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Cognitive Therapy is Based on a Cognitive Formulation of the Presenting Problems

Cognitive therapy distils cognitive theories of emotional disorders to the understanding of particular cases through the case formulation method. A skilled cognitive therapist aims to understand presenting problems in terms of cognitive theory while maintaining the 'essence' of the presenting problems for a particular individual. To the scientist-practitioner cognitive therapist, individualised case formulation is the heart of good practice (Tarrier & Calam, 2002). The process of clinical formulation has been described as' the linchpin that holds theory and practice together' (Butler, 1998), serving as a clinical tool that practitioners use as a framework for describing and explaining the problems that individuals may present with in cognitive therapy (Bieling & Kuyken, 2003). A case formulation should guide treatment and serve as a marker for change and as a structure for enabling practitioners to predict beliefs and behaviours that might interfere with the progress of therapy. It...

Cognitive Therapy In Practice

A typical cognitive therapy session involves checking how the client has been doing, reviewing the previous session, setting an agenda, working through the agenda items, setting homework, reviewing summarising the session and eliciting feedback. It begins with the therapist and client negotiating an agenda or list of topics that they agree to work on in that session. This involves ensuring the agenda is manageable, prioritising the items and linking them to the therapy goals. The therapist will usually ask the client for a brief synopsis of the time since they last met and as far as possible will try to enable a linking of both positive and negative experiences to thoughts and behaviours. For example, a client who reports feeling less depressed may go on to link this to returning to work and having less time to ruminate. A session would then review the homework from the previous session, again seeking to link progress or lack of progress to the therapy goals. For example, an...

Cognitive Therapy Focusses on Cognition and Behaviour

Cognitive Conceptualization Diagram

The cognitive model of emotional disorders is central to every aspect of cognitive therapy the formulation, intervention planning and change processes. Thus, the therapist seeks to understand the client's presenting problems in terms of maladaptive beliefs and behaviours and develops an intervention plan that will effect changes in the presenting problems through changes in beliefs and behaviours. When successes and difficulties are encountered in the therapeutic process these are formulated in terms of maladaptive beliefs and behaviours, and therapy proceeds accordingly.

Training And Supervision In Cognitive Therapy

Developing these skills requires training and supervision. Our experience suggests several goals for cognitive therapy trainers and supervisors. A first goal is to develop therapists' formulation skills, so that interventions have a clear rationale (Bieling & Kuyken, 2003 Needleman, 1999). Novice therapists often use cognitive therapy techniques without a clear basis in a cognitive formulation of the person's presenting problems. Learning formulation skills involves learning the technical aspects of a case formulation system, the cognitive theories that underpin it and having a good understanding of how this relates to the client's personal world. A second goal is to enable trainees to develop skills in collaborative empiricism. Trainees are encouraged to learn how to work with their clients to formulate hypotheses, carry out experiments, note and analyse the outcome of experiments, and through this process facilitate client cognitive and behavioural change. When done well this is...

The Structure of Cognitive Therapy Behavioural Techniques Cognitive Techniques and Homework

Table Disfunctional Thoughts Record

Cognitive therapy is made up of a range of therapeutic approaches (Figure 2.3). The first class of therapeutic approaches focus on the client's behaviour. The rationale is that for some people behaviour monitoring, behavioural activation and behavioural change can lead to substantive gains. For example, people with more severe depression often become withdrawn and inactive, which can feed into and exacerbate depression. They withdraw and then label themselves as 'ineffectual', fuelling the depression. By focussing on this relationship and gradually increasing the person's sense of daily structure and participation in masterful and pleasurable activities the person can take the first steps in combating depression (Beck et al., 1979). Other behavioural strategies include scheduling pleasurable activities, breaking down large tasks (such as finding employment) into more manageable graded tasks (buying a newspaper with job advertisements, preparing a resume ), teaching relaxation skills,...

Cognitive Therapy for Different Populations and in Different Settings

Given the common features of cognitive therapy and these widely differing areas of application, it is not surprising that cognitive therapy has evolved in several different formats to ensure it is acceptable and effective to a range of groups of people (children, adolescents, adults, older adults and people with learning disabilities), in different therapy formats (self-help, individual, couples, families, groups, organisations) and across different levels of service delivery (primary, secondary and tertiary care). There is increasing interest in cognitive therapy for children, in part because the approach appears acceptable to children and adolescents and pragmatic in these service settings (Friedberg & McClure, 2001). A comprehensive review of the outcome literature for children and adolescents suggests that cognitive therapy is effective for generalised anxiety, simple phobias, depression and suicidality (Fonagy et al., 2002 Kazdin & Weisz, 1998). As with adult populations, the...

Cognitive Behavioural Therapy Rationale

Cognitive behavioural therapy for depression, rather than referring to a single system of therapy, now more accurately describes a range of practices derived from the original work by Aaron Beck (Beck et al. 1979), focusing on the thinking patterns and associated emotional, behavioural and physiological systems operating within the depressed individual. Problematic schema, acquired in and reflecting the course of development are retained into later life and can be triggered by thematically congruent events. Such triggering events are argued to lead to characteristic negative automatic thoughts, thinking errors and erroneous or negatively biased (Power & Dalgleish, 1997) information processing and associated behavioural, emotional and physiological responses. The first goal of CBT is the identification of any such systematic errors and the second is the modification of thinking and reasoning patterns to replace them with evidence-based and rationale alternatives, thus facilitating...

Cognitive Therapy for Affective Disorders

The first full description of a cognitive therapy format was cognitive therapy for depression (Beck et al., 1979). There have been numerous randomised clinical trials that support the efficacy and effectiveness of cognitive therapy for depression, across a variety of clinical settings and populations (for review, see Clark, Beck & Alford, 1999 De Rubeis & Crits-Cristoph, 1998 Dobson, 1989 Robinson, Berman & Neimeyer, 1990). In outpatient trials, effect sizes are considerable compared to no treatment controls, with about half of the intent-to-treat patients showing full recovery (Hollon & Shelton, 2001). Some studies suggest cognitive therapy has particular relapse prevention effects (see, for example, Evans et al, 1992). More recently there have been important developments for recurrent and severe depression (McCullough, 2000) and for the prevention of depression relapse in individuals at high risk by virtue of their history of recurrent depression (Jarrett et al., 2001 Segal,...

The Evidence Base For Cognitive Therapy Ct And The Comparison Of Behaviour Therapy And Cognitive Therapy

A systematic review by Abramowitz (1997) found no significant difference between behaviour therapy and cognitive therapy. In a further RCT Cottraux (2001) found a similar response rate following behavioural and cognitive therapy. Obsessive cognitions changed with BT and CT. Few studies have tried to investigate whether cognitive therapy and ERP share a psychological mechanism or achieve the same results through different mechanisms. Van Oppen et al. (1995) showed that there was no difference on the Irrational Beliefs Inventory or YBOCS obsessions or compulsions subscales between the groups treated with cognitive therapy or ERP. However they used cognitive therapy that included behavioural experiments and the reality is that treatments will rarely be purely behavioural or cognitive. Freeston etal. (1997) showed that cognitive-behavioural treatment was effective for patients with only obsessive thoughts who completed treatment. However there was a significant drop-out rate.

Cognitive Therapy for Substance Misuse

There is a large body of research on psychosocial interventions for substance misuse, but cognitive therapy for substance abuse disorders is a more recent development (Beck et al., 1993 Marlatt & Gordon, 1985 Thase, 1997) and to date the evidence base for cognitive therapy as a preferred treatment choice is weak. The largest study in this area assigned 1 726 people with alcohol-abuse problems to cognitive therapy, a facilitated 12-step programme or motivational interviewing. Improvements were observed in all groups but, contrary to the study's hypotheses, there was no evidence that treatment matching improved outcomes or that any one intervention achieved improved outcomes (Allen et al., 1997). Evidence for cognitive therapy's evidence base with other substance abuse problems is decidedly mixed.

Cognitive Therapy for Psychosis

The last decade has seen an exciting development in cognitive therapy approaches for psychosis (Chadwick, Birchwood, & Trower, 1996 Fowler, Garety, & Kuipers, 1995 Morrison, 2002). While outcome research in this area is limited, a range of efficacy and effectiveness studies suggests that cognitive therapy is efficacious in the treatment of positive symptoms and that changes are maintained at follow-up (Garety et al., 1994 Kuipers et al., 1998 Rector & Beck, 2001 Tarrier et al., 1993).

