key term COGNITIVE THEORY AND THERAPY

8/19/2019 key term COGNITIVE THEORY AND THERAPY

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Reviewing Key Terms (Cognitive Theory and Therapy)

• Rational-

semantic

cognitivetherapy

Albert Ellis is generally credited with the

discovery and promotion of modern

rational approaches to psychotherapy.

Ellis formlated his approach after

progressively discovering in his

psychotherapy practice that traditional

psychoanalysis was grossly ine!ectal.

Those of yo familiar with Ellis"s theory

and interpersonal style can easily gess

why it might be a good idea to #ote him

directly when describing his therapetic

approach.

Ellis has a distinctive way of tal$ing and

writing abot his Rational-Emotive

%ehavior Therapy& so his own words help

the reader glimpse the theory.

• Collaborative

empirical

Cognitive

therapy

Aaron Beck and Cognitive Therapy 'i$e

Ellis& Aaron %ec$ was psychoanalytically

trained. Early in his career he became

interested in validating red"s anger

trned inward pon the self theory of

depression& bt instead he ended p

reecting red"s theory and articlatinghis own (%ec$& *+,*& *+,& *+/0 1. A.

Clar$& %ec$& 2 Alford& *+++).

3any psychoanalytic colleages

ostraci4ed %ec$ for #estioning red

*


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(5eishaar& *++). 6owever& over time&

%ec$"s grondbrea$ing wor$ on

depression was recogni4ed as empirically

valid& and his theory of depression and

speci7c approaches to its treatment still

represents one of the best-$nown and

most scienti7cally spported discoveries

in the 7eld of conseling and

psychotherapy.

8imilar to Ellis"s RE%T& cognitive therapy

has ta$en on many of %ec$"s personal

#alities. %ec$ is a soft-spo$en& gentle

man who wor$s with clients in a

collaborative and practical manner.

6is approach is as gentle as Ellis"s

approach is forcefl. %ec$ is not

interested in convincing clients of their

irrational beliefs. 9nstead& he ses a style

he refers to as collaborative empiricism,

wherein he wor$s together with clients to

help them discover for themselves the

maladaptive natre of their atomatic

thoghts. A $ey distinction between these

two cognitively oriented therapists is that

whereas Ellis emphasi4es the forcefl

eradication of irrational thoghts& %ec$

emphasi4es the collaborative

modi7cation of maladaptive thoghts

(%ec$ et al.& *++0 Clar$& %ec$& 2

:


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Alford&*+++).

• ;hilosophical

constrctivist

therapy

or the prposes of this chapter it is

enogh to note that several former

collaborative empirical cognitive

therapists have shifted their thin$ing

more toward the philosophical

constrctivist paradigm. 8peci7cally&

3ichael 3ahoney and 1onald

3eichenbam&

%oth of whom powerflly in


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processing system& of the individal. or a

response to occr& the individal"s

brain mst process the incoming

stimls. %ec$ (*+,) stated it this way@

>TBhere is a conscios thoght between

an eternal event and a particlar

emotional response? (p. :).

• The RE%T A%Cs Rational Emotive %ehavior Therapy

theory views hmans as neither

inherently good nor inherently bad.

9nstead& Ellis considers hmans to have

the potential for thin$ing both rationally

and irrationally. Dnfortnately& hmans

have a strong tendency to thin$ in

croo$ed& mista$en& and irrational ways

and this is the primary sorce of hman

misery.

Ellis ses an A-%-C model to describe and

discss 8-=-R theory. or Ellis& >A?

represents the >activating event? that

has occrred in an individal"s life0 the

>%? refers to

the individal"s belief abot the

activating event0 and >C? refers to the

conse#ent emotion and behavior

derived from the individal"s belief.

The A-%-C model of RE%T is best

illstrated throgh an eample@ Fem

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comes to therapy feeling angry&

depressed& hrt& and resentfl. 'ast night

his wife was not home at ,@// p.m. for

dinner as they had arranged. This event

trobled him greatly. 9n RE%T terms& the

fact that Fem"s wife was not home for

dinner on time is identi7ed as the

activating event. %ecase his wife was

late& he began mentally processing this

event& thin$ing&

>8he doesn"t care enogh abot me to be

home for dinner on time.? rther& he

started imagining that she was late

becase she was with another man. =f

corse& there

are a nmber of other speci7c beliefs he

may adopt& bt the main point is that

he"s thin$ing something li$e@ >8he

doesn"t really love me and prefers to

spend time with other men.?

• Collaborative

empiricism

Collaborative empiricism emphasi4es

oint wor$ on a mtally de7ned problem.

