module 6 Cognitive Approaches Flashcards
discuss the history of cognitive approaches
COGNITIVE THERAPY comes in a variety of specific types. eg Cognitive Behavioural Therapy.
Cognitive Therapy asserts that the way a person feels and behaves is influenced by the immediate situation and the individual’s interpretation of the situation. In cognitive therapy, when we see a strong emotion, we are often interested the person’s thinking at the time.
ie SITUATION»THOUGHTS»FEELINGS & BEHAVIOURS.
Thus in order to change feelings/behaviours (which are leading to dissatisfaction/conflict), need to change Thoughts.
Cognitive Behavioural Therapy is derived mainly from Beck’s model of idiosyncratic ways of processing information by troubled people such as;
a) Depression is where incoming information is processed via a negative filter; people tend to think negatively about self, present, future.
b) Anxiety is where incoming information is processed via an anxious filter; people tend to catastrophise and imagine the worst.
c) Anger is where incoming information is processed via a rigid filter; people tend to judge others using rigid inflexible rules.
Other emotions are also possible. Whenever there are strong emotions, there is the possibility that information is being processed in an idiosyncratic (abnormally reactive)way.
Albert Ellis developed Rational Emotive Therapy.
There are also multiple types of Cognitive Behavioural Therapy, including;
1. Beck’s cognitive Therapy
2. Ellis’s Rational Emotive Therapy
3. Acceptance and Commitment Therapy
4. Schema Focussed Therapy
5. Dialectical Behaviour Therapy
6. Mindfulness-based Therapy.
outline ways in which cognitive interventions can assist certain clients
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teach Socratic questioning to your clients to help them challenge long-standing beliefs
Many thoughts are accurate and in line with reality, however, some are inaccurate or irrational. Socratic questions are taught to clients so they can review their own thoughts, however, initially this is done together in session. It is important to remember, when using this method, to not directly challenge or argue a client out of a thought. It is best to teach the method, so the client can come to their own conclusion that the thought should be changed.
explain the use of a range of other cognitive approaches to counselling.
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Automatic Thoughts and Cognitive Distortions
Develop Core Beliefs as defensive mechanism from childhood. Often then develop Conditional Assumption ie if…then…as protective mechanism. eg A client who believes they are fundamentally unlovable may develop the conditional assumption that ‘as long as I’m good or helpful, then I’ll be okay’.
or eg. A client with the assumption that they are somehow defective may develop the conditional belief ‘if I don’t take risks, I’ll never fail’.
Automatic Thought is very quick and superficial, almost unconscious. Tend to be accepted uncritically and able to exert great influence over us. They are influenced by Cognitive Distortions. A cognitive Distortion filters incoming information in a biased way, such that any original problem is reinforced.
Negative Automatic Thoughts are conscious but almost automatic and difficult to ignore. They are like a negative commentary in one’s head.
COMMON COGNITIVE DISTORTIONS;
1. Polarised, or black-and-white, thinking;Things are either all good or all bad, with no in-between
2. Personalising ; Self-blame, accepting total responsibility
3. Overgeneralisation ; Project now into a future ‘always’
4. Filtering; Only notice information consistent with beliefs or thoughts
5. Mind reading;Assume you know what others think
6.Emotional reasoning;Feelings are facts, e.g. ‘I feel anxious, I must be in danger’
7.Catastrophising; Assuming the worst will happen
8.Minimising or magnifying; Either making things unimportant, or the opposite, exaggerating things out of proportion, e.g. minimising your own desirable qualities or making another person’s achievement much bigger than it actually is
9.Shoulds or musts;Setting rigid rules or unrealistic standards about people’s behaviour, e.g. ‘I should exercise more and not be so lazy’; the emotional consequence here is guilt
ABCD ANALYSIS
The A-B-C-D analysis is a common cognitive intervention in CBT.It focuses on the following;
1.Activating event: This refers to the initial situation or trigger.In helping clients identify the A, it is important for them to understand that this external situation or event does not cause their feelings (which are their reactions to how the external situation makes them feel).It is also important to discriminate between activating events that can be changed and those that cannot. For those that can be changed, clients can use good problem-solving skills to bring about change. For those situations that are outside the client’s control, it is important to focus on reactions to the event rather than the event itself.
