L4 - Cognitive therapy Flashcards
(54 cards)
1
Q
What is the basis for cognitive therapy?
A
- It recognizes the existence of other things besides cognitions, namely behaviour, emotions and their interconnectedness
- The difference from other therapies is that it chooses to from the point of the cognitive systems to achieve change in all other systems
- It focuses on how people perceive, interpret, assign meaning to events and situations related to yourself, to others, to the future, to the past
- CT aims to adjust information processing and initiate positive change in all systems by acting through the cognitive system
- CT has become very popular, maybe even more than CBT or BT alone for some disorders
- The clinical efficacy of CT is very clear
2
Q
What is the difference with BT and what do behaviourists say about CT?
A
- The two share: empirical, present centred, problem oriented, require explicit identification of problems and their situations and consequences, cognitions like behaviors can be modified
- Pure behaviourists say that it’s not distinguishable from behavioural systems because the cognitive systems are manifested in observable behaviour so you cannot and shouldn’t distinguish the two; i.e. cognitive system cannot be directly observed as with the behavioural system
- Difference: CT sees individuals as active participants in evironments, judging, evaluating stimuli, interpreting events, sensations and judging own responses (BT based on simple conditioning paradigms)
- Overlap: Exposure methods (cognitive and behavioral; e.g. verbalizing automatic thoughts in exposure scenarios)
- Cognitive changes do not necessarily follow from changes in behavior: Cognitive change must be demonstrated, not assumed
3
Q
How is CT and psychodynamic psychotherapy (PDPT) different/similar?
A
- both use procedures to identify common themes (modes), while these are mostly unconscious in psychoanalysis, in cognitive therapy they are accessible to conscious interpretation
- CT focus on linkage between symptoms, conscious beliefs, and current experiences; PDPT focus on repressed childhood memories and motivational constructs such as libidinal needs and infantile sexuality
- CT usually short-term (12-16 weeks), PDPt long-term
- CT therapist engaged in collaboration with the patient + structured; PDPT analyst is largely passive + unstructured
4
Q
How is CT and rational emotive behaviour therapy (REBT) different/similar?
A
- share emphasis on importance of cognition in psychological dysfunction, task of therapy: changing maladaptive assumptions, stance of therapist as active and directive
- REBT theory: distressed individual has irrational beliefs, lead to irrational thoughts, disputing them makes them disappear
- CT thinks in terms of dysfunction (nonadaptive) not irrationality
- CT differs with cognitive specificity (each disorder has its own typical cognitive content) -> Require different techniques
- REBT does not specify cognitive themes, but focuses on musts, should, and other imperatives assumed under the disorder
5
Q
What has the cognitive thinking developed into?
A
- CT has developed from a linear perspective that the cognitive system directly influences the other systems (motivational, behavioural, affective) into a more schema thinking where each of these systems is active and interact in what we call a mode
- Mode is a combination of all the systems/schemas
↪ Primal Modes, e.g. anxiety mode (universal and tied to survival) → Primal thinking (rigid, absolute, automatic, biased)
↪ Minor Modes, e.g. studying, conversing (under conscious control)
↪ In cognitive therapy, a thorough understanding of the mode and all its integral systems is part of the case con ceptualization - Not only the way you think affects your behaviour or mood, but also the way you behave will influence the way you think
- It’s a system that contains these four schemas
- Cognitive schemas contain people’s perceptions of themselves and others and of their goals and expectations, memories, fantasies, and previous learning - these greatly influence, if not control, the processing of information
6
Q
What are the three approaches used to treat dysfunctional modes?
A
- deactivate them
- modify their content and structure
- construct more adaptive modes to neutralize them
1) and 3) often accomplished simultaneously - particular belief may be demonstrated to be dysfunctional and a new belief to be more accurate or adaptive
7
Q
How does an exercise in CT look like?
A
- Think of something that you (don’t) look forward to today or tomorrow
- Try to make explicit your thoughts or expectations about it
- Collect evidence on the extent to whic these thoughts or expectations (don’t) make sense
- To the extent they don’t, which thoughts or expectations would make more sense?
- How do these new thoughts or expectations make you feel about it?
8
Q
What types of cognitions are there that we have within the cognitive system?
