COGNITIVE THERAPY • Definition of Cognitive Therapy

FOR PERSONALITY DISORDERS • Techniques Used In Cognitive

Therapy
Judith S. Beck, Ph.D. • Dysfunctional Assumptions of Axis
Director, Beck Institute for Cognitive Therapy and Research II Patients that Interfere with
Clinical Associate Professor of Psychology in Psychiatry
University of Pennsylvania Treatment

www.beckinstitute.org

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Co- Morbid Axis II Disorders

CBT is Effective for Axis II Disorders
Do Not Affect Axis I Outcome
in Case Reports
with CBT Treatment

• Morrison (2000) • Leibbrand, Hiller & Fichter (1999)

• Bizzini (1998) • Simun (1999)

• Davidson & Tyrer (1996) • Comer (1998)

• Dreessen, Hoekstra & Arntz (1997)

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CBT Studies Showing Poorer Outcome

CBT is Effective for Co-Morbid (Axis I
for Axis I Disorders with Co-Morbidity
and Axis II) Diagnoses
on Axis II
• Kuyken et al (2001) • Koerner & Linehan (2000)
• Woelwer (2001) • Leibbrand, Hiller & Fichter (1999)
• Vallis, Howes & Standage (2000)
• Black et al (1996)
• Marchand et al (1998)
• Fisher & Bentley (1996)
• Chambless, Tran & Glass (1997)
• Nelson-Gray (1996)
• De Haan et al (1997)
• Hoffart & Hedley (1997) • Neziroglu et al (1996)
• Steiger & Stotland (1996)
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 Research on CBT for
Borderline Personality Disorder
• Davidson et al (2006)
• Giesen-Bloo et al (2006)
• Weinberg et al (2006)
• Brown et al (2004)
• Linehan et al (1991)
Cognitive Therapy Checklist
1. Cognitive conceptualization
2. Strong therapeutic alliance
3. Agenda
4. Homework
5. Problem-solving orientation
6. Evaluation of thoughts and beliefs
7. Relapse prevention

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Core Beliefs
GENERAL COGNITIVE MODEL

Assumptions
Situation

Coping Strategies
Automatic Thoughts
and Images
Situation
Reaction
Emotional Automatic Thoughts
Behavioral
Physiological
Reaction
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Categories of Core Beliefs about

the Self Core Beliefs about the World and
• Helplessness Others

• Unlovability

• Worthlessness

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 TYPICAL OVERDEVELOPED and
COGNITIVE CONCEPTUALIZATION DIAGRAM
UNDERDEVELOPED STRATEGIES
RELEVANT CHILDHOOD DATA
Personality Disorder Overdeveloped Underdeveloped
CORE BELIEFS
Obsessive- Control Spontaneity
Compulsive Responsibility Impulsivity CONDITIONAL ASSUMPTIONS/ BELIEFS/ RULES
Systematization Light-heartedness
COPING STRATEGIES
Dependent Help-seeking Self-sufficiency
Clinging Decision-making
SITUATION #1 SITUATION #2 SITUATION #3
Subjugation
Passive-Aggressive Resistance Negotiation
Passivity Assertiveness AUTOMATIC THOUGHT AUTOMATIC THOUGHT AUTOMATIC THOUGHT
Sabotage Cooperation
MEANING OF AT MEANING OF AT MEANING OF AT

Emotion Emotion Emotion

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Behavior Behavior Behavior 14
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Building the Therapeutic Alliance Structuring Sessions

• Standard techniques
• When patients react negatively
• Using the alliance to achieve therapeutic
goals

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Structure of the Therapeutic Interview

In-Session Treatment Planning
Questions 1. Mood check

2. Setting agenda
• How can I help the patient feel better by
3. Bridge from last session
the end of the session?
4. Discussion of today’s agenda items

• How can I help the patient have a better 5. Homework assignment

week?
6. Capsule summaries plus summarization of session

7. Feedback from patient

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Evaluating Automatic Thoughts and
Socratic Questions
Images
• Standard techniques
What is the evidence that my thought is true?
What is the evidence that my thought is not
• When automatic thoughts are true true?

What’s an alternative explanation or

viewpoint?

What’s the worst thing that could happen?

How could I cope with that?
What’s the best that could happen?
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What’s the most likely outcome? 20
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TECHNIQUES TO MODIFY CORE

BELIEFS

What is the effect of telling myself ______
[this thought]? What could be the effect of
changing my thinking?
1. Educating patients about core beliefs

What would I tell ______[a specific
friend/family member] if he/she viewed this
situation in this way? 2. Presenting an information processing
model

What should I do now?

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Turned Neil down for date

Forgot sister’s birthday

3. Developing a new core belief

I am bad. Made mistakes at work
________
4. Motivating patients to modify old core
Should have helped more
+ beliefs
Helped sick neighbor

Should have worked harder

+
Stayed late at work

+
+ Work
+ Work
Work 23 24
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 5. Monitoring the strength of core beliefs 8. Creating yardsticks of evaluation
over time

9. Devising behavioral experiments

6. Modifying core beliefs daily

10. Acting “as if”

7. Contrasting with more extreme
negative role models
11. Doing intellectual/emotional roleplays

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CT for Personality Disorder References

12. Metaphors – Beck, J.S. (1995). Cognitive

therapy: Basics and beyond. New
York: Guilford.
13. Cognitive Continuum
– Beck, J.S. (2005). Cognitive therapy for
14. Historical Review of Evidence challenging problems: What to do when the
basics don’t work. New York: Guilford

15. Restructuring the Meaning of Early – Beck, A.T., Freeman, A., Davis, D. and
Experiences through Imagery Assoc. (2004). Cognitive therapy of
personality disorders, 2nd ed. New
York: Guilford.
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– Layden, M.A., Newman, C.F., Freeman, A., & Morse, Academy of Cognitive Therapy
S.B. (1993). Cognitive therapy of borderline
personality disorder. Boston: Allyn & Bacon.
Certifies Cognitive Therapists
Referrals
– Leahy, R. Overcoming resistance in cognitive
therapy. New York, Guilford. Consumer Information
Training Opportunities
– Young, J. (1999). Cognitive therapy for personality
Listserve
disorders: A schema-focused approach. Sarasota, Newsletter
FL: Professional Resource Exchange.
www.academyofct.org
– Young, J., Klosko, J. and Weishaar, M. (2003).
Schema therapy. New York, Guilford.
Email: info@academyofct.org
610-664-1273
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Beck Institute for Cognitive
Therapy and Research

Training
Clinical Care
Research
Reference lists, educational materials,
downloadable patient brochure, newsletter

www.beckinstitute.org

beckinst@gim.net
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