Intro to counseling psych 452 ch. 5 cognitive therapy – Flashcards
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When was cognitive therapy born?
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Cognitive therapy was born in 1956 during the cognitive revolution. (symposium at MIT). Has moved to the forefront of professional interest.
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What is the target of behavioral therapy?
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The unlearning of problematic behavior.
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What is the target of cognitive therapy?
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focus on an individual's beliefs about the self, the world, and the future. The targets of therapy are thoughts, manipulative cognition's that are frequently automatic and ingrained.
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Cognitive-behavioral therapies link behavioral therapy and cognitive therapy.
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By targeting both problematic behaviors and maladaptive cognition's. Thus, the term cognitive-behavioral therapy, or CBT, subsumes cognitive approaches and has at times been used interchangeably with the term cognitive therapy.
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Historical Background
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(stoic philosopher epictetus) "what upsets people is not things themselves but their judgments about the things."
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Psychological construcitvism
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Individuals are proactive and develop systems of personal meaning to organize their interactions with the world.
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schema construct
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cognitive representations of people, past experiences, and themselves.
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Third-wave cognitive-behavioral therapies. mindfulness
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Non-judgmental acceptance of cognition's and other internal experiences rather than cognitive restructuring.
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Third-wave cognitive-behavioral therapies. contextual-ism.
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a focus on emotional appraisal and regulation processes.
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Acceptance and commitment therapy (ACT)
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In the ACT model, psychopathology is believed to arise from a psychological inflexibility, as influenced by an over-reliance on literal linguistic rules, and experiential avoidance that arises because some internal events, such as thoughts and feelings, are perceived to be "bad" because it is assumed to arise from negative events.
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Acceptance and commitment therapy continued...
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Act holds that the individual should become aware of and examine their thoughts, and change the relationship they have with their thoughts-not confuse their thoughts with reality-and not to judge, evaluate, or attempt to modify their cognition's, but simply to observe and accept their cognition's and feelings.
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Mindfulness-Based cognitive therapy (MBCT)
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Developed to treat chronic or long standing major depressive disorder. Elaborates on the process by which schemas and a client's overlearned, habitual patterns of thinking process may become reactivated and trigger symptom relapses in vulnerable individuals during times of stress. Incorporates mindfulness training, utilizes techniques from mindfulness based stress management. Goals: Reactivate adaptive patterns of thinking through nonjudgmental awareness of cognitions, emotions, and bodily sensations, and to develop a decentered stance toward cognitions and feelings, which are viewed as passing events in the mind.
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Schema-based therapy
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Developed to address more specifically the needs of individuals with borderline personality disorder, and long standing or relapsing depressing or anxiety, eating disorders, and long standing relationship problems or intimacy problems. The focus is on early maladaptive schemas; self-defeating emotional and cognitive patterns that begin in development and repeat through life.
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schema avoidance (schema-based therapy)
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rearranging their lives so that problematic schemas are never activated.
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schema surrender (schema-based therapy)
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perceptions and behaviors are changed to conform to their schemas.
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schema neutralization/overcompensation (schema-based therapy)
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They act to neutralize the schema by behaving in a manner opposite to what is predicted by the schema. In addition to cognitive techniques, experiential activities, such as guided imagery and role playing, and techniques using the therapeutic alliance, such as reparenting techniques, are utilized both to explore schemas to develop a schema formulation with the client and to provide corrective experiences.
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Assumptions of cognitive therapy
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(1) The way individuals construe or interpret events and situations mediates how they subsequently feel and behave. (2) Interpretation of events is active and ongoing. The construal of events allows individuals to derive a sense of meaning from their experiences and permits them to understand events. (3) Individuals develop idiosyncratic belief systems that guide behavior. Beliefs and assumptions influence perceptions and memories, and memories are activated by specific stimuli or events. (4) stressors contribute to a functional impairment of an individual's cognitive processing and activate maladaptive, overlearned coping responses. (5) The cognitive specificity hypothesis states that clinical syndromes and emotional states can be distinguished by the specific content of the belief system and the cognitive process that are activated.
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The concept of personality
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Cognitions include our perceptions, memories, expectations, standards, images, attributions, plans, goals, and tacit beliefs. They include multiple factors that have gone into making up the personality of an individual. Cognitive variables, then, include thoughts in our conscious awareness, as well as inferred cognitive structures and cognitive processes.