A
- Conscious thought - we can know and verbalise very easily
- Semi-conscious/semiautomatic thought - normally not aware of them, but they are accessible after some deeper thinking (not immediately at the front of our mind)
↪ Usually emerge as themes or threats in CT - Unconcious/automatic processes - totally not or hardly not aware of them
CT focuses on the first and then a bit later on the second level
The distinction is not as clear - it’s a gradual, dimension rather than distinct thoughts
Thoughts can also include images (not just verbal) - also considered part of CT
9
Q
What are the core aspects of CT?
A
Strategies:
- Collaborative empiricism
- Guided discovery
Style
- Socratic dialogue
Techniques - form of collecting the evidence:
- Logical examination
- Behavioral experiments
Often combined with other (behavioral) techniques
Cognitive therapy ≠ wishful thinking or denying real problems (not everything will be fine, but things can get better - important to acknowledge this, otherwise the client might not believe the therapist)
10
Q
Strategies of CT
A
-
Collaborative empiricism - joined investigative attitude (curiousity, openness, transparency and equality) - you don’t know better than the patient
↪ The patient often doesn’t distinguish between their thoughts so the task of the therapist, using these strategies, is to reformulate into testable hypotheses
↪ The attitude also implies that the understanding the patient’s POV comes first and then possibly changing it by collecting info to test it - denial, confrontation etc will not help and might worsen the situation
↪ Patient plays active role in describing wishes for change, and how that might look -
Guided discovery - closely related to slowly and gradually discovering themes and threats that reoccur in patient’s narrative
↪ Curious and joined discovery rather than readily available answers by the therapist
11
Q
What is the theory of personality according to CT?
A
- CT emphasizes information processing in human responses and adaptation
- All aspects of human functioning as acting simultaneously as a mode (not just cognition as determining emotions and behavior)
- Personality attributes reflect basic schemas or interpersonal strategies (developed in response to environment)
- Importance of learning history
- Non adaptive behavior on continuum with normal behavior (not irrational etc.)
- Functional impairment of normal cognitive activity as reaction to events that threaten vital interests
12
Q
What is cognitive vulnerability?
A
- each person has a set of vulnerabilities, that predispose to psychological distress
- vulnerabilities are related to personality structure
- Personality is shaped by temperament and cognitive schemas (structures that contain fundamental beliefs and assumptions)
- Cognitive schemas become active when stimulated by specific stressor (otherwise more latent)
13
Q
What is the theory of causality?
A
Psychological distress is caused by many factors; there is no single cause, all these factors interact with one another:
- Innate
- Biological
- Developmental
- Environmental
14
Q
Types of cognitive distortions
A
= Systematic errors in patient’s thinking or reasoning and they may overlap
- Arbitrary inference - drawing conclusions even in the presence of conflicting/different evidence
- Selective abstraction - drawing conclusions on details that is out of context
- Overgeneralization - general rule from one or few isolated incidents, applying it too broadly and to unrelated situations
- Magnification/minimization - exagerating or overestimating situations without evidence
- Personalization - holding yourself responsible for events that have nothing to do with you
- Dichotomous thinking - thinking in extremes
- Cognitive specificity - people with differerent problems tend to show specific patterns in their thinking
There are many more and the distinctions between these are not always clear
15
Q
What is a systemic bias in psychological disorders?
A
- Characterizes most psychological disorders
- Generally applied to external information
- May start operating at early stages of information processing
- We look at systemic biases in different disorders
16
Q
Cognitive model of depression
A
- Cognitive triad characterizes depression: negative view of the self, the world, the future
- View of self: incompetent, expectation of failure, indicisiveness (incapability of making correct decisions)
- View of world: devoid of pleasure or gratification
- View of future: pessimistic, reflecting
the belief that current troubles will not improve -> hopelesness that may lead to suicidal ideation
17
Q
Cognitive model of anxiety disorders
A
- Excessive functioning or malfunctioning of normal survival mechanisms
- Basic mechanisms for threat same for normal and anxious people
↪ anxious person’s perception of danger is either based on false assumptions or exaggerated, whereas the normal response is based on a more accurate assessment of risk and the magnitude of danger
↪ normal individuals can correct their misperceptions using logic and evidence; anxious - difficulty recognizing cues of safety & other evidence that would reduce the threat of danger - cognitive content revolves around themes of danger, and the individual tends to maximize the likelihood of harm and minimize his or her ability to cope
18
Q
Mania
A
- Biased thinking revers of depressive’s
