Cognitive Therapy With Youth The Schools Jody Lieske, PhD Licensed Pediatric Psychologist Children and Adolescent Clinic, P.C. Hastings, Nebraska

o An event triggers the beginning of the cycle (Beck 1964). o The event triggers a thought in the students mind that generally comes unintentionally and automatically. o Next there is an emotional response to the thought. o Based on the thought and emotion, a behavior occurs. The Cognitive Model

 Situations themselves do not cause us to have certain feelings.  It is our thoughts about the situation that lead to the feelings.

THOUGHTSBEHAVIORSEMOTIONS Cognitive Triad

 Reactions (behavior, emotions, compensatory strategies)  Automatic Thoughts  Intermediate Beliefs  Core Beliefs Levels of Thought/Behavior

Reactions (behaviors/emotions) Automatic thoughts Intermediate/Core Beliefs Levels of Thoughts and Behavior

 ATs and images are the quick, evaluative thoughts and images that occur in response to outside events (Beck et al., 1979).  Can be positive or negative, helpful or unhelpful, accurate or inaccurate  Youth are not always aware of their automatic thoughts. Automatic Thoughts

1.Negative automatic thoughts and images often represent situations in which a person is assuming the worst, often with little or no evidence to support the assumption. 2.Permissive automatic thoughts and images are ideas a student has that allow or excuse behavior that would otherwise cause feelings of guilt or discomfort. 3.Coping thoughts and images help a person to handle difficult situations in a healthy way. Three Common Categories of ATs

Examples of ATs Negative  “I blew it.”  “He doesn’t want me anymore.”  “There’s no use trying.”  “She thinks I’m stupid.”  “I can’t do it.” Permissive  “I’ve earned it!”  “Just this once…”  “I held up my end of the bargain— it’s not my fault if they didn’t.”  “Everyone else does it, so I may as well.”  They blame me for it, so I may as well do it.”

COPING o “I will just do my best, and that will be enough.” o “I am proud of myself for trying.” o “No matter what, I can learn from this, and try again if I need to.” o “Everyone makes mistakes.” o “I may do even better than I expect!” Examples of ATs

 Errors in logical thinking  Occur more frequently in persons who are in emotional distress or have a psychiatric disorder than in people without emotional concerns (Beck, 1976) Cognitive Errors

Underlying beliefs are the way we understand ourselves, others, and the world around us. Automatic thoughts are quick, evaluative thoughts that are informed by those underlying beliefs.

 The lens through which we see the world.  Often formed as a result of interaction between our genetic makeup and our early life experiences.  Intermediate and core Underlying Beliefs

 A student’s internalized “rules” for how they think the world should work.  Rules are often framed as if-then statements.  If one things happens, then it will lead to a specific result (positive or negative). Intermediate Beliefs

 The foundation of how we see ourselves, others, and the world (Beck et al., 1979)  Usually developed in childhood and based on experience  Usually related to beliefs about helplessness or unlovability Core Beliefs

 Behaviors that students use to deal with their underlying beliefs and to live according to the “rules” of their world.  3 Categories:  Maintaining strategies  Opposing strategies  Avoiding strategies Compensatory Strategies

 Student 1: “Counseling may be helpful, but it may be a waste of time. I’ll give it a couple of sessions before I make a decision.”  Student 2: “Meeting with a counselor is a waste of time. She won’t get what I am going through and I’m missing art class.”  Student 3: “I really need some help. The counselor really helped Amy, so maybe she can help me.” What would you guess that each is feeling?

 When a student’s distress is a reasonable reaction to a situation, rather than related to unhelpful or inaccurate thoughts and beliefs, we move to collaborative problem solving. A decision point: Problem solving or intervention?

 A process in which the clinician asks questions in a manner that helps the student identify the problem, determine how to best respond to it, and in some cases, how to change the situation. Collaborative Problem Solving

Appropriate when:  The student’s emotions are appropriate to the situation.  The student is in a situation that places them at significant risk for harm.  You and the student have checked the student’s thought and it appears both accurate and useful.  The student is functioning at a lower level and initially finds it difficult to understand how the beliefs, thoughts, and behaviors relate to the problem. Collaborative Problem Solving

 Identify the problem  Think about possible solutions  Choose a solution to try  How well does it work? ITCH (Munoz, Ippen, Rao, Le, & Dwyler, 2000)

Situation What happened around you just before you felt the way you did? AT What thoughts went through your head? Emotion What emotion(s) did you feel- in one word description? Thought Record

 Involves asking strategic questions to lead a student to a new perspective  Use Columbo approach (Selekman, 1993) Guided Discovery

 Catch  Check  Change The Three C’S

 “What evidence do you have that the thought is true or untrue?”  “Is there another explanation?”  “What is the impact or your believing this thought?”  “What should you do about it?”  “If this happened to a friend, what would you tell him or her?”  “Is this thought helpful?” Checking Thoughts

 “What is the worst thing that will happen?”  “What is the best thing that could happen?”  What is the most likely thing to happen?”  “If the worst thing happened, could you deal with it?” Checking Anxious Thoughts

How Likely Is Each Explanation

 Replacement thoughts are not just thinking a happy thought!  Help students develop thoughts that are believable and in their own words. Changing Thoughts

 Is a skill or ability deficit is getting in the way?  Is the student not invested in therapy?  Has the student developed some resistance?  Are the concepts being explained in a way that is too complex for the student? Difficulties with Checking or Changing Thoughts

 Helps students to delve into the meaning of automatic thoughts, looking for underlying beliefs  Thoughts are a reflection of our beliefs about ourselves and the world The Downward Arrow

 Behavioral Experiments  Behavioral Activation  Replacement Behaviors  Exposure  Relaxation Techniques Behavioral Techniques

 Beck, A. T. (2005). The current state of cognitive therapy: A 40-year retrospective. Archives of General Psychiatry, 62,  Butler, A. C., Chapman, J. E., Forman, E. M., & Beck, A. T. (2006). The empirical status of cognitive-behavioral therapy: A review of meta-analyses. Clinical Psychology Review, 26(1),  Chambless, D. L., & Ollendick, T. H. (2001). Empirically supported psychological interventions: Controversies and evidence. Annual Review of Psychology, 52, Three of the best sources for reviewing the empirical evidence that supports CBT

Jody Lieske Children and Adolescent Clinic, P.C North Kansas Ave Hastings, Ne Questions?