This oint wor$ focses on identi7cation of

the client"s cognitive rles or hypotheses&

testing of the validity of these

hypotheses& and then possible

modi7cation of the hypotheses. This

approach re#ires the therapist to wor$

within the client"s frame of reference&

H


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trying to see the world throgh the

client"s eyes (8haw 2 %ec$& *+). 9t also

emphasi4es that clients are not defective

bt& instead& may need to adst the lens

throgh which they are viewing the world

(%ec$& Emery& 2 Ireenberg& *+JH).

• Atomatic

thoghts

These atomatic thoghts& core beliefs&

and their associated emotional

distrbances& can be modi7ed via

cognitive therapya procedre that does

not re#ire eploration of a client"s past.

• 8elf-schemas or

core beliefs

An individal"s maladaptive thoghts are

sally derived from deeply held

maladaptive core beliefs (a.$.a. schemas

or dysfnctional attitdes).

The nderlying schema may be >9 mst

stay very close to good people and get

away from the danger of bad people.?

• egative evalation of self@ >9 am

nworthy.?

• egative evalation of the world or

speci7c events@ >Everything is st

more evidence that the world is

falling apart.?• egative evalation of the ftre@

>othing will ever get better.?

• 8ocratic

#estioning

8ocratic #estioning to edcate clients

abot the natre and impact of stress&

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and conceptali4ation of stressfl

sitations as >problems to be solved?

(3eichenbam& *++,& p. G).

Another featre of %ec$"s approach is the

reglar se of Socratic questioning.

Therapists as$ #estions that help clients

focs on

(*) awareness of atomatic thoghts and

core beliefs&

(:) evalation of the seflness and

accracy of atomatic thoghts and core

beliefs& and

() possible strategies for modifying

atomatic thoghts and core beliefs.

• Cognitive

distortions

Beck’s Cognitive Distortions in

Cognitive Therapy :

Arbitrary Inference

Selective Abstraction

ersonali!ation@

"ichotomous or olari!ed Thinking

#abeling and $islabeling

$agni%cation and $inimi!ation

&vergenerali!ation@


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• Arbitrary

inference

Arbitrary Inference@ This distortion is a$in

to mping to conclsions and is similar to

Ellis"s (*+,:) catastrophi4ing& wherein

clients conclde withot any spporting

or relevant evidence that the worst

possible otcome will happen. or

eample& when a client with social

aniety heads ot to a party& he or she

might have the following atomatic

thoghts@ >=h no& 9 $now 9"m going to

ma$e a complete fool of myself. o onewill li$e me. They"ll probably lagh at me

and ma$e fn of me after 9 leave.? This

distortion may be connected to an

nderlying schema or core belief sch as

>9 am socially disgsting and will always

be reected by others.? 9n the case

eample later in this chapter& Richard

ma$es an arbitrary inference that his

therapist identi7es as a catastrophi4ing

thoght.

• 8elective

abstraction

Selective Abstraction@ 9n this distortion&

most relevant information abot a

sitation is ignored while one minor detail

provides the basis for a negative

conclsion. or eample& after completing

an eamination& yo might focs solely

on a test item yo missed& conclding& >9

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$now 9 missed that essential #estion.

The professor will $now how stpid 9 am. 9

might as well drop the class now. 9"m

sch a loser. 9n fact& the world wold

probably be a better place if 9 was st

dead.? =f corse& yo may have gotten

most other items on the test right. This

distortion might revealthis nderlying

schema@ >9f 9 don"t answer everything

perfectly& then it proves 9"m inade#ate&

ndeserving& and worthless.?

• ;ersonali4ation ersonali!ation@ This distortion is

sometimes referred to as self'

referencing. Lictims of this distortion ta$e

everything personally. 9f someone doesn"t

say hello& they conclde that it"s their

falt. 9f the cashier gives them bac$

incorrect change& they thin$ the person isprposely ta$ing advantage of them for

some speci7c reason. This style of

distortion can prodce either aniety or a

paranoid state. 9n the case of paranoia&

atomatic thoghts might inclde& >9

$now she"s ot to get me0 9 cold tell by

the way she loo$ed at me that she"s been

ot to get me ever since 9 came in this

store.? This distortion may be connected

to an nderlying schema of >;eople are

always ntrstworthy. 9f 9 don"t $eep an

eye on everybody all the time& someone"s

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going to ta$e advantage of me.?

• 1ichotomosM

polari4ed

thin$ing

"ichotomous or olari!ed Thinking@ This

distorted thin$ing style is common among

clients with borderline or narcissistic

personality traits. ;eople and sitations

are sally evalated as blac$ or white&

good or bad. 5hen these clients come to

conseling& they often either love or hate

their therapist& with atomatic thoghts

li$e >This is the best therapist 9"ve ever

$nown. 6e"s incredible. 6e"s so

insightfl.? The nderlying schema may

be >9 mst stay very close to good people

and get away from the danger of bad

people.?