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The concept of personality continued
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Although individuals may be born with certain temperaments shaped by genetic heritability, experiences from individuals' earliest years shape how they view the world around them. Beliefs shaped by these experiences are the focus of cognitive therapy. A child who feels secure in the love and attention of his or her primary caregiver will have a belief system that the world is a safe place to explore.
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Schemas play a central role in the formation of an individual's personality.
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Organized, tacit cognitive structures made up of abstractions or general knowledge about the attributes of a stimulus domain, and the relationships among these attributes. Although not in our conscious awareness, they direct our attention to those elements of our day-to-day experience that are most important for our survival or adaptation. Individuals tend to assimilate their experiences in response to preexisting schemas rather than to accommodate schemas to events that are unexpected or discrepant.
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Recent work on schemas has identified certain representative schemas that form the basis of psychopathology for each disorder.
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For example, highly sociotropic or autonomous personality styles may make an individual more vulnerable to depression. Highly sociotropic individuals have interpersonal schemas that are cognitive representations of interactions with others, such as attachment figures that maintain individual relationships. An example is the belief that when I ask for support, others will reject me.
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Psychological health and pathology
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cognitive processes are seen as playing a central role in organizing our responses both to daily events and to long-term challenges. Therefore, schemas form the basis of both "healthy" personalities and those of individuals with psychopathology. The standard cognitive therapy model posits that three variables play a central role in the formation and maintenance of common psychological disorders: the cognitive triad, schemas, and cognitive distortions.
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The cognitive triad
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(Beck 1963) a means of describing the negative thoughts of depressed inpatients. He viewed that the thoughts of depressed patients involved highly negative views of the self, the world, and the future. People who suffer anxiety are different from those with depression. They view the world or others as potentially threatening , and to maintain a vigilant and wary orientation toward their future. the concept of the negative triad serves as a useful framework for examining the automatic thoughts and tacit assumptions that clients describe. Virtually all client problems can be related to dysfunctional beliefs in one of these three areas. It's best to find out where they stand.
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Schemas
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Schemas are maintained, elaborated, and consolidated through processes of assimilation and are changed through accommodation to novel experiences. Schemas are developed over the course of an individual's infancy and childhood.
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Early Maladaptive schemas
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Are seen as serving an adaptive function and may represent internalizations of ongoing or repetitious parental behavior. The parent who is unsupportive, punitive, or unpredictable toward his or her infant will likely behave in a similar manner during later years. The child's nascent beliefs that "my needs won't be met by others", "I am flawed or inadequate", and "I must submit to the control of others to avoid punishment" are initially represented non-verbally as subjective encodings of interactive experiences, and are elaborated and consolidated by later events. They are reified as procedural memories, tacit beliefs, or representations about the self and the world.
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Early maladaptive schemas occur in five domains
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(1) disconnection and rejection, in which an individual perceives instability in interpersonal connections. (2) impaired autonomy and performance, in which one has difficulty functioning independently and successfully differentiating self from others. (3) impaired limits in regard to reciprocity and self-discipline. (4) Otherdirectedness that focuses on the needs of others while neglecting one's own needs. (5) overvigilance and inhibition that involve suppression of one's own impulses and feelings, and an internalization of rigid rules about one's functioning.
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Dichotomous thinking (cognitive distortions)
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Things are black or white; "you're with me or against me". This tendency toward all-or-nothing thinking is encountered in borderline personality and obsessive-compulsive disorders.
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Mind reading (cognitive distortions)
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"They probably think I am incompetent"; "I just know that they will disapprove." This processing style is common in avoidant and paranoid personality disorders.
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Emotional reasoning (cognitive distortions)
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"I feel inadequate, so I must be inadequate"; "I'm feeling upset, so there must be something wrong." This distortion is common among individuals suffering from anxiety disorders.
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Personalization (cognitive distortions)
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"That comment wasn't just random, I know it was directed toward me." At the extreme, this is common in avioidant and paranoid personality disorders.
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Overgeneralization (cognitive distortions)
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"everything i do turns out wrong"; "It doesn't matter what my choices are, they always fall flat." At the extreme, this is common among depressed individuals.
