Cognitive
Therapy
EDPS 602
NICOLE DARLINGTON, JOANNE TAKENAKA
AND ALICIA MARCHINI
Cognitive Therapy: Overview
2
History of Cognitive Therapy
Rationale of Cognitive Therapy
Goals of Cognitive Therapy
Change Agents of Cognitive Therapy
Contemporary Cognitive Therapy
Neurological Implications
History of Cognitive Therapy
Development of Cognitive Therapy
3
Success and limitations of behaviourism
Computer as a metaphor for human
information processing
Dissatisfaction with psychoanalysis
History of Cognitive Therapy
Success and Limitations of Behaviourism
4
Popularity of behaviourism in 1960s was
declining
Classical conditioning and operant condition were seen as
not going far enough in explaining the human condition
Missing cognitive processes
E.g. thoughts, beliefs, assumptions, attitudes, memories,
mental imagery and fantasies
Narrow focus on interactions between people and their
environments
Eventual acceptance that the conditioning
paradigm did not account for many important
aspects of the human condition
History of Cognitive Therapy
Computer as a Metaphor for Human Information
Processing
5
1956 symposium on information processing at
Massachusetts Institute of Technology
Credited for introducing cognitive paradigm
Information processing models fit well with
empirical methods
Computers do not have subjective experiences
Can be observed to process information according to
reliable rules
Metaphor suggested a model in which human
thought could be considered objective
(measurable) rather than merely subjective
History of Cognitive Therapy
Dissatisfaction with Psychoanalysis
6
Research on depression by Aaron T.
Beck
Trained in psychoanalysis
Attempted to validate Freuds theory of
depression as the result of anger turned
against the self
Observations of depressed patients during
traditional psychoanalysis
Observed a negative bias in their cognitive
processing, termed as a negative cognitive shift
Experienced specific types of cognitions in the
form of automatic thoughts, and conceptualized
as part of an internal information processing
system
Changes made to this system that were less
negatively biased revealed a less depressive affect
History of Cognitive Therapy
Dissatisfaction with Psychoanalysis
7
Treatment studies provide empirical support
for the effectiveness of cognitive therapy
Studies showed cognitive therapy to be as effective as
drug treatment for depression
Studies of panic attacks, obsessive-compulsive
disorder and other problems of excessive fear and
anxiety have produced similar results
Rationale of Cognitive Therapy
8
Based on the premise that behaviours and feelings
influence the way human beings make sense of
situations
Misinterpretations of situations/sensations and
negative expectations make us unhappy without
serving any useful function
Such distortions in our thinking are important in the
development and maintenance of a variety of psychological
disorders
Shifts in thinking, mood, and behaviour occur when
we view situations more objectively and rationally
Rationale of Cognitive Therapy
9
How we feel is not a reaction to a situation, but
rather our thoughts about the situation
influence our response
Thoughts that influence behaviour and mood tend to be
evaluative, brief, and automatic
Cognitive therapy helps to identify distressing
thoughts and to evaluate how realistic they are
Clients learn to change their distorted thinking
through a combination of strategies and tasks
Appropriate application of these tasks enables us to rid
ourselves of the source of our emotional difficulties
Goals of Cognitive Therapy
Teaching, Learning, and Changing
10
Problems in life and emotional distress are the
result of misperceptions, misinterpretations,
or dysfunctional interpretations of situations
Goals of Cognitive Therapy
Primacy of Cognitions
11
Initial Goal
Identify distorted or detrimental thought processes
Long-term Goal
To remove systematic biases in thinking, as well as, to
modify core beliefs
Key Understanding
To change beliefs, one must view them as testable
hypotheses not facts
Goals of Cognitive Therapy
Cognitive Change at Multiple Levels
12
Voluntary Thoughts
Most accessible and least stable
Automatic Thoughts
Stable thoughts that are outside of clients awareness
Intercede between an event and the clients emotional
and behavioural reactions
These thoughts are generated from underlying
assumptions
Core Beliefs
Absolute beliefs that are contained in cognitive schemas
If these beliefs can be identified, the negative effect can
be counteracted
Goals of Cognitive Therapy
Therapeutic Relationship
13
Collaboration
The therapist and client decide upon therapeutic tasks
and goals
Connections
An emotional bond between client and therapist is
important
Actively Engaged
Both the therapist and client have active roles
Goals of Cognitive Therapy
Key Aspects of the Therapeutic Relationship
14
Collaborative Empiricism
The therapist and client determine goals of therapy
together
Socratic Dialogue
The therapist uses carefully designed questions to
promote new learning
