1. Review outline in notes
Cognitive Therapy
Review outline in notes
I. Introduction
A. The foundation upon which cognitive therapy is established can be
II. Historical Background
views which they take of them.”
identified by the statement, “Men are disturbed not by things, but by the
conducted by Aaron Beck.
A. Cognitive therapy has its roots in the early 1960s research on depression
C. Lazarus’ concept of personal appraisal by an individual of an event has also
clients and behavioral techniques such as reinforcement and modeling.
B. Beck’s concepts have been expanded to include active, direct dialogues with
contributed to the cognitive therapy approach.
III. Indications for Cognitive Therapy
situation.
D. Cognitive therapy is aimed at modifying distorted cognitions about a
B. Today, it is also used with panic disorder, generalized anxiety disorder,
A. Cognitive therapy was originally developed for use with depression.
couples’ problems, bipolar disorder, hypochondriasis, and somatoform
eating disorders, substance abuse, personality disorders, schizophrenia,
social phobias, obsessive–compulsive disorder, posttraumatic stress disorder,
disorder.
the dysfunctional beliefs that predispose him or her to distort experiences.
A. The goal of cognitive therapy is for the client to learn to identify and alter
IV. Goals and Principles of Therapy
weeks.
B. Cognitive therapy is highly structured and short term, lasting from 12 to 16
1. Is based on an ever-evolving formulation of the client and his or her
therapy:
C. The following principles underlie cognitive therapy for all clients. Cognitive
problems in cognitive terms.
4. Is goal oriented and problem focused.
3. Emphasizes collaboration and active participation.
2. Requires a sound therapeutic alliance.
6. Is educative, aims to teach the client to be his or her own therapist, and
5. Initially emphasizes the present.
8. Sessions are structured.
7. Aims to be time limited.
emphasizes relapse prevention.
9. Teaches clients to identify, evaluate, and respond to their dysfunctional
D. Basic Concepts. The general thrust of cognitive therapy is that emotional
10. Uses a variety of techniques to change thinking, mood, and behavior.
thoughts and beliefs.
of environmental cues. Basic concepts include:
responses are largely dependent on cognitive appraisals of the significance
errors. Examples include:
situation, and without rational analysis. Sometimes called cognitive
1. Automatic thoughts. Thoughts that occur rapidly in response to a
a. Arbitrary inference. In this type of error, the individual
evidence to support it.
facts to support it, or even sometimes despite contradictory
automatically comes to a conclusion about an incident without the
are made based on one incident—a type of “all or nothing” kind of
b. Overgeneralization (absolutistic thinking). Sweeping conclusions
black-or-white, good-or-bad terms.
c. Dichotomous thinking. Situations are viewed in all-or-nothing,
thinking.
d. Selective abstraction (sometimes referred to as mental filter). A
e. Magnification. Exaggerating the negative significance of an event.
evidence.
conclusion is drawn based on only a selected portion of the
g. Catastrophic thinking. Always thinking that the worst will occur
f. Minimization. Undervaluing the positive significance of an event.
h. Personalization. Taking complete responsibility for situations
outcomes.
without considering the possibility of more likely positive
without considering that other circumstances may have contributed
individual’s fundamental beliefs and assumptions, which develop early
2. Schemas (core beliefs). Cognitive structures that consist of the
to the outcome.
others. These concepts are reinforced by further learning experiences
in life from personal experiences and identification with significant
specific, and positive or negative.
attitudes. Schemas may be adaptive or maladaptive, general or
and, in turn, influence the formation of other beliefs, values, and
V. Techniques of Therapy
2. Therapist provides information about cognitive therapy and provides
1. Client must be prepared to become own therapist.
A. Didactic (Educational) Aspects
3. A full explanation about correlation between distorted thinking and the
assignments to reinforce learning.
1. Recognizing automatic thoughts and schemas
B. Cognitive Techniques
client’s mental illness is provided.
a. Socratic questioning (also called guided discovery). The client is
possible dysfunctional thinking and produce a dissonance about the
Questions are stated in such a way that may stimulate recognition of
asked to describe feelings associated with specific situations.
b. Imagery. Through guided imagery, the client is asked to “relive”
validity of the thoughts.
individual within a situation that produces a maladaptive response
c. Role-play. With role-play, the therapist assumes the role of an
the stressful situation through his or her imagination.
in the client. The situation is played out in an effort to elicit
a written record of situations that occur and the automatic thoughts
d. Thought recording. In thought recording, the client is asked to keep
recognition of automatic thinking on the part of the client.
2. Modifying automatic thoughts and schemas. Techniques include:
that are elicited by the situation.
b. Examining the evidence. The client and therapist set forth the
possibilities than had originally been considered.
a. Generating alternatives. Helping the client see a broader range of
automatic thought as the hypothesis and study the evidence both for
validity of a negative automatic thought.
c. Decatastrophizing. The therapist assists the client to examine the
and against the hypothesis.
the tendency of attributing adverse life events to themselves.
d. Reattribution. This technique is aimed at helping clients decrease
extended thought recording instrument in which the client is asked
used in cognitive therapy to modify automatic thoughts. An
e. Daily record of dysfunctional thoughts (DRDT). A common tool
to record more rational cognitions than the automatic thoughts that
uncover potential automatic thoughts in advance of their
f. Cognitive rehearsal. A technique that uses mental imagery to
occurred. Changes in emotional responses are also recorded.
VI. Behavioral Interventions
occurrence in a stressful situation.
B. The following procedures are directed toward helping the client learn more
cognitions.
A. It is believed that cognitions affect behavior and behavior influences
adaptive behavioral strategies that will in turn have a more positive effect on
on an hourly basis and rate each activity for mastery and pleasure. The
1. Activity scheduling. The client is asked to keep a daily log of activities
cognitions:
during therapy.
schedule is then used to determine important areas needing concentration
time interval attached to each. This helps to make the client feel less
overwhelming, it is broken down into smaller subtasks, with a goal and
2. Graded task assignments. When a client perceives a task to be
powerless.
maladaptive behaviors that may be contributing to dysfunctional
rehearsal, this technique uses role-play to “rehearse” a modification of
3. Behavioral rehearsal. Often used in conjunction with cognitive
from the intrusive thoughts or depressive ruminations that are
4. Distraction. Use of activities to distract the client and divert him or her
social skills training, and thought stopping techniques may also be used
5. Others. Relaxation exercises, assertiveness training, role modeling,
contributing to the client’s maladaptive responses.
VII. Role of the Nurse: Application of the Nursing Process
to modify dysfunctional cognitions.
C. It is important for nurses to understand the basic concepts of cognitive
B. These concepts are often not a part of basic nursing education.
A. Cognitive therapy techniques are within the scope of nursing practice.
D. A case study presented the role of the nurse in cognitive therapy in the
therapy, as the scope of nursing practice continues to expand.
context of the nursing process.

