Cognitive

Therapy
EDPS 602
NICOLE DARLINGTON, JOANNE TAKENAKA
AND ALICIA MARCHINI

Cognitive Therapy: Overview

2

History of Cognitive Therapy

Rationale of Cognitive Therapy
Goals of Cognitive Therapy
Change Agents of Cognitive Therapy
Contemporary Cognitive Therapy
Neurological Implications

History of Cognitive Therapy

Development of Cognitive Therapy
3

Success and limitations of behaviourism

Computer as a metaphor for human

information processing
Dissatisfaction with psychoanalysis

History of Cognitive Therapy

Success and Limitations of Behaviourism
4

Popularity of behaviourism in 1960s was

declining

Classical conditioning and operant condition were seen as

not going far enough in explaining the human condition
Missing cognitive processes

E.g. thoughts, beliefs, assumptions, attitudes, memories,

mental imagery and fantasies

Narrow focus on interactions between people and their

environments

Eventual acceptance that the conditioning

paradigm did not account for many important

aspects of the human condition

History of Cognitive Therapy

Computer as a Metaphor for Human Information
Processing
5

1956 symposium on information processing at

Massachusetts Institute of Technology

Credited for introducing cognitive paradigm

Information processing models fit well with

empirical methods

Computers do not have subjective experiences

Can be observed to process information according to
reliable rules

Metaphor suggested a model in which human

thought could be considered objective

(measurable) rather than merely subjective

History of Cognitive Therapy

Dissatisfaction with Psychoanalysis
6

Research on depression by Aaron T.

Beck

Trained in psychoanalysis
Attempted to validate Freuds theory of
depression as the result of anger turned
against the self
Observations of depressed patients during
traditional psychoanalysis

Observed a negative bias in their cognitive

processing, termed as a negative cognitive shift
Experienced specific types of cognitions in the
form of automatic thoughts, and conceptualized
as part of an internal information processing
system

Changes made to this system that were less

negatively biased revealed a less depressive affect

History of Cognitive Therapy

Dissatisfaction with Psychoanalysis
7

Treatment studies provide empirical support

for the effectiveness of cognitive therapy

Studies showed cognitive therapy to be as effective as

drug treatment for depression
Studies of panic attacks, obsessive-compulsive
disorder and other problems of excessive fear and
anxiety have produced similar results

Rationale of Cognitive Therapy

8

Based on the premise that behaviours and feelings

influence the way human beings make sense of

situations
Misinterpretations of situations/sensations and
negative expectations make us unhappy without
serving any useful function

Such distortions in our thinking are important in the

development and maintenance of a variety of psychological
disorders

Shifts in thinking, mood, and behaviour occur when

we view situations more objectively and rationally

Rationale of Cognitive Therapy

9

How we feel is not a reaction to a situation, but

rather our thoughts about the situation

influence our response

Thoughts that influence behaviour and mood tend to be

evaluative, brief, and automatic

Cognitive therapy helps to identify distressing

thoughts and to evaluate how realistic they are

Clients learn to change their distorted thinking
through a combination of strategies and tasks

Appropriate application of these tasks enables us to rid

ourselves of the source of our emotional difficulties

Goals of Cognitive Therapy

Teaching, Learning, and Changing
10

Problems in life and emotional distress are the

result of misperceptions, misinterpretations,

or dysfunctional interpretations of situations

Goals of Cognitive Therapy

Primacy of Cognitions
11

Initial Goal
Identify distorted or detrimental thought processes
Long-term Goal

To remove systematic biases in thinking, as well as, to

modify core beliefs

Key Understanding
To change beliefs, one must view them as testable
hypotheses not facts

Goals of Cognitive Therapy

Cognitive Change at Multiple Levels
12

Voluntary Thoughts
Most accessible and least stable
Automatic Thoughts

Stable thoughts that are outside of clients awareness

Intercede between an event and the clients emotional
and behavioural reactions
These thoughts are generated from underlying
assumptions

Core Beliefs
Absolute beliefs that are contained in cognitive schemas
If these beliefs can be identified, the negative effect can
be counteracted

Goals of Cognitive Therapy

Therapeutic Relationship
13

Collaboration

The therapist and client decide upon therapeutic tasks

and goals

Connections

An emotional bond between client and therapist is

important

Actively Engaged
Both the therapist and client have active roles

Goals of Cognitive Therapy

Key Aspects of the Therapeutic Relationship
14

Collaborative Empiricism
The therapist and client determine goals of therapy
together
Socratic Dialogue

The therapist uses carefully designed questions to

promote new learning
The client arrives at logical conclusions based on the
questioning of the therapist

