Cognitive Therapy

Cognitive therapy (CT) is a comprehensive theoretical approach for cognitive reconstructing

that evolved from Aaron Becks early work with depressed individuals. Like Ellis, Beck
became disgruntled with psychoanalytics therapy,and like RET, his approach to
therapy.

DeRubeis and Beck (1988) identified six types of cognitive errors that occur at both the
automatic thought and core belief levels:

-Arbitrary inference – Drawing conclusion without supporting evidence or in spite of

contradicting evidence

-Selective abstraction- Ignoring the majority of features in situation and basing a

conclusion from isolated incidents and applying the rule in related and unrelated
situations.

-Overgeneralization- Drawing a general rule or conclusion from isolated incidents and

applying the rule in related and unrelated situations.

-Magnification and minimization- Making errors in judging the magnitude of an event,

thus distorting its significance

-Personalization- Relating events to self when there is no reason for doing so.

-Dichotomous thinking- Placing experiences in two opposite, extreme categories, such

as glorious or horrendous, and applying the negative categorization.
Clinical Techniques
As noted, CT is cognitive-behavioral therapy, and a variety of beavioral methods are used to
help bring about cognitive change.These include seld.monitoring, scheduling activites,
chinking,and using graded tasks. In CT, the client is insturcted to self-monitor behavior by
recording hourly any information that pertains to petinent activites.In some cases the clients
also is aksed to record the degree of maste or pleasure associated with an acitivity, often on as
scale ranging from 0 to 100.The therapist uses this record to learn how the client spends time,
to generate questions about the clients thought during specific activites,and to indentify
consistent patterns of events associated with good or bad feelings.

CT is an acitve-directive therapy consequently the client and the therapist collaborate in

schedualing acitivites that the clients must plan to accomplish. These activites include those
that are reported in self-monitoring as geenrating good feelings,or those that once were
rewarding but currently are avoided,or those that have the potential to be rewarding.Obstacles
related to activit scheduling are discussed in therapy. When clients avoid performin activites
the cognitios associated with the incident are discussed in therapy. For difficult activites
chunking is used.For example the task of writing on paper may begin with preparing an outline
for the paper.The cliens also may grade or swquence tasks so that simpler aspect are presented
first, for instance,choosing a topic for the paper.Although behavior strategies are important the
techniques that provide the backbone of CT are designed to directly change cognition.These
include keeping a daily record of dysfuncitional thoughts asking three types of question using
the downward arrow procedure identyfing cognitice errors,and identifying schemata.
Either with assistance by the therpist during a session or independetly for later discussion in
therapy.The daily record is a relaively simpe form that includes a colimn for the date a second
coliumn to descirbe the situations and a third column to describe the emotion and to rate the
degree of intensty on a scale ranging from 1 to 100. In the fourht columng indicudals attempt to
record the automatic thoughts that proceded the emotions and rete their belief in those
thoughts on a scale ranging form 0% to 100%.The fifth column is used to record a rational
response to the automatic thoughts and to rate extent of belief ona 0% to 100% scale.The sixth
and final coliumn is used to re-rate the clients belief in the automatic thoughts after they are
examined and to note and rate subsequent emotions.

Use of the record of dysfunctional thoughts enables the tharpis to spot breakdowns in any
stage of the therapic process- in indetifying problematic cognitions in the degree of belief that
remains after examinations and in the value or appropriatness of rational response that is
choosen. Once client have experience evalaitng their tinking the record can be dispensed with
however clients knowledge of the process or the seqence of steps that compromise it enables
them to practice CT throughout their lives .

As sugested the kystone of this approach is to teach clients to question their faulty cognitions.
To do so three types of question are taught-

-What is evidence for and against the belief ?

-What are alternative intepretations of the event or situation?

-What are real implications is the belief correct?

In addition to the use of the quiestion clients are helped to identify the type of cognitiive errors
that they are prone to make such as overgeneralization or magnification. Cliets scemas
amalgamations of cognitive processes typically used to view and respond to events in the world
are idnetifies by the consistend pattern of beliefs that clients associate with their psychological
problems.For example a client may consistently reason that if i am not perfect i am total failure.
Therefore unlike RET the CT aproach does not assume that therapist can readly idntifiy the
basic irrational toughts that trigger maladjustment but rather thath the cient is ultimately will
identfy them in the therapeutic process. Once faulty cognitive processes are idnetifies a
helathier schema can be idnetified practiced and reicnforced.
CT Applied

As noted, CT grew from Beck's interest in depression. Beck (1963, 1982) proposed that a
negative self-schema caused biased information process- ing, influencing the individual's
memories of past events and distorting current views. This "negativity hypothesis" of the
cognitive model of depression is strongly supported by clinical results (Ernst, 1985; Haaga, Dyck,
& Ernst, 1991). An initial step in treatment, assessment of the individual's cognitive schema, is
accomplished by measuring attitudes. Beck found that depressed persons had rigid attitudes
about their self- worth, tending to evaluate themselves in response to external events, such as
the approval of others and achievement. Also, they minimalized their accomplishments and
practiced phonyism (Ellis's [2003] term), be- 3. lieving that others would reject them if they
really knew them. Many aspects of CT have been used to treat depression in children and youth
(Curry & Reinecke, 2003; Maag & Swearer, 2005). Also, as cognitive theories have gained
credibility and acceptance, CT has been used to treat other types of disorders, including panic
disorders, general- ized anxiety disorders, phobias, hypochondriasis, obsessive-compulsive
disorders, eating disorders, and even multiple-personality disorders (Beck, 1993; Beck &
Newman, 2005). For example, Ottaviani and Beck (1987) applied the strategies to eliminate
panic disorders in 30 persons who had been experiencing an average of 4.5 attacks per week.
Panic disorder, including the familiar agoraphobia (morbid fear of large, open places), is an
intense manifestation of anxiety triggered by psy- chosocial or physical stress that is
characterized by physical sensations such as pain in the chest, shortness of breath, increased
heart rate, light-headedness, and numbness or tingling in extremities. These sensa- tions evoke
ideas and images of physical catastrophe (e.g., death, heart attack, and fainting) and mental or
behavioral catastrophe (e.g., loss of control or going crazy). Sometimes these symptoms are
accompanied by memory lapse or difficulty in reasoning. When the symptoms com- mence, the
individual's irrational fear of catastrophic consequences reduces the ability to think about less
serious causation. As catastrophic ideation increases, physical symptoms intensify, and panic as
well as other phobic behavior results. Fear of symptoms and the situation in which symptoms
occ

CT treatment of this condition is designed to show the client that physical sensations prior to
and during panic attacks are not dangerous. The steps to accomplish this include the following:
1. Conducting a thorough physical examination
2. Providing the client with information about panic disorders
3. Helping the client identify the misattributions or erroneous thoughts occurring during an
attack
4. Reinterpreting those thoughts (pain in the chest does not
5. Helping the client switch focus from internal sensations
6. Teaching relaxation or controlled-breathing techniques
7. Teaching other cognitive distraction techniques (in early heart attack) signify heart attack)
and catastrophic thoughts to external reality (used only in the early stages of an attack) stages,
to focus attention on conversation, the environment, a puzzle, etc.)
8. Inducing a mini-panic attack in the office (usually with hyperventilation) to show the client
that the attack can be stopped ur constitute the basis of phobias