• 8tress

inoclation

training

9s based on internal speech or verbal

mediation. 6e stated that >behavior

change occrs throgh a se#ence of

mediating processes involving the

interaction of inner speech& cognitive

strctres& and behaviors and their

resltant otcomes? (3eichenbam&

*+& p. :*J).

6is model& in the tradition of %andra& is

a reciprocal one& and therefore it

emphasi4es a moment-to-moment

interactive relationship between the

individal and the environment.

*/


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8tress inoclation training is now

considered an empirically spported

treatment for helping adlts who are

coping with stress (8anders& 1ris$ell&

6all& 2 8alas& *++,). The application of

self-instrctional procedres in the

treatment of children with implsive

behavioral problems contines to

profondly inproblems-to be- solved?

(3eichenbam& *++,& p. G). 5hen stress

is viewed as a challenge& the therapist

can begin assisting the client in

formlating personal or individali4ed

methods for preparing for& confronting&

and re


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taght and practiced in the oNce setting

and eventally in vivo. The particlar

s$ills taght are related to the individal

problems. Eamples inclde relaation

training& self-instrctional training&

emotional self-reglation& and

commnication s$ills training.

. Application and follo('through. 9n this

phase& clients apply their newly ac#ired

coping s$ills to increasingly challenging

stressors. ;ersonal eperiments are sed

to help inoclate clients from the e!ects

of later stressfl sitations. Relapse

prevention strategies& attribtion

procedres (in which clients are taght to

ta$e credit for their accomplishments)&

and booster sessions are bilt into this

7nal phase of the stress inoclation

training model.

• Collaborative

interviewing

or most therapists who wor$ within a

cognitive therapy frame (with the

possible eception of Albert Ellis)& a

collaborative assessment model is sed.

;ersons and Tomp$ins (*++) articlate

their approach to cognitive-behavioral

case formlation@

5henever possible& the process of

formlation is a collaborative one& with

patient and therapist wor$ing together to

*:


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ma$e a ;roblem 'ist& propose some core

beliefs& set goals for treatment& choose

interventions& and monitor progress. (p.

::)

The therapist is not the epert pon

whom all therapy sccess depends.

9nstead& epertise is achieved when the

client and therapist oin together& sing

an empirical or investigation-oriented

attitde. A central tas$ dring an initial

collaborative interview is to establish a

clear and comprehensive problem list.

9tems on the problem list shold be

described in simple& descriptive& concrete

terms. ;ersons and Tomp$ins (*++)

recommend that abot 7ve to eight items

be inclded on a problem list.

• ;roblem list ;roblem list dring a collaborative

interview@

*. "epressive thoughts. 8sanna reports

thoghts consistent with %ec$"s cognitive

triad (%ec$& *+/). 8he believes she is a

worthless loser (negative evalation of

self)& that the world is a rotten place

(negative evalation of the world)& and

that her life will contine to be miserable

(negative evalation of the ftre).

:. Social isolation. 8he is greatly

*


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dissatis7ed with her social life. 8he has

social contact otside of her wor$place

only once wee$ly or less.

. rocrastination and lack of self'

discipline. 8he strggles to $eep her

hose clean& pay her bills on time& attend

to personal hygiene& and organi4e her

daily activities.

G. Internet preoccupation. 8he spends

many hors a day sr7ng the 9nternet.

Althogh she reports enoying this& she

also reports that her 9nternet activity

increases mar$edly when she needs to

pay bills& has a social opportnity& or is

facing deadlines.

H. #ack of academic progress. 8he wold

li$e to 7nish her bachelor"s degree& bt

she fre#ently drops ot of class after

enrolling and either obtains an

incomplete or withdraws from the class.

,. "isrupted sleep patterns. 8he reports

diNclty sleeping& which she sees as

being related to her problems with

procrastination.

• Thoght Record

or cognitive self

monitoring

To practice cognitive therapy& it is crcial

to teach clients to pay attention to their

atomatic thoghts. Cognitive self-

monitoring is one of the most e!ective

*G


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ways to help clients increase awareness

of atomatic thoghts. Althogh cognitive

self-monitoring and the eploration of

maladaptive or irrational thoghts begin

within therapy sessions& it"s very

important for clients to contine

monitoring their thoghts otside therapy

sessions.

