Review outline in notes Cognitive Therapy Review outline in notes I. Introduction A. The foundation upon which cognitive therapy is established can be II. Historical Background views which they take of them.” identified by the statement, “Men are disturbed not by things, but by the conducted by Aaron Beck. A. Cognitive therapy has its roots in the early 1960s research on depression C. Lazarus’ concept of personal appraisal by an individual of an event has also clients and behavioral techniques such as reinforcement and modeling. B. Beck’s concepts have been expanded to include active, direct dialogues with contributed to the cognitive therapy approach. III. Indications for Cognitive Therapy situation. D. Cognitive therapy is aimed at modifying distorted cognitions about a B. Today, it is also used with panic disorder, generalized anxiety disorder, A. Cognitive therapy was originally developed for use with depression. couples’ problems, bipolar disorder, hypochondriasis, and somatoform eating disorders, substance abuse, personality disorders, schizophrenia, social phobias, obsessive–compulsive disorder, posttraumatic stress disorder, disorder. the dysfunctional beliefs that predispose him or her to distort experiences. A. The goal of cognitive therapy is for the client to learn to identify and alter IV. Goals and Principles of Therapy weeks. B. Cognitive therapy is highly structured and short term, lasting from 12 to 16 1. Is based on an ever-evolving formulation of the client and his or her therapy: C. The following principles underlie cognitive therapy for all clients. Cognitive problems in cognitive terms. 4. Is goal oriented and problem focused. 3. Emphasizes collaboration and active participation. 2. Requires a sound therapeutic alliance. 6. Is educative, aims to teach the client to be his or her own therapist, and 5. Initially emphasizes the present. 8. Sessions are structured. 7. Aims to be time limited. emphasizes relapse prevention. 9. Teaches clients to identify, evaluate, and respond to their dysfunctional D. Basic Concepts. The general thrust of cognitive therapy is that emotional 10. Uses a variety of techniques to change thinking, mood, and behavior. thoughts and beliefs. of environmental cues. Basic concepts include: responses are largely dependent on cognitive appraisals of the significance errors. Examples include: situation, and without rational analysis. Sometimes called cognitive 1. Automatic thoughts. Thoughts that occur rapidly in response to a a. Arbitrary inference. In this type of error, the individual evidence to support it. facts to support it, or even sometimes despite contradictory automatically comes to a conclusion about an incident without the are made based on one incident—a type of “all or nothing” kind of b. Overgeneralization (absolutistic thinking). Sweeping conclusions black-or-white, good-or-bad terms. c. Dichotomous thinking. Situations are viewed in all-or-nothing, thinking. d. Selective abstraction (sometimes referred to as mental filter). A e. Magnification. Exaggerating the negative significance of an event. evidence. conclusion is drawn based on only a selected portion of the g. Catastrophic thinking. Always thinking that the worst will occur f. Minimization. Undervaluing the positive significance of an event. h. Personalization. Taking complete responsibility for situations outcomes. without considering the possibility of more likely positive without considering that other circumstances may have contributed individual’s fundamental beliefs and assumptions, which develop early 2. Schemas (core beliefs). Cognitive structures that consist of the to the outcome. others. These concepts are reinforced by further learning experiences in life from personal experiences and identification with significant specific, and positive or negative. attitudes. Schemas may be adaptive or maladaptive, general or and, in turn, influence the formation of other beliefs, values, and V. Techniques of Therapy 2. Therapist provides information about cognitive therapy and provides 1. Client must be prepared to become own therapist. A. Didactic (Educational) Aspects 3. A full explanation about correlation between distorted thinking and the assignments to reinforce learning. 1. Recognizing automatic thoughts and schemas B. Cognitive Techniques client’s mental illness is provided. a. Socratic questioning (also called guided discovery). The client is possible dysfunctional thinking and produce a dissonance about the Questions are stated in such a way that may stimulate recognition of asked to describe feelings associated with specific situations. b. Imagery. Through guided imagery, the client is asked to “relive” validity of the thoughts. individual within a situation that produces a maladaptive response c. Role-play. With role-play, the therapist assumes the role of an the stressful situation through his or her imagination. in the client. The situation is played out in an effort to elicit a written record of situations that occur and the automatic thoughts d. Thought recording. In thought recording, the client is asked to keep recognition of automatic thinking on the part of the client. 2. Modifying automatic thoughts and schemas. Techniques include: that are elicited by the situation. b. Examining the evidence. The client and therapist set forth the possibilities than had originally been considered. a. Generating alternatives. Helping the client see a broader range of automatic thought as the hypothesis and study the evidence both for validity of a negative automatic thought. c. Decatastrophizing. The therapist assists the client to examine the and against the hypothesis. the tendency of attributing adverse life events to themselves. d. Reattribution. This technique is aimed at helping clients decrease extended thought recording instrument in which the client is asked used in cognitive therapy to modify automatic thoughts. An e. Daily record of dysfunctional thoughts (DRDT). A common tool to record more rational cognitions than the automatic thoughts that uncover potential automatic thoughts in advance of their f. Cognitive rehearsal. A technique that uses mental imagery to occurred. Changes in emotional responses are also recorded. VI. Behavioral Interventions occurrence in a stressful situation. B. The following procedures are directed toward helping the client learn more cognitions. A. It is believed that cognitions affect behavior and behavior influences adaptive behavioral strategies that will in turn have a more positive effect on on an hourly basis and rate each activity for mastery and pleasure. The 1. Activity scheduling. The client is asked to keep a daily log of activities cognitions: during therapy. schedule is then used to determine important areas needing concentration time interval attached to each. This helps to make the client feel less overwhelming, it is broken down into smaller subtasks, with a goal and 2. Graded task assignments. When a client perceives a task to be powerless. maladaptive behaviors that may be contributing to dysfunctional rehearsal, this technique uses role-play to “rehearse” a modification of 3. Behavioral rehearsal. Often used in conjunction with cognitive from the intrusive thoughts or depressive ruminations that are 4. Distraction. Use of activities to distract the client and divert him or her social skills training, and thought stopping techniques may also be used 5. Others. Relaxation exercises, assertiveness training, role modeling, contributing to the client’s maladaptive responses. VII. Role of the Nurse: Application of the Nursing Process to modify dysfunctional cognitions. C. It is important for nurses to understand the basic concepts of cognitive B. These concepts are often not a part of basic nursing education. A. Cognitive therapy techniques are within the scope of nursing practice. D. A case study presented the role of the nurse in cognitive therapy in the therapy, as the scope of nursing practice continues to expand. context of the nursing process.