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Catastrophizing (cognitive distortions)
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"If I go to the party, there will be terrible consequences"; "It would be devastating if I failed this exam"; "My heart's beating faster, it's got to be a heart attack." This distortion is characteristic of anxiety disorders, especially social anxiety, social phobia, and panic.
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Should statements (cognitive distortions)
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"I should visit my family every time they want me to"; "They should do what I say because it is right." This is common in obsessive-compulsive disorders an among individuals who feel excessive guilt.
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Selective abstraction (cognitive distortions)
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"The rest of the information doesn't matter. This is the salient point"; "I've got to focus on the negative details; the positive things that have happened don't count." At the extreme, this is common in depression.
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The process of clinical assessment
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Identifying specific problems and objectively evaluating the effectiveness of interventions are essential parts of cognitive psychotherapy. Assessment instruments, including self report questionnaires, behavior rating scales, and clinician rating scales, can be quite useful in this regard. They are frequently administered at the beginning of treatment and at later points. example: The dysfunctional attitude scale (DAS) and the young schema questionnaire. Depression=Beck Depressive inventory. Anixiety= Beck anxiety inventory (BAI), Zung anxiety rating scale (ZARS), State Trait anxiety inventory (STAI). Hoplessness= Beck Hopelessness Scale (BHS).
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Assessment of Vulnerability Factors
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There are circumstances, situations, or deficits that have the effect of decreasing the client's ability to cope effectively with life's challenges. These factors lower the client's tolerance for stress and may serve to increase suicidal thinking, lower the threshold for anxiety stimuli, or increase vulnerability to depressongienic thoughts and situations.
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Assessment of Vulnerability Factors; list of factors
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1: acute or chronic illness 2: hunger 3: fatigue 4: major or minor stressful events 5: loss of social support 6: alcohol and substance abuse 7: chronic pain 8: new life circumstances. An essential component of cognitive therapy is to use an unstructured or structured interview to assess for vulnerability factors that may be the diathesis that puts an individual at risk for psychopathology by activating negative schemas and automatic thoughts.
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The practice of therapy
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A common element across cognitive-behavioral models is an emphasis on helping clients to examine the manner in which they construe or understand themselves and their world (cognitions), and to experiment with new ways of responding (behavioral). By learning to understand the idiosyncratic ways they perceive themselves, the world and their prospects for the future, clients can be helped to alter negative emotions, and to behave more adaptively.
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In practice cognitive therapy sessions are...
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1: Structured, active, and problem oriented 2: time-limited and strategic 3: psychoeducational 4: based on constructivist models of thought and behavior 5: collaborative. Cognitive therapy attempts to identify specific, measurable goals and to move quickly and directly into those areas that create the most difficulty for the client.
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The first goal in cognitive therapy
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To establish rapport through empathic, active listening. Clients need to feel heard, and that their concerns are understood and acknowledged by their therapist. The cognitive therapist encourages and facilitates client speech and promotes the experience of affect in the therapy session. The cognitive therapist also identifies recurrent patterns in the client's behavior and thoughts, points out the use of maladaptive coping strategies or distortions, and draws attention to feelings and thoughts the client may find disturbing.
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Before specific interventions are made...
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The therapist carefully reviews a client's developmental, familial, social, cultural, occupational, educational, medical, and psychiatric history. These data are useful in helping to turn a client's presenting complaints in to a working problem list and a treatment conceptualization.
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A typical agenda might include the following...
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1: Discussion of events during the past week and feelings about the prior therapy session. 2: A review of self-report scales filled out by the client prior to the session. 3: A review of agenda items remaining from the previous session. 4: A review of the client's homework. the client's success or problems in doing the homework are discussed, as are the results of the assignment. 5. Current problems that are put on the agenda might involve the development of specific skills (e.g, social skills, relaxation training, or assertiveness skills) or the examination of dysfunctional thoughts.
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Problem conceptualization and treatment planning
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After the therapist conducts a comprehensive assessment, the problem conceptualization forms the foundation for a targeted treatment plan. It should explain past behavior, make sense of current difficulties, predict future behavior, and yield pragmatic recommendations. The conceptualization process begins with the compilation of a specific, behaviorally based problem list, which is then prioritized.
