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PSYC360 Ch. 7: COGNITIVE THERAPY

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Cognitive Therapy (CT)
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-Aaron Beck -Focus on role of information processing -Cognition, behavior, affect and motivation are intertwined + co-occur -Focus on primacy of cognition -Schemas -Uses cognitive + behavioral techniques *ALTERING THOUGHTS INFLUENCES FEELINGS, MOTIVATIONS, BEHAVIORS
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Cognitive schema
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-Structure containing self perceptions -Thoughts about others and world -Memories, goals, fantasies -Contains one’s core beliefs + assumptions
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Cognitive shift
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-Systematic bias in information processing -Selectively interpret info in certain manner
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Cognitive vulnerabilities
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-Specific attitudes predisposing the interpretation of experiences -Developed early on -When rigid, negative and ingrained, we are predisposed to pathology -Give rise to conditional assumptions (i.e. rules of living) as we mature
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Mode
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-Networks of (cognitive, affective, motivational and behavioral) schemas -Primal modes = universal + related to survival -Primal thinking
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Primal thinking
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Rigid Absolute Automatic Biased
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Dysfunctional modes treated by…
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-Deactivate -Alter structure + content -MODIFY CORE BELIEFS -Develop more adaptive mode
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Cognitive therapist relies on _________ and ___________
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-Collaborative empiricism -Guided discovery (Patients test beliefs and behaviors to develop positive mental health)
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Basic characteristics of CBT
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-Practical -Symptom focused -Empirically derived techniques -Patient collaboration -Acknowledges underlying precursors of symptoms BUT remains present-oriented -Case conceptualization drives treatment
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Primary roles of CBT Therapist
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-Conceptualize patient in cognitive terms -Structure sessions -Use collaborative empiricism + guided discovery -Set goals
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Cognitive model 1-3
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1. Situation + underlying beliefs 2. Automatic thoughts 3. Behaviors, emotions, physiological response
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Cognitive model explained
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-Automatic thoughts influence, emotional, behavioral, motivational and physiological responses -Bi-directional relationship (all systems act together as mode) -SIMULTANEOUSLY affect each other -Biological treatment can change thought; CBT can change biological processes -Underlying beliefs = cognitive vulnerabilities -Rigid, negative beliefs lead to pathology
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Strategies of CT
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-Collaborative empiricism -Guided discovery -Deactivation of dysfunctional modes (use techniques to modify content and structure) -Construct more adaptive modes
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CT vs. psychoanalysis
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-Both assume behavior influenced by beliefs of which we may be unaware -Focus on links among symptoms, conscious beliefs, current experiences -Little concern w/ unconscious feelings or repressed emotions -Minimal focus on childhood/developmental issues except when assessing or addressing core beliefs -Highly structured + short term (12-16 weeks) -Active collaboration w/ patient
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CT vs. REBT (repeat ch. 5)
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-Thoughts labeled DYSFUNCTIONAL -INDUCTIVE reasoning -Cognitive specificity for each disorder -FUNCTIONAL view of problem; arises from multiple cognitive distortions -More COLLABORATIVE -Psychoeducation early + critical part of treatment
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CT vs. behavior
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-Very diff. -Individual as more active than passive in change process -Emphasize expectations, interpretations, reactions (cognitions)
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CT vs. CBT???
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-CBT = overarching term for therapies that integrate cognitive + behavioral techniques -CT = most COMMONLY practiced form of CBT
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CT and medication
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-CT equivalent to psychotropic medication (depression, bulimia, anxiety) -COMBO of both is SUPERIOR to either used alone -CT + antidepressants show equal efficacy rates -BETTER COMBINED FOR BIPOLAR
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Aaron Beck
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-Developed cognitive therapy -Research on depression = FOUNDATION of CT -“Anger turned inward” theory towards depression -Found evidence for negative cognitions
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Influential names in CT
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-Beck -Bandura -Ellis -Mahoney -Meichenbaum
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CT shown to reduce __________ by ______________ over 18 months
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-Rate of suicide re-attempts -50%
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CT and personality
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-Thinking is problematic /distorted when it is… Extreme Broad Catastrophic Negative Idealistic Demanding Judgmental Obsessive Confusing
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Cognitive distortions
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-Arbitrary inference -Selective abstraction -Overgeneralization -Magnification/minimization -Personalization -Dichotomous thinking -Mind reading -Fortune teller error -Emotional reasoning -Should statements -Labeling and mislabeling
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Arbitrary inference
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-Drawing conclusion w/o evidence or in face of contradictory info -Ex: woman w/ anorexia believes she is fat though she is dying from starvation
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Selective abstraction
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-Dwelling on single negative detail taken out of context -Ex: on date, you said one thing you wish you could have said differently and now see entire evening as disaster
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Overgeneralization
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-Single negative event viewed as never-ending pattern of defeat -Ex: after job interview, accountant does not receive job and begins to think they will never find job despite qualifications
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Magnification/Minimization
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-Binocular trick -Things seem bigger or smaller than they really are -Ex: Employee thinks minor mistake will lead to being fired vs. alcoholic who believes he doesn’t have a problem
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Personalization
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-Assuming personal responsibility for something you’re not responsible for -Ex: seen in patients who are sexually abused
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Dichotomous thinking
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-Things are black and white -No gray or middle ground -Ex: Things are good or bad and perfect or failure
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Mind reading
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-Assuming someone is responding negatively to you without checking it out -Ex: husband in bad mood, assume it is your fault and don’t ask what’s wrong
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Fortune teller error
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-Creating negative self-fulfilling prophecy -Ex: You think you will fail important exam so you don’t study and fail
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Emotional reasoning
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-ASsume negative feelings result from fact that things are negative -Ex: If you feel bad, then world or situation is bad. You don’t consider that feelings are misrepresentation of facts
