Background Information of Cognitve Therapy

1. Background Information of Cognitve Therapy • CT is considered one of the therapies under the the classification (umbrella) of Cognitive Behavioural Therapies • CT is considered the second wave of CBT following the behavioural therapy (first wave) • The third wave is an emerging zeitgeist, mindfulness and acceptance • First Force was Psychoanalytic, second Force was Behavioural (Focuses on the relationship between thoughts and emotions. • Cognitions influence emotions and behaviour • It was derived out of ego psychology • Other CBT therapies include: Rational Emotive Behavioural Therapy (Ellis); Rational Behavioural Therapy (Maultsby) Dialectical Behavioural Therapy; Stress Innoculation Therapy (Meichenbaum).

2. Background Information of Cognitive Therapy (CT) • Dr. Aaron Temkin “Tim” Beck (1921 - ) developed CT in the 1960’s. • Beck initially practiced psychoanalysis and believed psychoanalysis offered important insights into mental disorders. • Throughout the 1960s and 1970s a paradiagmatic shift occurred in theory, research and treatment. It was within this emerging cognitive zeitgeist that Beck’s CT therapy of depression was born.

3. Central Constructs of Cognitive Therapy • Beck believed depression was a result of faulty thinking or irrational thoughts by the individual, which characterized cognitive distortions. • Assists individuals to look at their irrational thoughts, see how realistic they are • Cognitive Triad • Insert Beck

4. Therapeutic Content • Cognitive distortions (p. 314) • Common cognitive distortions: - all or nothing thinking, fortune telling, emotional reasoning, mental filter, overgeneralization, jumping to conclusions, should statements, magnification and minimization, blame and self-blame, dictomous

5. Cognitive Therapy (CT) • Cognitive Therapy is a form of psychotherapy proven in numerous clinical trials to be effective for a wide variety of personality disorders. • The therapist and client work together as a team to identify and solve problems. • Therapists help clients to overcome their difficulties by changing their thinking, behavior, and emotional responses.

6. Cognitive Therapy • Beck developed the Beck Depression Inventory (BDI) in 1964 • Depression could be measured, strategies could be developed to help individuals overcome their depression and then test it to see if the strategy was effective. • Recent research supports cognitive therapy as being just as effective or in some cases more effective than drug therapy.

7. 10 Principals: Strategies and techniques used in Cognitive Therapy • CT is based on the cognitive model of emotional disorders • CT is brief and time-limited • Sound therapeutic relationship is a necessary condition for effective CT • Therapy is a collaborative effort between therapist and patient • CT uses primarily the Socratic method

8. 10 Principals: con’t • CT is structured and directive • CT is problem-oriented • CT is based on an educational model • The theory and techniques of CT rely on the inductive method • Homework is a central feature of CT • IMPORTANCE: It offers practical suggestions as treatment goals, which can allow the individual control over their thoughts and emotions

9. Comparison of Cognitive Profile in Anxiety and Depression COGNITIVE PROCESSING NEGATIVE COGNITIONS

10. The Therapeutic Relationship • Socratic Dialogue – Collaborative Empiricism • Structured and directive • HW assigned collaboratively • Aspire to be empathic, warm & trusting (in the Rogerian sense) but not active in change as identification and remediation of problematic schemas • Therapist is expert about cognitive theory and client is an active partner who is responsible for implementation in life

11. Practicalities of CT • Brief because active, directive & structured • 50 min./week ind. or 90 min./week for group • Kids, adolescents, older adults • Couples, families, sex therapy, organizations • Unipolar depression, and anxiety most tested • Bipolar depression, personality disorders, substance abuse, psychotic conditions (borderline personality - DBT) • Amenable to combo with psychotropic medication

12. Mindfulness/Acceptance • CBT evolved from early association with BT and now with CT. A third wave may involve mindfulness and acceptance • Therapists train clients in and out of sessions • Bodily sensations, appreciating the moment, mindfulness meditations, retraining breathing • Being instead of doing • Creates distance from immediacy of distressing thoughts/emotions

13. Processes of Change (HOW) • Introduce Cognitive Model (vignette – impersonal) • Begins with looking at clients way of thinking rather than establishing relationship • Activity scheduling • Cognitive restructuring • Distancing • Disattribution technique

14. Criticisms of Cognitive Therapy • Behavioural Perspective: • Ellis advocates that REBT is a science, but there are only a handful of reported properly controlled experiments on its effectiveness.

15. Criticisms From Psychoanalytic Perspective • Clients faced with Socratic dialogues, they are made even more confused as their own explanations for their problems are characterized as dysfunctional, irrational and immature. • The CT offers a philosophical system that is glamorized as logical and empirical but is in reality a grand word game.

16. Cultural Perspective • Rational thinking and the scientific orientation may fit well into the preferred processes of white, male European Americans. • Some feminist and multicultural orientations, such as intuition, spirituality and connection are ignored or devalued in cognitive treatments. • Challenging beliefs may not be appropriate in some cultures • The problems with people and how to fix them are inside the individuals head rather than in the person’s culture and in the world.

17. From a Humanistic Perspective • CT does not recognize that the problem today is that people cannot feel enough, not they feel too much. • Alienation, not a negative schema, is the syndrome of our age. • Let’s not think problems away, let’s use our emotions to fuel constructive change. • Feel more, not less. • From a Cultural Perspective

18. From an Integrative Perspective • CT use “overgeneralizations” which negate the tragic side of life and devalue the emotional side of humans. • CT makes value judgment that holds that a person must be clean and orderly to be decent may be destructive. • The CT generalization that any moral imperative is foolish may be even more destructive of human moral.