Transcript Two Approaches to Cognitive Therapy

Unit 8: Approaches to
Psychotherapy II - Seminar
This week we read chapters 14 and
15, the topic for the Seminar
Discussion: are these four different
schools of psychotherapy
(Psychodynamic, Humanistic,
Behavioral, and Cognitive).
Discussion Scenario Part 1
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Which of these therapeutic approaches
appeals to you the most?
Based on what you know from research,
which type of therapy do you think is best?
Which approach seems to fit your style as a
therapist best?
Discussion Scenario Part 2
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Chapter 11, in a discussion of
psychotherapy research, refers to efficacy
vs. effectiveness.
How are these two kinds of research
different?
What implications do they have as you
interpret psychotherapy research findings?
Discussion Scenario Part 3
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Do you think you will practice different
types of therapy for different problems?
If so, what problems seem most appropriate
for which kinds of therapy?
Does Psychotherapy
Work?
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Through the mid-1900s, most answers to
this question came in subjective, nonempirical forms (few empirical studies)
In 1952, Hans Eysenck published a study in
which he concluded that therapy was of
little benefit
His finding has since been overturned, but
his study inspired decades of research on
therapy outcome
Behavioral Psychotherapy
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Behavioral therapy represents a
reaction against the lack of empiricism
inherent in psychodynamic and
humanistic approaches
– A reaction against mental processes that
can’t be precisely defined, directly
observed, or scientifically tested
Origins of Behavioral
Psychotherapy
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The clinical application of behavioral
principles
Roots of behaviorism include
– Ivan Pavlov’s classical conditioning
studies with dogs in Russia
– John Watson’s efforts to bring classical
conditioning to U. S.
– B. F. Skinner’s and E. L. Thorndike’s
studies of operant conditioning
Goal of Behavioral
Psychotherapy
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The primary goal of behavioral
psychotherapy is observable behavior
change
No emphasis on internal, mental
processes
– In contrast to previous approaches (e.g.,
psychodynamic and humanistic)
Discussion Question
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How does the behavioral approach to
psychological problems – namely,
reliance on observable, quantifiable
behaviors – differ from that of the
psychoanalytic and humanistic
perspectives presented in earlier
chapters?
Goal of Behavioral
Psychotherapy (cont.)
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Emphasis on empiricism
– Study of human behavior should be
scientific
– Clinical methods should be scientifically
evaluated via testable hypotheses and
empirical data based on observable
variables
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For example, baseline measures of problem
behavior at outset; subsequent measures
after some therapy
Goal of Behavioral
Psychotherapy (cont.)
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Defining problems behaviorally
– client behaviors are not symptoms of
some underlying problem—those
behaviors are the problem
– behavioral definitions make it easy to
identify target behaviors and measure
changes in therapy
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Clients’ own definitions can be very hard to
assess or measure
Goal of Behavioral
Psychotherapy (cont.)
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Measuring change observably
– Other kinds of therapists may measure
change in clients in more inferential ways,
but behavioral therapists use more
unambiguous indications of progress
– Introspection is not an acceptable way to
measure progress—not directly
observable
Cognitive Psychotherapy
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Cognitive therapy has risen in
popularity in recent decades
Currently, more clinical psychologists
endorse it than any other single-school
approach to therapy
Represents a reaction to both
behavioral and psychodynamic therapy
Goal of Cognitive Therapy
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the goal of cognitive therapy is an
increase in logical thinking, or to fix
faulty thinking
The way we think about or interpret
events determines the way we
respond emotionally
Importance of Cognition
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“Cognition” can also be called thought,
belief, or interpretation
Although we often describe our
feelings as stemming directly from
events, cognitions actually intervene
Events don’t make us happy or sad.
Instead, the way we think about those
events does.
Discussion Question
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What is your opinion of cognitive
treatment approaches? Are faulty
cognitions the root of all
psychopathology? Provide
explanations for your responses.