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Specific Interventions
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Interventions should be chosen specifically to address the distortions, maladaptive beliefs, and hypothesized schemas identified in the case formulation that underlie identified problem behaviors. The precise mix of cognitive and behavioral techniques will depend on the client's abilities, the level of pathology, and the specific treatment goals. When working with severely depressed clients initial treatment goals might center on facilitating behavioral activity, improving self-care, and reducing social isolation.
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Cognitive Techniques
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Defined as any intervention or technique that alters a client's perceptions or beliefs. These techniques should be taught to clients so they can be their own therapist.
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Idiosyncratic meaning
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In many ways, our constructs determine our perceptions. All words carry an idiosyncratic or personal meaning. The exploration of these meanings models the need for active listening skills, increased communication, and the value of examining one's assumptions. The meaning attached to the client's words and thoughts can be explored. The client who believes that he will be devastated by his spouse leaving might be asked what he means by devastated?
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Questioning the Evidence
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This technique involves systematically examining evidence in support of a belief, as well as evidence that is inconsistent with it. The reliability of the sources of the information might be examined, and the individual might come to recognize that he or she has overlooked information that is inconsistent with his or her beliefs.
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Reattribution
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Clients often take responsibility for events and situations that are only minimally attributable to them. A therapist can help a client distribute responsibility among all relevant parties.
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Rational Responding
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One of the most powerful techniques in cognitive therapy involves helping the client to challenge dysfunctional thinking. The Dysfunctional thought Record (DTR) is an ideal format for testing maladaptive beliefs. The process begins with a client identifying the thought, emotion, or situation that causes difficulty.
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Rational Responding involves four steps:
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1: a systematic examination of evidence supporting and refuting the belief 2: the development of an alternative, more adaptive explanation or belief 3: decatastrophizing the belief 4: identifying specific behavioral steps to cope with the problem.
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Examining Options and Alternatives
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This involves working with clients to generate additional options. Suicidal clients often see their alternatives as so limited that death becomes a viable solution.
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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. Through Socratic questioning they are encouraged to "keep the problem in perspective".
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Fantasized consequences
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Clients are asked to describe a fantasy about a feared situation, their images of it, and the attendant concerns. In verbalizing their fantasies, clients can often see the irrationality of their ideas. If the fantasized consequences are realistic, then the therapist can work with a client to assess the danger and develop coping strategies.
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Advantages and disadvantages
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By asking the client to examine both the advantages and disadvantages of both sides of an issue, the therapist can help the client achieve a broader perspective. This basic problem solving technique is useful in gaining a perspective, then plotting a reasonable course of action.
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Turning adversity to advantage
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There are times when a seeming disaster can be used to advantage. Having a deadline imposed may be seen as oppressive and unfair, but it may be used as a motivator. clients are assisted in identifying strengths or competencies they have acquired through overcoming past adversities.
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Guided Association/ discovery
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The therapist works with the client to identify relationships between ideas, thoughts, and images by means of Socratic questioning. Also refereed to as the vertical or downward arrow technique, the therapist encourages the client to identify a series of automatic thoughts. The use of statements such as "and then what?" or "And that means what?" allows the therapist to guide the client toward an understanding of themes within implicit automatic thoughts and to identify possible underlying schemas.
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Paradoxical Interventions
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By taking an idea to its extreme, the therapist can help to move the client to a more moderate or adaptive position vis-a-vis a particular belief and, paradoxically, cause the client to develop a sense of control over an uncontrollable symptom. For instance, providing homework of worrying (for those with generalized anxiety disorder) or crying (for those who are depressed) during a given time period may allow clients to see that they have some measure of control over when they choose to engage in a behavior.
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Scaling
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Useful for all-or-nothing thinking. scaling of emotions can lead a client to gain a sense of distance and perspective. A depressed client may be asked to make a scale of 1-100. 1 being the most incompetent person in the world, and 100 being the most competent. Then, rate themselves. (this works if they believe they are incompetent.
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Externalization of voices
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Most individuals can hear the voice of their thoughts in their head. When clients are asked to externalize these thoughts, they are in a better position to deal with these voices and thoughts. By having the therapist take the part of the dysfunctional voice, a client can gain experience in responding adaptively. The therapist might begin by modeling rational responses to a client's verbalizations of dysfunctional thoughts. With practice, the client comes to recognize the dysfunctional nature of the thoughts and becomes better able to respond adaptively to them.
