Cognitive Therapy Flashcards
Cognitive schemas
Contain people’s perceptions of themselves and others and of their goals and expectations, memories, fantasies and previous learning
Describe the main point if cognitive therapy
Maintains that people respond to life events through a combination of cognitive, affective, motivational and behavioural responses. These responses are based in human evolution and individual learning history. Aims to adjust info processing and initiate positive change in all systems by acting through the cognitive system. Maladaptive conclusions are treated as testable hypotheses. In a collaborative process, patient and therapist examine patient’s beliefs
Describe the role of biases in cognitive therapy
A specific bias affects how a person incorporates new info. Depression = negative view of self, world, future. Anxiety = themes of danger. Paranoia = indiscriminate attributions of abuse. Mania = exaggerated interpretations of personal gain
Cognitive vulnerabilities
Specific attitudes or core beliefs that predispose people under the influence of certain life situations to interpret their experiences in a biased way. Eg. Person who had belief that any minor loss = major deprivation may react catastrophically to any smallest loss. Eg. A person who feels vulnerable to sudden death may over interpret body sensations of impending death and have a panic attack
Modes
Networks of cognitive, affective, motivational and behavioural schemas that compose personality and interpret ongoing situations. Eg. The anxiety mode. Some are primal and others are under conscious control like studying
Primal modes include primal thinking. Nevertheless, conscious intentions can…
Override primal thinking
Collaborative empiricism
Views the patient as a practical scientist who lives by interpreting stimuli but who had been temporarily thwarted by his or her own information gathering and integrating apparatus. The therapist asks questions to understand the patient’s point of view, not solely to change the patient’s mind. The patient, in then, plays an active role in describing how he or she would like things to be different and what he or she might do to help create change
Guided discovery
Directed toward discovering what threats run through the patient’s current misconceptions and beliefs and linking them to relevant experiences in the part. Tell the story of the development of the patient’s disorder. Implicit is the notion that the therapist doesn’t provide answers but is curious about what they will discover as they gather data, examine and ask the patient
Socratic dialogue
The way in which guided discovery and collaborative empiricism are implemented. A style of questioning that helps uncover the patient’s views and examines his or her adaptive and maladaptive features
4 steps of the Socratic dialogue
- Asking informational questions
- Listening
- Summarizing
- Asking synthesizing or analytical questions that apply discovered info to the patient’s original belief
CT attempts to improve reality testing through…
Continuous evaluation of personal conclusions
What is the immediate goal of CT
Reduce cognitive distortions and biased judgements, thereby shifting info processing to a more neutral condition so that events will be evaluated in a more balanced way
Name 3 major approaches used to treat dysfunctional modes. Which are accomplished simultaneously in therapy? Why?
- Deactivate them
- Modify their content and structure
- Construct more adaptive modes to neutralize them
The first and third accomplished simultaneously because a particular belief may be demonstrated to be dysfunctional and a new belief to be more accurate or adaptive
Describe the techniques used in CT
Directed primarily at correcting errors and biases in information processing and modifying the core beliefs that promote faulty conclusions.
Purely cognitive techniques focus on identifying and testing the patient’s beliefs, exploring their origins and basis, correcting them if they fail an empirical or logical test, and problem solving
Core beliefs are explored in a similar manner and are tested for their validity and adaptive was.
Also uses behavioural techniques like skills training, role playing, behavioural rehearsal and exposure therapy
Cognitive therapy vs psychoanalysis
Procedures like identifying common themes, emotional reactions, narratives and imagery. But in CT, the common thread is a meaning readily accessible to conscious interpretation, whereas in psychoanalysis the meaning is unconscious. And thoughts are not deeply buried in the unconscious and the self report is not a screen for more deeply concealed ideas in CT. CT is more structured and short term. Relies on info processing and application of logic and behavioural experiments, rather than free association and in depth interpretations
CT vs REBT
Share emphasis on the primary importance of cognition in psychological dysfunction. Both see task of therapy as changing maladaptive assumptions and the stance of the therapist as active and directive
But, REBT states that individual has irrational beliefs that contribute to irrational thoughts and this will clear up when they are disputed. In contrast, CT helps patient translate interpretations and beliefs into hypotheses which are then subjected to empirical testing. Thus, CT eschews the word irrational in favour of dysfunctional. Another profound difference is that CT maintains that each disorder has it’s own typical cognitive content or cognitive specificity. Has cognitive profiles. REBT on the other hand doesn’t conceptualize disorders as having cognitive themes but instead focuses on musts, shoulds and other imperatives that underlie all disorders
CT vs behaviour therapy
Within behaviour therapy are numerous approaches that vary in their emphasis on cognitive processes. At one end, an approach that ignores internal events. On the other end, cognitive mediating processes are given increasing attention.
