Chapter 13 Cognitive Behavior Therapy Nothing is so terrible as activity without thought Johann Wolfgang von Goethe © 2011 Brooks/Cole, A Chapter Objectives After reading this chapter, you should be able to: •Outline the development of cognitive behavioral therapy •Explain the theory of cognitive behavioral therapy •Discuss the counseling relationship and goals in cognitive behavioral therapy •Describe assessment, process, and techniques •Demonstrate some therapeutic techniques •Clarify the effectiveness of cognitive behavioral therapy © 2011 Brooks/Cole, A Aaron Beck • Childhood fears were handled with reasoning • Likely motivated his work with cognitive therapy focusing on anxiety and depression • Graduated from Brown University and Yale Medical School • Studied psychiatry and was trained as a psychoanalyst • eventually his research led him to formulate cognitive therapy, the focus of his career at the University of Pennsylvania where the Beck Institute for Cognitive Therapy and Research is housed © 2011 Brooks/Cole, A Aaron Beck Beck contended that various mental disorders have particular cognitive patterns and that the most effective and lasting therapy involves intervention into those patterns © 2011 Brooks/Cole, A Beliefs • People are not passive victims of their inborn tendencies • People are actively creating and moving toward goals that are vital to them • Distress occurs when people experience a threat to their interests • The more crucial a person considers the goal to be, the greater the response © 2011 Brooks/Cole, A Four levels of cognition • automatic thoughts, • intermediate beliefs, • core beliefs, and • schemas © 2011 Brooks/Cole, A Cognitive distortions • Distortions convert incoming information to keep cognitive schema intact • They use the assimilation process to maintain homeostasis • The information contrary to core belief is cancelled out by the distortion process, and the person cannot identify any disconfirming evidence from his environment © 2011 Brooks/Cole, A Three assumptions Cognitive activity impacts behavior Cognitive activity can be monitored and changed A desired change in behavior can be accomplished through changing cognitions © 2011 Brooks/Cole, A Cognitive distortions associated with distress and maladaptive behaviors • Catastrophizing: expecting disastrous event • Mental filtering: seeing an entire situation based on one detail with all else ignored • Blame or assigning internal responsibility entirely to external events © 2011 Brooks/Cole, A Cognitive distortions associated with distress and maladaptive behaviors • All-or-nothing thinking: the person thinks in terms of two opposite categories • Discounting the positive: person says positives not count • Overgeneralization: a sweeping negative conclusion that goes beyond facts © 2011 Brooks/Cole, A Counselor Both a guide to help the client understand how beliefs and attitudes interact with emotions and behavior, and a catalyst promoting corrective experiences, leading to cognitive change, and building skills © 2011 Brooks/Cole, A Case formation • Dynamic process • Requires the counselor to generate and test their hypotheses • Five parts: problem list, diagnosis, working hypothesis, strengths and assets, and treatment plan © 2011 Brooks/Cole, A Fundamental concepts Collaborative empiricism - the cooperative working relationship of jointly determining goals and seeking feedback Socratic dialogue - a type of questioning designed to promote new learning Guided discovery - when the counselor coaches the child in a voyage of self-discovery in which the child does his or her own thinking and draws his or her own conclusions © 2011 Brooks/Cole, A Session outline • • • • • • • • • • Build an agenda that has meaning for the client Ascertain and measure the intensity of the person’s mood Identify and review presenting problems Ask about the client’s expectation for counseling Teach the person about cognitive therapy and the client’s role in it Give information about the person’s difficulties and diagnosis Establish goals Recommend homework Summarize Obtain the client’s feedback © 2011 Brooks/Cole, A Counseling Session Four Steps Review progress bringing counselor and client up to date Homework assignments checked for completion Four quadrants for last week 1.List high points 2.Low points 3.How week could have been better 4.Plans for next week Set agenda for current session based on point quadrant Clarify and set specific behavioral goals for next week Have client summarize session as bridge to next week: review new homework, anticipate obstacles, evaluate session © 2011 Brooks/Cole, A Stress inoculation CBT technique that includes • Self talk • Practice tests • Visualization • Relaxation training • Deep breathing exercises © 2011 Brooks/Cole, A Stress inoculation Michenbaum’s categories of self-talk • Preparation: what you have to • Confrontation: you can handle it • Coping: keep stress manageable • Reinforcing: I did it © 2011 Brooks/Cole, A [...]... client understand how beliefs and attitudes interact with emotions and behavior, and a catalyst promoting corrective experiences, leading to cognitive change, and building skills © 2011 Brooks/Cole, A Case formation • Dynamic process • Requires the counselor to generate and test their hypotheses • Five parts: 1 problem list, 2 diagnosis, 3 working hypothesis, 4 strengths and assets, and 5 treatment... Identify and review presenting problems Ask about the client’s expectation for counseling Teach the person about cognitive therapy and the client’s role in it Give information about the person’s difficulties and diagnosis Establish goals Recommend homework Summarize Obtain the client’s feedback © 2011 Brooks/Cole, A Counseling Session Four Steps 1 2 3 4 Review progress bringing counselor and client... determining goals and seeking feedback Socratic dialogue - a type of questioning designed to promote new learning Guided discovery - when the counselor coaches the child in a voyage of self-discovery in which the child does his or her own thinking and draws his or her own conclusions © 2011 Brooks/Cole, A Session outline • • • • • • • • • • Build an agenda that has meaning for the client Ascertain and measure... checked for completion Four quadrants for last week 1.List high points 2.Low points 3.How week could have been better 4.Plans for next week Set agenda for current session based on 4 point quadrant Clarify and set specific behavioral goals for next week Have client summarize session as bridge to next week: review new homework, anticipate obstacles, evaluate session © 2011 Brooks/Cole, A Stress inoculation... Visualization • Relaxation training • Deep breathing exercises © 2011 Brooks/Cole, A Stress inoculation Michenbaum’s 4 categories of self-talk • Preparation: what do you have to do • Confrontation: you can handle it • Coping: keep stress manageable • Reinforcing: I did it © 2011 Brooks/Cole, A ... help the client understand how beliefs and attitudes interact with emotions and behavior, and a catalyst promoting corrective experiences, leading to cognitive change, and building skills © 2011... Aaron Beck • Childhood fears were handled with reasoning • Likely motivated his work with cognitive therapy focusing on anxiety and depression • Graduated from Brown University and Yale Medical... Cognitive Therapy and Research is housed © 2011 Brooks/Cole, A Aaron Beck Beck contended that various mental disorders have particular cognitive patterns and that the most effective and lasting therapy