Cognitive Therapies

1. Cognitive Therapies Module 71

2. Cognitive Therapy • Assumes our thinking effects our feelings • Thoughts intervene between events and our emotional reactions • Depression often caused by self-blaming and overgeneralizing explanations of bad events • Therapy focuses on recognition and alteration of unhealthy thinking patterns • Teaches people new, more adaptive ways of thinking and acting

3. Self-Serving/Defeating Bias • Self-Serving Bias - Tendency to judge oneself favorably • Healthy people tend to do this • Self-Defeating Bias - tendency to blame themselves for problems and credit the environment for successes • Severely depressed patients tend to do this

4. Rational Emotive Behavior Therapy • Developed by Albert Ellis • People’s difficulties are caused by their faulty expectations and irrational beliefs • Goal is to expose and confront the person’s core irrational beliefs • ABCDE model: • Activating Event • Beliefs - Irrational • Consequences • Disputing Irrational Beliefs • Effective ways of thinking & behaving developed • When an Activating event (A) occurs, it is the person’s Beliefs (B) about the event that cause emotional Consequences (C) • Effective in the treatment of depression, social phobia, and certain anxiety disorders, and in helping people overcome self-defeating behaviors

7. How REBT Works • Step 1: Identify the core irrational beliefs or self talk that underlie personal distress • Step 2: Vigorously dispute and challenge the irrational beliefs. Therapist acts as a teacher to show patient how to do this. • Stop Irrational Thoughts • Reframe them to be more positive • Dispute irrational beliefs with evidence • Rational-emotive therapists tend to be very direct and even confrontational • From the client’s perspective, rational-emotive therapy requires considerable effort • person must admit her irrational beliefs and accept the fact that those beliefs are irrational and unhealthy • client must radically change her way of interpreting and responding to stressful events

8. REBT – AN EXAMPLE • PROBLEM: Social Phobic concerned they will be publicly embarrassed when giving a class presentation. • SOLUTION: Therapist questions the likelihood of such embarrassment occurring and impact of it. • Therapist’s goal is to show the client that not only is their failure unlikely, but even if it did happen, it would not be a big deal.

9. REBT Therapy

10. Aaron Beck’s Cognitive Therapy • Based on the assumption that thoughts, moods, and behaviors are interrelated • Beck believes that depression and other psychological problems are caused by distorted thinking and catastrophic beliefs • Focuses on changing the client’s unrealistic beliefs • Therapist acts as model and aims for a collaborative therapeutic climate • Therapy includes homework of writing down automatic thoughts or habits • Gentler, less combative approach than Albert Ellis’ REBT

13. Cognitive Therapy: How it Works • CT therapist encourages the client to empirically test the accuracy of his or her assumptions and beliefs • The client learns to recognize and monitor the automaticthoughts that occur without conscious effort or control • The client learns how to empirically test the reality of the automatic thoughts that are so upsetting • CT is very effective in treating depression, anxiety disorders, eating disorders, PTSD, and relationship problems. It may also help prevent depression from recurring

14. Ellis’ REBT vs. Beck’s Cognitive Therapy • Beck stresses the quality of the therapeutic relationship • Beck places more emphasis on the client discovering misconceptions for themselves. • The method is based upon the particular disorder. • REBT therapists logically debate and vigorously challenge or dispute the irrationality of a client’s beliefs. • Ellis views the therapist as a teacher and does not think that a warm personal relationship with a client is essential. • REBT is often highly directive, persuasive and confrontive. • REBT uses different methods depending on the personality of the client

16. Cognitive Behavioral Therapy • An integrated therapy that combines cognitive therapy (changing self-defeating thinking) with behavior therapy (changing inappropriate behaviors) • Based on the assumption that cognitions, behaviors, and emotional responses are interrelated • Cognitive-behavioral therapists challenge maladaptive beliefs and substitute more adaptive cognitions • They use behavior modification, shaping, reinforcement, and modeling to teach problem solving and change unhealthy behavior patterns • Effective for treatment of anxiety, depression & anorexia nervosa

17. Prevalence of Cognitive Therapy Half of all faculty in accredited clinical psychology doctoral programs now align themselves with a cognitive or cognitive-behavior therapy orientation. (Data from Mayne & others, 1994. Note: Some faculty identify with more than one perspective.)

18. Family and Group Therapies

19. Group and Family Therapy • Group therapy—one or more therapists working with several people at the same time. • Family therapy—based on the assumption that the family is a system and treats the family as a unit. • Couple therapy—relationship therapy that helps with difficulty in marriage or other committed relationships

20. Group Therapy • Having a therapist work with a number of patients at one time • Groups usually consist of 6 to 10 people • Cognitive, behavior, and humanistic therapists all can lead group therapies.

21. Advantage of Group Therapy • Therapists can help more than one person at a time. • Overall session cost is lower. • Patients interact with others having the same problems as they have. • Builds a sense of community

22. Self-help groups: Helping yourself by helping others • Self-help groups and support groups are typically organized and led by nonprofessionals • The groups are either free or charge nominal fees to cover the cost of materials. • Typically, members have a common problem and meet for the purpose of exchanging support • The format of such groups varies enormously, but many follow a 12-step approach • Self-help groups can be as effective as therapy • More research is needed on why self-help groups are effective and on the kinds of people and problems that are most likely to benefit from them

23. Family Therapy • Therapy that treats the family as a system • Views the patient’s problems as influenced by or directed at family members • Every family has certain unspoken “rules” of interaction and communication. • Issues are explored, and unhealthy patterns of family interaction can be identified and replaced with new “rules” that promote the psychological health of the family • Attempts to guide the family toward positive relationships and improved communication