Ch. 19 S. 4 : Cognitive Therapy and Behavior Therapy

1. Ch. 19 S. 4 : Cognitive Therapy and Behavior Therapy Obj: Describe how cognitive and behavior therapists try to help people.

2. Cognitive therapy and behavior therapy are considered together because both methods share the same goal – to help clients develop new ways of thinking and behaving. Both cognitive and behavior therapists encourage the clients to focus on their thoughts and actions. Advocates of these two theories contend that only by modifying self-defeating thoughts and behavior patterns will the client truly be able to solve his or her own problems.

3. Cognitive Therapy The aim of cognitive therapy is to help people learn to think about their problems in more productive ways. Cognitive psychologists focus on the beliefs, attitudes, and thought processes that create and compound their clients’ problems.

4. They believe that some people develop ways of thinking that are illogical or based on faulty assumptions. Such ways of thinking can lead to emotional and behavioral problems for these people. Cognitive therapists help people change their ways of thinking. The two most widely used cognitive therapy methods are rational-emotive therapy and psychiatrist Aaron Beck’s model of therapy, sometimes called cognitive restructuring therapy.

5. Rational-Emotive Behavior Therapy First developed by psychologist Albert Ellis in the 1950s, rational-emotive behavior therapy (REBT) is based on Ellis’s belief that people are basically logical in their thinking and actions.

6. However, the assumptions upon which they base their thinking or actions are sometimes incorrect. According to Ellis, people may develop emotional problems when they base their behavior on these faulty assumptions. An example of a commonly held false assumption that leads to emotional problems is “I must do everything perfectly.” People who believe they must do everything perfectly in order to be happy must also believe that if they are unhappy, it is because they did something imperfectly. Thus, their unhappiness is their own fault.

7. People are often unaware of their false assumptions even though the assumptions influence their conscious thoughts and actions. The role of the therapist in REBT is first to identify and then to challenge the false assumptions. To teach individuals to think more realistically, REBT therapists use techniques such as role-playing and modeling.

8. Beck’s Cognitive Therapy Another form of cognitive therapy was introduced in the 1960s by psychiatrist Aaron Beck. In contrast to REBT’s focus on faulty assumptions, the focus of Beck’s cognitive therapy is on restructuring illogical thought processes.

9. Beck has noted several types of illogical thought processes that may lead to emotional problems, particularly depression. Some of these include the following: • Arbitrary inference, or drawing conclusions for which there is no evidence. For example, when a teacher passes a student in the hall and does not smile, the student may arbitrarily conclude that the teacher is planning to fail her.

10. Selective abstraction, or drawing conclusions about a situation or event on the basis of a single detail and misinterpreting or ignoring other details that would lead to a different conclusion. For example, a person may look at his reflection in a mirror, but instead of feeling happy about his good features – say, a handsome smile and a muscular build – all he notices is the small blemish on his chin.

11. Overgeneralization, or drawing a general conclusion from a single experience. For example, a person may conclude that she is worthless because she failed one test. Using Beck’s approach gently guides clients in testing the logic of their own thought processes and developing more logical ways of thinking.

12. Evaluation of Cognitive therapy - Cognitive therapy tends to be a short term method, making it a realistic option for more people than traditional psychoanalysis. Studies of this therapy show that modifying irrational beliefs helps people with anxiety and depression. One reason for this is that cognitive therapy provides coping skills that reduce the risk of recurrence of depression once treatment ends. A combination of cognitive therapy and antidepressant medication may be superior to either treatment alone in the case of people with persistent depression.

13. Behavior Therapy The goal of behavior therapy, which is also called behavior modification, is to help people develop more adaptive behavior. Some people seek behavior therapy to acquire desirable behaviors, such as the skills needed to develop healthy social relationships or confront phobias.

14. Many behavioral techniques fall into two categories: counter conditioning, which helps people to unlearn undesirable behaviors, and operant conditioning, which helps in the learning of desirable behaviors. The choice of behavioral techniques for an individual client depends largely on the nature of the individual’s psychological disorder.

15. Counter conditioning If undesirable behaviors are conditioned, or learned through reinforcement, then presumably they can be unlearned, or counter conditioned. Counter conditioning pairs the stimulus that triggers an unwanted behavior with a new, more desirable behavior.

16. These techniques include systematic desensitization, modeling, and aversive conditioning. • Systematic desensitization – a person cannot feel anxious and relaxed at the same time. The therapist therefore trains the client to relax in the presence of an anxiety-producing situation. This is done in a systematic way. First, the therapist teaches the client how to relax completely. Once this has been accomplished, the therapist gradually exposes the client to the object or situation that causes the phobic response.

17. Systematic desensitization may be combined with other counter conditioning measures, such as modeling and aversive conditioning. • Modeling - involves observational learning. The client observes and then imitates the therapist or another person coping with the feared object or situation.

18. Aversive conditioning – is essentially, the opposite of systematic desensitization. In aversive conditioning, the therapist replaces a positive response to a stimulus with a negative response. (stop smoking) People who learn more desirable behaviors through counter conditioning often experience a boost in their self-esteem, because they will lead less restrictive lives.

19. Operant Conditioning The behavioral technique of operant conditioning is based on the assumption that behavior that is reinforced tends to be repeated, whereas behavior that is not reinforced tends to be extinguished. Behavioral therapists reinforce desirable behaviors with rewards and at the same time withhold reinforcement for undesirable behaviors.

20. Operant conditioning has sometimes proved effective in more severe cases, such as schizophrenia and childhood autism, that were previously resistant to other types of treatment. Operant conditioning is often used in institutional settings, such as mental hospitals.

21. Sometimes people find it difficult to adopt a new behavior all at once, finding it easier to change their behavior gradually. Another method of operant conditioning, called successive approximations, is useful in such situations. The term successive approximations refers to a series of behaviors that gradually become more similar to a target behavior. Through reinforcement of behaviors at each stage, the target behavior is finally achieved.

22. Evaluation of behavior therapy – it tends to be somewhat more effective overall than psychoanalysis or person-centered therapy. It is also a short-term therapy, sometimes bringing about lasting results in just a few months. BT is especially effective for well-defined problems such as phobias, PTSD, and compulsions. It has also helped people overcome depression, social problems and problems with self-control (like smoking)