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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 counterinstructions to avoid dysfunctional behavior.
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Thought stopping
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Given the relationship between thoughts and mood, maladaptive automatic thoughts can have a snowball effect, in that even mild feelings of dysphoria or anxiety can bias subsequent cognitive processes, leading the individual to feel continually more distraught. Thought stopping is best used when the negative emotional state is first recognized. anxious clients can be taught to picture a stop sign or hear a bell at the outset of an anxiety attack. This momentary break in the process allows them to reflect on the origin of the anxiety and to introduce more powerful cognitive techniques before their anxiety escalates.
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Distraction
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This technique is especially helpful for clients with anxiety problems. Because it is almost impossible to maintain two thoughts simultaneously, anxiogenic thoughts generally preclude more adaptive thinking. Conversely, a focused thought distracts from the anxiogenic thoughts.
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Direct Disputation
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When there is an imminent risk to the client, as in the case of suicide, the therapist might consider direct disputation. Because this approach is in some regard non-collaborative, the therapist risks becoming embroiled in a power struggle or argument with the client. Disputation of core beliefs may engender avoidance or a passive-aggressive response.
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Labeling of Distortions
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Fear of the unknown, or "fear of fear" can be important concerns for anxious clients. The more that can be done to identify the nature and content of the dysfuncional thoughts and to help label the types of distortions that clients use, the less frightening the entire process becomes. Clients can be taught to identify and label specific distortions during the therapy session and can be asked to practice the exercise at home. This can be accomplished with the aid of a "thought record" on which clients record their automatic thoughts on an ongoing basis during the day, or with a counter with which they simply record the frequency of thoughts.
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Developing Replacement Imagery
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Many anxious clients experience vivid images during times of stress. clients can be helped by training in the development of "coping images." for exaple, rather than imaging failure, defeat, or embarrassment, the therapist assists the client to develop a new, effective coping image. Once well practiced, clients can substitute these images outside the therapy session.
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Bibliotherapy
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Several excelling books can be assigned as readings for homework. These books can be used to educate clients about the basic cognitive therapy model, emphasize specific points made in the session, introduce new ideas for discussion, or offer alternative ways of thinking about clients' concerns.
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Act techniques
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Many techniques used within ACT focus on clients examining and distancing themselves from their cognitions, and encourage examination of problems in the context of client's own experiences. These techniques can include discussing with the client the paradoxical effect of trying to deny or control one's thoughts, which often causes an increase in unwanted thoughts and feelings. ACT also uses several techniques to promote distance from one's thoughts, such as exercises that encourage the client to view his or her thoughts as if cognitions are "soldiers on parade, so that the client is looking at thoughts, not from thoughts. In addition, acceptance is promoted through encouraging clients to observe and experience their thoughts and emotions nonjudgmentally as they are.
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Behavioral Techniques
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In cognitive therapy, adaptive behavioral changes that result from behavioral techniques are indeed viewed as desirable, but behavioral techniques are used primarily to facilitate cognitive changes. Using behavioral techniques, especially at the beginning stages of therapy, is viewed as important not only to change maladaptive behavior patterns, but also to instill hope and to provide for early success in therapy. Example: Severely depressed clients might benefit first from behavioral techniques, such as activity scheduling, in order to provide a foundation for eventually challenging their hopelessness about the future and their negative view of self. They challenge schemas of feeling helpless, ineffectual, powerless, weak , or incompetent.
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Homework
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No therapy takes place solely within the confines of the consulting room. Insights an skills gained within the therapeutic milieu may be consolidated and employed in the client's day-to-day life. Practicing cognitive-behavioral skills at home allows for a greater therapeutic focus and more rapid gains.
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Challenges
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Noncompliance, or resistance, often carries the implication that the client does not want to change or "get well" for either conscious or unconscious reasons. Resistance is anything in the clients' behavior, thinking, affective response, and interpersonal style that interferes with the ability of that client to utilize the treatment and to acquire the ability to handle problems outside of therapy.