2.Belief system: The belief system refers to how you interpret the activating event. What are the belief and expectations around what should happen?Differentiating between rational and irrational beliefs is primarily the responsibility of the counselor. Rational beliefs are those that are truly consistent with reality—in the sense that they can be supported with data, facts, and/or evidence and would be substantiated by a group of objective observers. Rational beliefs may result in moderate levels of consequence (Cs), or emotional consequences, and are useful in helping people attain their goals. Irrational beliefs, however, are those that are not supported by reality through data, facts, and/or evidence and would not be supported by a group of objective observers. As a person accumulates more IBs, that person becomes more troubled, not realizing that it is his or her belief system that is the source of the problem.
3.Consequence: What is felt and done in response to the belief system, i.e. the emotional and behavioural consequences of A and B?
The emotional consequences of the activating event are often what propel the client into counseling. People cannot tolerate bad or uncomfortable feelings too long, and if such feelings persist, they may be motivated to seek outside assistance. Examples of emotional consequences that lead clients into counseling include guilt, long-term anger, fear, depression, and anxiety.
4.Disputation: Here, beliefs and expectations are examined. Are they unrealistic or irrational? What is an alternative way to handle the situation? Generally, clients must be convinced that their belief systems are at the root of their problems. This is done by questioning and challenging the conclusions they have drawn regarding a particular event. Even when challenged, deeply committed irrational thinking must be addressed repeatedly until it transforms from “I feel defeated by my job status” to “I choose to feel defeated by my job status.” At the point of recognizing choice, the client gains control of the situation and is free to choose a different reaction
In an A-B-C-D analysis, the client monitors events that elicit strong emotions, and identifies associated thoughts. These can be assumptions, attitudes, rules, standards, longstanding beliefs, etc
RE-DECISION WORK
Re-decision work involves examining injunctions, beliefs, rules, etc. the client learned as a child, and deciding whether to continue to follow these rules. This can involve updating aforementioned belief, e.g. when James was a child it made sense to be seen and not heard, but now as an adult this stops him fully engaging in life. Therefore, he decides to challenge and change this belief or rule.
COGNITIVE INTERVENTIONS
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some types of Cognitive Interventions include;
1. Thought stopping/scheduling;a short-term intervention to help client develop ways to halt destructive or non-productive NATs about themselves or other people. It involves interrupting a negative thought, or scheduling time in a day outside of this stop. The more this negative thinking pattern is interrupted, the more likely we are to be able to develop alternatives.
2. Reframing; This technique involves gently offering alternate ways of viewing a situation, by offering new perspectives. Let’s say one of your clients complains that their son is so naughty and always shouting. You could offer a new perspective by asking some questions. For example, you could ask: ‘I wonder if your son gets frustrated because he doesn’t know how to put into words what he wants? Maybe together we can think about how to help him find his words?’
3. Anchoring; Anchors, or early warning signs, help by alerting your client to impending negative thoughts or feelings, It is a very important strategy for those who escalate quickly. For example, an anchor for an angry client might be that they are feeling hot in their head, and fists are clenching, whereas for an anxious client it might be the heart is beating faster
4.Pieces of pie; involves identifying a NAT and then testing it out using reframing or perspective taking. For example, when your client says people look at them on the tram because they are Black, you could ask ‘what else might people be thinking if not that?’. Together you then fill out a pie with the different ideas (ie pie chart)
5. ABCD analysis
6. Cognitive Disputation-challenge thoughts/behaviours by confronting assumptions and practices
7. Decibels and Countering-identify and replace thoughts which are associated with disturbed feelings
8. Redecision work
9. Cognitive Restructuring;involves helping the client replace negative automatic thoughts (NATS) with more adaptive, accurate, helpful thoughts. This technique is often used after an A-B-C-D analysis, or after a client has identified their NATs. It can also be used after the client has evaluated their thought, using Socratic questioning
10. Reframing;Helping the client recognize more constructive or realistic interpretations to events that he or she formerly interpreted negatively
11.Resisting Therapeutic Change;Suggesting to the client that change may not happen readily or may not be lasting as a way to counter irrational fears about the effectiveness of counseling. A form of Second-order intervention.
