Cognitive Theory SSS 571 Human Behavior & the Social Environment November 1, 2010 Eileen A. Dombo, MSW, PhD, LICSW

Today’s Plan Explore and challenge some misconceptions Review a bit about theory in general Present Cognitive theory via 7 questions Focus on people's problems and how this theory helps us help them change Put it all together by applying to case examples

Cognitive Theory as Response to Psychodynamic Psychotherapy

Theories of Cognition in Social Work Conscious thinking is believed to be the basis for almost all behavior and emotions. Our minds are actively engaged in constructing the reality we seek to understand. So long as a person’s cognitive style helps to achieve his or her goals, it is considered healthy.

However, a person’s thinking patterns can become distorted, featuring patterns of bias that ignore relevant information from the environment. Cognitive errors are habits of thought that lead people to distort input from the environment and experience psychological distress. Social workers who practice from cognitive theory assert that the individual’s thought process, not their emotions, should be the focus of intervention.

Cognition vs. Emotion COGNITION EMOTION Conscious & preconscious thinking processes Personal beliefs & subjective interpretations Erroneous beliefs result from misinterpretations and inaccurate conclusions; contribute to social dysfunction EMOTION Feeling states based on our appraisal of stimuli Affect—physiological expression of emotion Mood—a more stable feeling disposition; less intense and not situational

Meaning, Emotion and Cognition Cognitive theorists explore the conscious meaning of events (Beck). People are “meaning makers.” Public (objective) vs. private (unique). The private meaning is influenced by the emotional experience and is vulnerable to distortion; accounts for differences in emotional responses to situations.

Moving from Public to Private Meaning Event Conscious Emotion Private Meaning Meaning

Why does Dr. Early get so irritated when she hears “CBT”? Question: Is there such a thing as Cognitive/Behavioral theory? Answer: No

Why Not? Cognitive theory Assumes that reality is constructed “inside” - so each individual determines her/his subjective reality According to cognitive theory, we behave and change based on internal mental processes

Why Not? Behavioral theory Assumes that there is one objective reality “out there” that determines the individual According to behavioral theory, we behave and change based on external environmental influences

“CBT” is not the name of a theory. . . Cognitive-Behavioral Therapy (CBT) is a practice model, based on two theories: cognitive theory and behavioral theory.

Ok, so what is theory? an interrelated set of concepts that are based on observations the relationship between concepts is expressed as hypotheses These concepts and hypotheses are tested or testable and are intended to explain or predict phenomena.

What is clinical practice theory? An interrelated set of concepts that Explains the bio-psycho-social-spiritual nature of human beings Explains the development of stable patterns of adaptive and maladaptive thoughts, feelings, and behavior of human systems in transaction with their natural, built, and social environments Predicts how those stable patterns may change

Practice Theories have two functions Explanatory (or developmental) function Change (or practice) function

Practice Theory: The explanatory function Practice theory’s developmental or explanatory concepts explain how systems develop normally, why development goes awry, and/or how problems develop. Explanatory concepts are used in assessment. This is the focus of 571. Take out “client” between how and systems

Practice Theory: The change function Practice theory’s change concepts predict why systems change and how change can be facilitated. Change concepts are used in planning and intervention. Takes out “client between why and systems

Implementing the change function of practice theory: roles and techniques Practice roles and techniques are the concrete actions that flow from the abstract change concepts of practice theory. These actions, when performed by the helping person, facilitate client change.

7 Questions about Theory What are the major premises of the theory? Who thought this theory up? Who are the social workers building on this early thinking? How does the theory understand problems? How did problems come to be? How do problems go away on their own? How do social workers help make problems go away?

Cognitive Theory

QUESTION 1: What are the major premises of cognitive theory? We are what we think. We learn to think in the same ways we learn overt behavior (continuity assumption) That is, we learn to think in a particular way due to exposure to experience. To change what we are, we must change what we think by becoming aware of, evaluating, and challenging mediating thoughts

Mind as an information processing system Repeated similar experiences are stored in memory as thoughts about expectation, causation, attribution, etc. These patterns become automatic and outside of consciousness. Patterns of thought mediate between events and actions (mediational model) Memories are applied to multiple new events so they become less individual memory and more patterns for organizing experience (schema) Change comes through disputing or altering mediating thoughts.

The Cognitive ABC Activating Belief Consequential Event Feelings and Behavior

QUESTION 2: Who thought this theory up? Albert Ellis, PhD Aaron Beck, MD

The Fathers of Cognitive Theory: Aaron Beck and Albert Ellis

Albert Ellis ““Negative self rating is the major cause of human disturbance; we disturb ourselves.”