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Common Therapist Errors
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Mistakes occur during the practice of cognitive therapy, and knowledge of common errors can help us avoid them. These include 1: inadequate socialization of the patient. 2: failure to develop a specific problem list or to share a rationale with the patient. 3: Not assigning appropriate homework (and not following up on completed homework assignments). 4: Premature emphasis on identifying schemas. 5: therapist impatience and becoming overly directive during therapy i an attempt to resolve the patient's symptoms immediately. 6: premature introduction of rational techniques (before a formulation has been completed). 7: Lack of attention to developing a trusting collaborative rapport and inadequate attention to nonspecific factors of therapy relationship. 8: Not attending to the therapist's own emotional reactions, automatic thoughts, and schemas-the counter-transference.
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Termination
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Termination in cognitive therapy begins in the first session. Because the goal of cognitive therapy is not cure per se but more effective coping, the cognitive therapist does not plan for therapy in perpetuity. As a skills acquisition model of psychotherapy, the therapist's goal is to assist clients in acquiring the capacity to deal with internal and external stressors that are a part of life. Effective in 12-15 sessions, but there is no typical duration for the treatment.
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Therapeutic relationship and the stance of the therapist.
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As client-centered therapists have observed, therapist who are "nonpossessively warm", empathic, and genuine achieve greater gains than do those who are not. These are good but not enough to invoke behavioral and emotional change. Although, they are essential first steps. Also, cultural mistrust (cultures mistrust therapists). The transference relationship also plays a big role. The client's behavior towards therapist might be a sign of how they treat other relationships out side of the session. This also disputes schema beliefs.
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Efficacy and Effectiveness
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Does cognitive therapy really work? Meta analysis have reported that CBT is effective in the treatment for depression, generalized anxiety disorder, panic with and without agoraphobia, social phobia, posttraumatic stress disorder, and childhood depression and anxiety disorder.
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Depression
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A number of randomized controlled trials published during recent years support the utility of cognitive therapy for treating depression among adults and youth.
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Generalized Anxiety Disorder
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controlled outcome studies suggest that cognitive-behavioral interventions may be helpful in alleviating anxiety for clients with generalized anxiety disorder, and that gains are maintained over time.
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Panic disorder with and without agoraphobia
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A number of CBT protocols have been developed to treat panic disorder. Controlled outcome studies indicate that these approaches are superior to wait-list, medication, pill placebo, and relaxation training.
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Post-traumatic stress disorder
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Cognitive-behavioral models based on information-processing and emotion-processing paradigms have proven quite useful in providing an understanding of the ways traumatic experiences can disrupt core cognitive processes. or schemas and may result in the activation of pathological fear structures.
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social phobia
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Cognitive-behavioral interventions for social anxiety, including psycheducation, relaxation training, identification of maladaptive thoughts and expectations, rational disutation, social skills training, and in vivo exposure have been developed.
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Cognitive specificity hypothesis
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The postulate that emotional states (and clinical disorders) can be distinguished in terms of their specific cognitive contents and processes. Cognitive specificity directs our attention toward cognitive and behavioral processes that mediate specific disorders, and that may serve as a focus of treatment.
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Anxiety
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As anxious individuals confront a problematic situation (e.g., an upcoming exam), their perceptions of that event are influenced by their existing beliefs, memories, schemas, and assumptions. In evaluating the situation, they make two judgments-an assessment of the degree of risk or threat (which incorporates assessments of severity of the outcome and the probability that it will occur) and an assessment of their ability to cope with that risk. Treatment of anxiety disorders, involves reexamining beliefs, assumptions, and schemas; developing appropriate coping skills; enhancing perceptions of personal efficacy; decatastrophizing perceived threats; and discouraging avoidance or withdrawal.
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Anxiety continued...
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Anxious individuals appear to share a number of beliefs and may demonstrate attentional biases toward threat-relevant stimuli. Research suggests that anxious clients tend to believe that if a risk exists, then it is adaptive to worry about it (anxious overconcern), it is necessary to be competent and in control of situations (personal control/ perfection), and it is adaptive to avoid problems or challenges (problem avoidance). Moreover, they tend to demonstrate heightened levels of anxiety sensitivity, self-focused attention, and deficits in emotional regulation. As noted, common themes shared by the anxiety disorders are a perception of a threat and belief that the threat cannot be managed or avoided. The threats may be real or imagined, internal (somatic sensations, emotions, and thoughts) or external (job loss), and are most often directed toward the person or the personal domain.