If the client then has a setback, he or she is less concerned because the counselor cautioned that this might happen and advised the client not to be concerned about it. If the client does not have a setback, all the better! In fact, this particular second-order intervention often leads to more efficient therapeutic progress than not, because it creates a cognitive double-bind for the client who may be prone to resistance.
12.Positioning;Agreeing with a client’s irrational view in order to “double-bind” the client
13.Meaning Making;Attending to the unique meaning(s) a client ascribes to events and situations, including those that are spiritual and existential
gems
1.Many people apparently find it difficult to differentiate between their thoughts and their feelings. It is fairly common to hear a person say, “I feel like everyone is against me,” when the more accurate statement is, “I think everyone is against me.” A lot of thinking people have mislabeled their thoughts as feelings
2.errors in thinking, sometimes called faulty thinking, are especially likely to produce distressing emotions and/or problematic behavior
3.The person who feels easily may feel too much, and may need to be buffered by thinking and behaving differently; similarly, a person who thinks a lot may analyze too much, leading to overanalyzing or ruminating.
4.The application of cognitive interventions in counseling is extensive. They have been applied as the primary intervention for such problems as anxiety reduction, stress management, anger control, depression, phobic disorders, and sexual dysfunction
5. Cognitive interventions, then, are designed to magnify the “thinking it through” aspect of problem solving to help clients gain new insights that can lead to new options for tackling their problems.
6. The counselor must understand how clients determine meaning in their lives.It is human nature to try to make sense of life, but the sense that is made may be close to reality or it may have a tenuous relationship to reality; it may open up opportunities for growth and development or it may be self-defeating. Therefore, a first and essential task for the counselor is to follow the client’s logic, to assess outcomes of the client’s logic, and—to the extent possible—to determine the client’s faithfulness to detail and observation (i.e., to determine the extent to which the client does any reality testing).
7. For many clients, there is not a clear demarcation between the psychological and the spiritual. For those clients who have belief in a Deity (or, as Alcoholics Anonymous prefers, a Higher Power), the spiritual realm may be a necessary and fruitful area for healing but only if the counselor has both comfort and skill in addressing spiritual matters
8. Not all clients have an active or even tangential spiritual life; still, this does not preclude the client’s quest for meaning. Particularly for clients who have experienced loss or trauma, meaning-making interventions have been found to be invaluable
9. metaphor presents a contextually different scenario that may be close enough to allow the client to draw conclusions and gain insights about the problem.
Transactional Analysis
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Ellis’s List of Irrational Beliefs
Many clients’ thoughts can be deconstructed to contain some element of irrationality and can be fit into one of the following 11 irrational beliefs:
1. I believe I must be loved/approved of by virtually everyone with whom I come in contact.
2. I believe I should be perfectly competent in everything that comes my way, to be considered worthwhile.
3.Some people are bad, wicked or villainous, and therefore should be blamed or punished.
4. It is a terrible catastrophe when things are not as I would want them to be.
5. Unhappiness is caused by circumstances out of my control.
6. Dangerous or risky things are sources of great concern, and I should worry about them constantly.
7. It is easier to avoid certain difficulties and responsibilities than it is to face them.
8. I should be dependent on other persons and should have some person on whom I can rely to take care of me.
9. Past experiences and events are what determine my present behaviour;the influence of the past cannot ever be erased.
10. I should be quite upset over other people’s problems and disturbances.
11. There is always a right or perfect solution to every problem, and it must be found, or the consequences will be catastrophic.
