COGNITIVE PSYCHOTHERAPY TOWARD ANEW MILLENNIUM

COGNITIVE PSYCHOTHERAPY TOWARD ANEW MILLENNIUM SCIENTIFIC FOUNDATIONS AND CLINICAL PRACTICE

Edited by

Tullio Scrimali and Liria Grimaldi Department of Psychiatry Medical School University of Catania Catania, Italy

Foreword by Arthur Freeman

Springer Science+ Business Media, LLC

Proceedings of the International Congress of Cognitive Psychotherapy: Cognitive Psychotherapy Toward a New Millennium, held June 20-24, 2000, in Catania, Italy

ISBN 978-1-4613-5135-1 ISBN 978-1-4615-0567-9 (eBook) DOI 10.1007/978-1-4615-0567-9

©2002 Springer Science+Business Media New York Originally published by Kluwer AcademiclPlenum Publisher, New York in 2002

Softcover reprint of the Hardcover I st edition 2002

http://www.wkap.nl/

10987654321

A c.I.P. record for this book is available from the Library of Congress

All rights reserved

No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from the Publisher

This book is dedicated to Carlo Perris. He was a great Italian and a great man.

We have been and we will be forever proud of his friendship.

Ciao, Carlo!

Tullio Scrimali

Liria Grimaldi

Hey now, all you sinners Put your lights on, Put your lights on Hey now, all you lovers Put your lights on, Put your lights on [ ... J

Introduction to the images

Because there s a monster living under my bed Whispering in my ear There s an angel with a hand on my head She says I've got Nothing to fear f. .. J

"Put your lights on" - from: C. Santana - Supernatural - 1999

We tum on our lights on meeting other sorrowful human beings in therapy. Dancing in the moonlight in company, or crossing the soul's oceans and deserts with our fragmentary maps ... Rashly we take on the task of saving ship-wrecked souls in the storm of emotions. We keep our light on.

Lorenzo Filippone

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by Lorenzo Filippone

About the Editors

Tullio Scrimali

Tullio Scrimali (Catania, Italy, 1952) studied Medicine at the University of Catania and received specialty training in Psychiatry at the University of Milan where he had his Master Degree in 1981.

For the past 20 years he has taught cognitive psychotherapy at the University of Catania and has been a Teacher Member of the Italian Association of Cognitive Psychotherapy since 1987.

In addition to local teaching, he has lectured or presented workshops in many cities in Europe and North America.

Most recently, he set up an international training program in Warsaw, the first cognitive therapy training program in Poland.

He has published 6 books and more than 100 scientific articles on topics such as the links between brain functioning and cognition, constructivist approaches to therapy, cognitive therapy and rehabilitation of schizophrenic patients. The articles and chapters of book are published in many languages.

He founded the international journal, Complexity and Change and he was Chair of the Scientific Committee and of the Organizing Committee for the International Congress, "Cognitive Psychotherapy Towards a New Millennium," held in Catania in June, 2000.

Tullio Scrimali is actually Professor of Psychotherapy at the Department of Psychiatry, the Medical School of the University of Catania and also directs an International School of Cognitive Psychotherapy, called ALETEIA, he founded in Enna, Sicily.

Tullio Scrimali is Member of the Board of the International Association for Cognitive Psychotherapy. He is also a founder fellow of the International Academy of Cognitive Therapy.

Liria Grimaldi

Liria Grimaldi (Catania, Italy, 1954) studied Medicine at the University of Catania and specialized in Psychiatry at University of Messina.

She teaches cognitive psychotherapy at the University of Catania and she is also a Teacher Member of the Italian Association of Cognitive Psychotherapy.

She has lectured and presented workshops in many cities, in Europe and North America.

She has authored 5 books and more than 100 scientific articles.

Together with Tullio Scrimali, she founded the international journal, Complexity and Change and also the school of Cognitive Therapy ALETEIA

Liria Grimaldi is Professor of Psychotherapy at the Department of Psychiatry, the Medical School of the University of Catania.

Liria Grimaldi is a founder fellow of the International Academy for Cognitive Psychotherapy.

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List of Contributors

Darlys J. Alford University of Southern Mississippi, USA

Liliana H. Ar6stegui Cognitive Therapy Center of Buenos Aires, ARGENTINA

Monica Bacchetta Applied Technology for Neuro-Psychology Lab. Istituto Auxologico Italiano, ITALY

Brogna Barej Nowowiejski Hospital, POLAND

Sara Baringoltz Cognitive Therapy Center, of Buenos Aires, ARGENTINA

Margherita Baruffi Laboratorio Sperimentale di Ricerche Psicologiche, Istituto Auxologico Italiano, ITALY

Marco Bateni Centro per i disturbi d'Ansia e dell'Umore, Divisione di Psichiatria, Casa di Cura "Villa Margherita ", ITALY