The client arrives at logical conclusions based on the
questioning of the therapist
Guided Discovery
The therapist uses information, facts, and probabilities
to assist the client in gaining a realistic perspective
Change Agents of Cognitive Therapy
Cognitive Change Processes
15
To recognize and replace faulty information
processes with adaptive ones cognitive therapy
follows a general, sequential pattern to elicit change
Awareness of the cognitive content of their reaction to an
upsetting event
Recognize the connection between thoughts, feelings, and
behaviour
View the thoughts as hypothesis NOT facts
Substitute more accurate thoughts for biased thoughts
Learn how to identify and alter beliefs that predispose one to
distortions
Gather feedback to determine whether change made resulted
in desired outcome
Change Agents of Cognitive Therapy
Process of Cognitive Psychotherapy
16
Early Sessions
The therapist is more active than client
Middle Sessions
The focus shifts from clients symptoms to patterns of
thinking
Later Sessions
The therapist takes on the role of advisor rather than teacher
Ending Sessions
The therapy is terminated when goals are achieved
Change Agents of Cognitive Therapy
Change Tasks: Cognitive Techniques
17
1. Automatic Thoughts Identify and test them
(a central task)
Tested by direct evidence or by logical analysis
2. Maladaptive Assumption Appear as themes
in automatic thoughts
Once identified, it is open to modification
3. Decatastrophizing What if technique
Assists clients to prepare for feared consequences
Change Agents of Cognitive Therapy
Change Tasks: Cognitive Techniques
18
4. Reattribution Consider alternative explanations
Encourages reality testing and appropriate assignment of
responsibility
5. Redefining Change conceptualization to find
opportunity to change problem
Helps make problems more concrete, specific, and
controllable
6. Decentering Developed for primarily for clients
with anxiety
Tests the belief that they are the focus of everyones
attention
Change Agents of Cognitive Therapy
Change Tasks: Cognitive Techniques
19
7. Thought Stopping Breaking a thought stream that is
escalating
Assists clients with anxiety to consciously halt distressing
thoughts
8. Distraction Stop and change focus to something else
Focus on complex thoughts because distressing and nondistressing thoughts cannot be maintained simultaneously
9. Three Column Technique A homework assignment
for the client
Identification of the triggering situation, the automatic and
illogical thoughts, and the logical error in the automatic thoughts
Change Agents of Cognitive Therapy
Change Tasks: Behavioural Techniques
20
1. Homework Client can apply cognitive principles
between sessions
Focus on self-observation, self-monitoring, structuring time, and
implementing procedures and practicing new skills
2. Hypothesis Testing Both cognitive and behaviour
technique
Make a specific and concrete hypothesis and test it to arrive at
logical conclusion
3. Exposure Therapy Examines thoughts and images for
distortions
Can teach coping for anxious client by providing data on thoughts,
images, physiological symptoms, and self-reported tension levels
4. Behavioural Rehearsal and Role Playing practicing
skills and techniques
Used to apply in real life situations
May video record role-playing to obtain objective information to
evaluate performance
Change Agents of Cognitive Therapy
Change Tasks: Behavioural Techniques
21
5. Diversion Techniques Reduce strong emotions
and decrease negative thinking
May engage in physical activity, socializing, work, play or
visual imagery
6. Activity Scheduling Provides structure and
encourages involvement
Use a rating scale of 0 to 10 to determine level of mastery
and pleasure during daily activities
7. Graded Task Assignment Task difficulty is
gradually increased
Client initiates activity at non-threatening level and therapist
helps by gradually increasing difficulty of task
Contemporary Cognitive Therapy
Evolution and Variations
22
Cognitive therapy rationale can be applied to
an array of personal problems, contributing to
its strength as an approach to therapy
Contemporary Cognitive Therapy
Evolution and Variations
23
Structural Psychotherapy
Incorporates a rationalist worldview
Developed by Vittorio Guidano and Giovanni Lotti
Goal of therapy:
Rationale: Emotional problems can only be comprehensively
understood if the role of the individuals self-knowledge and the
way s/he perceives the world is taken into consideration
Used Bowlbys Attachment Theory to explain that knowledge
of self and the world is impacted by significant childhood
relationships
Guidano suggests that the change processes involve rejecting
old perceptions of self and the world and eradicating negative
beliefs
Client adopts new, functional worldviews and self-perceptions
Personal revolution
Change tasks are the same as those of other cognitive
therapists
Contemporary Cognitive Therapy
Evolution and Variations
24
Dialectical Behavioural Therapy
(DBT)
Introduced by Marsha Linehan
Used to treat suicidal behaviour,