Althogh there are several versions of

cognitive self-monitoring procedres

available& ;ersons (*+J+) recommends

the se of a generic >Thoght Record.? To

se a Thoght Record& clients are

instrcted to ot down the following basic

information immediately after

eperiencing a strong emotional

response@

(*) date and time of the emotional

response&

(:) the sitation that elicited the

emotional response&

() the behaviors the client engaged in&

(G) the emotions that were elicited&

(H) the associated thoghts that occrred

dring the sitation& and

(,) any other related responses.

*H


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The client"s Thoght Record provides a

fondation for cognitive interventions.

%ec$ and his colleages (%ec$ et al.&

*++)& as well as other cognitive athors

(%rns& *+J+)& recommend transforming a

generic Thoght Record into a more

speci7c theory-based therapetic tool by

having clients se the langage of

atomatic thoghts& cognitive distortions&

and rational responses.

Clients are instrcted to create colmns

with these terms as labels and to record

their eperiences accordingly. This is

called the three colmn- techni#e. Table

J.: provides a sample of a more

epanded Thoght Record. 1eveloping

either a Thoght Record or a record sing

the three colmns is a common

homewor$ assignment.

• Ienerating

alternativeinterpretations

Ienerating alternative interpretations is a

sefl techni#e with clients who hold

onto maladaptive or irrational atomatic

thoghts despite the fact that other&

more reasonable& interpretations or

eplanations eist. As 3c3illin (*+J,)

notes& the 7rst interpretation of a scene is

often the worst& the most negative& or the

most catastrophic. Dnfortnately& 7rst

interpretations can be diNclt to conter.

*,


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This techni#e teaches clients to

immediately conter 7rst interpretations

with at least for other reasonable

alternatives& sing the following

gidelines@

*. The client $eeps a written log of the

very worst emotions eperienced dring

a *- wee$ period. This log incldes a brief

description of the activating event (A)

and a brief description of the 7rst

interpretation (i%).

:. At the net session this homewor$ is

reviewed and the client is given an

additional assignment@ >After logging yor

initial interpretation& add for di!erent

bt e#ally plasible interpretations.?

3c3illin (*+J,) ses the following

eample@ Situation@ A single :H-year-old

woman st bro$e p with her boyfriend.

)irst interpretation@ There is something

wrong with me. 9 am inade#ate& and 9"ll

probably never develop a lasting

relationship with a man.

Alternative interpretations*

O 9 haven"t met the right man.

O 9 don"t want to give p my freedom

right now.

*


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O 3y boyfriend and 9 didn"t have the right

chemistry together.

O 3y boyfriend was afraid to commit to

me or to the relationship. (3c- 3illin&

*+J,& p. *:)

. At the net session& the therapist helps

the client determine which of the for

interpretations

has the most spporting evidence. 9t is

important to help the client se an

obective review of the data rather than

sbective impressions or hnches.

G. The client contines sing this for

alternative procedre when an

emotionally distressing event occrs.

Additionally& the client is coached to writedown the alternative interpretations& bt

then to wait and decide which

interpretation is best only after ade#ate

time has passed to distance her from the

event. Then the client is as$ed to practice

this procedre with every psetting event

for the net month ntil it becomes an

atomatic response (3c3illin& *+J,).

• 3isattribtion of

hostility

'i$e the generation of behavioral

alternatives& this techni#e is especially

sefl with adolescents. 9n a series of

stdies& Kenneth 1odge and his

*J


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colleages have demonstrated that

yoths who consistently display

aggressive behavior often do so& in part&

becase they have #ic$ly and incorrectly

interpreted the behavior of other yoths

as hostile (1odge& *+J/0 1odge 2 rame&

*+J:0 1odge 2 8omberg& *+J). This

phenomenon is called misattribution of

hostility.

or eample& if a yoth disposed toward

aggression is wal$ing throgh the hall at

school and another stdent inadvertently

bmps him& the yoth is li$ely to attribte

the bmp to an intentional hostile act.

Conse#ently& the potential for retaliation

is increased. 9n or wor$ with aggressive

yoths& we have sed the techni#e of

generating alternative interpretations

with two minor modi7cations. irst& we

sometimes se a timing device to add a

real-world pressre to the interpretation

generation process@ >=$ay& now yo"ve

got ,/ seconds to come p with as many

alternative eplanations as possible. 9"ll

time yo.? 8econd& we sometimes add aconcrete reward (stic$ers& money&

baseball cards) as an incentive for yoths

to come p with alternative

interpretations@

*+


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>9"ll give yo one baseball card for every

alternative yo can come p with? (see

8ommers- lanagan 2 8ommers-

lanagan& *++).