CT and BT share some features. Empirical, present centred, problem oriented, require explicit identification of problems and situations in which they occur and consequences.
In contrast to radical BT, CT applies same kind of functional analysis to internal experiences. Also in contrast, sees individuals as active participants who judge and evaluate stimuli.
Studies on techniques like exposure methods show that treatments of CT and BT work together
Describe CT’s theory of personality
When a person perceived that a situation requires a response, a whole set of emotional, cognitive, motivational and behavioural schemas are activated. Previously, thought that cognitions determined emotions. Now, all aspects of functioning
According to CT, what is personality shaped by?
Interaction between innate disposition and environment. Personality attributes or interpersonal strategies developed in response to the environment
Beck, Epstein and Harrison found 2 major personality dimensions relevant to depression and possibly other disorders
- Social dependence (sociotropy)
2. Autonomy
CT posits that sociotropy and autonomy are styles of behaviour, not fixed personality structures. This stands in marked contrast with which theory
Psychoanalytic
Discuss CT and social learning theory
CT emphasizes a person’s learning history. Emphasis on learning history endorses social learning theory and importance of reinforcement. Emphasizes the idiographic nature of cognition because the same event may have very different meanings to 2 people. The way a person structures experience is based on consequences of past behaviour, expectations, and vicarious learning from significant others
CT’s theory of causality
Psychological distress is caused by many inmate, bio, developmental and enviro factors interacting with one another, so there’s no single cause of psychopathology. Eg. Hereditary susceptibility -> depression, diseases that cause neurochemical abnormalities -> cognitive vulnerabilities
Cognitive distortions
Systematic errors of reasoning that are evident during psychological distress
Arbitrary inference
Drawing a specific conclusion without supporting evidence even in the face of contradictory evidence.
Eg. After a busy day a working mother thinks “I’m a terrible mother”
Selective abstraction
Conceptual icing a situation on the basis of a detail taken out of context, ignoring other information.
Eg. A man who becomes jealous on seeing his gf tilt her head towards another man to hear him better at a noisy party
Over generalization
Abstracting a general rule from one or few isolated incidents and applying it too broadly and to unrelated situations
Eg. After a discouraging date, a woman concludes “I’ll always be rejected”
Magnification and minimization
Seeing something as far more significant or less significant than it actually is.
Eg. Student says “if I appear the least bit nervous in class, it will mean disaster”. Another person, rather than facing that his mother is terminally I’ll, decides that she will soon recover from her “cold”
Personalization
Attributing external events to oneself without evidence supporting a causal connection
Eg. A man waves to an acquaintance across a busy street. After not getting a greeting in return, he concludes “I must have done something to offend him”
Dichotomous thinking
Categorizing experiences in one of two extremes, like a total success or failure.
Eg. A doctoral candidate stated “unless I write the best exam they’ve ever seen, I’m a failure as a student”
Cognitive triad of depression
Negative view of self, world and future
Cognitive profile of depression
Negative view of self, experience and future
Cognitive profile of hypo mania
Inflated view of self and future
Cognitive profile of anxiety disorder
Sense of physical or psychological danger
Cognitive profile of panic disorder
Catastrophic interpretation of bodily or mental experiences
Cognitive profile of phobia
Sense of danger in specific, avoidable situations
Cognitive profile of paranoid state
Attribution of bias to others
Cognitive profile of hysteria
Concept of motor or sensory abnormality
Cognitive profile of obsession
Repeated warning or doubts about safety
Cognitive profile of compulsion
Rituals to ward off perceived threat
Suicidal behaviour
Hopelessness and deficiencies in problem solving
Cognitive profile of Anorexia nervosa
Fear of being fat
Cognitive profile of hypochondriasis
Attribution of serious medical disorder
In CT, what are the goals of psychotherapy
To correct faulty info processing and help patients modify assumptions that maintain maladaptive behaviours and emotions. Challenge dysfunctional beliefs and promote more realistic adaptive thinking
How can cognitive change promote behavioural change?