Cognitive Therapy for Anxiety Disorders

Cognitive therapy has been adapted for the full range of anxiety disorders generalised anxiety disorder (Beck & Emery with Greenberg, 1985) panic disorder (Clark, 1986 Craske & Barlow, 2001) social phobia (Heimberg & Becker, 2002) and obsessive-compulsive disorder (Frost & Steketee, 2002 Salkovskis, 1985). For generalised anxiety disorder, Chambless & Gillis (1993) computed effect sizes across five studies in which cognitive therapy was compared with one of several control conditions non-directive therapy (Borkovec & Costello, 1993) or waiting list (Butler etal., 1987, 1991). Substantial effect sizes (1.5-2) at post-test and follow up suggest that cognitive therapy is an efficacious intervention for generalised anxiety disorder. A review of 12 trials of cognitive therapy for panic suggested that 80 of patients achieved full remission at the end of treatment (Barlow & Lehman, 1996). De Rubeis & Crits-Christoph (1998) reviewed 11 outcome studies of cognitive therapy for panic disorder....

Cognitive Therapy for Eating Disorders

Only more recently has cognitive therapy been adapted for eating disorders (Vitousek, 1996). In their review of eight outcome studies, Compas et al. (1998) concluded that cognitive therapy for bulimia nervosa meets criteria for an efficacious approach, although effectiveness research suggests that on average only 55 are in full remission at follow up. A recent multi-site study has broadly replicated these findings (Agras et al., 2000). It is premature to comment on cognitive therapy for anorexia nervosa as, although several adaptations have been suggested (Vitousek, Watson & Wilson, 1998), there is very limited research attesting to its efficacy or effectiveness to date.

Cognitive Therapy Draws on a Wide Range of Cognitive and Behavioural Techniques to Change Thinking Beliefs Emotions and

The development of cognitive therapy over several decades has drawn on other therapeutic modalities, the extensive accumulated clinical expertise of cognitive therapists, increasingly sophisticated and fine-tuned theory and a large body of research. This has led to the development of a wide range of cognitive and behavioural therapeutic strategies on which a cognitive therapist can potentially draw. The main cognitive approaches involve teaching clients to be able to identify, evaluate and challenge cognitive distortions (such as all-or-nothing thinking) and maladaptive beliefs ('I have to be upbeat and bubbly at all times to be liked'). The main behavioural approaches involve increasing positively reinforcing behaviours (for example, behaviours that are pleasurable and generate a sense of mastery in people diagnosed with depression) and extinguishing or replacing negative behaviours (such as 'safety behaviours' that maintain a fear in people diagnosed with an anxiety disorder).

Cognitive Therapy Areas Of Application

The last few decades have seen cognitive therapy adapted for mood, anxiety, personality, eating and substance misuse disorders. As well as these formal psychiatric disorders, cognitive therapy has been adapted for relationship problems and the psychological aspects of a range of medical disorders. Most recently cognitive therapy has been applied to the problem of anger generally and its manifestations in conflict specifically, while colleagues, mainly in England, have applied cognitive therapy to people with psychosis. A thorough review of these applications is beyond the scope of this chapter, but a brief overview is provided for the main areas of application. Interested readers may wish to follow up the references describing these adaptations and the following excellent reviews of evidence-based psy-chotherapies (Compas et al., 1998 De Rubeis & Crits-Cristoph, 1998 Fonagy et al., 2002 Kazdin & Weisz, 1998 Rector & Beck, 2001).

Cognitive Therapy Aims to Enable Clients to Identify Evaluate and Respond to Maladaptive Thoughts Beliefs and Behaviours

The change process in cognitive therapy involves clients learning to recognise how their thoughts, feelings and behaviours are related to one another and how they are implicated in the presenting difficulties. Clients then go on to learn how to actively evaluate and respond to maladaptive thoughts and behaviours. Early phases of cognitive therapy involve the therapist in an active and educative role middle phases involve much more of a joint problem-solving stance with later stages involving clients essentially 'running their therapy'. Placing the client in this active role of evaluating problematic patterns of thought and behaviour serves the parallel functions of increasing a sense of hope and mastery.

Cognitive Therapy for Personality Disorders

The 1990s saw several developments of cognitive therapy for personality disorders. Beck, Freeman & Davis (2003) adapted traditional cognitive therapy for each of the DSM-IV personality disorders. Layden et al. (1993) developed a more in depth adaptation for borderline personality disorder, and Linehan (1993) developed a more integrative behavioural-cognitive Zen Buddhist approach for this client group. Meanwhile, Young developed a schema-focussed cognitive therapy for personality disorders, which emphasises the importance of underlying schema change in this group (Young, 1994 Young, Klosko, & Weishaar, 2003). Several preliminary effectiveness studies suggest that these approaches produce significant symptom changes in people diagnosed with personality disorders (Kuyken et al., 2001, Linehan etal., 1999 Linehan, Heard & Armstrong, 1993). It is premature to comment on whether these are evidence-based interventions although several large-scale trials are currently under way.

Cognitive Therapy is Structured

Cognitive therapy has evolved a structured format that enables the therapist and client to work in the most efficient and effective way. The structure remains constant throughout therapy making therapy more transparent and understandable for both therapist and client. Having outlined what distinguishes cognitive therapy, we aim to convey a sense of how cognitive therapy proceeds in practice. We will outline a typical therapy session, as well as a typical progression for therapy as a whole. We will conclude with a case example, illustrating this process. The interested reader is referred to J. Beck (1995) for a comprehensive overview of cognitive therapy in practice.

The Assumption That Cognitive Psychology Has Epistemological Import Can Be Challenged

Only the assumption, that one day the various taxonomies put together by, for example, Chomsky, Piaget, Levi-Strauss, Marx, and Freud will all flow together and spell out one great Universal Language of Nature would suggest that cognitive psychology had epistemological import. But that suggestion would still be as misguided as the suggestion that, since we may predict everything by knowing enough about matter in motion, a completed neurophysiology will help us demonstrate Galileo's superiority to his contemporaries. The gap between explaining ourselves and justifying ourselves is just as great whether a programming language or a hardware language is used in the explanations. (Rorty, 1979, p. 249)

Cognitive Psychology Has Not Succeeded in Making a Significant Contribution to the Understanding of the Human Mind

Cognitive psychology is not getting anywhere that in spite of our sophisticated methodology, we have not succeeded in making a substantial contribution toward the understanding of the human mind A short time ago, the information processing approach to cognition was just beginning. Hopes were high that the analysis of information processing into a series of discrete stages would offer profound insights into human cognition. But in only a few short years the vigor of this approach was spent. It was only natural that hopes that had been so high should sink low. (Glass, Holyoak & Santa, 1979, p. ix)

Cognitive Therapy in Health Psychology Settings

A cognitive model of stress examines the role of beliefs in illness and proposes that aperson's beliefs about illness determine both emotional reactions to illness health and to health behaviours (Beck, 1984 Pretzer, Beck & Newman, 1989). This formed the basis for forms of cognitive therapy for a range of problems in health psychology and behavioural medicine, including pain, HIV AIDS, cancer, heart disease and health-related behaviours like exercise and smoking. For example, a link has been established between anger and hostility and coronary heart disease (Emmelkamp, & Van Oppen, 1993). Cognitive therapy to reduce anger and hostility therefore suggests a way of reducing the rates of heart disease. R. Beck and Fernandez (1998) analysed 50 studies, over two decades, incorporating 1 640 angry subjects treated with cognitive therapy. Using meta-analysis, it was found that cognitive therapy had a mean-effect size of 0.70, which indicated that the average individual treated with cognitive...

Cognitive Therapies

Adapted versions of the cognitive therapies are being used increasingly with people with ID. It had been considered by earlier writers that methods for cognitive therapy would have to be adapted considerably in order to be understood clearly by individuals with mild ID (Kroese, 1997). However, more recent research suggests that with minor adaptations, simplification and so on, assessment and treatment are extremely similar to those seen in mainstream therapy. Dagnan & Sandhu (1999) used an adapted version of the Rosenberg Self-esteem Scale (Rosenberg, Schooler & Scoenbach, 1989) and the Gilbert & Allen (1994) Social Comparison Scale in a study of the impact of social comparison and self-esteem on depression in people with mild intellectual disabilities. Psychometric analysis of these scales indicated a factor structure that is consistent with the factor structure of the original scales when used in the mainstream population and a good level of internal and test re-test reliability....

The Cognitive Model

At the heart of cognitive therapy lies a deceptively simple idea. Perceptions of ourselves, the world and the future shape our emotions and behaviours. What and how people think profoundly affects their emotional well being. As Shakespeare's Hamlet put it' is nothing either good or bad, but thinking makes it so . . . ' From this principle comes the idea that if we evaluate and modify any dysfunctional thinking, we can profoundly affect our emotional Figure 2.1 Factors involved in the development of evidence-based cognitive therapy. Salkovskis (2002). Reprinted with permission. Figure 2.1 Factors involved in the development of evidence-based cognitive therapy. Salkovskis (2002). Reprinted with permission. This central feature of cognitive therapy is based on two broader assumptions. First, that a broader bio-psycho-social context is implicated in the development and maintenance of emotional disorders. Cognitive therapy theorists and researchers have themselves emphasized different...