Antonello Bellomo Department of Psychiatry, University ofF oggia, ITALY

Maciej Bennewicz Nowowiejski Hospital, POLAND

Maria Bernardini Centro per i disturbi d'Ansia e dell'Umore, Divisione di Psichiatria, Casa di Cura "Villa Margherita", ITALY

Behrooz Birashk Tehran Psychiatric Institute, IRAN

Lucio Bizzini Department of Psychiatry, Clinic of Geriatric Psychiatry of Geneva, SWITZERLAND

Vera Bizzini Department of Psychiatry, Clinic of Geriatric Psychiatry of Geneva, SWITZERLAND

JohnR. Bola Assistant Professor School of Social Work University of Southern California, Los Angeles, CA

Anna Maria Bramante Department of Psychiatry, University of Catania, ITALY

Claudia Bregman Fundacion Aigle, ARGENTINA

Celina Brykczynska Institute of Psychiatry and Neurology, POLAND

Ludwik Bryla Department of Psychiatry Medical University of Warsaw, POLAND

Paula Budich Centre of Cognitive Therapy, Buenos Aires, ARGENTINA

Enrique Camacho UCLA Center for Research on Treatment & Rehabilitation of Psychosis, USA

Giuseppe Cannella Department of Psychiatry, University of Catania, ITALY

Antonino Carcione Associazione di Psicologia Cognitiva (APC), Terzo Centro di Psicoterapia Cognitiva di Roma, ITALY

Isabel Caro Universidad de Valencia, SPAIN

Maria Teresa Cattaneo University of Milan, ITALY

Suma P. Chand Sultan Qaboos University, SULTANATE OF OMAN

Young Hee Choi Seoul Paik Hospital, Inje University, SOUTH KOREA

Kinga Chutkowska Nowowiejski Hospital, POLAND

Alicia Cortejarena Cognitive Therapy Center of Buenos Aires, ARGENTINA

Frank M. Dattilio University of Pennsylvania, School of Medicine, USA

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Gianluigi Dell'Erba Centro di Salute Mentale, Gallipoli, ITALY

Giorgia Della Giusta Centre for Clinical Sexuology, ITALY

Fabrizio Didonna Centro per i disturbi d'Ansia e de//,Umore, Divisione di Psichiatria, Casa di cura "Villa Margherita", ITALY

Giuseppe Giancarlo Dimaggio Associazione di Psicologia Cognitiva (APC), Terzo Centro di Psicoterapia Cognitiva di Roma, ITALY

Michael Dolan Department of Psychology, Philadelphia College of Osteopathic Medicine, USA

Thomas Dowd The University of Akron, USA

David Edwards Department of Psychology, Rhodes University, SOUTH AFRICA

Maurizio Falcone Associazione di Psicologia Cognitiva (APC), Terzo Centro di Psicoterapia Cognitiva di Roma, ITALY

Christine Favre Clinique Romande de Readaptation, Sion, SWITZERLAND

Guillem Feixas University of Barcelona, SP AlN

Hector Fernandez-Alvarez Centre for Cognitive Therapy of Buenos Aires, ARGENTINA

Lorenzo Filippone DSM 1, AUSL 8 di Siracusa, ITALY

Arthur Freeman Department of Psychology, Philadelphia College of Osteopathic Medicine, USA

Kenji Fukui Department of Psychiatry, Kyoto Prefectural University of Medicine, JAPAN

Dario Galati Department of Psychology, University of Turin, ITALY

Contributors

Carlos Giambroni Cognitive Therapy Center of Buenos Aires, ARGENTINA

Panteleimon Giannakopoulos Department of Psychiatry, Clinic of Geriatric Psychiatry of Geneva, SWITZERLAND

Liria Grimaldi Department of Psychiatry, University of Catania, ITALY

OlgaGuriz Ankara Residency Training Hospital, Department of Psychiatry, TURKEY

Inga Huld Hermosdottir Faculty of Social Science, University of Iceland, ICELAND

Kazuomi Inoue Department of Human Development, Naruto University of Education, JAPAN

Banu Isik Ankara Residency Training Hospital, Department of Psychiatry, TURKEY

Thomas E. Joiner Jr. Department of Psychology, Florida State University, USA

Chryssoula Karba-Schina Laboratory of Developmental Psychology and Psychopathology, Department of Preschool Education, University ofThessaly, GREECE

Nobuhide Kashiwagi Yamatogawa Junior High School, Osaka, JAPAN

Diana Kirszman Fundacion AlGLE of Buenos Aires, ARGENTINA

Andrzej Kokoszka Department of Psychiatry Medical University of Warsaw, POLAND

Katharine Kolcaba The University of Akron, USA

Alex Kopelowicz UCLA School of Medicine & San Fernando Mental Health Center Los Angeles, USA

Dominic Lam Psychology Department, Institute of Psychiatry, UNITED KINGDOM

Contributors

Maria Lidia Lamberto Cognitive Therapy Center of Buenos Aires, ARGENTINA

Robert L. Leahy Department of Psychiatry, Weill Cornell University Medical College, New York Presbyterian Hospital, USA

