1. Chapter 9
Cognitive and Cognitive-Behavioral Therapy

2. Cognitive and Cognitive-Behavior Therapy
Cognitions – thoughts, beliefs, and internal images that people have about events in their lives.
Cognitive counseling theories focus on mental processes and their influences on mental health.
A common premise is that how people think largely determines how they feel and behave.

3. Aaron Beck
A Philadelphia psychiatrist who was originally trained as a psychoanalyst.
His approach to mental disorders emphasizes the importance of cognitive thinking, especially dysfunctional thoughts.
Found that cognitive therapy is effective as a short-term treatment for depression and general anxiety.

4. Donald Meichenbaum
Considered to be one of the founders of Cognitive-Behavior Therapy (CBT).
Born and raised in New York City where he frequently observed people on the street talking to themselves.
Noted for his work with individuals with anger control and aggressive behavior and training adults with post-traumatic stress disorder.

5. View of Human Nature/Personality
Usually employed with individuals who suffer from:
dysfunctional automatic thoughts - involving content specific to an event.
schemata - general rules about themselves or the world associated with an event.
These individuals often engage is self-statements that affect their behavior.

6. Cognitive Distortions
“All or Nothing” Thinking
Selective Abstraction
Overgeneralization
Magnification
Minimization
Personalization
Labeling (Mislabeling)
Catastrophizing
Mind-reading
Negative Predictions

7. Roles of the Counselor Operate as a collaborator.
Share responsibility with clients to bring about change.
Function as experts on cognitions, behaviors, and emotions.
Allow clients to examine their beliefs functionally.
Diagnoses are used only as a way of working with clients to overcome a disorder.

8. Goals
Primary goal is to teach clients ways to monitor their negative or automatic thoughts.
Recognize the relationship between thoughts and emotions or behavior.
Compile evidence for and against the distorted automatic thoughts.

9. Process and Techniques
Specific and goal-directed.
Emphasizes modification of thoughts in order to bring about therapeutic changes.
Thought organization
Cold cognition – descriptive and non-evaluative
Warm cognition – preferences and non-preferences
Hot cognition – heavily-laden emotional-demand statements

10. 4 Step Procedure of Implementing Cognitive Strategies (Burns, 1989; Schuyler, 1991)
Use standardized guidelines for understanding in a concrete manner the events in people’s lives.
Set up a way of recording or reflecting people’s thoughts about those events in order to understand their cognitions in a clear, precise way.
Counselors and clients work to find a means to identify and challenge distorted thoughts.
Implement new ways of thinking that are realistic and productive.

11. Prevalent Cognitive Techniques
Specifying automatic thoughts.
Homework.
Cognitive interventions.
Challenging absolutes.
Reattribution.
Labeling of distortions.
Challenging “All or Nothing” thinking.
Cognitive Rehearsals.
Scriptotherapy.

12. Cognitive-Behavioral Techniques
CBT’s as a group emphasize:
The present
The environment
Learning
Common Interventions of CBT
Self-instruction training
Stress-inoculation training
Thought-stopping
Cognitive restructuring

13. Multicultural and Gender Sensitive Issues
Cognitive counseling and CBT approaches are applicable to multicultural populations.
Cognitive approaches may also be appropriate for both men and women in dealing with gender-specific concerns.
Drawback: Some women may become too dependent on their counselors to structure sessions and help them examine their beliefs.

14. Strengths and Contributions
Focused on teaching how to identify and monitor thoughts and behaviors and how to change or modify them.
Proactive in nature.
Demystify the process and techniques that are associated with choice and change.
Generally empowering.
Applicable to a wide range of disorders.

15. Limitations and Criticisms
For maximum benefit, clients need to have average or above-average intelligence.
Clients can not be psychotic or disabled by present problems.
Clients must be willing and able to complete systematic homework assignments.
Clients must possess a repertoire of behavioral skills and responses or be able to learn them rapidly.
Do not explore past influences including the unconscious or underlying conflicts.

16. The Case of Linda: Cognitive and Cognitive-Behavioral Therapy
How would you conceptualize this case using cognitive and cognitive-behavior therapy?
What would be your treatment plan for this client using a cognitive or cognitive-behavioral approach?