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Should statements
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-Guilt self by using words like should, must, ought instead of IT WOULD BE PREFERRED
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Labeling and mislabeling
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-Name calling rather than just criticizing behavior
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CBT session structure
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-Mood check -Goals -Bridge from last session -HW assignment -Summarizing throughout + at end of session -Patient feedback
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General principles of CT
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-Goal: correct dysfunctional thinking + modify negative assumptions -Patient taught to be scientists + generate and test hypotheses -Collaborative relationship
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Fundamental concepts of CT
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-Collaborative empiricism to demystify therapy -Socratic dialogue (questioning to help patients come to own conclusions) -Guided discovery (therapist collab. w/ patient to develop behavioral experiments and test hypotheses
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CT Therapy Process
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1. Initial sessions -Essential to build relationship -Problem definition -Goal setting -Therapist provides psychoeducation 2. Middle sessions -Shift focus from symptoms + behaviors to patterns of thinking 3. Termination -Expectation that therapy time is limited
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Ex. of behavioral interventions in CT
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-Weekly activity monitoring w/ pleasure and mastery ratings -Activity scheduling -Graded assignments -Conducting behavioral experiments -Exposure -Role plays
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Weekly activity monitoring
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-Record activities -Rate for pleasure and mastery -Allows sense of accomplishment, evaluation auto. thoughts,
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Ex. of cognitive interventions in CT
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-Elicit automatic thoughts through dysfunctional thought records -Identify whether thoughts represent distortions in info processing -Socratic questions to evaluate thought process -Generate alternatives of how to think/act differently
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De-catastrophizing
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“What if that happened? Then what?”
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Reattribution
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Alternative explanations systematically examined
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Redefining
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-Help patient define a problem differently -Ex: nobody ever talks to me –> I need to try to initiate convos so people become interested
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Decentering
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-Used w/ social anxiety to shift focus -Patients taught that thoughts are thoughts and not “reality”
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LARGE effect size of CT for..
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-Unipolar depression -GAD -Panic disorder!!!!!!! -Social phobia -Childhood disorders
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MODERATE effect size CT
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Marital probs Anger Childhood somatic disorders Chronic pain
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SMALL effect size CT
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-Schizophrenia -Bulimia
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CT vs. antidepressants
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-Lower relapse rates -Reduced risk of symptom relapse
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Individuals w/ personality disorders are largely operating from….
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Deliberate thinking
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READ:
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p. 232 p. 235 p. 236 238 239 245 250
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Collab. empiricism – patients acts as a
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Practical scientist
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Guided discovery
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-Therapist serves as guide to clarify problem behaviors and thoughts -Patient creates HW assignments for selves called “behavioral experiments” WITH input from therapist
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CT will label non-adaptive thought as…
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Dysfunctional
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Most effective way to change thought is teach patient to… (Bandura)
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-Change a behavior
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Primary influences on cognitive theory
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-Phenomenological psychology -Structural theory -Cognitive psychology
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3 concepts of cog. model
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Cognitive triad Schemas Cognitive errors
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Efficacy of CT vs. medication for depression
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CT is superior or equal to
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Suicide risk is associated w/
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Hopelessness
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Beck’s 2 personality dimensions/modes related to….
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Sociotropy + autonomy
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Hypomania
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Inflated view of self and future
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Panic disorder
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Catastrophic interpretations of bodily/mental experiences
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Paranoia = inflated sense of
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Injustice
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In CT patient learns beliefs that are…
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REALISTIC
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Cognitions that are most accessible and least stable
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Voluntary thoughts
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Goal in initial CT sessions
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Problem definition Symptom relief Build relationship
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CT alone is not treatment for
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Bipolar disorder (need meds too)
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Asking patient “what if” is…
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Decatastrophizing
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Graded task assignment
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Assist patient in initiating task at nonthreatening level then gradually increase task difficulty
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Largest effect size of treatment for…
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Panic disorder
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Thoughts _____________ shifts in emotion
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Co-occur with or influence
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CT ______ reasoning
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INDUCTIVE
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_________ is strong predictor of eventual suicide
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Hopelessness
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Core beliefs vs. voluntary thoughts
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-Most stable, least accessible -Least stable, most accessible
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Use of __________ questions
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Socratic
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Early in treatment = ___________ techniques vs. later ___________ techniques
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early = behavioral later = cognitive
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OVERALL!!!!!
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-Aaron Beck -Thoughts influence: behavior, motivation, physiology and emotions -Behavioral and cognitive techniques -Socratic “what if” questions -Guided discovery and collaborative empiricism -Inductive -Adapt more realistic beliefs -Pathology from dysfunctional beliefs -Modes -Schemas -Vulnerability/predisposition