Robert Paul Liberman UCLA School of Medicine & San Fernando Mental Health Center Los Angeles, USA

Grazia Lomunno ALA.M C. (Associazione Italiana di Analisi e Modijicazione del Comportamento), ITALY

Lars-Gunnar Lundh Department of Psychology, Stockholm University, SWEDEN

William J. Lyddon University of Southern Mississippi, USA

Francesco Mancini Scuola di Specializzazione in Psicoterapia Cognitiva, Associazione di Psicologia Cognitiva di Roma, ITALY

Chantal Mansour Laboratory of Cognitive Psychology, Department of Psychology, University Saint Joseph de Beyrouth, LlBAN

Carlos Meza Cognitive Therapy Center of Buenos Aires, ARGENTINA

Enrico Molinari Laboratorio Sperimentale di Psicologia, ATN-P Lab. Istituto Auxologico Italiano, Verbania, ITALY

Dipart. di Psicologia, Universita Cattolica del Sacro Cuore, Milan, ITALY

Antonella Montano Istituto Skinner di Roma, ITALY

Shirley Morrissey University of Tees side, UNITED KINGDOM

Loren R. Mosher Director, Soteria Associates San Diego, & Clinical Professor of Psychiatry School of Medicine University of California at San Diego, USA

Maciej Moskwa Department of Psychiatry, The Medical University of Warsaw &Department of Philosophy, Warsaw University, POLAND

Cecilia Navarrini Institute of General and Clinical Psychology, Faculty of Medicine and Surgery, University of Siena, ITALY

Ghassem Naziri Tehran Psychiatric Institute, IRAN

Arthur M. Nezu MCP Hahnemann University, USA

Giuseppe Nicolo Associazione di Psicologia Cognitiva (APC), Terzo Centro di Psicoterapia Cognitiva di Roma, ITALY

AynurOzel Ankara Residency Training Hospital, Department of Psychiatry, TURKEY

Christine A. Padesky Center for Cognitive Therapy, Huntington Beach, USA

Alessandra Palma Department of Psychology, University of Palermo, ITALY

Marisol Perez Department of Psychology, Florida State University, USA

Carlo Perris Svenska Institutet for Kognitiv Psykoterapi, SWEDEN

Gianpiero Petriglieri Department of Psychiatry, University of Catania, ITALY

Gianpaolo Pierri Department of Neurological and Psychiatric Sciences, University ofBari, ITALY

Olimpia Pino Institute of Psychology, University of Parma, ITALY

Claudio P. Pia Cognitive Therapy Center of Buenos Aires, ARGENTINA

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Elzbieta Plonecka Nowowiejski Hospital, POLAND

Katia Polopoli Department of Psychiatry, University of Catania, ITALY

Igor Pontalti Associazione di Psicologia Cognitiva (APC), Terzo Centro di Psicoterapia Cognitiva di Roma, ITALY

Agnieszka Popiel II Department of Psychiatry Medical University of Warsaw, POLAND

Jorg Prieler Schuhfried Ges.m.b.H., AUSTRIA

Michele Procacci Associazione di Psicologia Cognitiva (APC), Terzo Centro di Psicoterapia Cognitiva di Roma, ITALY

Georges Rabbath Laboratory of Cognitive Psychology, Department of Psychology, University Saint Joseph de Beyrouth, LIBAN

Joseph Reser University of Durham, Stockton on Tees, UNITED KINGDOM

John H. Riskind George Mason University, Virginia, USA

Giuseppe Riva Istituto Auxologico Italiano, Verbania, & Dipartimento di Psicologia, Universita Cattolica del Sacro Cuore, Milano, ITALY

RobertRizk Laboratory of Cognitive Psychology, Department of Psychology, University of Saint Joseph de Beyrouth, LIBAN

Roberto A. Rubio Cognitive Therapy Center of Buenos Aires, ARGENTINA

Jeremy D. Safran New School University, USA

Mauricette Saikali Laboratory of Cognitive Psychology, Department of Psychology, University Saint Joseph de Beyrouth, LIBAN

Contributors

Santoni Rutgiu Day Hospital per la diagnosi e la cura dei disturbi del comportamento alimentare presso if Policlinico di Bari, ITALY

Luis A. Saul University of Salamanca, SPAIN

Oliver Scheibenbogen Schuhfried Ges.m.b.H., AUSTRIA

George Schreiner University of Southern Mississippi, USA

Jan Scott Department of Psychological Medicine, University of Glasgow, UNITED KINGDOM

Tullio Scrimali Department of Psychiatry, University of Catania, ITALY

Gabriel E. Sella Ohio Valley Disability Institute, USA

Antonio Semerari Associazione di PSicologia Cognitiva (APC), Terzo Centro di Psicoterapia Cognitiva di Roma, ITALY

Liliana Signorini Institute of General and Clinical Psychology, Faculty of Medicine and Surgery, University of Siena, ITALY

