of a situation or the likelihood of a negative outcome

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Fantasized consequences

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Clients are asked to describe a fantasy about a feared situation, their images, and attendant concerns to see the irrationality of their idea

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Advantage and disadvantages

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Asking the client to examine both sides of an issue can help the client achieve a broader perspective and gain reasonable course of action

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Turning adversity to advantage

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Seeming disaster can be used to advantage and clients are asked to identify strengths or competencies they have acquired through overcoming past adversities

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Guided association/discovery

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client to identify relationships between ideas, thoughts, and images by means of Socratic questioning and encourages the client to identify a series of automatic thoughts and guide clients towards an understanding of themes within implicit automatic thoughts and to identify possible underlying schema by asking "and what" What does that mean?"

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Paradoxical interventions

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Causes the client to develop a sense of control over an uncontrollable symptom

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Scaling

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Used to counter all-or-nothing thinking and for the client to gain a sense of distance and perspective

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Externalization of voices

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Client can gain experience in responding adaptively to their thoughts by externalizing or voice their thoughts; self-talk

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Self-instruction

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Clients can be taught to offer direct self-instructions for more adaptive behavior as well as counter-instructions to avoid dysfunctional behavior; self-talk

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Thought stopping

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Visual thoughts or imagery to help client's stop their thoughts

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Distraction

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Taking the focus away from their initial thought by focusing on something else, like counting, math, reading upside down, counting people with red on

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Direct disputation

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Engender avoidance or a passive-aggressive response used with imminent risk clients

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Labeling of distorations

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Clients can be taught to identify and label specific distortions and can be asked to practice the exercise at home

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Replacement Imagery

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Client can develop coping images rather than imaging failure defeat or embarrassment

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Bibliotherapy

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Assigning reading as homework, could be about CBT so client is educated on the model; writing, journaling

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ACT techniques

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Focuses on clients examining and distancing themselves from their cognition and encourages examination of problems in the context of client's own experience

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Behavioral techniques

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Used to facilitate cognitive change and to instill hope to provide for early success by directly challenging a client's faulty assumptions, rules, and ultimately core beliefs

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Homework

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Is cognitive or behavioral and an extension of skills developed during the session; complete activity schedule, try a new behavior and should be reviewed, rewarded, and troubleshooted.

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Common Therapist Errors

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inadequate socialization of the client to the model; failure to develop a specific problem list or to share rationale with the client, not assigning appropriate homework or following up with it, premature empathizes on identifying schemas, therapist impatience and becoming overly directive during therapy in an attempt to resolve the client's symptoms immediately, premature introduction of rational techniques before formulation, lack of attention to developing a trusting collaborative rapport and inadequate attention to nonspecific factors of the therapy relationship, and not attending to the therapists countertransference.

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Piaget

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Social learning; thoughts come from family, friend, experience, not just from psychoanalytic

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Bandura

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Social learning theory; faulty cognition can lead to depression , poor self-esteem, psychosocial distress and behaviors

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Stages/ Phases of change

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Precontemplation, contemplation, determination, action, maintance

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Contemplation

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Recognized something is going on, believes something may be wrong

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Precontemplation

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Don't think something is wrong; no concept that they have a problem

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Determination

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Story is loosen; begin to ready oneself for transformation

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Action

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Going to do something or take steps to change

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Maintenace

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What is going to be done to maintain growth and for sustainability; room for relapse, which is not a failure but an opportunity to reflect and have gain a better self understanding

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