- Selectively perceive individual gains in each experience
- Blocking out negative experiences, or reinterpreting as good
- Unrealistically expecting positive results
- Exaggerated concepts of abilities, worth, accomplishments lead to euphoria
- These provide large sources of energy and
drives the manic individual into continuous goal-directed activity
19
Q
Panic disorder
A
- Prone to regard any unexplained symptoms or sensation as sign for coming catastrophe
- Characteristic: conclusion that vital systems (heart, breathing, CNS) will collapse -> vigilant toward internal sensations
- Each patient has specific “equation” (e.g. chest pain = catastrophe -> panic)
- Specific cognitive deficit: an inability to view their symptoms and catastrophic interpretations realistically
20
Q
Phobia
A
- Anticipation of physical or psychological harm in specific situations
- Avoidance of the situation in the future is reinforced everytime they encounter the object and feel relief when successfully avoided it
21
Q
Paranoid states
A
- Bias: Attributing prejudice to others
- People are assumed to be deliberately abusive, interfering, or critical
- In contract to depressive patients (treatment from otehrs justified), paranoid patients feel the treatment is unjustified
22
Q
Obsessions and compulsions
A
- Introduce uncertainty into appraisal of situations that most would consider safe
- Continually doubt whether they have performed acts necessary for safety
- Sense of responsibility (accountable for having taken action)
- Meaning given to intrusive thoughts that causes distress
23
Q
Suicidal behaviour
A
- Two features of cognitive process:
1) High degree of hopelessness, or belief things cannot improve
2) Cognitive deficit (difficulty in solving problems) - Thinking becomes more rigid
24
Q
Anorexia Nervosa
A
- Constellation of maladaptive beliefs -> “My body weight and shape determine my worth and social acceptability”
- Distortions in info processing: misiterpret fullness after meal as getting fat and mispercieve their image in a mirror
25
Schizophrenia
- Complex interaction between: oredisposing neurobiological, environmental, cognitive and behavioral factors
- Excessive psychophysiological reactions in response to stress
- Dopaminergic system which contributes to development of delusions and halucinations
- Cognitive disorganization: neurocognitive deficits (e.g. attentional problems, impaired EF, WM)
- Delusions: cognitive biases (external attributions) and jumping to conclusions (cognitive shortcut)
- Hallucinations: tendency to distort perceptions and negative self-schemas
26
Levels of cognitions
Picture 1
E.g. Woman on a street in the night sees a man and might have a **voluntary thought** 'how can I avoid this man' because maybe there is an **automatic thought** below the voluntary one: 'this man might attack me.' This way she is trying to solve a situation, she thinks might be problematic in a certain way. Because below that might be a **maladaptive assumption** 'all men are just after sex/women'. These maladaptive assumptions, you're not aware of as a patient but they gradually emerge as themes in therapy. Below that are even more fundamental **core beliefs** which might emerge as themes behind the assumptions, such as: 'I'm a worthless person, I don't deserve a happy life.' These core beliefs are known as **cognitive vulnerabilities**
- There is an opposite relationship between accessibility and stability - the voluntary thoughts are more easy to challenge and investigate than core beliefs, which takes time to become aware of them and they are very ingrained so they are harder to modify
- CT gradually progresses from the top to the bottom
27
How is the therapeutic relationship in CT?
* **Collaborative** - therapist assesses sources of distress and dysfunction and helps the patient clarify goals
↪ Patient provides: thoughts, images, beliefs, motions, behaviors
↪ Shared responsibilty in setting agenda and doing homework
* Directive if neccessary (e.g., severe symptoms or crises)
* Guidance (‘leading from behind’)
* Continuous (mutual) feedback - ask the patient whether you're on the right tract, how is therapy feeling for him/her, how is the patient feeling
↪ Also encourage the patient to give this feedback freely on their own
28
What role does the therapist play in CT?
- Expertise in examining and modifying beliefs and behavior
- Not passive expert or decider of correct thinking
- Actively pursue client’s personal worldview
- Specifies problems
- Focuses on important areas
- Teaches specific cognitive and behavioral techniques
- Good interpersonal skills and flexible
- Sensitive to patient
- Uses techniques rationally and with skill (understanding of individuals needs)
29
How does the therapist help the client come to other possible alternatives to their thoughts?
- The therapist has their own thoughts and it's important to find a good balance in that, to not
impose this on the patient; you follow the patient from the back, without interfering by your own thinking
- But there should be some acknowledgment that there is a possibility that the patient's thinking isn't 100% correct, that there migth be an alternative because then you have no starting point
- But already the willingness to come to CT can be used as an indication of the willingness to consider the possibility that there is a different way of thinking about things
30
What is the goal and theory behind CT?