Cognitive Disputation
Cognitive disputation makes use of persuasion, direct questions, and logical reasoning to help clients dispute their irrational beliefs.
Questions of Cognitive Disputation include eg:
Is that good logic?
Is that true? Why not?
Can you prove it?
Why is that so?
Could you be overgeneralizing?
What do you mean by that term?
If a friend held that (self-defeating) idea, would you accept it?
In what way?
Is that very good proof?
Explain to me why . . . (e.g., “you’re so stupid”; “you don’t belong in college”).
What behaviors can you marshal as proof?
Why does it have to be so?
Where is that written?
Can you see the inconsistency in your beliefs?
What would that mean about you as a person?
Does that follow logically?
What’s wrong with the notion that you’re special?
How would you be destroyed if you don’t . . . ?
Why must you?
Let’s assume the worst. You’re doing very bad things. Why must you not do them?
Where’s the evidence?
What would happen if . . . ?
Can you stand it?
As long as you believe that, how will you feel?
Let’s be scientists. What do the data show?
Counselors who use cognitive disputation must recognize that this method can lead to client defensiveness and must be sensitive to resulting client responses, particularly to their nonverbal cues. It is important to realize that clients may have difficulty with the disputation process because they are unable to discriminate between irrational and rational beliefs. When this occurs, persistence is called for, often supplemented by counselor modeling of the difference between an irrational and a rational belief.
Imaginal Disputation
Technique of Disputation where client imagines themselves in problem situation-what thoughts are they having? Then imagine having different thoughts/behaviours.Rational Emotive Imagery such as this are useful for wrong-feeling solutions to quickly feel right. Usually client needs to practise this several times a day for several weeks.
Desibels Intervention
desibels stands for “DESensitizing Irrational BELiefS”)
Used to help clients become aware of disturbances in thinking, which simultaneously eliminates consequent distressing feelings. Most often set as 10min daily homework for clients to think about the following q’s;
What irrational belief do I want to desensitize and reduce?
What evidence exists for the falseness of this belief?
What evidence exists for the truth of this belief?
What are the worst things that could actually happen to me if I don’t get what I think I must (or if I do get what I think I must not)?
What good things could I make happen if I don’t get what I think I must (or if I get what I think I must not)?
The desibels intervention may be more effective if daily compliance is followed by some form of client self-reinforcement, such as engaging in an enjoyable activity.
Countering Intervention
Clients are asked to identify, both verbally and in writing, counterarguments for each of their significant irrational or problematic beliefs, using the following six “rules.”;
1.Counters must directly contradict the false belief. For example, if the irrational belief is, “I’m a failure if my wife leaves me,” a contradicting counter would be, “My wife’s behavior is independent of my own success and accomplishments.”
2.Counters are believable statements of reality. For example, a reasonable or believable statement of reality is, “I don’t have to get straight As in high school in order to get a reasonably good job,” whereas “I don’t have to go to high school to get a reasonably good job” is not.
3.Develop as many counters as possible in order to counteract the effects that the irrational beliefs have produced over time.
4.Counters are created and owned by the client. The counselor’s role in developing counters is limited to coaching. This rule is important, because clients are likely to be more invested in counters that they themselves generate. Also, effective counters are often highly idiosyncratic to specific clients.
5.Counters must be concise. Lengthy, long-winded counters are easily forgotten. The most effective counters can be summarized in a few words.
6.Counters must be stated with assertive and emotional intensity. It has been suggested that if the client attempts a counter but is unconvincing, the counselor should have the client first repeat the counter nasally; then mechanically (without feeling); and then with vigor, filling her or his lungs with air and vehemently stating the new belief. This helps make an indelible memory for the client.