Guided Discovery
The therapist uses information, facts, and probabilities
to assist the client in gaining a realistic perspective

Change Agents of Cognitive Therapy

Cognitive Change Processes
15

To recognize and replace faulty information

processes with adaptive ones cognitive therapy

follows a general, sequential pattern to elicit change

Awareness of the cognitive content of their reaction to an

upsetting event
Recognize the connection between thoughts, feelings, and
behaviour
View the thoughts as hypothesis NOT facts
Substitute more accurate thoughts for biased thoughts
Learn how to identify and alter beliefs that predispose one to
distortions
Gather feedback to determine whether change made resulted
in desired outcome

Change Agents of Cognitive Therapy

Process of Cognitive Psychotherapy
16

Early Sessions
The therapist is more active than client
Middle Sessions
The focus shifts from clients symptoms to patterns of
thinking
Later Sessions
The therapist takes on the role of advisor rather than teacher
Ending Sessions
The therapy is terminated when goals are achieved

Change Agents of Cognitive Therapy

Change Tasks: Cognitive Techniques
17

1. Automatic Thoughts Identify and test them

(a central task)

Tested by direct evidence or by logical analysis

2. Maladaptive Assumption Appear as themes

in automatic thoughts

Once identified, it is open to modification

3. Decatastrophizing What if technique

Assists clients to prepare for feared consequences

Change Agents of Cognitive Therapy

Change Tasks: Cognitive Techniques
18

4. Reattribution Consider alternative explanations

Encourages reality testing and appropriate assignment of
responsibility
5. Redefining Change conceptualization to find

opportunity to change problem

Helps make problems more concrete, specific, and

controllable

6. Decentering Developed for primarily for clients

with anxiety

Tests the belief that they are the focus of everyones

attention

Change Agents of Cognitive Therapy

Change Tasks: Cognitive Techniques
19

7. Thought Stopping Breaking a thought stream that is

escalating

Assists clients with anxiety to consciously halt distressing

thoughts

8. Distraction Stop and change focus to something else

Focus on complex thoughts because distressing and nondistressing thoughts cannot be maintained simultaneously
9. Three Column Technique A homework assignment

for the client

Identification of the triggering situation, the automatic and

illogical thoughts, and the logical error in the automatic thoughts

Change Agents of Cognitive Therapy

Change Tasks: Behavioural Techniques
20

1. Homework Client can apply cognitive principles

between sessions

Focus on self-observation, self-monitoring, structuring time, and

implementing procedures and practicing new skills

2. Hypothesis Testing Both cognitive and behaviour

technique

Make a specific and concrete hypothesis and test it to arrive at

logical conclusion

3. Exposure Therapy Examines thoughts and images for

distortions

Can teach coping for anxious client by providing data on thoughts,

images, physiological symptoms, and self-reported tension levels

4. Behavioural Rehearsal and Role Playing practicing

skills and techniques

Used to apply in real life situations

May video record role-playing to obtain objective information to

evaluate performance

Change Agents of Cognitive Therapy

Change Tasks: Behavioural Techniques
21

5. Diversion Techniques Reduce strong emotions

and decrease negative thinking

May engage in physical activity, socializing, work, play or

visual imagery

6. Activity Scheduling Provides structure and

encourages involvement

Use a rating scale of 0 to 10 to determine level of mastery

and pleasure during daily activities

7. Graded Task Assignment Task difficulty is

gradually increased

Client initiates activity at non-threatening level and therapist

helps by gradually increasing difficulty of task

Contemporary Cognitive Therapy

Evolution and Variations
22

Cognitive therapy rationale can be applied to

an array of personal problems, contributing to

its strength as an approach to therapy

Contemporary Cognitive Therapy

Evolution and Variations
23

Structural Psychotherapy
Incorporates a rationalist worldview
Developed by Vittorio Guidano and Giovanni Lotti

Goal of therapy:

Rationale: Emotional problems can only be comprehensively

understood if the role of the individuals self-knowledge and the
way s/he perceives the world is taken into consideration
Used Bowlbys Attachment Theory to explain that knowledge
of self and the world is impacted by significant childhood
relationships
Guidano suggests that the change processes involve rejecting
old perceptions of self and the world and eradicating negative
beliefs
Client adopts new, functional worldviews and self-perceptions
Personal revolution

Change tasks are the same as those of other cognitive

therapists

Contemporary Cognitive Therapy

Evolution and Variations
24

Dialectical Behavioural Therapy

(DBT)