Steven M. Silverstein Weill Medical College of Cornell University and New York Presbyterian Hospital, USA

Monika Sitarz Department of Psychiatry, Medical University of Warsaw, POLAND

Malgorzata Siwiak -Kobayashi Institute of Psychiatry and Neurology, POLAND

Jakob Smari Faculty of Social Science, University of Iceland, ICELAND

Diane Spangler Department of Psychology, Brigham Young University, USA

Cheri Lynn Sparks University of Southern Mississippi, USA

Contributors

SiguIjon Stefansson Department of Neurology, University of Iceland, ICELAND

Richard Steiner The University of Akron, USA

Jakub Szumanski II Department of Psychiatry, Medical University of Warsaw, POLAND

Lydia Tineo Cognitive Therapy Center of Buenos Aires, ARGENTINA

M. Hakan Turkcapar Ankara Residency Training Hospital, Department of Psychiatry, TURKEY

Berardina Valerii DEA (Dipartimento Emergenza Accettazione), Azienda Ospedaliera Policlinico "Umberto I", Roma, ITALY

Francesco Vincelli Laboratorio Sperimentale di Psicologia, ATN-P Lab. Istituto Auxologico Italiano, Verbania, & Department of Psychology, Universita Cattolica di Milan, ITALY

Brenda Wiederhold Center for Advanced Multimedia Psychotherapy,

CSPP Research and Service Foundation, California, USA

Ruth Irene Wilner Cognitive Therapy Center of Buenos Aires, ARGENTINA

Michael Wohlman Department of Psychology, Rhodes University, SOUTH AFRICA

Grace Wong Psychology Department, Institute of Psychiatry, London, UNITED KINGDOM

Michi Hatashita-Wong Weill Medical College of Cornell University and New York Presbyterian Hospital, USA

Maria Zafiropoulou Laboratory of Developmental Psychology and Psychopathology, Department of Preschool Education, University ofThessaly, GREECE

Marek Zebrowski Nowowiejski Hospital, POLAND

Anna Zinetti Department of Psychiatry, Clinic of Geriatric Psychiatry of Geneva, SWITZERLAND

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o

Foreword

In the roughly two decades since Aaron T. Beck published the now classic "Cognitive Therapy of Depression," and Michael J. Mahoney declared the "Cognitive Revolution," much has happened.

What was proposed as the "cognitive revolution" has now become the zeitgeist, and Cognitive Therapy (CT) has grown exponentially with each passing year. A treatment model that was once seen as diffe­rent, strange, or even alien, is now commonplace. In fact, many people have allied themselves with CT claiming that they have always done CT. Even my psychoanalytic colleagues have claimed that they often use CT. "After all," they say, "Psychoanalysis is a cognitive therapy."

Cognitive Therapy (or Cognitive Psychotherapy) has become a kaleidoscope model of treatment, with influences coming from many sources. Some of these contributory streams have been information pro­cessing, behavior therapy, Constructivist psychology, and dynamic psychotherapy.

Each of these sources have added color, shading, and depth to the CT model. What was originally uni­dimensional in terms of the CT focus on depression has become multidimensional as the CT model has been applied to virtually every patient population, treatment setting, and therapy context.

CT must now be seen as a general model of psychotherapy that, with modifications, can be applied to the broad range of clinical problems and syndromes.

What has tied these various applications of CT together is the emphasis on a strong grounding in cogni­tive theory, a commitment to empirical support, and a dedication to broadening the model.

It is said that Freud was concerned that his psychoanalysis was being derided as the "Viennese Science". After all, psychoanalysis was founded in Vienna, promoted in Vienna, and the most visible practitioners were Viennese. Freud's inclusion of Jung in the early circle gave the movement a more international flair by including a Swiss member (albeit a German Swiss).

CT has not had that same experience. From the earliest days, CT included the cognitive and behavio­ral work of many contributors. Practitioners and researchers in both Britain and Sweden were early in the fold, notably John Teasdale and Ivy Blackburn in England and the late Carlo Perris in Sweden.

I was fortunate by being in the best place, with the right people, at the perfect time. That place was the University of Pennsylvania, the time was the late 1970's and the group of people were led by Aaron T. Beck. Part of Beck's genius was to draw in some of the most brilliant researchers, teachers, and theo­reticians into the group. Some of the early group included Maria Kovacs, Brian Shaw, Steve Hollon, Gary Emery, John Rush, and Ruth Greenberg.

I recall being at a psychological congress with Dr. Beck in 1979, before the depression book was published. We put signs around the conference venue asking people interested in discussing Cognitive Therapy to meet that evening in one of the hotel meeting rooms. About ten people showed up.

Two years later, a symposium at the annual meeting of the American Psychological Association filled a room with over 500 people. The symposium had the rather pretentious title, "New Directions in Cognitive Therapy". The pretension came from the fact that in 1981 we had barely established old directions for CT.

