Theories of Psychotherapy and Counseling: Concepts and Cases 6th Edition Richard S. Sharf Chapter 10 Cognitive Therapy © 2016 Cengage Learning. All rights reserved. © 2016 Cengage Learning. All rights reserved. Influences on Beck's Development of Cognitive Therapy Sigmund Freud - unconscious thoughts anger can be internalized into depression Alfred Adler - cognitive nature of individuals active therapeutic approach Albert Ellis - focus of belief systems challenging inaccurate assumptions George Kelly - dichotomous personal constructs Jean Piaget - cognitive development Cognitive science - models of mental functioning Slide 1 Chapter 10 © 2016 Cengage Learning. All rights reserved. Important Constructs in the Cognitive Theory of Personality Childhood development of beliefs- Long standing views of self and world develop Automatic thoughts- Ideas or thoughts that occur without effort or choice and may lead to emotional responses Cognitive schemas- Ways of thinking that comprise a set of core beliefs and assumptions about self and the world Slide 2 Chapter 10 © 2016 Cengage Learning. All rights reserved. Ways in Which Individuals Distort Their Thinking •All-or-nothing thinking- black or white thinking •Selective abstraction- selecting one fact and ignoring others •Mind reading- belief that we know what another person is thinking •Negative prediction- belief that something bad may happen •Catastrophizing- exaggerating possible consequences of an event Slide 3 Chapter 10 © 2016 Cengage Learning. All rights reserved. •Overgeneralization- applying rules broadly •Labeling and mislabelingnegative view based on errors one has made •Magnification- An imperfection is exaggerated •Minimization- A positive event becomes less important •Personalization- An event is related to oneself when there is no relationship Goals of Cognitive Therapy Remove biases and distortions in thinking to produce more effective functioning Produce positive feelings, behavior, and thinking Specify goals clearly and concretely Prioritize goals and develop them in collaboration with the client Slide 4 Chapter 10 © 2016 Cengage Learning. All rights reserved. Assessment in Cognitive Therapy Assessment is specific and continues throughout therapy Interviews - frequent questions Self-monitoring of thoughts, feelings, and behavior outside the office Use of the Dysfunctional Thought Record Thought sampling Scales and questionnaires - such as Beck Depression Inventory Scale for Suicide Ideation Dysfunctional Attitude Scale Slide 5 Chapter 10 © 2016 Cengage Learning. All rights reserved. Process of Making Therapeutic Changes in Cognitive Therapy • Guided discovery (Socratic dialogue) • Three-question technique 1. What is the evidence for the belief? 2. How else can you interpret the situation? 3. If it is true, what are the implications? • Specifying automatic thoughts • Assigning homework • Termination and relapse issues Slide 6 Chapter 10 © 2016 Cengage Learning. All rights reserved. Methods for Changing Cognitive Distortions • • • • • • • • Understanding idiosyncratic meaning- Understand words clients use as related to their automatic thoughts and cognitive schemas Challenging absolutes- Point out exaggerations such as “everyone”, “always”, and “never” to client Reattribution- Help clients place responsibility appropriately for an event Labeling of distortions- Point out when client is distorting a thought or event Decatastrophizing- “What if” technique is used to point out actual rather than feared events Challenging all-or-nothing thinking- Use scaling to turn a dichotomy into a continuum Listing advantages and disadvantages- Write down advantages and disadvantages Cognitive rehearsal- Use constructive imagination for new events Slide 7 Chapter 10 © 2016 Cengage Learning. All rights reserved. Types of Cognitive Distortions and Strategies to Change Them Distortions Change Strategies All-or-nothing thinking Challenging all-or-nothing thinking Selective abstraction Mind reading Negative prediction Catastrophizing Decatastrophizing Labeling and mislabeling Labeling of distortions Magnification Minimization Personalization Understanding idiosyncratic meaning Reattribuiton Varied distortions Challenging absolutes Listing advantages and disadvantages Slide 8 Chapter 10 © 2016 Cengage Learning. All rights reserved. Cognitive rehearsal Cognitive Therapy Concepts Used in Treating Depression Cognitive triad - a depressed person's negative view of oneself the world one's future resulting in a variety of cognitive distortions Slide 9 Chapter 10 © 2016 Cengage Learning. All rights reserved. Psychological Disorders: Examples of Cognitive Therapy Disorders Therapist Patient Depression Liese & Larson (1994) Paul Anxiety Freeman et al. (1990) Amy Obsessive Wells (1997) Electrician Substance abuse Beck et al. (1993) Bill Slide 10 Chapter 10 © 2016 Cengage Learning. All rights reserved. Cognitive Methods Used in Treating Case Examples Disorder Patient Methods Depression Paul Socratic, three question, DTR Anxiety Amy Socratic, decatstrophizing Obsessive Electrician Socratic, defusing thoughts from actions Substance Abuse Bill Socratic, three questions Practicing control beliefs Slide 11 Chapter 10 © 2016 Cengage Learning. All rights reserved. Current Trends in Cognitive Therapy : Mindfulness based stress reduction: Group program Schema-focused cognitive therapy for individuals with personality disorders. Typical schemas: Abandonment/Instability Mistrust/Abuse Emotional deprivation Defensiveness/Shame Social isolation/Shame Developing treatment manuals to work with a wide variety of disorders such as personality disorders and schizophrenia Slide 12 Chapter 10 © 2016 Cengage Learning. All rights reserved. Gender Issues and Cognitive Therapy Bem's gender schema view Issues with depressed women Collaboration - encourage woman's power Support client beliefs and values as well as challenge distorted beliefs Issues with gay men Learn about sexual orientation Challenge assumptions about sexuality and sexual roles Counter misinformation about being gay Role play "coming out" Deal with shame issues Slide 13 Chapter 10 © 2016 Cengage Learning. All rights reserved. Multicultural Issues and Cognitive Therapy Cultural schemas - cultural beliefs and values Cognitive therapy's practical and active approach may help to counteract negative stereotypes about therapy. Educational focus of therapy may have wide appeal. Application to African-Americans, Latinas, Latinos, and Native Americans Slide 14 Chapter 10 © 2016 Cengage Learning. All rights reserved.