Cognitive Therapy

Owing to the fact that vaginismus is often a conditioned response, the role of cognitive therapy is small. The active ingredient in cognitive therapy is therefore to break the conditioned response, that is, just get on with things (exposure in vivo). Women with vaginismus will undoubtedly have irrational thoughts of too thick, does not fit, and so on, especially when the complaints have been present for some time. Although such thoughts can be removed cognitively by means of good patient education, in principle, this will have little or no effect on the occurrence of the complaints. Many patients have followed this path of little success. The most important aspect of cognitive therapy therefore is not so much removing the complaint, but instead motivating the patient, offering insight into the origination of the complaint, and further tackling the problem if it appears to contain a strong rational component. Particularly if the woman's body is expressing what she cannot put into...

Theoretical Formulations

The cognitive model of GAD developed by Adrian Wells is based on a distinction between two types of worry Type 1 worries, which concern everyday events and bodily sensations, and Type 2 worries, which are focused on the act of worrying itself and reflect both positive and negative appraisals of worrisome activity (Wells, 1999). There is evidence that the content of Type 1 worries is very similar to normal worries (Craske et al., 1989) and that GAD is associated in particular with Type 2 worries. The theory proposes a particular sequence of events. Once triggered, the worry cycle persists initially through the activation of positive Type 2 worries (positive metacognitions such as 'worry helps me cope', 'worry prevents bad things happening'), which in turn increase the accessibility of, and sensitivity to, threat-related information and lead to more intense worrying. The balance of appraisal then shifts to predominantly negative Type 2 worries ('my worries are uncontrollable', 'I could...

Cognitive Behaviour Therapy

The cognitive behavioural approach, with its success in the management of depression and anxiety disorders (Department of Health, 2001), soon turned its focus to schizophrenia. It had the advantage of collaborative relationship and shared formulation of the patient's problem based on common sense. Most importantly, it de-stigmatised psychosis by giving due importance to the patient's perspective (Kingdon & Turkington, 1994) on the experience of psychosis - the sufferer now had a say. Cognitive behavioural and family work could all be woven into the work with the individual (Kuipers, 2000). There is evidence that the gains made through cognitive therapy are durable at least in the medium term (Sensky et al., 2000). However, adequate evidence does not exist to support the view that CBT can reduce relapse rates in schizophrenia except when a specific focus is taken on relapse prevention (Gumley et al., 2003). This can be explained by the fact that patients enrolled in the majority of CBT...

Studies Of Psychological Treatments In Bipolar Disorders

For BP have focussed on psychoeducational models, the three most well-researched manu-alized psychological approaches - interpersonal social rhythms therapy (IPSRT), cognitive therapy (CT) and family focused therapy (FFT) - or techniques derived directly from these manualized therapies. The latter are used primarily to improve medication adherence or to teach recognition of prodromes and relapse prevention techniques. Cognitive Therapy Cognitive therapy

Social Anxiety In Children And Adolescents

An intervention called Social Effectiveness Therapy for children (SET-C) has been developed to treat socially anxious preadolescent children (ages 8 to 12) (Beidel, Turner & Morris, 1996). It was adapted from the adult SET programme (Turner et al., 1994b) and comprises separate group social skills training and individual exposure sessions for 12 weeks. A unique aspect of this treatment is that each child is paired with a non-anxious peer helper to assist in interactions in age-appropriate social outings. Parent involvement is limited to assistance with conducting the structured interaction homework assignments. Cognitive restructuring is not a fixed component of SET-C because the authors believe that children in Piaget's concrete operational stage may not endorse catastrophic negative thoughts during socially stressful situations. Cognitive-Behavioural Group Treatment for Adolescents Cognitive-behavioural group treatment for adolescents with social anxiety disorder (CBGT-A) (Albano et...

Is EMDR a Power Therapy

Rosen et al. (1998) describe EMDR as a 'power therapy' (Figley, 1997), and group it together with therapies such as thought field therapy (Callahan, 1995), trauma incident reduction (Gerbode, 1989), and emotional freedom techniques (Craig, 1997). Rosen et al. say 'These Power Therapies appeal to popular healthcare models with an emphasis on tapping energy points.' Poole, De Jongh & Spector (1999), however, respond that the theoretical foundations of these procedures linked together have no common ground whatsoever. Eye movement desensitisation and reprocessing incorporates well-established therapeutic principles of exposure, cognitive restructuring and self-control procedures, and should be viewed as part of an overall treatment process, rather than a 'one-off' treatment method. They also point out that none of the other procedures mentioned had been evaluated by any properly controlled randomised studies, whereas EMDR had been evaluated by several.

Good Therapeutic Relationship is Necessary but Not Sufficient for Effecting Change

Cognitive therapists, like other therapists, aim to provide an empathic, warm, genuine and respectful context in which to work. Given the focus of cognitive therapy, they should be particularly skilled at seeing the world from their clients' perspective (accurate empathy) while holding a realistic perspective in the face of what may be quite distorted thinking. Cognitive therapists explicitly model a hopeful, collaborative and problem-solving stance.

Cartwright D S 1957 Annoted Bibliography Of Research And Theory

The Self in Process Towards a Post-Rationalist Cognitive Therapy. New York Guilford. Neimeyer, R.A., Heath, A.E. & Strauss, J. (1985). Personal reconstruction during group cognitive therapy for depression. In F. Epting & A.W. Landfield (eds), Anticipating Personal Construct Psychology (pp. 181-197). Lincoln University of Nebraska Press. Wexler, D.A. (1974). A cognitive theory of experiencing self-actualization, and therapeutic process. In D.A. Wexler & L.N. Rice (eds), Innovations in Client-Centered Therapy (pp. 49-116). New York Wiley. Winter, D.A. & Watson, S. (1999). Personal construct psychotherapy and the cognitive therapies different in theory but can they be differentiated in practice Journal of Constructivist Psychology, 12, 1-22.

Summary And Conclusions

Exposure therapies are the treatment of choice in adult specific phobia, social phobia, agoraphobia, and obsessive-compulsive disorder (Emmelkamp, 2004) and have also been found quite effective in phobic children (Nauta et al., 2003). Studies of the behavioural treatment of depression have come to a standstill due to the rise of cognitive therapy in this area but the lack of further research into the behavioural treatment of depression is not justified by the data. There are still a number of important issues that need to be addressed. For example, we have no idea why cognitive therapy, behavioural interventions, IPT and pharmacotherapy work equally well with depressed patients, although various researchers provide various theoretical explanations. Unfortunately, to date there is no evidence that

Difficulties In Assessing Outcome Research

With these caveats in mind we will proceed to examine the evidence base for psychological therapies in the treatment of personality disorder. Recent systematic reviews (Bateman & Fonagy, 2000 Bateman & Tyrer, 2002 Binks et al., 2006 Perry, Banon & Ianni, 1999 Roth & Fonagy, 2005 Roy & Tyrer, 2001 Shea, 1993) have varied in their inclusiveness. For reasons of space the following section is limited to consideration of large-cohort and controlled studies in which patients were selected on the basis of Axis II disorders, treatments were clearly described and adequate measures were used. The approaches considered are dynamic psychotherapy, cognitive therapy, interpersonal group psychotherapy, behaviour therapy and dialectical behaviour therapy delivered through outpatient, day hospital or inpatient programmes. Therapeutic communities will be briefly considered at the end, together with treatment programmes for personality disordered offenders.

Questionnaires Selfmonitoring and Observation of Behaviour

When the therapist and patient have determined what behaviour needs to change, it can be useful to have the patient complete a self-monitoring diary to elucidate the conditions under which the behaviour occurs. Such diary registrations can illuminate crucial associations between problem behaviour and critical events (antecedents and consequences of the problem behaviour). It is important to tailor the registration forms to the individual needs of the patient. In general, during the self-monitoring phase, patients are asked to record date and time, the situation they are in, their emotion and its intensity, the presence of any physical sensations, their automatic thoughts and the occurrence of the problem behaviour. In contrast to cognitive therapy, where diaries are used as a means of changing cognitions, in behaviour therapy diaries are used as an assessment instrument to enhance the problem analysis (see Figure 4.1) and the evaluation of treatment. In this respect, it can also be...

Problemsolving Skills Training

Problem orientation, during which patients explore their personal attitude towards problems. The most important aspects are that the patients learn to recognize their negative feelings as signals of problems and learn to distinguish between problems over which one can exert personal control (such as arguments) versus those where one can not (such as cancer).

