Chapter 3 – Cognitive Therapy

1. Chapter 3 – Cognitive Therapy

2. Identify the key tenets of cognitive therapy Recognize the contributions of Beck, Ellis, and Young to the development of cognitive therapy Explain the techniques of cognitive therapy Recall the empirical support for cognitive therapy

3. The most rapidly growing psychotherapy in the world today (Prochaska & Norcross, 2007)

4. Ellis • Rational-Emotive Behavior Therapy (REBT) • A philosophical approach • Epictetus: “People are not disturbed by things, but by the view they take of them.” • Core principle of “demandings” or “shoulds and musts” • Move people from “demanding” to preferring • Directly challenging client’s beliefs • ABCDE

5. Beck • “the father of cognitive therapy” • A personal scientist model • Focused on collaborative exploration of client’s beliefs through experimentation and Socratic questioning • Schemas – mental blueprints • 5 types • Cognitive • Affective • Motivational – wishes and desires • Instrumental • Control – inhibit or direct behavior

6. Schemas have: • Breadth – amount of psychological terrain covered in a schema • Flexibility or rigidity • Valence – level of activation at any given time • Cognitive vulnerabilities – susceptibility to certain stressors

7. Humans favor assimilation over accommodation, i.e. they will strive to maintain rather than change existing schemas Constructivism – narratives – more optimistic and flexible view of human agency

8. Cognitive Distortions • Arbitrary inference • Conclusion not supported by existing evidence • Selective abstraction • Conceptualizing based on a detail • Overgeneralization • Creating a rule based on only one (or few) incidents • Magnification/Minimization • Personalization • Dichotomous (polarized) thinking • Interpreting in terms of extremes • Incorrect assessment of danger versus safety • Sensing risk as dangerously high

9. Therapist as collaborator, not expert • Therapeutic alliance • Collaborative empiricism • Socratic dialogue • Automatic thoughts and daily thought record • Downward arrow/vertical descent • Homework

10. Definition of schema • Early maladaptive schemas • Disconnection and rejection • Impaired autonomy and performance • Impaired limits • Other directedness • Overvigilance and inhibition • Cognitive approach in schema therapy – testing veracity of schemas

11. Strategies and Interventions Defining terms Examining the evidence Testing the thoughts Generating alternatives Maladaptive vs. inaccurate beliefs Cost-benefit analysis Positive reframing Examining the logic of thoughts Creating a pie chart showing the factors involved in a problem Downward arrow – what would be so bad if thoughts were true Double standard Daily log Distinguishing possibility from probability

12. Strategies and interventions Examining the feared fantasy Maladaptive assumptions Examining the patient’s value system Distinguishing progress from perfection Borrowing someone else’s perspective Core schemas Historical identification of the schema sources Imagery and emotions Imagery restructuring Letter writing Schema dialogues homework

13. Rooted in scientific tradition since inception One of the most well studied psychotherapies Very effective across a wide range of problems from severe psychopathology to more minor issues like marital distress