• Ligoros and

forcefl

disptation

A )avorite Technique from Albert +llis 9n

the boo$ )avorite Counseling and

Therapy Techniques (Rosenthal& *+++)&

Albert Ellis shared his approach for

vigorosly dispting irrational beliefs.

This techni#e stems from Ellis"s view

that an individal can begin to lightly

adopt a rational belief (e.g.& >9 want

people to li$e me& bt 9 can live happily if

they don"t?) while at the same time

strongly holding onto an opposing

irrational belief with more intensity (e.g.&

>%t 9 really absoltely need their

approval and have nothing to live for if 9don"t get itP?).

To help clients who have this problem&

Ellis sggests that yo 7rst eplain to

them that >vigoros& forcefl& and

persistent? dispting of irrational beliefs

is often needed to >actally replace them

with rational beliefs? (Ellis& *+++b& p. ,).

et& provide yor

clients with the following written

instrctions& encoraging them to parta$e

in this homewor$ assignment to

:/


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vigorosly dispte their irrational beliefs.

• Thin$ing in

shades of grey

This techni#e is derived from %rns

(*+J+). 9t involves ta$ing a client"s

atomatic thoghts& assmptions& or

conclsions abot a speci7c performance

and placing them on a concrete&

measrable scale.

9n the following case& Fac$son& a H-year-

old engineer& was referred to therapy

becase his perfectionistic standards

were reslting in etremely slow

performance. Additionally& he was

s!ering from several depressive

symptoms that seemed to be associated

with his perfectionism and wor$

performance. After focsing on his

atomatic thoghts& he prodced the

following written description of himself

and his core beliefs or self-schema@

>9 am basically defective. Therefore& to

prove 9"m not defective& 9 have to do a

better& higher #ality ob on my wor$

than anyone else. Every tas$ 9 do mst be

performed


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assmption is that to fail at one tas$ is to

fail altogether.?

• Eploring the

conse#ences of

giving p the

shold rle

This techni#e is a variation of response

prevention discssed by %ec$ and

colleages (%ec$ et al.& *++0 8haw 2

%ec$& *+). 9t was employed in Fac$son"s

case becase mch more wor$ was

needed to help him change his self-

schema. 8peci7cally& Fac$son was

instrcted to clearly verbali4e his

>shold? rle& to predict what wold

happen if the shold was not followed& to

carry ot an eperiment to test the

prediction& and to revise his shold rle

according to the otcome of the

eperiment (%ec$ et al.& *++& p. :HH).

As in the eample in %ec$"s wor$& Fac$son

was given a series of activities designed

to test his shold statement@ >Every tas$ 9

do mst (shold) be performed


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treatments empirically validated treatments@

Eamining the citations for empirically

validated treatments identi7ed in the

*++H tas$ force report& we 7nd not a

single stdy inclded tests of the eNcacy

of the treatment for ethnic minority

poplations. 3ost investigators did not

specify ethnicity of sbects or

sed only white sbects. =t of abot G*

stdies cited& only ,Q made any

reference to race or ethnicity of

sbects. . . . ot one sed ethnicity as a

variable of interest. (Chambless et al.&

*++J& p. H)

'ac$ing relevant controlled stdies on

therapy e!ectiveness& we trn to

anecdotal& analoge& and #asi-

eperimental data to gide or

eploration of the di!erential

e!ectiveness of varios therapy

approaches with diverse cltral grops.

As reviewed by 3eichenbam in an

interview with 3ichael 6oyt (6oyt& :///)&

there are some reports of

recommendations for di!erent cognitive-

behavioral procedres for trama victims

of di!erent cltres.

or eample& Agger and Fensen (*++/)

:


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reported that tortre victims from several

8oth American contries eperienced

great bene7t from writing abot and

reliving their tramas. 9n contrast&

therapists who wor$ with tortre victims

from 8otheast Asia report st the

oppositethat their clients do not bene7t

from trama memory wor$ and instead

seem to gain the most from concrete&

here-and-now interventions designed to

facilitate their coping and fnctioning athome and at wor$ (Kin4ie& *++G0 3ollica&

*+JJ).

These reports sggest that client

ethnicity may play a strong role in

determining the appropriate treatment

approach for diverse clients. They also

indicate that it"s nli$ely that any speci7c

techni#e for a speci7c problem will be

niversally e!ective for di!erent cltral

grops. A recent stdy demonstrated that

an empirically validated treatment

eposre for Agoraphobiawas less

e!ective for African American clients

(Chambless 2 5illiams& *++H). Thisshold case frther #estions abot the

generali4ability of e!ective treatments

from Cacasian clients to non Cacasian

clients.

:G

key term COGNITIVE THEORY AND THERAPY

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