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The cognitive model of anxiety
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The cognitive model of anxiety involves several elements. Anxiety, which is an adaptive response to one's environment, begins with the perception of a threat in a specific situation. The meaning that an individual attaches to the situation is determined by his or her schemas and memories of similar situations in the past The individual then assesses the seriousness of the threat and evaluates his or her ability to cope with it. If the situation is viewed as threatening, a sense of danger endues. If a mild threat is perceived, the individual responds to it as a challenge and feels excitement and enthusiasm. Cognitive and perceptual processes can be affected by an individuals' current mood. In this case, when an individual begins feeling anxious, he or she is likely to become even more vigilant to perceived threats and begin to recall threatening experiences in his or her past.
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Anxiety threshold
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Ability to tolerate anxiety. Each person has a general anxiety threshold as well as an ability to tolerate anxiety in specific situations. These thresholds may shift in response to stresses in the individual's day-to-day life and available supports. The therapist begins by asking what specific events, situations, or interactions trigger the individual to become anxious. Next, an assessment is made of automatic thoughts accompanying the feelings of anxiety.
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Panic Disorder (automatic thoughts)
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Is Characterized by a sensitivity or vigilance to physical sensations and a tendency to make catastrophic interpretations of these somatic feelings.
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Agoraphobia (automatic thoughts)
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Involves a fear of being unable to reach a "safety zone" rapidly, such as one's house-leading the individual to avoid cars, planes, crowded rooms, bridges, and other places where ready escape might be blocked.
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Phobias (automatic thoughts)
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Stem from a fear of specific objects (e.g., large dog) or a situation (e.g., speaking in public).
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Obsessive compulsive Disorder (automatic thoughts)
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Is characterized by a fear of specific thoughts or behaviors.
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Generalized Anxiety disorder (automatic thoughts)
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Involves a more pervasive sense of vulnerability and a fear of physical or psychological danger.
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Personality disorders.
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Personality disorders refer to enduring patterns of thought, perception, and interpersonal relatedness that are inflexible and maladative. They tend to occur in a range of settings and are often accompanied by significant distress. More often than not, they greatly impair individuals' social or occupational functioning. They are both chronic and pernicious. Personality disorders differ from other clinically important problems in that they tend not to fluctuate over time and are not characterized by discrete periods of distress.
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Schemas of a dependent individual. (personality disorders)
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Tend to be characterized by beliefs of the form, "I am a flawed or incapable person" (self) and, "The world is a dangerous place" (world) and by the assumption, "If I can maintain a close relationship with a supportive person, then I can feel secure." As a consequence, the individual with dependent personality disorder continually seeks relationships with others, fears the loss of relationships, and feels despondent and anxious when deprived of the support of others.
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Schemas of a schizoid individual
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May not only hold the belief that "the world is a dangerous place" (world) but also maintain the schema, "others are dangerous or malevolent" (world), and the assumption, "If I can avoid intimate relationships with others, then I can feel secure." As a consequence, the behavioral and emotional responses of such an individual are quite different. Such an individual tends to be indifferent to the praise or criticism of others, to maintain few close friendships, and to be emotionally aloof from others. As one client succinctly stated, "my dream is to get through law school so I can get a lot of money...then I'd buy an island...I'd never have to deal with anyone, that would be ideal."
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Psychotic disorders
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The treatment of psychotic disorders historically lay in the realm of psychotropic medication, social skills training, and crisis management. Individual psychotherapy was often regarded as futile for individuals suffering from delusions and hallucinations by many in the medical community. CBT for psychotic disorders has changed both the understanding and the treatment of these disorders, and is now frequently used as an adjunct to medication or as the sole treatment in cases that involve problems with medication management and resistance.
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positive symptoms
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Historically, the positive symptoms of psychotic disorders have been understood as Neuro-biological and not amenable to psychological intervention. cognitive-behavioral therapists agree with the neurobiological underpinnings of such disorders, but they also see such symptoms as being the result of identifiable cognitive biases and distortions that maintain symptoms and can be understood within the context of the patients life. They are exaggerated manifestations on a continuum of normal perceptions, thoughts, or beliefs that can be understood and treated in a manner similar to other disorders.
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Negative symptoms
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Today , cognitive theory views negative symptoms as the result of a combination of neurobiological, environmental, and psychological processes.
