Chapter 14 Cognitive-Behavioral Therapies

What are Cognitive- Behavioral Therapies? cognitive-behavioral therapies combine cognitive and behavioral techniques to help clients to: understand problems see patterns of irrational thought evaluate behaviors based on more rational thinking teach new skills to promote self-regulation

Why Cognitive Processes Can Be Important cognitive processes appear central to a number of problem behaviors clinical depression involves cognitions related to hopelessness, pessimism, and low self-esteem people become fearful of highly publicized but unlikely events those worried about pain tend to rate pain as higher

Why Cognitive Processes Can Be Important (continued) highly aggressive individuals make hostile attributions about the intent of others explicit memory systems allow us to be aware of those situations we fear and consciously think about them

Evolution of Cognitive- Behavioral Therapy ancient Greek and Buddhist writings include assumptions that conscious thought influences our action cognitive methods became more widespread as the field of psychology adopted a more cognitive orientation behaviorists saw that the cognitive approach could address new issues

Evolution of Cognitive- Behavioral Therapy (continued) behavior therapists have accepted cognitive approaches when therapy is evaluated by measuring changes in overt behavior some continue to argue that the cognitive methods are too vague and may not be that powerful

Cognitive Restructuring Approaches cognitive restructuring focuses on reducing dysfunctional thought Ellis's rational-emotive therapy (RET) –developed to help individuals change irrational thought –based on the assumption irrational interpretations predict that upcoming events will be emotionally unpleasant

Cognitive Restructuring Approaches (continued) Beck’s cognitive therapy –holds that faulty and negativistic thought patterns lead to behavioral and emotional problems –beliefs are held in schema that automatically evaluate situations –distorted stored beliefs can automatically generate irrational thoughts

Cognitive Restructuring Approaches (continued) –clinical depression includes a negative view of self, the world, and the future (negative triad)

Ellis's A-B-C-D-E Paradigm RET follows Ellis's A-B-C-D-E paradigm: activating experiences are events that precipitate emotional responses beliefs are our interpretations about what those events mean consequences are emotional reactions to those beliefs dispute irrational beliefs in therapy emotional relief follows recognition of irrationality of beliefs

Effectiveness of RET research suggests RET is somewhat effective –it works better than no treatment for problems such as anxiety –it might be less effective than procedures like systematic desensitization little evidence is available regarding treatment durability much of the research has been poorly designed

Cognitive Therapy cognitive therapy uses a collaborative approach between client and therapist cognitive therapy uses a hypothesis testing approach the client typically is assigned homework –evaluation of thoughts –collection of evidence to test beliefs –behavioral activities like relaxation exercises

Beck’s Cognitive Errors Beck identified a number of common erroneous thought patterns: dichotomous thinking involves all-or-none evaluations in overgeneralization, a rule or belief is applied too broadly arbitrary inference refers to drawing inaccurate conclusions based on insufficient, ambiguous, or contrary evidence

Beck’s Cognitive Errors (continued) magnification involves exaggeration of the meaning or impact of an event

Effectiveness of Cognitive Therapy appears to be effective and durable in treating depression may be least likely to work with those who are more severely depressed research on effectiveness with problems other than depression suggests the treatment is promising, but studies are not conclusive

Cognitive Skills Training Approaches skills training approaches focus on training new thinking skills Meichenbaum's stress inoculation training teaches cognitive skills that allow clients to deal with stressful events problem-solving training teaches strategies for identifying, discovering, or inventing ways of addressing problems

Three Phases of Stress Inoculation Training conceptualization focuses on the nature of stress and how people respond to it skills acquisition and rehearsal teaches specific behavioral and cognitive coping skills such as relaxation, desensitization, and coping statements application and follow-through involves the transition to real-world application of the skills

Effectiveness of Stress Inoculation Training many of the components (e.g., relaxation, modeling, desensitization) have been validated when applied independently preliminary evidence suggests that this method is as effective as its component procedures

Problem-Solving Training problem-solving training teaches strategies for identifying, discovering, or inventing ways of addressing problems problem-solving training is fast and effective for depression and anxiety improvement may be durable and generalize to other settings with adults

Problem-Solving Training (continued) durability and generalization may be lacking when used with children few studies have compared the procedure with other approaches

A Five-Step Approach to Problem-Solving Training D'Zurilla and Goldfried gradually increase responsibility problem orientation focuses on identification of problems, reduction of fears of addressing problems, and encouragement to confront problems problem definition and formulation defines problems in behavioral terms

A Five-Step Approach to Problem-Solving Training (continued) generation of alternate solutions uses brainstorming to generate a list of potential solutions decision making eliminates unacceptable solutions and then evaluates the consequences of the remaining solutions solution implementation and verification involves evaluation of the effectiveness of the solution and consideration of alternatives

Combined Therapy Approaches programs that combine therapy approaches seem to work Lazarus’s multimodal therapy first identifies the dimensions of a client's problem and then chooses a treatment appropriate for each dimension some research has shown no advantage or that programs become less effective