borderline personality disorder,
dissociative disorders, and drug abuse
Cognitive skills training program to
manage emotions that are difficult for
the client to cope with
1. Determine triggers
2. Establish solutions to change selfdestructive behaviour
3. Individual therapy, supplemented by
group therapy to change behaviours
that negatively affect quality of life
Contemporary Cognitive Therapy
Evolution and Variations
25
Cognitive-Analytic Therapy (CAT)
Introduced by Anthony Ryle
Merges psychodynamic and cognitive
therapies
Transference and countertransference
manifest in observable, procedural
terms
Focuses on identifying problematic
coping strategies that are assumed to
develop from early life experiences
and transforming them into effective
coping strategies using various
cognitive and behavioural change
tasks
Contemporary Cognitive Therapy
Evolution and Variations
26
Schema Therapy
Introduced by Jeffrey Young
Used to treat personality disorders and other chronic
problems
Focuses on cognitive schemas that are rooted in early
childhood relationships
Treatment entails cognitive change tasks and a
therapeutic relationship with client to change schemas
by meeting emotional needs that were not met during
childhood
Contemporary Cognitive Therapy
Example: Cognitive-Behavioural Therapy in Children
27
Based on the assumption that emotional
issues result from underlying distortions
in thinking and information processing,
which develops in early childhood
These issues may not emerge until an event,
such as parental separation, occurs and triggers
negative thought patterns
Contemporary Cognitive Therapy
Example: Cognitive-Behavioural Therapy in Children
28
Problem: Anxiety
Distortions in the childs thinking entail
exaggerated perceptions of threat (or thinking
the worst) and negative perceptions of
themselves and their ability to cope with
situations
Contemporary Cognitive Therapy
Example: Cognitive-Behavioural Therapy in Children
29
When the sense of perceived threat persists, physiological
responses to stress occur and, due to the childs distorted
thinking, the child focuses on the bodily sensations that
he feels (e.g., sweating, increased heart rate, and nausea)
The way the child perceives physiological responses causes the sense
of threat to heighten, triggering more negative thoughts
Common Result: Avoidance of stressful situations, which perpetuates
the problem
Some children develop strategies to help them face
threats (e.g., special routines or holding on to something),
but these strategies become counterproductive as the
child becomes dependent on them
Neurological Implications
Neuroplasticity
30
Neuroplasticity refers to changes in neural
pathways and synapses of the brain
Brain changes through learning
Bottom-up approach: using medication to alter it
Top-down approach: training the frontal cortex to learn
new ways to approach the world
Without this training, nothing will truly change
Environment can change brain, but most of the time,
counselling or cognitive behavioural training (i.e., activity
dependent learning) is needed for change
Depression: Brains ability to change stops
With CBT, counselling, and/or medicine, there is a rebirth
of neuroplasticity and regrowth of withering nerve cells
Neurological Implications
Learning
31
The brain learns things
through action and practice
= Fake it til you make it
Try out a skill, response or carry it
out using scripts and eventually,
connections in the brain will be
made as the new skill or
response is learned
Continuous practice consolidates
the new skill or response
In cognitive therapy,
modifications to thinking can
be learned through the
change tasks
Neurological Implications
32
Amygdala has two
different parts where
information enters, and it
can send information to
make us less responsive
or more reactive in
unpleasant or stressful
situations, depending on
the pathway of the
information
We can influence the
pathway to go up to the
frontal cortex and the
motor cortex to make us
more active by acting
more and developing skills
to be more active in our
lives
Neurological Implications
33
The way we think will influence the way we
feel and behave
Cognitive training teaches a client how to
think differently, and consequently, feel and
behave differently
Causes structural and functional changes in the brain
References
34
Aaron Beck on Cognitive Therapy Video [Video File]. Retrieved from
https://www.youtube.com/watch?v=xrX43cCW6uE
An introduction to Cognitive Behavioural Therapy - Aaron Beck [Video File].
Retrieved from https://www.youtube.com/watch?v=KyluZW23m0U
Martin, J. H. (2005). Neuroanatomy: Text and Atlas. New York, NY: McGrawHill.
Neuroscience and the Brain: Implications for Counseling and Therapy [Video
File]. Retrieved from
http://ezproxy.lib.ucalgary.ca:2048/login?url=http://ctiv.alexanderstreet.com.ez
proxy.lib.ucalgary.ca/view/1778729
Truscott, D. (2010). Becoming an effective psychotherapist: Adopting a theory of
psychotherapy thats right for you and your client. Washington, DC: American
Psychological Association.