Denise Davis, a young psychologist at that meeting was so taken with what she heard that she sought training from Dr. Beck, and is now a colleague and collaborator with Dr. Beck and me. Denise also ser-

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xviii Foreword

ved as the founding editor of the journal, Cognitive and Behavioral Practice.

After that meeting, I shared a taxi with Dr. Beck from the hotel to the airport. He was enthusiastic about the great display of interest we had just seen. With his typical humility he wondered how long this inte­rest would last and where we would go with this new movement. He had no idea of how his work would grow over the next 20 years.

There is an American folk-hero. His name was John Chairman. He is better known as Johnny Appleseed. Chairman traveled throughout the frontier during the early years of the United States plan­ting apple trees. Several years after he was gone, there were thousands of apple trees resulting from his planting the seeds. In the past two decades I have been honored and privileged to help to plant a num­ber of seeds around the world.

We have heard the terms, "cultural diversity," "cultural sensitivity," or cross cultural awareness". The implication of these terms is that different cultures may be so very different that models of assessment or treatment developed in one culture may not be valid in another culture.

I was not terribly surprised, however, that when I taught in the United Kingdom that the English said, "We are interested in CT because it well suits the English mind." It also made sense when I heard the same message in Sweden. It was, however, when I traveled to the East, to Japan and China, that being told the CT was interesting because " ... .it well suits the Chinese (or Japanese) mind".

Now I was really puzzled. Having now traveled to 22 countries, I have seen this phenomenon again and again. The basic CT model has been able to fit many cultures, often quite different one from the other. CT books in English have been translated into many other languages. How could this be so?

The answer is quite simple. CT is not content based but rather process based. The goal of the cogniti­ve therapist, wherever they practice, is to help the patient to understand the basic templates that we all develop for perceiving and understanding the world.

These "schema" influence every aspect of our responses. CT has been, from its earliest formulation, schema-based and schema focused. What differs from culture to culture are the schema. The process for understanding the schema transcends the particular culture.

Beck could not have predicted in the early days the contribution and influence that CT would have. There is now an international association for cognitive psychotherapy (IACP) that sponsors and sup­ports a triennial international conference.

The association's journal, The Journal of Cognitive Psychotherapy: An International Quarterly publis­hes articles by professionals from around the world.

IACP is a constituent member of the World Congress Committee and thereby has an effect on another international meeting, the triennial World Congress of Behavioral and Cognitive Therapies.

The Academy of Cognitive Therapy is working to set performance standards for what is considered the highest level of practice of CT.

The editors of this volume, Tullio Scrimali and Liria Grimaldi, are two of the foremost practitioners, researchers and teachers of cognitive therapy. They have, in a very brief time, created a series of mira­cles.

If word of these miracles traveled from the University in Catania in Sicily north to the Vatican and who knows what honors these two would receive? Their miracles have included the establishment of the

Foreword XIX

first chair in Cognitive Psychotherapy in any Italian University.

They have established a state accredited training school for the education and training of cognitive the­rapists. They have exported their training model to other countries, most notably Poland. Tullio and Liria have produced a superb journal, Complexity and Change, with articles in both Italian and English.

Tullio almost single-handedly organized, promoted, and ran a most successful and inspiring congress in Catania in the summer of 2000. Tullio and Liria have published several volumes and far too many chapters and journal article to record here.

One of their crowning achievements to date, however, is this volume. Nowhere is this intemational focus of CT more clear and obvious than in this book. Tullio and Liria have sought contributions from the preeminent cognitive therapists in the world. Contributors from 14 countries have addressed the broadest range of clinical topics.

As the reader will quickly see, cognitive therapists are not of one mind nor are we moving lock-step in a parochial or orthodox manner. While this lack of orthodoxy is troubling to some cognitive therapists it is thrilling to me. It shows the breadth and depth of the model and the diversity within the model.

It is also fitting and notable the the publishers of this volume, Kluwer AcademiclPlenum, were pioneers in publishing the earliest texts in CT. Some of the early work of Mahoney, Meichenbaum, Foreyt and Rathgen, Freeman, and others was published under the Plenum imprint.

Creative applications of CT, expansion of the model to new populations, and ongoing outcome research will continue to drive our work. The continued growth of CT will be based on how the basic process is understood and used in new cultural settings. The watchwords for the future are process, structure, and empiricism. The need and emphasis for empirical support of the model will continue to be a hall­mark of CT.

A final, and more personal note. I have been blessed and privileged to have met Tullio and Liria many years ago. To count them among my very dearest friends has been wonderful, both personally and pro­fessionally. This is why their request for me to write this foreword is so flattering.

I commend this volume as a standard for the dissemination of information about CT. I commend their choice of contributors. Finally, I commend the excellence of the individual contributions. With this volume and the conference upon which it was based, CT has moved strongly and forcefully into the 21 st century.

Arthur Freeman Philadelphia, Pennsylvania

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"Images"

by Lorenzo Filippone

Preface

At the beginning of the new millennium, and after a turbulent development process of almost fifty years, Cognitive Psychotherapy still does not seem to have reached a full epistemological, doctrinaire and applicative maturity.

