Topic 25: Cognitive Behavioral Therapies

Question 1

Cognitive Behavior

Answer 1

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

Question 2

Cognitive Behavior Modification

Answer 2

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)

Question 3

Cognitive Restructuring

Answer 3

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

Question 4

Cognitive Coping Skills Training

Answer 4

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

Question 5

Cognitive Therapy

Answer 5

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

Question 6

Behavior Activation

Answer 6

a treatment for depression focusing on getting the client to engage in a larger number and variety of reinforcing activity

Question 7

Cognitive Distortions

Answer 7

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

Question 8

Self-Instructional Training

Answer 8

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

Question 9

What do cognitive behavioral therapies help clients to do?

Answer 9

understand problems

see patterns of irrational thought

evaluate behaviors based on more rational thinking

teach new skills to promote self-regulation

Question 10

What do cognitive processes include?

Answer 10

thoughts
perceptions
beliefs
expectations
attributions
self-statements

Question 11

Why are cognitive processes are important in many problem behaviors?

Answer 11

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

Question 12

What did B.F. Skinner contribute to cognitive behavioral therapies?

Answer 12

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

Question 13

What is the Association of Behavior Therapy (AABT)?

Answer 13

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

Question 14

How was the term cognitive behavioral therapy coined in the 1970s?

Answer 14

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”

Question 15

What are the assumptions of cognitive restructuring therapies?

Answer 15

people interpret and react to events in terms of their perceived significance

cognitive deficiencies can cause emotional disorders

Question 16

What is the focus of cognitive restructuring therapies?

Answer 16

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)

Question 17

What is Rational-Emotive Behavior Therapy (REBT)?

Answer 17

Albert Ellis

developed to help individuals change irrational thoughts

based on the assumption irrational interpretations predict that certain events will be emotionally unpleasant

Question 18

What is the A-B-C-D-E paradigm?

Answer 18

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

Question 19

What is an empirical/scientific dispute?

Answer 19

ask yourself “Where is the evidence that this belief is true?”

Question 20

What is a functional dispute?

Answer 20

ask yourself “Is my irrational belief helping me or does it make things worse for me?”

Question 21

What is a logical dispute?

Answer 21

ask yourself “Is this belief logical? Does it ring true to common sense?”

Question 22

What are the three main irrational beliefs according to Ellis?

Answer 22

1. I must do well and win the approval of others for my performances or else I am no good
2. 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
3. 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

Question 23

What are the procedures used to modify irrational beliefs?

Answer 23

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

Question 24

What is the effectiveness of Rational-Emotive Behavior Therapy?

Answer 24

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

Question 25

What is cognitive therapy (CT)?

Answer 25

Aaron “Tim” Beck

holds that faulty and negativistic thought patterns lead to behavioral and emotional problems

beliefs are held in schemas that evaluate situations

Question 26

What are negative automatic thoughts?

Answer 26

maladaptive (irrational) cognitions are automatically generated by distorted stored beliefs

Question 27

What are common cognitive distortions or erroneous thought patterns?

Answer 27

selective abstraction

personalization

overgeneralization

magnification

minimization

arbitrary inference

Question 28

What is selective abstraction?

Answer 28

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

Question 29

What is personalization?

Answer 29

erroneously attributing an external event to yourself

e.g. you hear people laughing, and believe they are laughing at you

Question 30

What is overgeneralization?

Answer 30

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

Question 31

What is magnification?

Answer 31

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

Question 32

What is minimization?

Answer 32

downplaying the meaning or impact of a beneficial events

e.g. scoring the winning goal, but thinking it was just luck

Question 33

How does cognitive therapy apply collaborative empiricism?

Answer 33

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?

Question 34

Why is the client typically assigned homework in cognitive therapy?

Answer 34

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)

Question 35

What is the effectiveness of cognitive therapy?

Answer 35

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

Question 36

What are the assumptions of cognitive coping skills training?

Answer 36

some problems are maintained by a deficit of adaptive cognitions

Question 37

What is self-instructional training?

Answer 37

Donald Meichenbaum

initially developed to treat impulsive children’s behaviors

Question 38

What are the basic steps of self-instructional training?

Answer 38

1. identify the problem situation, define desirable target behavior to be increased, and identify competing behaviors
2. identify self-instructions to be used in the problem situation; may include cue cards to use as prompts
3. use behavioral skills training to teach self-instructions: instructions, modeling, rehearsal, feedback

Question 39

What is the effectiveness of self-instructional training?

Answer 39

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

Question 40

What is stress inoculation training?

Answer 40

Donald Meichenbaum

teaches cognitive skills that allow clients to deal with stressful events

Question 41

What are the phases of stress inoculation training?

Answer 41

1. conceptualization phase: therapist collaborates with client, focuses on the nature of stress and how people respond to it
2. 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
3. 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

Question 42

What is the effectiveness of stress inoculation training?

Answer 42

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

Question 43

Why is enhancing the image of the field a challenge for behavior modification?

Answer 43

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

Question 44

Why is closing the gap between research and practice a challenge for behavior modification?

Answer 44

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

Question 45

Why is integrating therapy approaches a challenge for behavior modification?

Answer 45

future work needs to consider combing medication with behavioral approaches

Question 46

What are future improvements to behavior modification?

Answer 46

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