Cognitive - Cognitive Therapy Cognitive Therapy Aaron T...

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Unformatted text preview: Cognitive Therapy Cognitive Therapy Aaron T. Beck Nature of Human Nature of Human Infants are endowed with the motive to survive and later on to procreate To accomplish this, one must process information, perceive, interpret and learn from experience; draw conclusions, make predictions and formulate goals Function of Psyche Function of Psyche To process information, infant is endowed with a variety of functions: – Sensation – Emotions – Memory – Potential for increasingly voluntary motor movement – Ability to form sensory images and verbal thoughts Function of Psyche Function of Psyche Very primitive in infants: nonverbal visual, auditory, tactile, olfactory and gustatory images. Child develops cognitively, information processing becomes increasingly verbal, abstract and subject to growing ability to reason, while retaining sensory basis At every stage of development, “the processing of information is crucial for the survival of any organism.” (Beck & Weishaar) Structure of Psyche Structure of Psyche From a cognitive perspective, human psyche consists of schemas, systems, and modes. These components comprise the personality. Schemas Schemas Cognitive Emotional Physiological Motivational Behavioral Schemas Schemas Cognitive schemas are core beliefs such as those about perceived danger, violation, loss and gain Emotional schemas are the core emotions, such as anxiety, anger, sadness, and joy Motivational schemas are core impulses: to escape or avoid, lash out, to grieve or to seek and approach Schemas Schemas Behavioral schemas are core actions, including shaking, scowling, crying and smiling Physiological schemas refer to the core ways that the body’s autonomic, motor and sensory systems are energized along with emotional arousal Modes Modes Subpersonality structure comprised of a network of interrelated cognitive, emotional, physiological, motivational, and behavioral schemas During waking life, one mode is dominant at a given time, while others lie dormant, awaiting activation Modes Modes Orienting mode – Constant process of scanning the environment for threats and opportunities related to one’s interests, both vital and otherwise. Minor mode – Pursuing less than vital interests: working at one’s job, or in one’s garden, conversing with a friend, playing computer games. “Driving mode” Major or primal mode – Perceived environmental circumstances matches the template of threat or opportunity to one’s vital interests. Conscious control system Conscious control system Separate from and relatively independent of modes When activated, has the potential to de­ energize the mode by thinking about and acting on one’s cognitive and behavioral systems The Cognitive Model The Cognitive Model CT’s View of Personality CT’s View of Personality Thinking is problematic or distorted when it is very: – – – – – – Extreme Broad Catastrophic Negative Unscientific Pollyanish – – – – – – Idealistic Demanding Judgmental Comfort­seeking Obsessive Confusing CT’s Cognitive Distortions CT’s Cognitive Distortions Arbitrary inferences Selective abstraction Overgeneralization Magnification and minimization Personalization Dichotomous thinking CT’s Cognitive Triad CT’s Cognitive Triad Pattern that triggers depression: Exaggerated and relatively persistent and pervasive negative thoughts about self, others and world. 1. Client holds negative view of themselves 2. Selective abstraction: Client has tendency to interpret experiences in a negative manner 3. Client has a gloomy vision and projections about the future Cognitive Model of Anxiety Cognitive Model of Anxiety Person’s information processing is faulty Cognitive themes of exaggerated and relatively persistent thoughts of danger and likelihood of harm – Trouble correcting misconceptions and recognizing safety cues and other evidence General Principles of CT General Principles of CT Goal is to correct dysfunctional thinking and help patients modify erroneous assumptions Patient is taught to be a scientist who generates and tests hypotheses Relationship between patient and therapist is collaborative Fundamental Concepts Fundamental Concepts Collaborative Empiricism – Goal is to demystify therapy Socratic Dialogue – Form of questioning used to help patients come to their own conclusions about their thoughts and behaviors Guided Discovery – Therapist collaborates with patient to develop behavioral experiments to test hypotheses Primary roles of CT therapist Primary roles of CT therapist Conceptualizing the patient in cognitive terms Structuring the sessions Using collaborative empiricism and guided discovery to specify problems and set goals Structure of CT session Structure of CT session Mood Check Setting the Agenda Bridging from Last Session Today’s Agenda Items Homework Assignment Summarizing Throughout and at End of the Session Feedback from Patient Process of Therapy Process of Therapy Initial Session – Essential to build rapport – Focus is problem definition, goal setting and symptom relief – Therapist provides psychoeducation in initial sessions – Behavioral interventions may be more prominent Middle Sessions – Emphasis shifts from symptoms/behaviors to patterns of thinking Termination – Expectation that therapy is time limited Cognitive Interventions Cognitive Interventions Eliciting automatic thoughts through Dysfunctional Thought Records Identifying whether the thoughts represent distortions in information processing Using Socratic questions to evaluate the thought process Generating alternatives in terms of how to think or how to behave differently Setting Effective Homework Setting Effective Homework Make sure rationale is clear When feasible, have patient choose the task Personalize task to therapy goals Begin where the client is, not where you think he/she should be Be specific and concrete: where, when… Formalize the task (write on paper) Plan ahead for potential obstacles and “trouble shoot” Practice task in session Review homework at the beginning of each session Other CT Techniques Other CT Techniques De­catastrophizing: “What if that happened, then what?” Reattribution: Alternative explanations systematically examined Redefining: Help patient define problem differently Decentering: Used with social anxiety to shift focus. Applications for CT with Applications for CT with highest efficacy Depression Generalized Anxiety Disorder Panic Disorder Social Phobia Childhood Depression and Anxiety Disorders References References Corsini, R. J. & Wedding, D. (2008). Current psychotherapies. (8th ed). F.E. Peacock Publishers, Inc.: Itasca, Ill. Fall, K.A., Holden, J.M. & Marquis, A. (2004). Theoretical models of counseling and psychotherapy. Brunner­Routledge: New York. ...
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