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Chapter 15: Cognitive Psychotherapy and Mindfulness-Based Therapies (Goals…
Chapter 15: Cognitive Psychotherapy and Mindfulness-Based Therapies
Cognitive therapy
prominent approach to psychotherapy
Is brief, structured and targeted but focuses on mental processes
Development
Applications of behavioral therapy doesn't always work or sin't practical- cognition is important in behavior (not just external stimuli)
Aaron Beck & Albert Ellis: broke from psychoanalytic approaches and each forged their own styles of therapy to achieve goals of addressing clients' symptoms more directly and in the present
Began as revision of behavioral therapy within a context of increasing dissatisfaction with psychodynamic therapy
Many cognitive therapists use both cognitive and behavioral techniques
Goals of Cognitive Therapy
Simple goal= logical thinking; the way we think about events determines the way we respond- interpretations determine reactions
Cognitions are used interchangeably with thoughts, beliefs, interpretations and assumptions- very important in daily life
Revising cognitions is essential in ensuring thoughts are rational and correspond to the event itself
Illogical cognitions are identified, challenged and replaced with more logical cognitions
Therapists may initiate revisions, but ultimately the client should revise the cognitions themselves
Automatic thoughts: take place in an instant without deliberation
Unconscious thoughts are not the focus of therapy
Three-step model: something happens, we interpret it and the interpretation influences feelings/mood
Therapist functions as a teacher to teach the client about the three-step process and about cognition
Therapists assign homework for clients to do in between sessions because this is when the most valuable therapy is conducted
Outcome is strived for in 15 sessions or less
Efficiency is due to focusing on the client's current problems, goal-identified focus on symptoms and structured therapy sessions
Approaches to Cognitive Therapy
Albert Ellis
Rational Emotive Behavior Therapy (REBT): emphasizes the connection between rationality and emotion- making beliefs less irrational means we can live happier lives
ABCDE model for understanding and recording the impact of cognitions on emotions (expanding 3-step theory)
A: activating agent
B: belief
C: emotional conseuqence
D: dispute
E: effective new belief
Aaron Beck
Originally developed cognitive therapy to conceptualize and treat depression
Cognitive triad: thoughts about the self, the external world and the future contribute to our mental health
Dysfunctional thought record: way to organize thoughts in a form
Description of event/situation
Automatic thoughts
Emotions
Adaptive response
Outcome
Common thought distortions
All-or-nothing thinking: irrationally evaluating everything as either wonderful or terrible- nothing in between
Catastrophizing: expecting the worst event though it is unlikely to occur
Magnification/minimization: making events significantly worse or better/less important than they actually are
Personalization: assuming excessive personal responsibility for negative events
Overgeneralization: applying lessons learned from negative experiences more broadly than should happen
Mental filtering: ignoring positive events while focusing excessively on negative events
Mind reading: presuming to know that others are thinking critically or disapprovingly when it isn't possible to know what they think
When thought distortion labels are assigned to illogical thoughts, they grow weaker
Beliefs are hypotheses- they can be put to the test in real life
Recent Applications of Cognitive Therapy
Third-wave therapies: focus on mindfulness and acceptance; refer to the evolution from strict behaviorism to cognitive therapies to the new therapy
Mindfulness promotes full engagement with one's own internal mental processes in a non-confrontational way; changes peoples relationships to their thoughts rather than the thoughts themselves
Clients can engage in acceptance which allows internal experiences to run the course without fighting them
Urge surfing: approach to treatment of addictive behaviors that encourages clients to relate differently to the urges than they have previously- goal is not to stop urge
Acceptance and commitment therapy (ACT): internal psychological experience is encouraged to face & accept feared thought
Commitment to one's personal values; client must first discover personal values
A= accepting inner experiences. C= choosing directions based on core values, T= taking action
FEAR: Fusion (with inner experiences which limits flexibility in responding), Evaluation (of inner experiences), Avoidance (of unpleasant inner experiences), Reason-giving (leaning on unhealthy rationalizations)
Dialectal behavior therapy (DBT): developed by Marsha Linehan for the treatment of borderline personality disorder (BPD)
Conceptualization of BPD as problem of emotional regulation stemming from biological disposition and environment
Problem solving: thinking through stressful situations to strategize for best possible outcome
Validation: focuses on client's feelings that have not been validated in the past- feelings are important and a sensible reaction to their emotions
Dialects: exchanges between client and therapist which resolve simultaneous, contradictory feelings
Modules of training (problem-solving strategies): emotion regulation, distress tolerance, interpersonal effectiveness, mindfulness skills
Metacognitive therapy: activating event can be a cognition itself rather than some external occurrence- a reaction happens to thoughts rather than things that happen to the person
Cognitive attentional syndrome (CAS): brooding, ruminative, problematic thinking style that underlies many psychological problems
Positive beliefs & negative beliefs- thoughts about thoughts build up quickly
Cognitive therapy for medical problems
Schema therapy: intended for clients who have borderline personality disorder or other long-standing, complex clinical issues
Based on the idea that when young children experience poor parenting, they are likely to develop schemas about themselves and relationships with others that match their experiences but are maladaptive