By allowing the patient to take risks. In turn, experience in applying new behaviours can validate the new perspective
What role do emotions play in cognitive change
Learning is enhanced when emotions are triggered.
Cognitive change can occur at which 5 levels
- Voluntary thoughts
- Continuous or automatic thoughts
- Underlying assumptions
- Core beliefs
Explain how cognitions are organized in a hierarchy
Each level of the hierarchy differs in it’s accessibility and stability.
The most accessible and least stable cognitions are voluntary thoughts. The next level are automatic thoughts, which come to mind when triggered by circumstances and are given credibility without ever being challenged - seem plausible, accompanied by emotions, consistent with individual logic. Automatic thoughts are generated from underlying assumptions. Core beliefs are contained in cognitive schemas
In schema therapy, core beliefs are called what
Early maladaptive schemas
Describe the therapeutic relationship in CT
Collaborative. In cases of severe depression/anxiety, patients may initially need therapist to take more directive role.
Patient provides thoughts, images, beliefs. Patient takes responsibility for helping set agenda and do homework
Therapist is a guide and a catalyst. Therapist actively pursues patient’s point of view. Therapist specifies problems, focuses on important areas, teaches specific techniques. Therapist is flexible and elicits feedback from the patient
Describe the initial sessions of CT
Initiate a relationship with the client, elicit essential info, produce symptom relief. Diagnosis, past history, current life situation, psych problems, attitudes about treatment.
Problem definition + symptom relief begin in first session. Critical to focus on very specific problem and provide rapid relief in first session.
Therapist plays more active role.
Homework directed at recognizing connections bw thoughts, feelings and behaviour.
A problem list is generated. If therapist can help patient solve problem early in treatment, this success can motivate patient to make further changes
Describe the middle and later sessions of CT
Emphasis shifts from patient’s symptoms to patient’s patterns do thinking.
Connections bw thoughts, emotions and behaviours are demonstrated through the examination of automatic thoughts.
Once the thoughts are challenged, patient can consider underlying assumptions.
Emphasis more on cognitive, than on behavioural.
In later sessions, patient assumes more responsibility for identifying problems and creating homework assignments.
Therapist becomes an advisor
Describe ending treatment in CT
Length of treatment depends on severity of client’s problems. For unipolar depression, 15-20 sessions at weekly intervals. For moderate/severe depression, twice a week for 4-5 weeks and then weekly sessions for 10-15 weeks. Same with anxiety.
From the outset, patient and therapist share the expectation that therapy is time limited. Termination is planned for, even in the first session as rationale is being presented. Patients told that the goal of therapy is for them to learn to be their own therapists
Some patients have concerns about relapse or functioning autonomously. What do these concerns include and how do you respond?
Include cognitive distortions like dichotomous thinking (I’m either sick or 100% cured) or negative prediction (I’ll get depressed again and won’t be able to help myself)
Review the goal of therapy: to teach patient to handle problems more effectively, not to pursue a cure. Remind patient that setbacks are normal and give them the opportunity to practice new skills. Can also use cognitive rehearsal before termination by having patients imagine future difficulties and report how they would deal with them
List the 3 common denominators that cut across effective treatments
- A comprehensible framework
- The patient’s emotional engagement in the problem situation
- Reality testing in that situation.
How does CT conceptualize change
Modification of dysfunctional assumptions leads to effective cognitive, emotional and behavioural change.
Change can only occur if patient experiences a problematic situation as a real threat. One mechanism of change focuses on making accessible those cognitive constellations that produced the maladaptive Behavior symptomology.
Simply arousing emotions and the accompanying cognitions are not sufficient. Need to let the patient experience emotional arousal and reality testing simultaneously
Automatic thoughts can be evaluated according to what 3 characteristics
- Validity
- Utility
- Conclusion
Name the 6 cognitive distortions
- Arbitrary inference
- Selective abstraction
- Over generalization
- Magnification and minimization
- Personalization
- Dichotomous thinking