Evidencebased Psychotherapy With Older People

Despite an increasing awareness of the importance of anxiety disorders in older people there still remains a limited number of systematic studies examining psychotherapy for anxiety in later life (Gatz et al., 1998 Nordhus & Pallesen, 2003 Stanley & Beck, 2000 Woods & Roth, 1996). This paucity of systematic studies is all the more surprising given the evidence supporting cognitive therapy as a treatment of choice for panic disorder and phobic disorders (Laidlaw et al., 2003). There are many more papers published that comment on King & Barrowclough (1991) developed a series of individual case studies to evaluate CBT's effectiveness as a treatment for late-life anxiety. The study was a naturalistic one as reflects the pilot nature of interventions being evaluated. Many of the participants were prescribed medication at a stable dose during their participation in the study. Outcome was impressive as seven out of 10 patients benefited from CBT. King & Barrowclough (1991) used standard...

Criteria For Evaluating The Outcome Of Treatment

Kazdin (1994) and Lambert &Hill (1994) emphasise that measures of outcome should be of proven reliability and validity and should be sensitive to change. Kazdin (1994) and Roth & Fonagy (1996) note that several measures are probably necessary to represent all aspects of patients' wellbeing. However, it is then necessary to make sure that change in only a few of several measures is not the result of chance variation. Subjects should be assigned at random to treatments and procedures should be conducted for comparison. Their characteristics, including diagnoses and demographic measures, should be reliably recorded to ensure that the groups are comparable, especially if the samples are small. A sufficiently large number of subjects should be recruited to ensure that the design has sufficient power to reject the null hypothesis if it is false. Studies that meet all these standards are very rare. The outstanding example has been the multicentre trial of cognitive therapy for depression...

Comparison Of Psychological And Drug Treatments And Combinations Of Treatment

One study showed a significantly greater improvement in obsessions with behavioural therapy plus the selective serotonin reuptake inhibitor drug fluvoxamine, compared to behavioural therapy plus placebo tablet (Hohagen et al., 1998). O'Connor et al. (1999) found that a combination of cognitive behavioural therapy and medication seemed to potentiate treatment efficacy. However other studies have not shown any additional benefit of combining behavioural therapy or cognitive therapy with a serotonin reuptake inhibitor drug, compared to using any of the three treatments alone (De Haan et al., 1997 Kobak et al., 1998 Van Balkom et al., 1998). De Haan et al. (1997) compared ERP, cognitive therapy, ERP plus fluvoxamine and cognitive therapy plus fluvoxamine and found no differences in efficacy between the four treatments. They found that a short-term positive response is a good predictor of long-term effect. However one-third of non-responders at post-treatment (16 weeks) had also become...

Cognitive And Behavioural Therapies

Over the past decade, a number of studies have examined the efficacy of psychological (mostly cognitive-behavioural) treatments for social anxiety disorder. The most commonly investigated treatments have been in vivo exposure (with or without the addition of cognitive restructuring techniques), social skills training, and relaxation training. The International Consensus Group on Depression and Anxiety's 'Consensus Statement on Social Anxiety Disorder' concluded that there is good evidence for the efficacy of exposure-based cognitive-behavioural interventions for social anxiety (Ballenger et al., 1998). Accordingly, these interventions receive the bulk of our attention in this review. Treatments that combine exposure techniques and cognitive restructuring are by far the most extensively researched psychosocial interventions for social anxiety disorder. Cognitive models of social anxiety disorder (see, for example, Beck, Emery & Greenberg, 1985 Clark & Wells, 1995 Rapee & Heimberg,...

Bloodinjury And Injection Phobia

Not addressed Three Groups one session of cognitive therapy, or dental information, waiting list Negative cognitions decreased in credibility and frequency in all groups. Cognitive therapy showed greatest change but was not superior in frequency of cognitions on follow-up. Dental Anxiety declined most rapidly with cognitive therapy Two groups massed spaced cognitive therapy and relaxation

Behaviour Therapy Rationale

Behaviour therapies for depression are underpinned by learning theory as a means of explaining the decline into and resolution of the depressive state and are primarily aimed at engaging or re-engaging the patient in pleasurable and consequently positively reinforcing behaviours. Relative to psychotherapy, behaviour therapy concentrates more on behaviour itself and less on a presumed underlying cause. The basic premise of behavioural treatments is that depression is a learned response in light of low rates of positively reinforcing behaviours and insufficient positive reward from routine behaviour. The aim therefore is to increase the reward experience through behavioural activation. Interventions combine skills based learning such as relaxation skills and problems solving with distress tolerance for negative emotions. Behavioural marital therapy progresses through three stages, employing social learning, behavioural change and cognitive techniques. The initial phase concentrates on...

Examples Of The Evidence Base

One of the most famous and most expensive therapy outcome studies was the National Institute of Mental Health (NIMH) Treatment of Depression Collaborative Research Program, which will be considered in order to illustrate the problems that have arisen from the general failure to find differential effectiveness of therapy outcome (see Elkin et al., 1989 Elkin, 1994) but also to illustrate other issues about the evidence base. This trial was the largest of its kind ever carried out. There were 28 therapists working at three sites eight therapists were cognitive-behavioural, 10 were interpersonal therapists, and a further 10 psychiatrists managed two pharmacotherapy conditions, one being imipramine plus 'clinical management', the second being placebo plus 'clinical management'. Two-hundred-and-fifty patients meeting the criteria for major depressive disorder were randomly allocated between the four conditions. The therapies were manualised and considerable training and supervision...

Summary

Obsessive compulsive disorder is a disabling and often chronic disorder. Behavioural therapy is largely successful for treatment completers. Developing a therapeutic alliance and using motivational techniques are extremely important. Cognitive therapy has not shown clearly that it adds anything to behavioural therapy but may have a role in improving engagement in therapy and in improving outcome by treating co-morbid disorders. Medication is effective for many but symptoms commonly recur when medication is stopped.

The Emdr Procedure

The third phase is named the 'assessment' phase. During this phase the first memory to be reprocessed is targeted. A visual image or picture that represents the worst part of the traumatic memory is elicited. Next a negative belief or cognition associated with the identified picture is elicited. This negative belief needs to be meaningful in the present as well as in the old memory. Next a positive or preferred belief or cognition is elicited that the client would like to be able to believe. This positive belief is then rated on the 'validity of cognitions' (VOC) scale (Shapiro, 1989), which is a seven point semantic differential scale from disbelief to full belief. The emotions associated with the targeted memory are identified and the disturbance level in relation to the traumatic incident is rated on the SUD scale (Wolpe, 1958). Finally physical sensations and their location in relation to the targeted traumatic memory are elicited. Each stage of this assessment stage is very...

Flying Phobia

Three sessions exposure to external stimuli, exposure to anxiety symptoms, cognitive therapy, control group Four groups one session exposure, five sessions exposure, five sessions cognitive therapy, waiting list Fear Survey Schedule (FSS), Fear of Flying Scale (ad hoc for present study) rating scales for expected anxiety, negative thoughts rating scale, Behavioural Test (BT), heart rate

Spider Phobia

Studies of recall and perceptual bias in spider phobia have been contradictory (Cameron, 1997). Disgust and fear evoked by spiders are largely independent of one another (Smits, Telch & Randall, 2002 Thorpe & Salkovskis, 1995) even though both decline with brief exposure (Smits, Telch & Randall, 2002 Thorpe & Salkovskis, 1997). Disgust as well as fear is, therefore, probably worthy of attention. Many people with spider phobia are also afraid, in the presence of spiders, of being unable to move, of making a fool of themselves, screaming and feeling faint (Thorpe & Salkovskis, 1995). Responses on measures that address these beliefs improve with brief exposure coupled with cognitive therapy, a change that is correlated with a reduction in fear (Thorpe & Salkovskis, 1997). However, it is not clear if cognitive therapy was necessary for that. Trials in adults and children (Table 20.4) show, without exception, that exposure to live spiders, usually in a graded manner, produces improvement...

Hypertension

The impact of antihypertensive medication on coronary heart disease has been less than expected, however, most likely because of the influence of adverse side effects and poor compliance. There has led to renewed interest in the non-pharmacological management of hypertension, with the aim of reducing stress by focusing on cognitive and behavioural stress coping strategies and reducing sympathetic arousal. Psychological interventions to date have tended to focus on either one or a combination of biofeedback, relaxation and stress-management techniques. An early meta-analysis purporting to assess the efficacy of cognitive behavioural techniques for hypertension included biofeedback, meditation and relaxation as forms of CB therapies, concluding that there was a lack of support for such interventions (Eisenberg et al., 1993). However, Linden and colleagues have suggested that there is such a varied interpretation of the term 'stress management', ranging from transcendental meditation to...

Treatment

Cognitive Therapy Three CT techniques have been described challenging obsessional thoughts, thought stopping and challenging negative automatic thoughts. Patients can be taught to monitor the obsessional thoughts and then learn how to replace them with more helpful thoughts or learn to challenge the belief in the thoughts by employing rational counter claims. In thought stopping patients are taught to say a cue word, such as 'stop', to disrupt a chain of obsessional thoughts. The patients can also be instructed to picture a positive image after saying the cue word. The third technique uses Beckian principles to challenge the negative automatic thoughts that result from the obsessional intrusive thoughts, rather than targeting the obsessional thoughts. The patients are helped to consider alternative, less threatening explanations. Cognitive Behavioural Therapy for Obsessions Salkovskis, Forrester & Richards (1998) has devised a cognitive-behavioural treatment for obsessions. In...