- Goal: correct faulty information processing, help modify assumptions that maintain maladaptive behaviors and emotions
- Cognitive + behavioural methods - used to challenge dysfunctional beliefs and promote more realistic adaptive thinking
- Emotions play a role in cognitive change becasue learning is enhanced when emotions are triggered
31
First cognitive technique: Challenging thoughts
- Part of almost of CTs
- It's a form through which you teach patients to systematically examine situations and the relationships between situations, how they feel, think and behave
- Picture 2
32
Second cognitive technique: behavioural experiment
Core technique of CT - you go through all of the steps systematically:
1. Precisely identify the belief/thought/process the experiment will target
2. Collaborate with your patient to brainstorm ideas for
n experiment; be as specific as you can (how can we test this - have to be very concrete, has to be something testable)
3. Write predictions about the outcome and devise a method to record (monitor, observe) the outcome
4. Anticipate problems and brainstorm solutions
5. Conduct the experiment
6. Review the experiment and draw conclusions
33
Example of behavioural experiment from a clip he showed
- Women who struggles with social anxiety becasue she is scared she will make a mistake in public and that will get people angry, irritated or that they will complain. So they identify one such situation this could happen (dropping groceries in a line at the cashier) and went to the supermarket to test it. The likelihood of the situation that people will get angry and whatever dropped from 90% to 60% as identified by the patient (it's not 0 which demonstrates that it's not straightforward but it requires also practice outside of the therapy session - 0 is not the aim and shouldn't be, also because sometimes people will be irritated)
- At the beginning, the therapists mentions that therapy is not only for fear but also for psychotic disorders (e.g. what will happen if you won't follow up with what the voices are telling you?)
- The clip illustrates the clear steps and planning that is required for the exercise to work (answering all questions beforehand: e.g. if I drop the groceries, an old man, how is it diffferent if you dropped them? will people react differently?)
- Also the gradual approach - the patient was too scared to do it so the therapist did it himself first and she observed
34
Why is the behavioural experiment a cognitive technique and not a behavioural one?
- Most behavioral experiments involve (new) behaviors and exposure to feared situations. However:
↪ Explicitly intended to challenge and modify dysfunctional thoughts
↪ Reduction of fear during experiment is not required (but neither in modern thinking about exposure?)
* Particularly suitable to solidify (new) thoughts that have high credibility but are not yet ‘felt’ to be true
35
Third cognitive technique: pie chart
- very relevant for cognitions related to guilt (e.g. I caused this, it's my fault)
- In the pie chart, other factors/sources are identified to reduce the patient's blame on themselves
36
# Style of CT
Fourth cognitive technique: Socratic dialogue
- a style of questioning that helps uncover the patient’s views and examines his or her adaptive and maladaptive features
- designing questions to promote new learning, client arrives at logical conclusions based on questions, posed with goal to understand client (not trap, lead on, or attack)
- Steps:
1) asking informational questions (also questions that probe reasons and evidence)
2) listening
3) summarizing
4) asking synthesizing or analytical questions that apply discovered information to the patient’s original belief
- Questions from the therapist are generally to:
1) Clarify or define problems
2) Assist in identification of thoughts, images, assumptions
3) Examine meanings of events for patient
4) Assess consequences of maintaining maladaptive thoughts and behaviors
- Employed throughout CT
- Attempt to improve reality testing through continuous evaluation
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Fifth cognitive technique: multidimensional evaluation
- used when clients have oversimplified, negative core beliefs about themselves
- It's convincing because the client themselves come up with their own dimensions and rate themselves, but also because there are always more nuances than they thought
- Black-and-white thinking and persistent judgments are transformed into more nuanced conception on a continuum
- They identify the biggest core belief the client has (e.g. failure) and then 9 other dimensions that make a person a failure or succesful and then the client rates themselves on each and they see that they are not a failure
38
Some possibly problematic cognitions of Kamran M.
- His father was a well-known critical journalist, who instilled **the belief of maintaining a strong public image and providing for the family are non-negotiable responsibilities as a man**. His father often emphasized that **“success comes to those who work the hardest”** and that **high education and good career are important**. Kamran respects his parents immensely; **he internalized these values and has always equated his self-worth with professional success**.