The foundation on which cognitive therapy is established can be identified by the statement, “Men are disturbed not by things but by the views which they take of them.”

Indications for Cognitive Therapy Depression Panic disorder Generalized anxiety disorder Social phobia Obsessive-compulsive disorder Posttraumatic stress disorder Substance abuse Personality disorders Schizophrenia Couple’s problems Bipolar disorder Hypochondriasis Somatoform disorder Eating disorders

Goals and Principles of Therapy The goal of cognitive therapy is for clients to learn to identify and alter the dysfunctional beliefs that predispose them to distort experiences. Cognitive therapy is highly structured and short-term, lasting 12 to 16 weeks. Cognitive therapy Is based on an ever-evolving formulation of the client and his or her problems in cognitive terms Requires a sound therapeutic alliance Emphasizes collaboration and active participation Is goal-oriented and problem-focused Initially emphasizes the present

Basic Concepts “The general thrust of cognitive therapy is that emotional responses are largely dependent on cognitive appraisals of the significance of environmental cues.” (Wright, Beck, & Thase, 2003)

Basic Concepts (cont.) Automatic thoughts – thoughts that occur rapidly in response to a situation and without rational analysis; sometimes called cognitive errors Some examples are: Arbitrary inference Overgeneralization Dichotomous thinking Selective abstraction Magnification Minimization Catastrophic thinking Personalization

Basic Concepts Schemas (core beliefs) – “Cognitive structures that consist of the individual’s fundamental beliefs and assumptions, which develop early in life from personal experiences and identification with significant others. These concepts are reinforced by further learning experiences and, in turn, influence the formation of other beliefs, values, and attitudes.” (Beck & Weishaar, 2005) Schemas may be adaptive or maladaptive, general or specific, and positive or negative.

Techniques of Cognitive Therapy Didactic (Educational) Aspects Clients must be prepared to become their own therapist. Therapists provides information about cognitive therapy and provides assignments to reinforce learning. A full explanation about correlation between distorted thinking and clients’ mental illness is provided. Cognitive Techniques Recognizing automatic thoughts and schemas Socratic questioning, Imagery, Role play and Thought recording

Behavioral Interventions (cont.) Distraction Relaxation exercises Assertiveness training Role modeling Social skills training Thought-stopping techniques