Cognitive Therapies Module 71

Cognitive Therapy Assumes our thinking effects our feelings –Thoughts intervene between events and our emotional reactions –Depression often caused by self-blaming and overgeneralizing explanations of bad events Therapy focuses on recognition and alteration of unhealthy thinking patterns –Teaches people new, more adaptive ways of thinking and acting

Self-Serving/Defeating Bias Self-Serving Bias - Tendency to judge oneself favorably –Healthy people tend to do this Self-Defeating Bias - tendency to blame themselves for problems and credit the environment for successes Severely depressed patients tend to do this

Rational Emotive Behavior Therapy Developed by Albert Ellis People’s difficulties are caused by their faulty expectations and irrational beliefs Goal is to expose and confront the person’s core irrational beliefs ABCDE model:  Activating Event  Beliefs - Irrational  Consequences When an Activating event (A) occurs, it is the person’s Beliefs (B) about the event that cause emotional Consequences (C) Effective in the treatment of depression, social phobia, and certain anxiety disorders, and in helping people overcome self- defeating behaviors  Disputing Irrational Beliefs  Effective ways of thinking & behaving developed

How REBT Works Step 1: Identify the core irrational beliefs or self talk that underlie personal distress Step 2: Vigorously dispute and challenge the irrational beliefs. Therapist acts as a teacher to show patient how to do this. – Stop Irrational Thoughts – Reframe them to be more positive – Dispute irrational beliefs with evidence Rational-emotive therapists tend to be very direct and even confrontational From the client’s perspective, rational-emotive therapy requires considerable effort – person must admit her irrational beliefs and accept the fact that those beliefs are irrational and unhealthy – client must radically change her way of interpreting and responding to stressful events

REBT – AN EXAMPLE PROBLEM: Social Phobic concerned they will be publicly embarrassed when giving a class presentation. SOLUTION: Therapist questions the likelihood of such embarrassment occurring and impact of it. Therapist’s goal is to show the client that not only is their failure unlikely, but even if it did happen, it would not be a big deal.

REBT Therapy

Aaron Beck’s Cognitive Therapy Based on the assumption that thoughts, moods, and behaviors are interrelated Beck believes that depression and other psychological problems are caused by distorted thinking and catastrophic beliefs Focuses on changing the client’s unrealistic beliefs Therapist acts as model and aims for a collaborative therapeutic climate Therapy includes homework of writing down automatic thoughts or habits Gentler, less combative approach than Albert Ellis’ REBT

Cognitive Therapy: How it Works CT therapist encourages the client to empirically test the accuracy of his or her assumptions and beliefs – The client learns to recognize and monitor the automatic thoughts that occur without conscious effort or control – The client learns how to empirically test the reality of the automatic thoughts that are so upsetting CT is very effective in treating depression, anxiety disorders, eating disorders, PTSD, and relationship problems. It may also help prevent depression from recurring

Ellis’ REBT vs. Beck’s Cognitive Therapy Beck stresses the quality of the therapeutic relationship Beck places more emphasis on the client discovering misconceptions for themselves. The method is based upon the particular disorder. REBT therapists logically debate and vigorously challenge or dispute the irrationality of a client’s beliefs. Ellis views the therapist as a teacher and does not think that a warm personal relationship with a client is essential. REBT is often highly directive, persuasive and confrontive. REBT uses different methods depending on the personality of the client

Cognitive Behavioral Therapy An integrated therapy that combines cognitive therapy (changing self-defeating thinking) with behavior therapy (changing inappropriate behaviors) Based on the assumption that cognitions, behaviors, and emotional responses are interrelated Cognitive-behavioral therapists challenge maladaptive beliefs and substitute more adaptive cognitions They use behavior modification, shaping, reinforcement, and modeling to teach problem solving and change unhealthy behavior patterns Effective for treatment of anxiety, depression & anorexia nervosa

Prevalence of Cognitive Therapy Half of all faculty in accredited clinical psychology doctoral programs now align themselves with a cognitive or cognitive- behavior therapy orientation. (Data from Mayne & others, Note: Some faculty identify with more than one perspective.)

Family and Group Therapies

Group and Family Therapy Group therapy—one or more therapists working with several people at the same time. Family therapy—based on the assumption that the family is a system and treats the family as a unit. Couple therapy—relationship therapy that helps with difficulty in marriage or other committed relationships

Group Therapy Having a therapist work with a number of patients at one time Groups usually consist of 6 to 10 people Cognitive, behavior, and humanistic therapists all can lead group therapies.

Advantage of Group Therapy Therapists can help more than one person at a time. Overall session cost is lower. Patients interact with others having the same problems as they have. Builds a sense of community

Self-help groups: Helping yourself by helping others Self-help groups and support groups are typically organized and led by nonprofessionals The groups are either free or charge nominal fees to cover the cost of materials. Typically, members have a common problem and meet for the purpose of exchanging support The format of such groups varies enormously, but many follow a 12-step approach Self-help groups can be as effective as therapy More research is needed on why self-help groups are effective and on the kinds of people and problems that are most likely to benefit from them

Family Therapy Therapy that treats the family as a system Views the patient’s problems as influenced by or directed at family members Every family has certain unspoken “rules” of interaction and communication. Issues are explored, and unhealthy patterns of family interaction can be identified and replaced with new “rules” that promote the psychological health of the family Attempts to guide the family toward positive relationships and improved communication