- His father, a strict but loving figure, often emphasized **the importance of being a hard worker and excelling in school.** His mother frequently reminded him that his successes reflected on the entire family, saying, **"When you succeed, we all succeed."** Kamran was praised for being a high achiever, but the family often put pressure on him **(“Always do your best, one mistake and it can all be gone.”).**
- Kamran recalls feeling both proud of his family’s values and **burdened by the weight of expectations.** He tends to think that **not meeting these expectations might lead to losing everything.**
* He feels **responsible for every detail of his team's output**, frequently rechecking others' work to ensure it meets his standards. Kamran feels a pressure to “prove himself”, **thinking he must work “twice as hard” to be taken seriously by his predominantly Dutch colleagues**.
* Despite requests from HR to delegate more tasks, Kamran says, **"I don’t want to burden anyone else with my problems."**
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# Process of psychotherapy
Initial sessions
- initiate relationship
- Gather info about the patient’s expectations, and demonstrate the relationship between cognition and affect
- Problem definition (may take several sessions) - functional and cognitive analyses of the problem
- Symptom relief - specific problem solving, clarifying vague or general complaints into workable goals, or gaining objectivity about a disorder
- More active therapist role (gather info, socializes patient to CT, conceptualizes patient's problem) + assigns homework
- Problem list is generated and priorities are assigned as treatment targets
40
# Process of psychotherapy
Middle and later sessions
- Shift from client’s symptoms to patterns of thinking
- Learn to challenge thoughts
- Consider underlying assumptions that create thoughts
- Greater emphasis on cognitive than behavioral techniques
- Modifying thoughts
- More responsibility for identifying problems and solutions, creating homework
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# Process of psychotherapy
Ending treatment
- Goals have been reached
- Patient able to practice sklls and perspectives independently
- Length dependent on severity of problems
- Termination planned for even in earlies sessions (learn to be own therapist)
- Booster sessions (1-2 months after termination)
42
What are the three mechanisms of change across effective psychotherapy
1. Comprehensible framework
2. Patient’s emotional engagement in problem situations
3. Reality testing in those situations
Change only possible if patient experiences problematic situation as real threat - be engaged in problem situation and respond adaptively
43
Who can CT help? What different forms are there?
- Present-centered, structured, active, cognitive, problem-oriented approach
- All kinds of disorders
- Individual, group, etc.
- Stand alone, combined with pharmacotherapy
- Inpatient, outpatient
- Very effective for unipolar depression - also if the patient is refractory to medication
- Not recommended as exclusive treatment for Bipolar or psychotic depression
- Not used alone for schizophrenia
- Best results with intact reality testing, good concentration, sufficient memory functions, being able to focus on automatic thoughts, accept therapist-client roles, tolerate anxiety for experiments, postpone gratification to complete therapy
44
Cognitive therapy consists of highly specific learning experiences designed to teach patients to:
1) Monitor negative, automatic thoughts
2) Recognise connections between cognition, affect, behavior
3) Examine evidence for and against distorted automatic thoughts
4) Substitute biased cognitions with more reality-oriented interpretations
5) Learn to identify and alter beliefs that predispose to distorted experiences
Both cognitive and behavioural techniques are used to reach these goals - the specific one used at any given time is dependent on the patient's level of functioning, the particular symptoms and problems presented
45
What are verbal techniques used for?
- Elicit automatic thoughts and analyze their logic
- Identify maladaptive assumptions and examine the validity of those assumptions
46
How can automatic thoughts be elicited and how can they be tested?
- Occurs during upsetting situations - “Hot” cognitions (real-time thoughts) are more accurate, accesible, powerful and habitual
- If recall is difficult, imagery or role-play can help
- Patients are taught to recognize and record upsetting thoughts
- The therapist doesn't interpret thoughts but explores their meaning - he investigates why neutral thoughts may trigger strong emotions
- Testing of automatic via direct evidence (personal experience) or logical analysis
- Behavioral experiments can test beliefs empirically (e.g., testing social anxiety through conversations)
- Examining thoughts can uncover inconsistencies and cognitive distortions - identifying distortions helps patients correct specific errors (cognitive change can occur)
47
How can maladaptive assumptions be identified and modified?
- Harder to access than automatic thoughts
- Can be identified through recurring themes or inferred by the therapist
- Therapist collaborates with patient to verify or rephrase assumptions
- Once identified, it's open to modification
Modifying assumptions:
- Patients examine the reasonableness of assumptions
- Weigh reasons for and against them
- Consider evidence that contradicts them
- Recognize that reasonable assumptions in one context can be dysfunctional in others (e.g., productivity at work vs. during leisure).