Dental Phobia

The studies of phobic patients in Table 20.1 show that exposure to video displays of patients receiving dentistry can reduce anxiety under test conditions. That has enabled subjects to accept one invasive dental procedure according to verifiable records in three studies (Bernstein & Kleinknecht, 1982 Harrison, Berggren & Carlsson, 1989 Jerremalm, Jansson & Oest, 1986). The studies that have tested cognitive therapy (De Jongh et al., 1995 Ning & Liddell, 1991) provide no evidence that the patients were more able to accept dental treatment even though improvements in anxiety on standard measures were recorded. Hypnosis, which is popular among dentists, has been examined in very few controlled studies. Moore et al. (1996) compared hypnotherapy plus graded exposure to dentistry, systematic desensitisation, group therapy and a waiting-list control group. The subjects in all treatments showed a greater reduction in anxiety than the control group but half those who received hypnosis failed...

Counselling

The authors include a list of the 92 papers included in their meta-analysis of counselling. A quick review of these references shows that the studies in the meta-analysis included the following counselling techniques anger management, assertiveness training, social skills training, exposure treatment for obsessive compulsive disorder, desensitisation, relaxation training, cognitive therapy, group cognitive behaviour therapy, shaping, reinforcement of non-depressed behaviours and implosion. Hence, the possibility that the apparent effectiveness of counselling was due largely to the inclusion of traditional behaviour therapy cannot be excluded. At this time we must conclude that there are very limited data to support the use of counselling with people with intellectual disabilities.

Behaviour Therapy

Other studies have adapted the Linehan model of DBT delivery in different ways. Evans et al. (1999) conducted an RCT (N 34) to assess the efficacy of manualised DBT and cognitive therapy (MACT) for treatment of outpatients who met criteria for Cluster B personality disorders and had made a parasuicide attempt in the past 12 months. Individuals were assigned to MACT or TAU and assessed at six months. The rate of parasuicide was significantly lower in the MACT group, and self-ratings of depression also showed significantly more improvement in this cohort.

Case Example

Thomas attended 16 therapy meetings over eight months. Initially meetings were weekly, but later meetings were biweekly and then monthly. The steps in cognitive therapy were (1) education about social anxiety, depression and the cognitive model to normalise Thomas's experience, (2) diary keeping of thoughts, feelings and behaviour across a range of upsetting situations to help Thomas further understand his beliefs and their role in his psychological difficulties, (3) reducing avoidance of feared situations in graded homework assignments and (4) testing and challenging hypothesised conditional and core beliefs. In terms of his presenting problems, Thomas responded well to cognitive therapy's pragmatic 'here-and-now' approach. Thomas identified the following strategies from cognitive therapy as helpful in managing his social anxiety (1) the solicitous use of self-disclosure, (2) 'what-if' thinking (asking yourself 'What would be so terrible if the feared consequences really did happen...

Future Directions

We predict that the period to 2030 will see a range of exciting developments in cognitive therapy research and practice. In the area of outcome research, the most obvious area for advancement is where promising initial research suggests that cognitive therapy may prove to be an evidence-based approach personality disorders, anorexia nervosa and substance misuse. Here efficacy and effectiveness research is urgently needed to establish whether people with these complex mental health problems can be helped through cognitive therapy. Similarly, psychotherapy outcome research is needed to examine how cognitive therapy fares when it is adapted to different populations (for example, older adults) and to different service settings (such as primary care). In a climate of managed health care, evidence-based practice and practice guidelines, researchers, practitioners and policy makers are increasingly asking the question 'What works best for whom ' Beyond the comparative outcome studies, this...

Conclusions

Although there is the beginning of an evidence base for cognitive therapy with people with intellectual disabilities, especially for anger management, it is much more limited. The possibility that the effects of cognitive therapy merely reflect the behavioural procedures contained in most treatment packages labelled 'cognitive therapy' has yet to be addressed (Sturmey, 2004). There is currently no convincing evidence base to support the use of counselling or sensory therapies with people with intellectual disabilities.

In Search Of Depressogenic Thought Processes

A variety of studies using a variety of cognitive methods have sought to discover the depressogenic thought processes responsible for depression (for reviews, see MacLeod & Mathews, 1994 Segal, 1988 Segal & Ingram, 1994). However, one problematic result emerges from this research. Specifically, it is extremely difficult to distinguish formerly depressed participants from never depressed participants on measures of cognitive bias (e.g., Segal & Ingram, 1994). That is, depressive biases in cognition seem to be more statelike than traitlike. The reader will note that such findings are parallel to those involving anxiety disorders and attentional threat bias, in that successful psychotherapy eliminates the attentional threat bias (MacLeod, 1999). Our lab has been pursuing relevant procedures for a couple of years now (e.g., Robinson & Clore, 2002b). Participants are asked to judge the extent to which they generally feel various positive and negative emotions. Because stimuli are presented...

Individual Defense Mechanisms

Individual defense mechanisms are not utilized exclusively in the service of negative emotions. In fact, defenses relate to all emotions. Subjects whose test results reveal avoidance of depressive feelings, for example, frequently seek continual external stimulation and engage in compensatory fantasy and behavior. The purpose of this defensive operation, which specifically utilizes the mechanism of compensation, is to secure sustained feelings of pleasure. This pleasurable feeling would be diminished if the defense did not operate and in such a case the depression would surface.

Activities Programming

One of the most effective means of managing behavior problems, at least for short periods of time, is the implementation of activities that keep elders interested and engaged. Too often, persons with dementia are allowed to play a passive role during activities that may increase boredom and restlessness that may exacerbate behavior problems. This may result in part from the selection of inappropriate individual or group activities, which are either too challenging or not challenging enough to provide sufficient stimulation to the person with dementia. For instance, a typical scenario in a nursing home involves a nursing assistant or other staff member reading the newspaper to a large group of residents. Although a few residents may be able to attend to this activity, many more are likely to sleep or leave the room. Fortunately, options for activities programming do exist that increase the likelihood that persons with dementia will remain involved and decrease the likelihood that they...

Conclusion 207 References 208

Although clinical and experimental psychologists have made contributions to the legal system since the early 1900s (e.g., see Travis, 1908 Munsterberg, 1908 Wrightsman, 2001) clinical forensic psychology has thrived as a subspecialty only for the past 25 years (Otto & Heilbrun, 2002). For the purposes of this chapter, we adopt the broad definition of forensic psychology that was crafted by the Forensic Psychology Specialty Council (2000) for submission to the American Psychological Association (APA), which was accepted by the APA Council of Representatives in August 2001. Forensic psychology is defined here as the professional practice by psychologists within the areas of clinical psychology, counseling psychology, neuropsychology, and school psychology, when they are engaged regularly as experts and represent themselves as such, in an activity primarily intended to provide professional psychological expertise to the legal system (Forensic Psychology Specialty Council, 2000). More...

The Behavioristic View

There are two forms of systematic desensitization in vitro and in vivo. In vitro means that the desensitization takes place in a fantasy situation, whereas in vivo means that it takes place in the real situation. Systematic desensitization in vivo is the more commonly used method for the treatment of women with vaginistic complaints. First, the woman learns to relax. Then she learns to gradually accept objects of increasing diameter in her vagina, such as fingers or vaginal rods. She starts with the smallest size and finishes with the largest size that matches the size of the partner's penis in erection. Many therapists employ systematic desensitization (23,25,27,29-33). It is often combined with other techniques, such as muscle exercises (23,34-36), stroking exercises (29,34-37), discussing difficult relational aspects (34), and cognitive therapy (33). Some therapists exchange the relaxation exercises for tranquillizers or hypnosis. The aim of muscle exercises is to teach women to...

Developmental Aspects of Attachments

Attachment theorists believe that these infant-caregiver relationships address two fundamental needs of the infant (see Ainsworth et al., 1978 Cassidy & Shaver, 1999). First, a caregiver's support reduces a young child's fear, distress, or anxiety in novel or challenging situations and enables the child to explore with confidence and to manage negative emotions (Ainsworth, 1967 Emde & Easterbrooks, 1985). This is commonly reflected in secure base behavior, by which an infant maintains reassuring psychological contact

The Psychobiology Of Stress

Emotional activity in the prefrontal cortex appears to be lateralized, with activity (for review, see Davidson, 1994 Davidson & Slagter, 2000) in the right prefrontal cortex supporting negative affectivity, while activity in the left supports positive affectivity. It is interesting to note that baseline asymmetry predicts susceptibility to negative and positive emotion-eliciting stimuli and may index the extent of prefrontal-cortex inhibition of limbic-hypothalamic stress circuits. Specifically, greater activity in the right prefrontal cortex may result in disinhibition of the stress system, whereas greater activity in the left prefrontal cortex may help contain and terminate stress reactions. It is not yet clear how this laterality is related to the functioning of specific frontal structures involved in the regulation of the stress response. Nonetheless, the focus on right-frontal asymmetry is consistent with evidence that there is a right bias in the reactive components of the...

