Skip to content →

Cognitive Behavior Therapy

(6-21-18)

How to enter the conversation: thought/feeling/behavior

The premise of cognitive therapies is that it is our cognitive appraisals that most directly influence our emotions and actions.

Thinking and behavior therapy

Wolpe (1990, p. 101) discusses clinical situations involving problems in living and calling for Life Guidance, typically using logic and persuasion. In the past, Wolpe has spoken of “correcting misconceptions” (Wolpe, 1973; Wolpe & Lazarus, 1966).

Rational-emotive Therapy

Walen, DiGiuseppe, & Wessler (1980) discuss Ellis’ conceptual scheme for RET:

  • The ABC model:
    • A–the Activating event
    • B–the Belief
    • C–the emotional or behavior Consequences

Basic preposition: events and other people do not cause feelings, thoughts cause feelings and behavior

  • Beck, A.: Cognitive Therapy
    • situation: thought: emotion
  • Meichenbaum: Cognitive-Behavioral Therapy
    • situation: emotion: thought: response
  • Beck, J: Cognitive Therapy
    • “How is it that the patient came to develop this disorder?
    • What were significant life events, experiences, and interactiosn?
    • What are her assumptions, expectations, rules, and attitudes (intermediate beliefs)?
    • What strategies has the patient used throughout life to cope with these negative beliefs?
    • Which automatic thoughts, images, and behaviors help to maintain the disorder?
    • How did her developing beliefs interact with life situations to make the patient vulnerable to the disorder?
    • What is happening in the patient’s life right now and how is the patient perceiving it?” (Beck, 1995, pp 23-24)
    • look for “hot cognitions”, emotionally arousing/aroused

Persons (1989) Case Formulation model

Overt Difficulties and Underlying Psychological Mechanisms

  • Overt Difficulties
    • Cognitions
    • Behavior
    • Mood
    • The problem list: comprehensive, all-inclusive
  • Underlying Psychological Mechanisms
    • Irrational Beliefs (early maladaptive schemas)
    • Hypothesizing underlying mechanism
      • Examine problem list: “What do all these problems have in common?” (p. 51) Examine patient’s pattern of behavior: “What belief would a person who is behaving like this have?” (p. 51)
      • Examine automatic thoughts
      • Study the chief complaint
      • Look for antecedents and consequences
      • Use a standardized measure, such as The Dysfunctional Attitude Scale (DAS) (Weissman, 1979; Weissman & Beck, 1978)
      • Testing the proposed underlying mechanism, 5 tests:
        • “How well does it account for the problems on the problem list?” (p. 55)
        • “the patient’s report of the events precipitating the current episode ought to fit with the formulation in an easily understandable way.” (p. 55)
        • “the therapist can test the mechanism by making predictions based on it, then test the predictions by collecting the relevant data.” (p. 55)
        • “ask the patient’s reaction to the proposed mechanism.” (p. 55)—views patient acceptance of formulation as supporting evidence.
        • “the outcome of treatment can be viewed as an indirect test of the accuracy of the formulation.” (p. 55)

Persons (1989) recommends teaching client to recognize maladaptive thoughts by asking 4 questions:

  1. Does this thought help my mood?
  2. Does this thought help me think productively about the situation?
  3. Does this thought help me behave appropriately?
  4. Does this thought reinforce my irrational beliefs? Persons, 1989, p. 103
Skip to toolbar