Revising Cognitions
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If cognitions determine feelings, revising
illogical cognitions can lead to more
appropriate emotional reactions
If cognitions are more extreme than
warranted, unwanted feelings can
unnecessarily occur
Three steps to revising cognitions:
– Identify illogical cognitions (automatic thoughts)
– Challenge them
– Replace them with more logical cognitions
Teaching as a Therapy
Tool
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Cognitive therapists often function as
teachers with their clients
– Educate clients about the cognitive model
– Use handouts, mini-lectures, readings
– Written assignments
– Aspire for clients to ultimately be able to
use the lessons learned to teach
themselves rather than remaining
dependent on the teacher
Homework
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Cognitive therapists often assign
homework between sessions
– Written
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Keep a record of events, interpretations, and
feelings
– Behavioral
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Perform certain behaviors to examine the
validity of a cognition that may be illogical
A Brief, Structured,
Focused Approach
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Cognitive therapy is typically
– Relatively brief—often 15 sessions or less
– Structured and planned
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Sessions may not be as free-flowing or
spontaneous as in other therapies
– Focused on particular goals determined
by client and therapist at the outset
Two Approaches to
Cognitive Therapy
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Albert Ellis
– His approach is known as Rational
Emotive Behavior Therapy (REBT)
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Despite the word “behavior” in the name, it is
cognitive (not behavioral) therapy
– Emphasizes a connection between
rationality and emotion
Two Approaches to
Cognitive Therapy (cont.)
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Albert Ellis (cont.)
– ABCDE model
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Activating Event
Belief
Consequence (emotional)
Dispute
Effective new belief
– These five columns provide a format for written
records of client experiences
– Also provide a model of understanding and
change for client
Two Approaches to
Cognitive Therapy (cont.)
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Aaron Beck
– General term “cognitive therapy” is label
for his approach
– Dysfunctional Thought Record instead of
ABCDE format for recording client
experiences
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Different column headings, but similar
concepts
Two Approaches to
Cognitive Therapy (cont.)
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Aaron Beck (cont.)
– Common thought distortions
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All-or-nothing thinking (no gray area)
Catastrophizing (unrealistically expecting the worst)
Magnification/minimization (mountain out of molehill)
Personalization (assume too much responsibility)
Overgeneralization (negative thoughts applied too
broadly)
Mental filtering (ignoring positive events and focusing
only on negative events)
Mind reading (presuming to know what others think)
Two Approaches to
Cognitive Therapy (cont.)
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Aaron Beck (cont.)
– Beliefs as hypotheses
Our beliefs are hypotheses , even though we
may live as if they are proven facts
 Therapy can involve putting these beliefs to
the test to see if they hold true
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Discussion Question
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If an individual experiences cognitive
distortions in which he interprets
events in an uncharacteristically
optimistic fashion, does he require
cognitive therapy?
Are all cognitive distortions
psychologically unhealthy?
Recent Applications of
Cognitive Therapy
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Cognitive therapy for medical
problems
– The way patients think about injury,
illness, or condition can be powerful,
especially when irrational
– Increasing logical thinking can improve
mental and physical health
– Has been successfully applied to a variety
of medical problems
Discussion Question Part 1
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Cultural factors undoubtedly contribute to
an individual’s cognitions. How should a
psychologist employing cognitive techniques
approach a client’s thoughts that are based
on deep-seated traditions or beliefs? For
example, consider a young woman who is a
Christian, but has nonetheless engaged in
premarital sex; she reveals that she often
thinks of herself as sinful and impure after
such sexual encounters, and ultimately
experiences depressive symptoms as a
result of these cognitions.
Discussion Question Part 2
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Although premarital sex is universally
denounced as a sinful act by Christian
religion, should a cognitive
psychologist attempt to modify this
client’s most intimate beliefs in the
name of altering arguably faulty
cognitions? Is there another, noncognitive approach that might better
serve such a client?
Questions?