Vulvar Vestibulitis Syndrome

Vulvar Vestibulitis Treatment

Factors such as psychological distress, anxiety, depression, low sexual self-esteem, harm avoidance, somatization, shyness, and pain catastrophization (41,55,56,60,68,69) have been found in women with vulvar vestibulitis. Whether they precede or develop subsequent to the pain remains to be elucidated however, it is crucial to investigate the role of these factors in the maintenance of dyspareunia as negative affect has been shown to modulate pain intensity (70). Negative affect is also associated with an increase in attention towards pain stimuli, otherwise known as hypervigilance (71), which in turn can increase perceived pain intensity (72). In a recent study (73), hypervigilance for pain stimuli was examined in women with vestibulitis and matched control women. Results indicated that women with vulvar vestibulitis syndrome reported hypervigilance to coital pain and exhibited a selective attentional bias towards pain stimuli, an effect mediated by anxiety and fear of pain. These...

How Therapeutic Challenges Are Conceptualized And Managed

Although cognitive therapy may seem simple and straightforward when it is presented in a textbook or a workshop, there is no shortage of therapeutic challenges when applying cognitive therapy to the treatment of personality disorders. The complex, deeply ingrained, persistent, and inflexible problems presented by clients with personality disorders are, by all clinical accounts, difficult to treat. Authors often note that a number of problems arise in the course of treatment, including difficulty obtaining clear reports of thoughts and emotions, low tolerance for strong emotion, poor compliance with homework assignments, and questionable motivation for change (McGinn & Young, 1996 Padesky, 1986 Rothstein & Vallis, 1991).

Teacher Learning Education and Curriculum

The chapter begins with an overview of prior research conducted to identify a knowledge base associated with what an effective beginning teacher needs to know, to do, and to value (Ball & Cohen, 1999). Theoretical shifts in studies of teaching have followed much the same route as that observed in the broader field of educational psychology. Views of a good teacher have moved from a focus on discrete knowledge and skills, to studies of the cognitions and decisions that occur during teaching, to more recent studies on the interplay of personal beliefs, knowledge, skills, and situational or contextual mediators of initial teachers' learning.

Process Of Therapeutic Approach

The approach used in cognitive therapy has been described as collaborative empiricism (A. T. Beck et al., 1979, chapter 3). The therapist endeavors to work with the client to help him or her recognize the factors that contribute to problems, to test the validity of the thoughts, beliefs, and assumptions that prove important, and to make the necessary changes in cognition and behavior. Although it is clear that very different therapeutic approaches, ranging from philosophical debate to operant conditioning, can be effective with at least some clients, collaborative empiricism has substantial advantages. By actively collaborating with the client, the therapist minimizes the resistance and oppositionality that is often elicited by taking an authoritarian role, yet the therapist is still in a position to structure each session as well as the overall course of therapy to be as efficient and effective as possible (A. T. Beck et al., 1979, chapter 4). In cognitive therapy, a strategic...

Causes and symptoms

Other clinicians attribute IED to cognitive distortions. According to cognitive therapists, persons with IED have a set of strongly negative beliefs about other people, often resulting from harsh punishments inflicted by the parents. The child grows up believing that others have it in for him and that violence is the best way to restore damaged self-esteem. He or she may also have observed one or both parents, older siblings, or other relatives acting out in explosively violent ways. In short, people who develop IED have learned, usually in their family of origin, to believe that certain acts or attitudes on the part of other people justify aggressive attacks on them.

Secure base and individual behaviour

The determining factor governing the nature of attachment a mother establishes with her infant will be the mother's management of her own negative emotional experiences. Defensiveness in the mother may lead to a lack of understanding or dismissal of the infant's anxiety, creating an avoidant attachment for the infant. Alternatively, the mother's incomplete understanding of her infant's states induces a preoccupation with anxiety and an ambivalent attachment pattern. Conversely, a mother who can accept and process her own negative emotions is able to tolerate and moderate her infant's emotional experiences and offer herself as a secure attachment figure. As a consequence, the mother's understanding and love gives the child the experience of being able to process emotions and manage personal distress.

Cognitivebehavioural therapy CBT

CBT has become established as the psychotherapy of choice, being perceived as effective and cost-effective. It remains important to understand the twin strands of CBT. Behaviour therapy per se is now less prominent. However, cognitive therapists are happy to admit that their treatment involves components of behaviour therapy, such as activity scheduling, and that the term 'cognitive therapy' is effectively shorthand for CBT. The principles of cognitive therapy and behavioural therapy will now be described, followed by an account of how they are brought together in CBT. Cognitive therapy is based on the work of Aaron Beck. Like most American psychiatrists of his era, his training was psychodynamic. However, he became frustrated with the lack of progress of patients under his care, in relation to the amount of input. He thus sought to address practically and directly, rather than through the convolutions of psychoanalysis, the maladaptive beliefs and attitudes presumed to contribute to...

Conceptualization Of The Problem Of Weight Regain

To maintain adherence to changes in diet and activity. In addition, the most satisfying aspect of treatment, namely, weight loss, usually ceases with the completion of treatment. Consequently, the dieter sees a high behavioral '' cost'' of continued dietary control and little ''benefit'' in terms of weight loss. Without professional assistance, a sense of hopelessness may ensue, and a small weight regain may lead to attributions of personal ineffectiveness, negative emotions, and an abandonment of the weight control endeavor (32,33).

Current Presentations Of The Field

Several consistent conceptual threads ran through the majority of invited chapters. One was the critical paradigm shift from behaviorism to cognitive psychology that shaped the discipline over the period covered. Another commonality across topics was that this conceptual shift resulted in a vigorous debate regarding research methods. What has emerged is a greater range of analytical tools a methodological pluralism marked by some promising new practices such as exploratory data analysis (Jaeger & Bond, 1996) and design experiments (Brown, 1992). In drawing conclusions about the field, Berliner and Calfee suggested that the discipline's bread-and-butter issues had not changed as dramatically as did the conceptual and methodological tools that educational psychologists employ to understand educational phenomena. They also concluded on a note of congratulatory celebration at what educational psychology as a discipline has contributed, and they looked optimistically to its future....

The Politics And Misunderstandings In Personalityassessment

With the impact of cognitive therapy there have been radical changes in the ways in which some training programs teach assessment, seemingly without knowledge of the significant improvements in assessment research and practice that have taken place in the last 15 years or so. There seems to be a Throw the baby out with the bathwater approach, whereby traditional instruments are derided and replaced primarily with self-report measures. This is an important issue because it has major implications for teaching assessment in graduate school and in internship settings.

Is Absent or Impaired Genital Responsiveness a Valid Diagnostic Criterion

Genital response, evoked feelings of anxiety, disgust, and worry. These negative feelings may have downplayed reports of sexual feelings, and were probably evoked by the sexual stimuli and not by the participants becoming aware of their genital response, because reports of genital response were unrelated to actual genital response. Negative appreciation of sexual stimuli may extend to, and perhaps even be amplified in, real-life sexual situations, because in such situations, any negative affect (i.e., towards the partner or the sexual interaction) may be more salient. Negative affect may, therefore, be partly responsible for the sexual arousal problems in the women diagnosed with sexual arousal disorder.

Personalityguided Context

Therapeutic efforts responsive to problems in the pain-pleasure polarity would, for example, have as their essential aim the enhancement of pleasure among schizoid, avoidant, and depressive personalities (+ pleasure). Given the probability of intrinsic deficits in this area, schizoids might require the use of pharmacologic agents designed to activate their flat mood temperament. Increments in pleasure for avoidants, however, are likely to depend more on cognitive techniques designed to alter their alienated self-image, and behavioral methods oriented to counter their aversive interpersonal inclination. Equally important for avoidants is reducing their hypersensitivities especially to social rejection (- pain) this may be achieved by coordinating the use of anxiolytic medications for their characteristic anguished mood temperament with cognitive-behavioral methods geared to desensitization. In the passive-active polarity, increments in the capacity and skills to take a less reactive...

Contemporary Theories Of Personality Disorders And Treatment

The dominant theoretical models for understanding and treating personality disorders are generally accepted and understood. There are various other models, too, one of the most exciting of which is Eye Movement Desensitization and Reprocessing (EMDR), that have been developed or are being developed that also have application and appear to offer innovative techniques (Manfield & Shapiro, this volume). Most models, however, fall within the spectrum of the following schools psychodynamic, cognitive, cognitive-behavioral, interpersonal, psychobiological, family, integrative, and unified. The first four of these models are primary schools that emphasize the various domains with which they are associated, such as affect-anxiety-defense in psychodynamic, cognitive schema in the cognitive model, and neurotransmitters in the psychobi-ological. The psychodynamic and cognitive concentrate on the intrapsychic domain. The interpersonal, primarily dyadic, configurations and the cognitive-behavioral...