However, at a clinical level, Cognitive Psychotherapy may be considered as one of the most valid and efficient instruments.

It is supported by an enormous mass of research and experimental data, covering a numerous series of clinical problems such as mood disorders, with particular reference to depression, as well as anxiety, personality and eating disorders.

Recently, also in the field of schizophrenia, several works have been carried out, capable of suggesting an original cognitive approach to the therapy and rehabilitation of psychotic patients.

Along with the standard approach, by the Philadelphia School, started by A. T. Beck, a pool of further evolutions of the original cognitive paradigm have been taking place and are still under development.

Among these, the relational and constructivist approach, seem to be particularly relevant.

In June 2000, an international Congress, proposed by the International Association for Cognitive Psychotherapy, and organised by our team, was held in Catania.

This Conference was attended by some of the most important Authors from the different International Schools of Cognitive Psychotherapy.

The Congress was a very important chance to compare the different positions and to summarize the current orientations of Clinical Cognitivism and Cognitive Psychotherapy.

This book includes a series of contributions presented at the Congress.

We hope it will be a useful instrument, giving an extensive review of the various outlines of contem­porary Cognitive Psychotherapy.

The theoretical chapters, of the first part of the book, are focused on the great issues of Contemporary Cognitive Psychotherapy.

The second part includes a series of chapters dealing with clinical applications.

The third part covers almost all psychiatric disorders.

Hopefully this volume is going to be a useful contribution to the critical reflection about the develop­ment of Cognitive Psychotherapy at the beginning of the third millennium.

Tullio Scrimali Liria Grimaldi

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Acknowledgments

We wish to thank all the Colleagues who gave their contribution and also the Publisher Kluwer Academic who supported us in the difficult effort of pUblication.

We would like also to thank to Dr. Katia Popolopoli who worked extremely hard to help us in editing the work and in preparing the index.

We are gratetul to Angela Del Popolo for her translations into English and to Elena Passarello for the final revision of the English of our chapters.

Tullio Scrimali Liria Grimaldi

INTER ATIONAl CONGRESS OF COGNITIVE PSYCHOTHERAPY

~ COGNITIVE PSYCHOTHERAPY ~ TOWARD A NEW MILLENNIUM

7 ~.('~" (.{ '-':~ k~~ " f·j;i) International Association

Sf>O" ,..1 by. ";C',~. <''»';,. for Cognitive Psychotherapy i'. ...., , t, \ ~

I,titulo Su~rio .. per It Scienlt Cognilive

Departmenf of P,}'chialry. M.diGlI choo!. Univcr~ly of Ulani.,

f'..ongrtltS Center IOLe Ciminient C.uan;" , Italy, June 20-24, 1000

The final programme of the Conference held in Catania.

xxiii

Contents

Part I: Scientific foundations

1. Complex Systems Cognitive Therapy: A New Perspective in Psychiatry and Psychotherapy ................................................................ .3 Tullio Scrimali and Liria Grimaldi

2. Adult Attachment and Cognitive Psychotherapy ..................................................................... 33 Tullio Scrimali and Liria Grimaldi

3. Modern and Postmodern Metaphors of Self, Mind and Memory ............................................. 39 George Schreiner and William J Lyddon

4. The Client as Architect of Change ............................................................................................ 51 Christine Padesky

5. Identifying Patients' Willingness, Ability, and Motivation to Change: An Aid in Treatment Planning and Outcome Evaluation ......................................................... 61 Arthur Freeman and Michael Dolan

6. Metaphor and Change in Cognitive and Constructive Psychotherapies ................................... 69 William J Lyddon and Darlys J Alford

7. Impasse and Transformation Negotiating Ruptures in the Therapeutic Alliance ................................................................... 81 Jeremy Safran

8. Cognitive Therapy of Affective Dependence ........................................................................... 85 Hector Fernimdez-Alvarez

9. Problem-Solving Therapy ......................................................................................................... 89 Arthur Nezu

10. Progress in Cognitive Therapy for Schizophrenic Disorders and a Look at the Future ........... 95 Carlo Perris

11. Improving Family Life for the New Millennium ................................................... 103 Frank Dattilio

12. Cognitive Hypnotherapy: A New Direction in Cognitive Therapy .............................. 105 Thomas Dowd

13. Let's do Process Research in Cognitive Psychotherapy ........................................... 109 Isabel Caro

Part II: Clinical Applications

Setting and procedures

14. Psychopharmacology, Placebo and Psychotherapy ................................................ 119 Tullio Scrimali, Liria Grimaldi, and Lorenzo Filippone

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15. The Development of a Cognitive Therapy CD-ROM for Clinicians ............................. 133 Kazuomi Inoue and Kenji Fukui

16. On Line Psychotherapy ................................................................................ .135 Antonella Montano and Berardina Valerii