2. The foundation on which cognitive therapy is established can be identified by the statement, “Men are disturbed not by things but by the views which they take of them.”

3. Indications for Cognitive Therapy
Depression
Panic disorder
Generalized anxiety disorder
Social phobia
Obsessive-compulsive disorder
Posttraumatic stress disorder
Substance abuse
Personality disorders
Schizophrenia
Couple’s problems
Bipolar disorder
Hypochondriasis
Somatoform disorder
Eating disorders

4. Goals and Principles of Therapy
The goal of cognitive therapy is for clients to learn to identify and alter the dysfunctional beliefs that predispose them to distort experiences.
Cognitive therapy is highly structured and short-term, lasting 12 to 16 weeks.
Cognitive therapy
Is based on an ever-evolving formulation of the client and his or her problems in cognitive terms
Requires a sound therapeutic alliance
Emphasizes collaboration and active participation
Is goal-oriented and problem-focused
Initially emphasizes the present

5. Basic Concepts
“The general thrust of cognitive therapy is that emotional responses are largely dependent on cognitive appraisals of the significance of environmental cues.” (Wright, Beck, & Thase, 2003)

6. Basic Concepts (cont.)
Automatic thoughts – thoughts that occur rapidly in response to a situation and without rational analysis; sometimes called cognitive errors
Some examples are:
Arbitrary inference
Overgeneralization
Dichotomous thinking
Selective abstraction
Magnification
Minimization
Catastrophic thinking
Personalization

7. Basic Concepts
Schemas (core beliefs) – “Cognitive structures that consist of the individual’s fundamental beliefs and assumptions, which develop early in life from personal experiences and identification with significant others. These concepts are reinforced by further learning experiences and, in turn, influence the formation of other beliefs, values, and attitudes.” (Beck & Weishaar, 2005)
Schemas may be adaptive or maladaptive, general or specific, and positive or negative.

8. Techniques of Cognitive Therapy
Didactic (Educational) Aspects
Clients must be prepared to become their own therapist.
Therapists provides information about cognitive therapy and provides assignments to reinforce learning.
A full explanation about correlation between distorted thinking and clients’ mental illness is provided. Cognitive Techniques
Recognizing automatic thoughts and schemas
Socratic questioning, Imagery, Role play and Thought recording

9. Behavioral Interventions (cont.)
Distraction
Relaxation exercises
Assertiveness training
Role modeling
Social skills training
Thought-stopping techniques