Introduced by Marsha Linehan

Used to treat suicidal behaviour,
borderline personality disorder,
dissociative disorders, and drug abuse
Cognitive skills training program to
manage emotions that are difficult for
the client to cope with
1. Determine triggers
2. Establish solutions to change selfdestructive behaviour
3. Individual therapy, supplemented by
group therapy to change behaviours
that negatively affect quality of life

Contemporary Cognitive Therapy

Evolution and Variations
25

Cognitive-Analytic Therapy (CAT)

Introduced by Anthony Ryle
Merges psychodynamic and cognitive
therapies

Transference and countertransference

manifest in observable, procedural
terms

Focuses on identifying problematic

coping strategies that are assumed to
develop from early life experiences
and transforming them into effective
coping strategies using various
cognitive and behavioural change
tasks

Contemporary Cognitive Therapy

Evolution and Variations
26

Schema Therapy
Introduced by Jeffrey Young
Used to treat personality disorders and other chronic
problems
Focuses on cognitive schemas that are rooted in early
childhood relationships
Treatment entails cognitive change tasks and a
therapeutic relationship with client to change schemas
by meeting emotional needs that were not met during
childhood

Contemporary Cognitive Therapy

Example: Cognitive-Behavioural Therapy in Children
27

Based on the assumption that emotional

issues result from underlying distortions

in thinking and information processing,
which develops in early childhood

These issues may not emerge until an event,

such as parental separation, occurs and triggers
negative thought patterns

Contemporary Cognitive Therapy

Example: Cognitive-Behavioural Therapy in Children
28

Problem: Anxiety
Distortions in the childs thinking entail
exaggerated perceptions of threat (or thinking
the worst) and negative perceptions of
themselves and their ability to cope with
situations

Contemporary Cognitive Therapy

Example: Cognitive-Behavioural Therapy in Children
29

When the sense of perceived threat persists, physiological

responses to stress occur and, due to the childs distorted

thinking, the child focuses on the bodily sensations that
he feels (e.g., sweating, increased heart rate, and nausea)

The way the child perceives physiological responses causes the sense
of threat to heighten, triggering more negative thoughts
Common Result: Avoidance of stressful situations, which perpetuates
the problem

Some children develop strategies to help them face

threats (e.g., special routines or holding on to something),

but these strategies become counterproductive as the
child becomes dependent on them

Neurological Implications
Neuroplasticity
30

Neuroplasticity refers to changes in neural

pathways and synapses of the brain

Brain changes through learning

Bottom-up approach: using medication to alter it

Top-down approach: training the frontal cortex to learn
new ways to approach the world

Without this training, nothing will truly change

Environment can change brain, but most of the time,
counselling or cognitive behavioural training (i.e., activity
dependent learning) is needed for change

Depression: Brains ability to change stops

With CBT, counselling, and/or medicine, there is a rebirth

of neuroplasticity and regrowth of withering nerve cells

Neurological Implications
Learning
31

The brain learns things

through action and practice

= Fake it til you make it

Try out a skill, response or carry it

out using scripts and eventually,
connections in the brain will be
made as the new skill or
response is learned
Continuous practice consolidates
the new skill or response

In cognitive therapy,

modifications to thinking can

be learned through the
change tasks

Neurological Implications
32

Amygdala has two

different parts where

information enters, and it
can send information to
make us less responsive
or more reactive in
unpleasant or stressful
situations, depending on
the pathway of the
information

We can influence the

pathway to go up to the
frontal cortex and the
motor cortex to make us
more active by acting
more and developing skills
to be more active in our
lives

Neurological Implications
33

The way we think will influence the way we

feel and behave

Cognitive training teaches a client how to
think differently, and consequently, feel and
behave differently

Causes structural and functional changes in the brain

References
34

Aaron Beck on Cognitive Therapy Video [Video File]. Retrieved from

https://www.youtube.com/watch?v=xrX43cCW6uE
An introduction to Cognitive Behavioural Therapy - Aaron Beck [Video File].
Retrieved from https://www.youtube.com/watch?v=KyluZW23m0U
Martin, J. H. (2005). Neuroanatomy: Text and Atlas. New York, NY: McGrawHill.
Neuroscience and the Brain: Implications for Counseling and Therapy [Video
File]. Retrieved from
http://ezproxy.lib.ucalgary.ca:2048/login?url=http://ctiv.alexanderstreet.com.ez
proxy.lib.ucalgary.ca/view/1778729
Truscott, D. (2010). Becoming an effective psychotherapist: Adopting a theory of
psychotherapy thats right for you and your client. Washington, DC: American
Psychological Association.