Topic 25: Cognitive Behavioral Therapies Flashcards
Cognitive Behavior
covert verbal or imaginal behavior
examples include thinking, talking to yourself, imagining specific behaviors or situations, and recalling events of the past
cognitive behavior is influenced by the same environmental variables that influence overt behavior
Cognitive Behavior Modification
procedures used to help people change some aspect of their cognitive behavior
includes procedures to help people eliminate undesirable cognitive behaviors (i.e., cognitive restructuring) and procedures to teach people more desirable cognitive behaviors (i.e. cognitive coping skills training)
Cognitive Restructuring
a cognitive behavior modification procedure in which the client learns to identify thoughts that are distressing and then learns to eliminate those thoughts or to replace them with more desirable thoughts
Cognitive Coping Skills Training
a cognitive behavior modification procedure in which the person learns specific self-statements for use in a problem situation to improve his or her performance or influence his or her behavior
an example is self-instructional training
Cognitive Therapy
a type of cognitive restructuring, originally developed by Beck, in which the therapist taches the client to identify and change his or her distorted thoughts or self-talk
Behavior Activation
a treatment for depression focusing on getting the client to engage in a larger number and variety of reinforcing activity
Cognitive Distortions
a type of thinking in which individuals negatively evaluate or interpret events in their life or make logical errors in their thinking that lead to negative mood or depressed behavior
Self-Instructional Training
a type of cognitive behavior modification procedure in which the client learns to make specific self-statement that increase the likelihood that a target behavior will occur in a specific situation
What do cognitive behavioral therapies help clients to do?
understand problems
see patterns of irrational thought
evaluate behaviors based on more rational thinking
teach new skills to promote self-regulation
What do cognitive processes include?
thoughts
perceptions
beliefs
expectations
attributions
self-statements
Why are cognitive processes are important in many problem behaviors?
clinical depression involves cognitions related to hopelessness, pessimism, and low self-esteem
people become fearful of highly publicized but unlikely events
people worried about pain tend to rate their pain as higher
highly aggressive people 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
What did B.F. Skinner contribute to cognitive behavioral therapies?
gave behavioral interpretations of psychoanalytic terms, like repression
wrote about “clinical behavior analysis” which was about applying radical behaviorism to outpatient adult behavior therapy (not hospital populations)
by the late 1950s, dissatisfaction with the vagueness of psychotherapy (e.g. psychoanalysis) and the paucity of evidence of its effectiveness was growing
the term “behavior therapy” emerged in the late 1950s, referring to respondent conditioning treatments of anxiety disorders
What is the Association of Behavior Therapy (AABT)?
formed in 1966
changed name to Association for Behavioral and Cognitive Therapies (ABCT) in 2005
began publishing Behavior Therapy in 1970
with the cognitive revolution in the 1960s, there was an increasing emphasis on cognitive processes
How was the term cognitive behavioral therapy coined in the 1970s?
in the 1970s, therapists began to focus on treating dysfunctional behaviors by changing the thought patterns believed to underlie those behaviors
approaches that included behavior modification methods came to be known as “cognitive behavior modification” or “cognitive behavioral therapies”
What are the assumptions of cognitive restructuring therapies?
people interpret and react to events in terms of their perceived significance
cognitive deficiencies can cause emotional disorders
What is the focus of cognitive restructuring therapies?
changing faulty thinking patterns/reducing dysfunctional thought processes directly
or indirectly through overt behavioral interventions (e.g. arguing for a political position you do not favor makes you more favorably disposed to it)
What is Rational-Emotive Behavior Therapy (REBT)?
Albert Ellis
developed to help individuals change irrational thoughts
based on the assumption irrational interpretations predict that certain events will be emotionally unpleasant
What is the A-B-C-D-E paradigm?
activating events occur: antecedents
beliefs: our (irrational) interpretations about what the activating events mean
consequences: cognitive, behavioral, and emotional reactions to the activating events, interpreted through our beliefs
dispute: (refute, challenge, and question) irrational beliefs in therapy
emotional relief: follows recognition of the irrationality of one’s beliefs
What is an empirical/scientific dispute?
ask yourself “Where is the evidence that this belief is true?”
What is a functional dispute?
ask yourself “Is my irrational belief helping me or does it make things worse for me?”
What is a logical dispute?
ask yourself “Is this belief logical? Does it ring true to common sense?”
What are the three main irrational beliefs according to Ellis?
- I must do well and win the approval of others for my performances or else I am no good
- other people must treat me considerately, fairly and kindly, and in exactly the way I want them to treat me. If they don’t, they are no good and they deserve to be condemned and punished
- I must get what I want, when I want it; and I must not get what I don’t want. It’s terrible if I don’t get what I want, and I can’t stand it
What are the procedures used to modify irrational beliefs?
identifying thoughts based on irrational beliefs
challenged the irrational beliefs
teaching client to replace thoughts based on irrational beliefs with thoughts based on rational beliefs
therapist is confrontational, working directively to challenge irrational thinking
What is the effectiveness of Rational-Emotive Behavior Therapy?
has modest empirical support
many studies are poorly designed; REBT is often not operationally defined
is superior to no-treatment groups in treating anxiety
but is only equal to or less effective than other therapies (like exposure therapies or relaxation techniques)
confrontational nature of REBT does not work well with clients who have certain disorder or OCD
What is cognitive therapy (CT)?
