Cognitive behavioral therapy

JOSHUA J. BATALLA IP

Cognitive Therapy

Theory of Personality

• A Person’s charachteristic pattern of thinking, feeling and acting

Personality

• all mental activities associated with thinking, knowing, remembering and communicating

Thinking or Cognition

• Cognitive therapy perceives psychological problems as stemming from commonplace processes such as faulty thinking making incorrect inferences on the basis of inadequate or incorrect information and failing to distinguish between fantasy and reality..

CT on Personality

July 18, 1921 Providence, Rhode Island

“Tim”His parents were Jewish ImmigrantHis family suffered the loss of first two

children.At age 7, Broke his arm and developed acutely

serious bone infection which required surgeryHe missed being promoted into Second gradeBad case of whooping cough, chronic Childhood asthmaInterest in Nature

Significant Childhood Events

Event:

His mother was too emotional

Broke his arm; developed serious bone infection

Interest in Nature

Repercussions:

He became sensitive to others with strong EmotionsHe developed blood and injury phobiaBecame his primary motivation in entering medical schoolPiqued his interest in knowing “ what makes people tick; what makes them happy or sad and confident or insecure

Cognitive Therapy at Present

Short Term ApproachMost number of research publishedCured Thousands for Depressions and other

psychological disorderScientificActivePresent FocusLearning Focus

Aaron T. Beck M.D

“Father of Cognitive Therapy”

Professions: Psychiatrist, Psychologist, Researcher, Professor, Author

President Emeritus of Beck Institute of Cognitive Behavior Therapy

Recognized as one of the 10 individuals who shaped the face of American Psychiatry

Known for:Psychotherapy, Psychopathology, Suicide And Psychometrics

Development of Theory

• Results from anger turned inward against the self, emerging outwardly as the patient’s “need to suffer”

Psychoanalytic View of Depression

Beck’s Experiment

The Conclusi

on

• “There’s still the unconscious hostility, but the way it’s showing up in the dreams is that the patient has a need to suffer and the need to suffer is then being expressed in these negative dreams.”

Depressed Person

Dreams with more themes of hostility

Dreams of being the subject of an

unpleasant occurrence

Development of Theory

• Results from anger turned inward against the self, emerging outwardly as the patient’s “need to suffer”

Psychoanalytic View of Depression

Beck’s Experiment

The Conclusion

• “The motivation was not to suffer but to get positive reinforcement of some type.”

• “Dreams are representations of the way the patient perceives himself or herself, and the way they perceive their experiences, and that this could be rock bottom.”

Depressed Person

Will be upset by success

Reacted positively to successful outcomes

View on Human Nature

1. An organism needs to process information in an adaptive way in order to survive


2. Psychological distress is the ultimate consequence of the interaction of the innate, biological, developmental and environmental factors.

Biological Psychological Social

Mentally Healthy / Psychopathology


3. It is our cognitions, which include our thoughts, beliefs and the manner in which we perceive a situation, that are the basis for what we believe, how we act and how we feel.

Action

Thoughts

Em

oti

on V

ision

Cognitive Model

Core BeliefIntermediat

e BeliefsAutomatic Thoughts

Reactions:Emotional Behavioral

Physiological

Situation

I am incompetent

Attitude: It’s terrible to failRule: I should give up if a challenge seems great.Assumption: If I try do something difficult, I’ll fail. If I avoid doing it, I’ll be okay

Sit: Reading a new text

AT: This is just too hard. I’m so dumb. I’ll never master this. I’ll never make it as a therapist

Emotional: DiscouragementBehavioral: Avoids tasks and watches TV insteadPhysiological: Heaviness in body


4. The Cognitive model proposes that dysfunctional thinking ( which influences the patient’s mood and behavior) is common to all psychological disturbances

Cognitive Distortions

Black or white

Catastrophisizing

Discounting the positive

Emotional reasoning Labeling

Magnification

/minimization

Mental filter

Mind-reading

Overgeneralization

Personalization

Should and must

Tunnel vision

Depression Vicious Cycle

1) Stressful Experienc

e

2) Negative explanatory Style

3) Depressed Mood

4) Cognitive Changes

5) Behavior

al Changes

Therapeutic Approach

1) Building a strong therapeutic Alliance

Empathy

Caring

Optimism

Essential Techniques


• Sample use of Three-Question Technique:

2. Socratic Questioning



• Therapy involves formulating the case of the clients in “cognitive terms.” (Cognitive Conceptualization)

3. Educating the client about the Cognitive Model


Initial Questions To

Ponder On

• What is the patient diagnosis(es)?• What are his current problems? How did these

problems develop and how are they maintained?• What dysfunctional thoughts and beliefs are

associated with the problems? What reactions (emotional, physiological, and behavioral) are associated with his thinking?


• “… the first step … is to help clients identify their automatic thoughts and images. These thoughts and images are the most readily understood aspect of the cognitive model because clients can easily “catch” them, and because clients can quickly see the direct connection between their thoughts and their negative feelings and dysfunctional behaviors.”

4. Identifying and Challenging Automatic Thoughts and Images


Are you aware of anything that you

are saying to yourself that may be causing you to feel this badly?

Can you imagine what kinds of self-

statements, thoughts, or

images you are having that could cause you to feel

this way?

Have you noticed any thoughts or images you have that kind of drift

through your mind while you

have been feeling this way?


• This is important because automatic thoughts are often based on cognitive distortions

5. Identifying and Challenging Cognitive Distortions


Example: Decatastrophizing/ Scaling


6. Identifying and Challenging Intermediate Beliefs

7. Identifying and Challenging Core Beliefs

8. Homework


Commonly Used Techniques

1. Thought-stopping

Replacing a negative thought

with a newly identified

positive one

Yelling to oneself or out loud, “Stop it!” when a

negative thought is identified

Placing a rubber band

on one’s writs and

snapping it whenever one has a negative thought

Actively diverting

one’s thoughts to

more pleasant thoughts

Participating in a

relaxation exercise in

order to “move” one’s

thoughts to a different

place


2. Imagery-changing

Following Images to

CompletionJumping Ahead

in TimeCoping in the

ImageChanging the

Image

Reality-Testing the Image

Repeating the Image Image-stopping Image-

Distracting


3. Rational-emotional role play

It allows the client to debate between the rational and emotional parts of themselves


4. Behavioral and Emotive Techniques

Example:

Case

A mother who insists that she is a bad mother

because she yells too much

Behavioral Approach

To develop additional

parenting skills such as the use

of a sticker chart

Emotive TechniqueTo yell into a pillow every

time she becomes

overwhelmed with her children

Recent Activities:

Becks Institute current researches focuses on:

Cognitive Therapy for schizophrenia

Cognitive Therapy for suicide prevention

Dissemination of cognitive therapy to community settings

References:

David G. Myers Psychology 10th EditionTheory and Practice of Counseling and

Psychotherapy – Gerald CoreyCognitive Therapy – GaleNeukrug, Edward. Counselling theory and

practice. Brooks/Cole Cengage Learning: Belmont. CA. 2011

Annual Reviews Conversations: A Conversation with Aaron T. Beck

Thank You!

Health & Medicine

Cognitive behavioral therapy