Phenotypic variation in human female reproductive development

Environmental adversity, including economic hardship and marital strife, compromise the emotional well-being of the parent and thus influence the quality of parent-child relationships (Repetti et al., 2002). High levels of maternal stress are associated with increased parental anxiety, less sensitive childcare (Dix, 1991 Goldstein et al., 1996), and insecure parental attachment (Goldstein et al. 1996 Vaughn et al., 1979). Parents in poverty or other environmental stressors experience more negative emotions, irritable, depressed, and anxious moods, which lead to more punitive parenting (Belsky, 1997a Conger et al., 1984 Fleming, 1999 Grolnick et al., 2002). The greater the number of environmental stressors (e.g., lesser education of parents, low income, many children, being a single parent), the less supportive the mothers are of their children such mothers are more likely to threaten, push, or grab them, and display more controlling attitudes. Fleming (1988) reported the anxiety of...

Catching The Mind In Action Implicit Methods In Personality Research And Assessment

Implicit methods are based on performance (e.g., reaction times) and therefore do not require self-insight explicit methods (e.g., trait measures) are based on self-report and therefore require self-insight. The history of research on introspection has taught us that self-reports of mental processes cannot be trusted (MacLeod, 1993). This is why cognitive psychologists measure reaction time, memory accuracy, and perception within tightly controlled experimental paradigms (MacLeod, 1993). Thus, a focus on implicit methods should, ideally, foster a greater integration of personality psychology with cognitive psychology, a cross-fertilization that should enrich both areas.

Improving Assessment Results Through Modification Of Administration Procedures

Students are also reluctant to modify standardized instructions by merely adding additional tasks after standardized instructions are followed. For example, the first author typically recommends that students ask patients what they thought of each test they took, how they felt about it, what they liked and disliked about it, and so on. This approach helps in the interpretation of the test results by clarifying the attitude and approach the patient took to the task, which perhaps have affected the results. The first author has designed a systematic Testing of the Limits procedure, based on the method first employed by Bruno Klopfer (Klopfer, Ainsworth, Klopfer, & Holt, 1954). In this method the patient is questioned to amplify the meanings of his or her responses and to gain information about his or her expectations and attitudes about the various tests and subtests. This information helps put the responses and the scores in perspective. For example, when a patient gave the response, A...

Assessment Approaches And Personality Theory

Interpret the TAT from a variety of cognitive viewpoints (Ronan, Date, & Weisbrod, 1995 Teglasi, 1993), as well as from a motivational viewpoint (McClelland, 1987). Martin Mayman's approach to the interpretation of the Early Memories Procedure (EMP) is from an object relations perspective, but the EMP is also used by adherents of social learning theory and cognitive psychology (e.g., Bruhn, 1990,1992).

Cognitive Restructuring

The cues for overeating and underexercising include not only physical cues such as the sight and smell of food, but also cognitive cues. A person's thoughts, such as the thought ''I've had a bad day. I deserve a treat. I'll go for some ice cream'' can lead to inappropriate behavior. Dividing the world into good and bad foods, developing excuses or rationalizations for inappropriate behavior, and making comparisons with others can all serve as negative thoughts. Behavioral programs teach participants to recognize that they are having these negative thoughts, to understand the function these thoughts serve for the participant, and then to counter these negative thoughts with more positive self-statements (41,42).

Summary And Conclusion

The system we have termed synergistic therapy may have raised concerns as to whether any one therapist can be sufficiently skilled, not only in employing a wide variety of therapeutic approaches, but also to synthesize them and to plan their sequence. As the senior author was asked at a conference some years ago Can a highly competent behavioral therapist employ cognitive techniques with any measure of efficacy and can he prove able, when necessary, to function as an insightful intrapsychic therapist Can we find people who are strongly self-actualizing in their orientation who can, at other times, be cognitively confronting Is there any

Research And Empirical Support

One of the strengths of cognitive therapy is that the approach is based on extensive research. In addition, both the adequacy of cognitive conceptualizations and the effectiveness of cognitive therapy have been tested empirically. Cognitive conceptualizations of personality disorders are of recent vintage and, consequently, only limited research into the validity of these conceptualizations has been reported. Recent studies have examined the relationships between the sets of beliefs hypothesized to play a role in each of the personality disorders and diagnostic status. These hypotheses have been supported for Borderline Personality Disorder (Arntz, Dietzel, & Dreesen, 1999) and for Avoidant, Dependent, Obsessive-Compulsive, Narcissistic, and Paranoid Personality Disorders (A. T. Beck et al., 2001). The other personality disorders were not studied because of an inadequate number of subjects. These studies show that dysfunctional beliefs are related to personality disorders in ways that...

Range Of Psychopathology And Personality Disorders Within Scope Of Treatment

Cognitive therapy was initially developed as a treatment for depression (A. T. Beck, Rush, Shaw, & Emery, 1979) and has subsequently been applied with a wide range of disorders such as anxiety disorders (A. T. Beck & Emery, 1985), substance abuse (A. T. Beck, Wright, Newman, & Liese, 1993), marital and family problems (Epstein & Baucom, 2002), and even schizophrenia (Perris & McGorry, 1998). However, although the principles of cognitive therapy apply across the full range of psychiatric problems, the treatment approach needs to be modified to take into account the characteristics of the individuals being treated. Some have argued that cognitive therapy of depression (A. T. Beck et al., 1979) is not an appropriate treatment for individuals with personality disorders (McGinn & Young, 1996 Rothstein & Vallis, 1991 Young, 1990) and this is indeed the case. Cognitive therapy of depression is a protocol for treating depression and somewhat different protocols are used in treating other...

Mechanisms Of Change And Therapeutic Action

Cognitive therapy's view of the mechanisms of change focuses on understanding the persistence of dysfunctional cognitions and behaviors. Many dysfunctional cognitions persist because Selective perception and cognitive biases often result in the individual's ignoring or discounting experiences that would otherwise conflict with the dysfunctional cognitions. Cognitive distortions often lead to erroneous conclusions. Thus, cognitive interventions focus on identifying the specific dysfunctional cognitions that play a role in the individual's problems and examining them critically. The therapist works to correct for the effects of selective perception, biased cognition, and cognitive distortions and to help the individual to face and tolerate aversive affect.

From Philosophy To Theory

While the concept of prototype and subtype allows the natural heterogeneity of persons to be accommodated within a classification system, there are as many ways to fulfill a given diagnosis as there are subsets of the number of diagnostic criteria required at the diagnostic threshold. For example, there are many ways to score five of a total of nine diagnostic criteria, whatever the actual syndrome. In the context of an idealized medical disease model, which Axis I approximates, the fact that two different individuals, both of whom are depressed, might possess substantially different sets of depressive symptoms is not really problematic. The symptoms may be expressed somewhat differently, but the underlying pathology process is the same and can be treated in the same way. For example, while one person gains weight and wakes early in the morning, and the other loses weight and sleeps long into the day, both may be treated with an antidepressant and cognitive therapy. Personality,...

Complex Syndrome Treatment Goals

Parallel Cognitive Therapies Given their emphasis on conscious attitudes and perceptions, cognitive therapists are inclined to follow an insight-expressive rather than an action-suppressive treatment process. Both cognitive and in-trapsychic therapists employ the insight-expressive approach, but the focus of their explorations differs, at least in theory. Cognitivists attend to dissonant assumptions and expectations that can be consciously acknowledged by an examination of the patient's everyday relationships and activities. The therapist may not only assume authority for deciding the objectives of treatment, but may confront the patient with the irrationalities of his thinking. For example, there is the practice of exposing the patient's erroneous or irrational attitudes, and the reworking of his or her belief structure into one with a more rational and stable composition. In what he terms rational-emotive therapy, Ellis (1967) considers the primary objective of therapy to be...

Application Of An Informed Classification To Therapeutic Strategy

As noted elsewhere (Millon, 1990), a theoretical basis is developed from the principles of evolution, to which three polarities are considered fundamental the pain-pleasure, the active-passive, and the self-other. As a general philosophy, specific treatment techniques are selected as tactics to achieve polarity-oriented balances. Depending on the pathological polarity to be modified and the integrative treatment sequence one has in mind, the goals of therapy are, in general to overcome pleasure deficiencies in schizoids, avoidants, and depressive styles and disorders to reestablish interpersonally imbalanced polarity disturbances in dependents, histrionics, narcissists, and antisocials to undo the intrapsychic conflicts in sadists, compulsives, masochists, and negativists last, to reconstruct the structural defects in schizotypal, borderline, and paranoid persons (Millon et al., 1999). These goals are to be achieved by the use of modality tactics that are optimally suited to the...