Aaron Beck “The thesis that the special meaning of an event determines the emotional response forms the core of the cognitive model of emotions and emotional disorders: The meaning is encased in a cognition – a thought or an image.”

QUESTION 3: Who are the social workers building on this early thinking? Sharon Berlin Paula Nurius

Sharon Berlin & Paula Nurius “This filtering is at the heart of the concept of mediation. As one kind of lens, or filtering mechanism, our self-conceptions tend to bias us in the direction of reconfirming what we already believe to be true about ourselves.”

QUESTION 4: How does cognitive theory understand “problems”? Problems are generally feelings and behaviors that are maladaptive for a person Problem feelings and behaviors emerge in response to activating events that are mediated by a distorted interpretive thought These immediate (automatic) thoughts are triggered by external events but are shaped by internal schemata, or ways of thinking, that may be distorted Present events “recruit” different schema that were learned in the past

QUESTION 5: How did problems come to be? Problem feelings and behaviors are the result of patterns of thinking that were learned in the past They are triggered in the present by activating events and mediated by situation specific automatic thoughts shaped by more general deeply held core beliefs

Problems (often feelings & behaviors) A B C Activating event belief consequential feeling or behavior feeling (sadness) activating automatic event thought (boyfriend breaks up (“of course it didn’t work”) behavior with me) (get drunk) core belief (I’m unlovable)

Raylene Raylene Shame/Self-Blame Date-raped “It’s my fault” Goes back to abusive ex Bad things happen to me because I am a bad person

Bob Fight with wife anger She doesn’t respect me storms out anger abates I am powerless

QUESTION 6: How do problems go away on their own? Through changing one’s mind Cognitive activity affects behavior Cognitive activity may be monitored and altered Desired behavior change may be affected through cognitive change.

We process much information that makes sense Some information comes is easily processed through existing meaning structures (schema) The information “fits,” or is congruent. the information makes sense; it is meaningful

But we also process information that makes no sense Other information cannot be processed easily through existing meaning structures (schema), The information does not fit; it is discrepant, when we experience contrasts between what we want and what we have; how things were and how they are; what we expect and what actually happens. The information makes no sense; it is meaningless

How to Adapt to Discrepant Informational Cues (DIC) When faced with discrepant informational cues (DIC), people adapt by Retreat: Changing the DIC (removing oneself from poisoned environment or remove the stressor) Assimilation: making the DIC fit with existing schema (distort the information to fit the schema) Accommodation: Reorganizing existing schema to fit the new DIC (change schema to fit the information)

QUESTION 7: How do social workers help make problems go away? Techniques to recognize maladaptive automatic thoughts and core beliefs Techniques to evaluate maladaptive automatic thoughts and core beliefs Techniques to challenge and restructure maladaptive automatic thoughts and core beliefs Techniques to recruit and strengthen existing adaptive thoughts (the strengths perspective – introduced by the social workers!)

Cognitive Distortions/Errors Absolute thinking Overgeneralization Selective abstraction (focus on negative) Arbitrary inference (negative conclusion without sufficient evidence) Magnification Minimization Personalization

The Cardinal Question of Cognitive Therapy Aaron Beck directs, “Whenever you experience an unpleasant feeling, try to recall what thought you had prior to it.” Judith Beck says the cardinal question of cognitive therapy is, “What was going through your mind when the mood changed?”

From concept to technique in cognitive therapy Focus on mediating thoughts and beliefs Recognizing or becoming aware of thoughts Evaluating thoughts to determine viability Challenging and restructuring those that do not serve one’s goals

Critiques Cognitive theories are criticized for ignoring the environment Behavioral theories are criticized for reducing all human behavior to simple responses to stimuli without critical thought or feeling involved (more on this next week).

Social Learning Theory “People are neither entirely determined by internal causes nor environmental stimuli, but psychological functioning is accounted for by a reciprocal interaction of personal & environmental determinants.” (Bandura, 1977)

Philosophical underpinnings: Behavior is learned when individuals respond to environment through stimuli, reinforcement, & imitation Behavior is influenced by personal interpretations & expectations about the environment

The central process in learning is imitation Behavior is the result of modeling + thought and reasoning Employs moral and cognitive development by addressing self-efficacy and self-reinforcement We do what makes us feel personally competent Behavior becomes self-regulated through self-reinforcement Dysfunctional thoughts lead to dysfunctional behavior

In closing . . . . . . . . . . . . . . . . . . . . We are what we think; to change what we are, we must change what we think.