17. The Application of the Automatic Thought Record into Different Modalities of Group Psychotherapy: A Preliminary Study ....................................................... .143 Agnieszka Popiel, Ludwik Bryla, Monika Sitarz, Jakub Szumanski, Andrzej Kokoszka, Brogna Barej, Maciej Bennewicz, Kinga Chutkowska, Elzbieta Plonecka, and Marek Zebrowski

18. Functional and Dysfunctional Families .............................................................. 147 Diana Kirszman

19. Reworking Family Schemas .......................................................................... .151 Frank M Dattilio

20. Adult's Psychotherapy: The Couple .................................................................. 157 Maria Lidia Lamberto

Processes

21. How Does Cognitive Behavioural Therapy Work? Using Structural Equation Modeling to Pinpoint Mechanisms and Mediators of Change ................................... .161 Diane Spangler

22. Kuhn's Structure of Scientific Revolutions: A Metaphor for the Development, Exploration, and Resolution of Psychological Distress ............................................ 165 Cheri Lynn Sparks and William J. Lyddon

23. Detection and Analysis of Cognitive Conflicts: Implication for Case Formulation and Therapy Process .......................................... 173 Guillem Feixas and Luis A. SaUl

24. Practical Rationality as a Goal in Cognitive Psychotherapy ..................................... .177 Maciej Moskwa

25. The Role of Attention Processes in the Development of Metacognitive Capacity ............ 181 Grazia Lomunno

26. Methodology of the Evaluation of the Metacognitive Functions During Psychotherapy ..... 183 Antonio Semerari, Antonino Carcione, Giuseppe Giancarlo Dimaggio, Maurizio Falcone, Giuseppe Nicolo, Igor Pontalti, and Michele Procacci

27. Resistance in Cognitive Therapy ..................................................................... 187 Thomas Dowd

28. Cognitive and Narrative Therapy .................................................................... .189 Ruth Irene Wilner

29. Cognitive-Behavioural Methods in an Integrated Psychotherapy System for Neurotic Disorders ................................................................................................. 193 Malgorzata Siwiak-Kobayashi and Celina Brykczynska

Contents XXVlI

30. Beyond Cognitive-Behavioral and Psychodynamic Approaches ................................. 197 Andrzej Kokoszka, Agnieszka Popiel, and Jakub Szumanski

The Therapist's Formation

31. Training and Care of the Therapist: Dichotomy or Integration? ................................. 201 Sara Baringoltz

Trans-cultural Aspects

32. Developments of Latin-Americans Cognitive Psychotherapies .................................. 205 Claudia Bregman

33. Cultural Aspects of Cognitive Psychotherapy in Oman ........................................... 209 Suma P. Chand

34. Cognitive Therapies in Argentina ..................................................................... 213 Lydia Tineo

Part III: Specific Approach to Different Disorders

Disorders Usually First Diagnosed in Infancy, Childhood or Adolescence

35. Cognitive Behaviour Modification and Learning Disabilities .................................... .219 Chryssoula Karba-Schina and Maria Zajiropoulou

36. Saying-Doing Correspondence: Subjects' Verbalisation and Intermittent Reinforcement Procedures in Management of Hyperactive-Conduct Disordered Children ..................... 223 Olimpia Pino and Alessandra Palma

37. Perception Disorders in Hyperactive Children and Delinquent Adolescents: Exploring a New Material ............................................................................. 227 Robert Rizk and Mauricette Sai'kali

Substance Related Disorders

38. An Integrated Behavioural and Cognitive Approach to the Rehabilitation of Drug Addicts in a Community Programme ...................................................... 233 Grazia Lomunno

Schizophrenia

39. An Integrated Approach to the Treatment and Rehabilitation of Persons with Schizophrenia ........................................................................................... 237 Enrique Camacho, Robert Paul Liberman, and Alex Kopelowicz

40. The Soteria Project: Twenty Five Years of Swimming Upriver ................................. 247 Loren Mosher and John R. Bola

41. Procedures for Improving Attention in Treatment of Refractory Schizophrenia .............. .255 Steven M Silverstein and Michi Hatashita- Wong

XXVllI Contents

Mood Disorders

42. Pessimism as Risk-Management ..................................................................... 259 Robert L. Leahy

43. A Psychophysiological Approach to Assess Adequacy of Cognitive Therapy for Early Demented Depressed Patients .................................................................. .267 Lucio Bizzini, Panteleimon Giannakopoulos, Anna Zinetti, Gisella Riva, Dario Galati, and Maria Teresa Cattaneo

44. Inpatient Cognitive Group Therapy for Severely Depressed Patients: What are and How Can We Deal with the Obstacles? ............................................. 273 Fabrizio Didonna, Maria Bernardini, and Marco Bateni

45. Enriching CT with Decentering Strategies to Improve Efficacy for the Treatment of Geriatric Depression ................................................................................. 277 Christine Favre, Lucio Bizzini, and Vera Bizzini

