CBT

Aaron Beck

Relationship

•the Rogerian conditions of empathy, warmth, positive regard, and genuineness; and (2) the therapeutic alliance.

automatic and reflexive response

•innate disposition and an ability to adapt and change


•We have an innate subjectivity (that means we all see the world our own way)


•Cognitions are verbal thoughts and picture images


•We are born with the ability to create Schemas, Assumptions, and Automatic Thoughts

• •Our main motive in life is to survive—to live (and of course to do so in a pleasant way—as we define pleasant)
• •Operating principles of interpretation and organization to predict and control environment
• •Process information, interpret, LEARN!

•Different temperaments at birth

•When we feel threatened, we become distressed.

•Individuals learn from experience and significant life events (this starts early)

•Personality reflects the individual’s cognitive organization

•Schemas continue to be reshaped by the ongoing interaction between individuals and their environments; just as interactions grow out of schemas

•Cognitions are formed in a hierarchy with varying levels of accessibility and stability:

–Schemas

–Assumptions

–Automatic Thoughts

• –Underlying organization and belief system
• –How individuals think about their world
• –Positive and Negative
• –Core phenomena that are five supporting systems: cognitive, emotional, physiological, motivational, and behavioral.
• •Develop early in life, when interacting with others
• •Associate with distress
• •Certain cognitive distortions are present
• •Look to affect—ask “What were you just thinking right now?”
• •Strong affective component
• •Vary to the length of held beliefs
• •Usually acquired from other individuals (Sound familiar?)
• •How pervasive
• •Behavior is affected, too

–If/Then propositions


–“IF” I do not make an “A”, “THEN” I am not worthwhile


–“IF” I am not approved, “THEN” I am not a lovable person

–Conscious


–Situation specific


–Spontaneous


–No effort


–Attaches to basic beliefs about the self (often distorted, might I add…)

•Early Childhood Experiences


•Helps form


•Development of Schemas, Basic beliefs, and Conditional beliefs


•Which play out in


•Critical Incidents


•Leading to


•Activation of schemas, basic beliefs, and conditional beliefs (assumptions)


•Triggered by


•Automatic Thoughts


•That lead to


•Emotions Behaviors Physiologic Responses

•Healthy individuals are ready to examine and modify beliefs


•Happens when they perceive evidence that refutes their logic and have more insight and awareness

•Relatively more maladaptive thoughts


•Biased selection of information


•Distorted interpretations, due to rigid schemas, Cognitive Disorders, & Distorted Processing


•Only look for information that is consistent with my beliefs


•Selective attention

•Combination of biological, environmental and social factors.


•Some may be related to early childhood events


•Lack of experience


•Setting unrealistic goals

•It is not a THOUGHT that causes the maladaptation; It is a combination of Biological, Environmental, & Developmental factors!

•Dichotomous Thinking: By thinking that something has to be just as we want it, or we are a failure (Unless I get an A, I have failed)


•Selective Abstraction: Pick an event that has been bad and focus on it, rather than the whole picture


•Arbitrary Inference: Mind reading (It is a negative prediction)


•Catastrophizing: Take an event, make an ASSUMPTION that they will do something stupid


•Overgeneralization: One negative experience, then everything will be bad


•Labeling: Based on errors and mistakes, give oneself a name


•Magnification: Magnify imperfections, minimize good ones


•Personalization: Take an event that is unrelated, and make it about the self

•Identify automatic thoughts


•Identify connection with thoughts, feelings, behaviors


•Subject thoughts to reality testing; substitute more realistic ones


•Identify the advantages of having and maintaining automatic thoughts

•When the demands of life outweigh the client’s ability to adapt


•Unaware of thoughts


•Distress


•Discomfort in the real world

•Client must play an active role


•Good concentration and memory


•Ability to delay gratification


•Self-responsibility

•Clients can change, BUT…


•The client must be able to identify thoughts and have a capacity for reality testing

•May be a result of the client, counselor, and the therapeutic relationship


•Client may not believe in counseling


•Counselor may not explain the technique


•May not agree on goals

•Warm, caring, bright, helpful


•Guide, Catalyst for change


•Expert


•Structure the session


•Becomes less directive as the client takes a more active role

•Symptom Relief


•Modify maladaptive thoughts & assumptions—Reduce distressing feelings by identifying and critically examining thoughts, beliefs, assumption schemas

•Collaborative


•Warm


•Genuine


• Positive Regard


•Accepting


•Sound familiar? (It better…) Not very warm, but truthful…

•Three areas to remember:


•Stages of Counseling


•Assessment


•Then Techniques

•Initial: Understand CT, develop relationship, discuss expectations, correct misconceptions, understand AT


•Middle: Shift from ID of AT to ID patterns of thinking/Assumptions


•Later: Client ID problems; relapse prevention; reduce sessions

•Ongoing through counseling


•Structured sessions


•Variety of formal assessment (BDI, etc.)


•ID the “Hot” Thought

•Socratic Dialogue—purposeful questioning


•Also called Guided Discovery


•Decastrophizing: ID solutions to fears


•Reattribution: ID reasons for events


•Redefining: see what one can control


•Self-monitoring: Daily record of Dysfunctional thoughts


•Self-Observation


•Homework


•Test Hypothesis