Aaron “Tim” Beck
holds that faulty and negativistic thought patterns lead to behavioral and emotional problems
beliefs are held in schemas that evaluate situations
What are negative automatic thoughts?
maladaptive (irrational) cognitions are automatically generated by distorted stored beliefs
What are common cognitive distortions or erroneous thought patterns?
selective abstraction
personalization
overgeneralization
magnification
minimization
arbitrary inference
What is selective abstraction?
attending to a particular detail while ignoring the overall context
e.g. a friend (who was late) did not stop to talk to you, so you feel rejected and worthless
What is personalization?
erroneously attributing an external event to yourself
e.g. you hear people laughing, and believe they are laughing at you
What is overgeneralization?
drawing an overly general conclusion based on a single incident
e.g. after one failed attempt at painting a landscape, you believe that you will never succeed at painting landscapes, portraits, painting, art, or anything else
What is magnification?
exaggerating the meaning or impact of an adverse event
e.g. after receiving a paper with corrections on it, you believe that you will fail the course
What is minimization?
downplaying the meaning or impact of a beneficial events
e.g. scoring the winning goal, but thinking it was just luck
How does cognitive therapy apply collaborative empiricism?
collaborative approach between client and therapist, using a hypothesis-testing approach to evaluate beliefs
what is the evidence that supports a belief?
what are some alternative explanations for a given distortion of cognition?
what are the implications of an erroneous belief?
Why is the client typically assigned homework in cognitive therapy?
evaluations of thoughts
collection of evidence to test beliefs
behavioral interventions, like relaxation exercises and activity schedules (written plan of daily activities that provides a sense of direction and control)
What is the effectiveness of cognitive therapy?
effective and durable in treating depression (at least as effective as medication)
may be least likely to work with those who have more severe depression
research on effectiveness with problems other than depression (anxiety disorders, personality disorders, delusions, substance use disorders) suggest the treatment is promising
What are the assumptions of cognitive coping skills training?
some problems are maintained by a deficit of adaptive cognitions
What is self-instructional training?
Donald Meichenbaum
initially developed to treat impulsive children’s behaviors
What are the basic steps of self-instructional training?
- identify the problem situation, define desirable target behavior to be increased, and identify competing behaviors
- identify self-instructions to be used in the problem situation; may include cue cards to use as prompts
- use behavioral skills training to teach self-instructions: instructions, modeling, rehearsal, feedback
What is the effectiveness of self-instructional training?
has been successfully applied to impulsive behaviors, schizophrenic behaviors, anger, obesity, bulimia, and poor body image, as well as deficits in assertive behaviors, math problem solving, and cognitive and motor performance due to brain injuries
less successful with social anxiety and personality disorders
although primarily used with children, can also be used with adolescents an adults, and those with intellectual disabilities
What is stress inoculation training?
Donald Meichenbaum
teaches cognitive skills that allow clients to deal with stressful events
What are the phases of stress inoculation training?
- conceptualization phase: therapist collaborates with client, focuses on the nature of stress and how people respond to it
- skills acquisition and rehearsal phase: teaches specific behavioral and cognitive coping skills such as progressive muscle relaxation (to alleviate stress-related muscle tension), desensitization, and coping statements
- application and follow through phase: involves practicing skills, and transition to real-world application of the skills, can include modeling, role playing, and in vivo exposures to “inoculate” the client
What is the effectiveness of stress inoculation training?
many of the components (e.g. relaxation, modeling, desensitization) have been validated when applied independently
evidence suggests that this method is as effective as its component procedures
Why is enhancing the image of the field a challenge for behavior modification?
early conceptions of behavior modification viewed it as cold, impersonal, and simplistic
more recent attempts to change the image seem to have been successful
recent work finds students rate teaching methods labeled as “behavior modification” and “humanistic” equally acceptable
Why is closing the gap between research and practice a challenge for behavior modification?
a review of meta-analyses found “the evidence-base of CBT is bery strong”
but empirically supported psychological treatments for psychiatric disorders are not being delivered to patients in routine clinical care
a meta-analysis foudn that CBT was applied in a minority of cases
Why is integrating therapy approaches a challenge for behavior modification?
future work needs to consider combing medication with behavioral approaches
What are future improvements to behavior modification?
more research supporting the effectiveness of behavior modification
increasing promise shown in the area of prevention (e.g. smoking, drug use)
more work needs to be done to reduce the likelihood of relapse
more research needed to document cost-benefit ratios of behavior modification
more work needed to address systemic racism, racial inequalities, and unique Indigenous issues