46. Treating Depression with Cognitive Therapy and Pharmacotherapy, Each Alone and in Combination: A Clinical Decision Analysis ................................................ 281 Nobuhide Kashiwagi and Kazuomi Inoue

47. A Randomised Controlled Trial of Cognitive Therapy in Bipolar Disorders .................. 285 Jan Scott

48. Prodromes, Coping Strategies and Course of Illness in Bipolar Affective Disorders ......... 289 Dominic Lam and Grace Wong

49. The Use of Amisulpride in the Integrated Treatment of Depressed Patients ................... 293 Giuseppe Cannella, Anna Maria Bramante, Gianpiero Petriglieri, and Katia Polopoli

Anxiety Disorders

50. Experience with Argentine Patients Suffering From Fear of Flying .............................. 297 Liliana H Ar6stegui, Claudio P. Pia, Roberto A. Rubio, and Carlos Meza

51. Some Clinical Observation on Patients with "Panic Attack" Diagnosis ........................ 303 Sara Baringoltz

52. Cognitive Psychotherapy and Psychology of the Obsessive-Compulsive Disorder: General Features and Efficacy Study ............................................................... .307 Antonello Bellomo, Gianluigi Dell 'Erba, and Gianpaolo Pierri

53. Selective Bias to Guilt Related Cues in Information Processing of Obsessive-Compulsive Patients ..................................................................................... 317 Behrooz Birashk and Ghassem Naziri

54. Resistance of Weakly Justified Beliefs ............................................................... 321 Francesco Mancini

55. Spatial and Temporal Dynamics ofPhobics' Attentional Bias after Subliminal Presentation of Threatening Stimuli .................................................................. 325 Chantal Mansour, Georges Rabbath, and Mauricette Saikali

Contents XXIX

56. Thought Suppression in Relation to Arousal and Obsessive Symptoms ........................ 331 Jakob Smari, Inga Huld Hermosdottir, and Sigurjon Stefansson

57. Multi-Center Study for the Treatment of Panic Disorders with Agoraphobia: The Experiential-Cognitive Therapy ................................................................. 335 Enrico Molinari, Francesco Vincelli, Gisella Riva, Young Hee Choi, and Brenda Wiederhold

Dissociative Disorders

58. The Role of Cognitive Psychotherapy in Dissociative Disorders: A Study from Oman ...... 343 Suma P. Chand

Sexual Disorders

59. Behavioral Versus Post-Rationalist Cognitive Approach to Sexual Dysfunctions ............ 347 Giorgia Della Giusta

60. Beliefs, Sexuality and Fertility ........................................................................ 353 Carlos Giambroni, Alicia Cortejarena, and Paula Budich

Eating Disorders

61. Perfectionism, Self-Esteem and Self-Perception of Weight Combine to Predict Bulimic Symptoms ................................................................................................ 355 Marisol Perez and Thomas E. Joiner

62. Treatment of Body Image in Obesity: The Use of Virtual Reality ............................... 357 Gisella Riva, Monica Bacchetta, Margherita Barujji, and Enrico Molinari

Sleep Disorders

63. Cognitive Methods in the Treatment ofInsomnia .................................................. 363 Lars-Gunnar Lundh

Adjustment Disorders

64. Psychological Preparedness and Psychological Impacts. Preparing a Community for Cyclones: A Stress Inoculation Approach ........................................................... 369 Shirley Morrissey and Joseph Reser

Personality Disorders

65. Variation of the Metacognitive Functions within a Psychotherapy of Personality Disorder .................................................................................................. 373 Antonio Semerari, Antonino Carcione, Giuseppe Giancarlo Dimaggio, Maurizio Falcone, Giuseppe Nicolo, Igor Pontalti, and Michele Procacci

66. Today: Personality Disorders? ........................................................................ 377 Lydia Tineo

67. Locus of Control in Antisocial Personality Disorder ...... , ....................................... 381 M Hakan Turkcapar, Aynur Ozel, Olga Guriz, and Banu Isik

xxx Contents

Psychosomatic Medicine

68. The Addition of Coaching to Cognitive Strategies: Interventions for Persons with Urinary Incontinence .............................................. 385 Therese Dowd, Katharine Kolcab, and Richard Steiner

69. Testing a Cognitive-Behavioral Treatment Model for Chronic Pain: Three Case Studies ..................................................................................... 389 David Edwards and Michael Wohlman

70. Biofeedback Aided Psychotherapy (BAP) .......................................................... 393 Oliver Scheibenbogen and Jorg Prieler

71. Surface Electromyografy (S-EMG): Investigative and Biofeedback Modality ................ 397 Gabriel E. Sella

72. Drop-Out Predictive Factors in Tension-Type Headache Treatment ............................ 407 Liliana Signorini and Cecilia Navarrini

Author Index ............................................................................................ .409

Subject Index ........................................................................................... .417

COGNITIVE PSYCHOTHERAPY TOWARDANEW MILLENNIUM