48
What are the specific cognitive techniques
* **Decatastrophizing** (“what-if” technique): prepares for feared outcomes and reduces avoidance
* **Reattribution**: challenges self-blame by exploring alternative causes (encourages realistic thinking and shared responsibility)
* **Redefining**: reframes problems as changeable through personal action
↪ Makes issues more concrete and behavior-focused.
* **Decentering**: opposes belief of being the center of others’ attention (patients with SAD)
↪ Uses behavioral experiments to shift focus outward
* **Imagery techniques**: restructure distressing images (e.g., trauma) to reduce impact
↪ Empowering changes (e.g., shrinking attacker) aid coping
* **Experiential techniques**: support belief in change and freedom from harmful patterns.
↪ Use imagery and role-play to access emotions
49
What are behavioural techniques used for in CT?
- Aimed at modifying automatic thoughts and assumptions
- Behavioral experiments help challenge maladaptive beliefs and promote new learning
↪ Patients predict an outcome based on automatic thoughts
↪ They carry out the behavior and evaluate evidence based on the experience
↪ It's crucial to understand the patient’s reactions and thoughts after each experiment
They are used to:
- Expand response repertoire (skills training)
- Relaxation (e.g., progressive muscle relaxation)
- Increase activity levels (activity scheduling)
- Prepare for avoided situations (behavioral rehearsal)
- Address fear responses (exposure therapy)
50
What behavioural techniques are used in CT?
1. **Homework** - reinforces therapy between sessions; i ncludes self-observation, self-monitoring, time structuring, and managing specific situations
↪ Helps patients track automatic thoughts and practice new skills like thought challenging
2. **Exposure Therapy**: provides data on thoughts, images, physiological symptoms, self-reported level of tension
↪ Identifies distortions and teaches coping strategies
↪ Provides evidence to disconfirm inaccurate anxious thoughts
3. **Behavioral Rehearsal, Role-Playing, and Modeling**: practicing real-life skills or techniques.
↪ Role-playing may be videotaped for objective feedback and performance evaluation
4. **Diversion Techniques**: reduce strong emotions, decrease neg. thinking (phys. activity, social contact, work, play, visual imagery)
5. **Activity Scheduling**: structures time, promotes engagement
↪ Patients rate mastery and pleasure (0–10) for each activity
↪ Highlights mood variations and counters beliefs about inability or low activity levels
6. **Graded-Task Assignment**: begin with easy tasks, gradually increase difficulty
↪ Example: A socially anxious person starts with short, simple social interactions and builds up over time
51
What are the settings and logistics of CT?
- Referrals from doctors, schools, therapists, or self-referral
- Typically 45-minute sessions + weekly (more frequent for severe cases)
- Questionnaires like the BDI may be completed before sessions
- Real-life work may occur outside the office (e.g., with phobias).
- Informed consent and confidentiality are important
- Therapists provide emergency contact numbers
- Significant others can be included with consent,
↪ Helps clarify treatment goals and improve support
↪ Especially useful when close ones misunderstand the illness or act counterproductively
- Problems may arise from unrealistic expectations, incorrect technique use, or ignoring key issues
↪ Therapists acknowledge and correct their own mistakes when needed
52
Guidelines for difficult clients and those with history of unsuccessful therapy
1. Avoid stereotyping client as problem
2. Remain optimistic
3. Identify and deal with own dysfunctional cognitions
4. Remain focused on task instead of blaming client
5. Maintain problem-solving attitude
These help therapists stay resourceful and model resilience for the patient
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What is the Evidence-based practice in psychology (EBPP)?
- EBPP integrates the best available research with clinical expertise and patient characteristics, culture, and preferences
- It includes empirically supported methods in assessment, case formulation, therapeutic relationship, and intervention
- Emphasizes internal validity (efficacy) and external validity (utility, generalizability, feasibility)
- Fundamental component - **empirically supported treatments**: —those demonstrated to work for a certain disorder or problem under specified circumstances
↪ Treatments must demonstrate efficacy through RCTs
↪ Meta-analyses quantify treatment outcomes and effect sizes
↪ Other methods (e.g., qualitative, single-case designs) are useful but less generalizable
- CT and CBT show strong empirical support, especially for depression and anxiety - lowest relapse rates
-
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What are the multicultural considerations in CT?
- CT respects cultural context - focuses on patient’s own beliefs, not imposing therapist’s values
- Aims to evaluate adaptiveness of beliefs and foster emotional well-being
- Translated into many languages and represented worldwide
- CT research is global but concentrated in industrial countries - needs expansion to developing countries
