1. Chapter 15 Cognitive Psychotherapy

2.  Cognitive therapy has risen in popularity in recent decades  Currently, more clinical psychologists endorse it than any other single-school approach to therapy  Represents a reaction to both behavioral and psychodynamic therapy

3. Goal of Cognitive Therapy  Increase in logical thinking, or fix faulty thinking  The way we think about or interpret events determines the way we respond emotionally

4. Importance of Cognition  “Cognition” can also be called thought, belief, or interpretation  Although we often describe our feelings as stemming directly from events, cognitions actually intervene  Events don’t make us happy or sad. Instead, the way we think about those events does. Things happen We interpret those things Those interpretations influence our feelings

5. Revising Cognitions  If cognitions determine feelings, revising illogical cognitions can lead to more appropriate emotional reactions  If cognitions are more extreme than warranted, unwanted feelings can unnecessarily occur  Three steps to revising cognitions: Identify illogical cognitions (automatic thoughts) Challenge them Replace them with more logical cognitions  Regarding culture, are some beliefs too sacred to dispute?

6. Teaching as a Therapy Tool  Cognitive therapists often function as teachers with clients Educate clients about the cognitive model Use handouts, mini-lectures, readings Written assignments/homework Aspire for clients to ultimately be able to use the lessons learned to teach themselves rather than remaining dependent on the teacher

7. Homework  Cognitive therapists often assign homework between sessions Written Keep a record of events, interpretations, and feelings Behavioral Perform certain behaviors to examine the validity of a cognition that may be illogical

8. A Brief, Structured, Focused Approach  Cognitive therapy is typically: Relatively brief—often 15 sessions or less Structured and planned Sessions may not be as free-flowing or spontaneous as in other therapies Focused on particular goals determined by client and therapist at the outset

9. Two Approaches to Cognitive Therapy  Albert Ellis His approach is known as Rational Emotive Behavior Therapy (REBT) Despite the word “behavior” in the name, it is cognitive (not behavioral) therapy Emphasizes a connection between rationality and emotion

10. Two Approaches to Cognitive Therapy (cont.)  Albert Ellis (cont.) ABCDE model Activating Event Belief Emotional Consequence Dispute Effective New Belief These five columns provide a format for written records of client experiences Also provide a model of understanding and change for client

11. ABCDE Model Example AActivating EventStudying for or thinking about the CPA exam BBelief “I absolutely have to pass the CPA exam on my first attempt”; “If I don’t pass the CPA exam on my first attempt, my career is doomed, and that would destroy me.” CEmotional ConsequenceAnxiety DDispute “Who says you have to pass the CPA exam on your first attempt? I understand that’s a preference, but is it a life-or-death necessity? Realistically, don’t quite a few accountants fail the CPA exam on their first try? And don’t many of them pass it later and go on to have successful careers? And even if you don’t end up with the career in accounting that you envisioned, does that mean your life is ruined? There are plenty of ways for you to have a rewarding career that don’t involve accounting at all.” EEffective New Belief“I want to pass the CPA exam my on my first attempt, but it’s not an absolute necessity. If I pass it on a later attempt, that will probably work out fine also, and in the big picture, my happiness doesn’t depend entirely on following the career path I’ve imagined.”

12. Two Approaches to Cognitive Therapy (cont.)  Aaron Beck Daughter Judith Beck has become a leading figure as well General term “cognitive therapy” is label for his approach Dysfunctional Thought Record instead of ABCDE format for recording client experiences Different column headings, but similar concepts

13. Two Approaches to Cognitive Therapy (cont.)  Aaron Beck (cont.) Common thought distortions All-or-nothing thinking (no gray area) Catastrophizing (unrealistically expecting the worst) Magnification/minimization (mountain out of molehill) Personalization (assume too much responsibility) Overgeneralization (negative thoughts applied too broadly) Mental filtering (ignoring positive events and focusing only on negative events) Mind reading (presuming to know what others think)

14. Two Approaches to Cognitive Therapy (cont.)  Aaron Beck (cont.) Beliefs as hypotheses Our beliefs are hypotheses, even though we may live as if they are proven facts Therapy can involve putting these beliefs to the test to see if they hold true

15. Recent Applications of Cognitive Therapy  Mindfulness- and acceptance-based therapies Known as “third wave” therapies Mindfulness involves full attention to present moment without judging or wishing things were otherwise Engage with own mental process rather than experiential avoidance Derives from Buddhist tradition

16. Recent Applications of Cognitive Therapy (cont.)  Specific “third wave” therapies: Acceptance and Commitment Therapy Dialectical Behavior Therapy Metacognitive Therapy

17. Acceptance and Commitment Therapy (ACT)  Steven C. Hayes  Learn to accept internal psychological experience  Commit to one’s own personal values  Move from FEAR to ACT

18. Dialectical Behavior Therapy (DBT)  Marsha Linehan  Treatment of borderline personality disorder (BPD)  BPD conceptualized as problem of emotional regulation  Core practices of DBT Problem solving Validation Dialectics

19. DBT (cont.)  Four specific modules of skills training Emotion regulation Distress tolerance Interpersonal effectiveness Mindfulness skills

20. Metacognitive Therapy  Metacognition = thinking about thinking  The “activating event” can be a cognition itself  The cause of unhappiness is our thoughts about our thoughts  Metacognitive therapists make thinking about thinking the primary focus

21. Recent Applications of Cognitive Therapy (cont.)  Cognitive therapy for medical problems The way patients think about injury, illness, or condition can be powerful, especially when irrational Increasing logical thinking can improve mental and physical health Has been successfully applied to a variety of medical problems

22. How Well Does Cognitive Therapy Work?  Efficacy of cognitive therapy is strongly supported by a body of empirical evidence that is large and continues to grow Empirical support for treatment of many disorders, including depression, anxiety disorders, bulimia, PTSD, and others Cognitive therapists often conduct therapy in a manner that facilitates empirical study