Stress and Personality

Several cognitive models of adaptation and coping with stress have been proposed. These models postulate different cognitive strategies that may be preferred by people with different personalities. An earlier model of this sort is Byrne's (1961) repression-sensitization conception of a continuum representing different responses to stress. Information-avoidance behaviors are at the repression end of the continuum, and information-seeking behaviors at the sensitization end. Another cognitive model of coping is Folkman and Lazarus's (1980) distinction between problem-focused and emotion-focused strategies. A problem-focused strategy consists of obtaining additional information to actively change a stressful situation, whereas an emotion-focused strategy is concerned with employing behavioral or cognitive techniques to manage the emotional tension produced by stressful situations. Rather than focusing on one strategy, most people employ a combination of the two. Although Folk-man,...

Multicultural Assessment And Treatment Practices

Cognitive therapy for depression can be used as an example. The basic principles of cognitive therapy are the same for individuals suffering from depression regardless of their racial and ethnic background. It is a traditional form of psychological therapy appropriate for African Americans as it is for Hispanics, Asian Americans, American Indians, Native Americans, and European Americans. An example of the way in which cognitive therapy could be applied across diverse populations from a multicultural perspective is that individual explanatory models are linked to the cultural background of the person. For example, in culture A, needs for achievement, individual responsibility, and guilt may be intricately tied to a patient's explanatory model, whereas in culture B, needs for acceptance, interdependence, and fatalistic beliefs may be linked to their explanatory model. An individual clinical assessment in the development of a cognitive therapy plan that does not identify such cultural...

Psychological factors

The cognitive theory of depression was popularized by Beck. It proposes that depression of mood can be caused, or at least exacerbated, by a person's repeatedly and automatically thinking negative thoughts. For example, patients may 'run themselves down', or put everything that happens in the worst possible light. The corollary is that depression could be treated by training the patient to think positive thoughts, and there is indeed evidence that such training, in the form of cognitive therapy, can be effective.

Mental features of depression

In any clinically significant depressive illness, the patient's intellectual function will seem to them to be affected. Perhaps because of lack of drive or preoccupation with negative ideas or both, the ability to concentrate will be reduced. This means that work becomes harder and takes longer not infrequently, patients believe that they are losing their memory, whereas, in fact, they are not remembering things in the first place because they are not able to concentrate properly.

Implications Of These Frameworks For Analysis Of Genetic Issues

The individualistic frameworks we have outlined do impact on genetic issues in some very problematic ways. First, the notions of patient and disease are automatically individualized. Thus, a patient is an individual with a disease who is receiving treatment. But genetic disease does not necessarily fit this pattern because genetic problems may be shared with family members and future offspring and the genetic information and proposed treatment(s) may have significant benefits or liabilities for others. Thus parents contemplating proceeding with a pregnancy which involves a baby with a genetic defect must think of the effect on future or present siblings in terms of their health and prospects and may well need to involve family members. A good test case was that of a U.S. couple named the Hamptons1 who discovered that their first pregnancy involved twins, both of whom had Cystic Fibrosis. They understood that they had to face the prospect that they would outlive their children. They...

Memory and Information Processes

In the 1950s, information processing theorists provided an alternative to behaviorism and offered a rebirth for cognitive psychology. Mayer (this volume) reviews the dominant influence of information processing theories of cognition over the past several decades. A major premise underlying information processing theory is that the human mind seeks to build and manipulate mental representations and that these cognitive processes can be accessed and studied through physiological responses and more recently, by using introspective interviews and other learning-based observations. Work is Schunk and Zimmerman (this volume) discuss the role of self-generated or self-directed activities that students use during learning. These notions strongly suggest that students are actively constructing and exercising control over their learning and social goals. Five theoretical perspectives are reviewed that have characterized work within this area operant theory, information processing theory,...

Influence of the Judge

Were jurors swayed by the judges' hints Data on this issue are somewhat fuzzy. Although the judges' biases in summing up were closely associated with the results of most cases, jurors' verdicts occasionally did not agree with the judges' apparent inclinations. So, for example, 9 of jurors who believed that the judge favored conviction reported that their jury opted to acquit. Of jurors who perceived a mild bias in favor of conviction, 13 decided to acquit. These data suggest that at least some juries are able to resist the influence of the judge's perceptions if those perceptions are counter to their own. However, some juries went against their personal beliefs and convicted or acquitted because the judge favored that particular verdict.

Cognitive Psychologists Construe the Abstract Mechanisms Underlying Behavior

The task of the cognitive psychologist is a highly inferential one. The cognitive psychologist must proceed from observations of the behavior of humans performing intellectual tasks to conclusions about the abstract mechanisms underlying the behavior. Developing a theory in cognitive psychology is much like developing a model for the working of the engine of a strange new vehicle by driving the vehicle, being unable to open it up to inspect the engine itself

Cognitive Task Analysis

The term cognitive task analysis (CTA), sometimes referred to as cognitive job analysis, has been defined in various ways and is associated with numerous methodologies. Generally, CTA refers to a collection of approaches that purport to identify and model the cognitive processes underlying task performance (Chipman, Schraagen, & Shalin, 2000 Shute, Sugrue, & Willis, 1997), with a particular focus on the determinants of expert versus novice performance for a given task (Gordon & Gill, 1997 Means, 1993). Although the term CTA first emerged in the late 1970s, the field has grown substantially in the last decade, and some authors seem to have forgotten that most methodologies are adapted from the domain of cognition and expertise (see Olson & Biolsi, 1991, for a review of knowledge representation techniques in expertise). Instead, CTA is sometimes treated as if it evolved entirely on its own (Annett, 2000). The value added for CTA is not that it represents a collection of new activities...

Binge Eating Disorder

Both CBT (100,123) and IPT (100) have been shown to promote reductions in binge eating for up to 12 months following treatment. Treatment is generally similar to that used for bulimia nervosa, with some modifications. It has been hoped that, as these psychotherapies may work through differing mechanisms, patients failing to improve with one form of psychotherapy might respond favorably to another. However, a study using IPT as ''salvage'' therapy for patients who failed to respond to CBT found no additional benefit of IPT in this group (124). Another form of psychotherapy, dialectical behavior therapy (DBT), has recently been adapted for use in binge eating disorder (125). DBT is an empirically validated treatment for individuals with borderline personality disorder, which conceptualizes pathologic behaviors as faulty attempts at affect regulation (126). The treatment attempts to teach clients more functional methods of dealing with negative emotions.

Asian Pacific Islander Americans

Not permit Asian and Pacific Island women to enter this country, combined with the detention of Japanese-Americans in concentration campus during World War II, left a reservoir of negative feelings in some members of the Asian-American community. Be that as it may, Asian-Americans are perhaps the best example of how the United States can still be a land of opportunity for immigrants who are skilled and motivated to work and save.

Clinical classification of depression

A 44-year-old married man came to the attention of a junior hospital psychiatrist after taking an overdose in the context of marital breakdown. He described depressed mood, anhedonia, and continuing suicidal ideation. Although he made a fairly rapid improvement sufficient to return to work, his symptoms only partially resolved. The psychiatrist tried a number of antidepressants and some cognitive therapy to little avail, and, determined to explore all treatment options, he was thinking of suggesting ECT or referral for dynamic psychotherapy.

Empirical Evidence And The Postulation Of Mental Systems

But do not all the functions of cognition lie in the brain, and therefore shouldn't the structure of the brain be a reasonable playground for the construction of cognitive theories The answer is no, for the same reason that neither protein strings, nor molecules, nor atoms, nor quarks should be the building blocks of a cognitive theory. Theoretical entities in cognitive psychology are only useful insofar as they allow a handy categorization of experimental results. Thus, despite the fact that habituation in the eye and in the ear take place in different brain regions, we nonetheless recognize a unifying concept that unites the two forms of learning. the granddaddy of all distinctions in human memory, that between episodic and semantic memory (Tulving, 1983). Episodic memory stores events from an autobiographical perspective semantic memory stores facts and knowledge and contains no information about specific past episodes. This distinction has been among the most useful in modern...

The elements of a therapeutic professional relationship

In a similar way, Bion (1959) also explored the mother infant relationship and applied it to the professional relationship. There are however some additional ideas which relate to what happens as a result of the mother being attuned to the infant's vulnerable, anxious self. Bion used the terms 'contained' by the 'container' to describe the process of anxiety being understood (contained), by the container (the mother). More importantly, the mother is capable of transforming the anxious or angry negative emotions of the infant and giving them back in a positive form. In everyday life this happens when a mother is heard lovingly saying to her screaming infant, 'Oh, dear you are so upset, you are tired .' In the professional relationship the terms refer to the ability of the counsellor to tolerate negative emotions, to be able to internally process them and transform them into positive feelings of empathy, concern and compassion. In practice, the counsellor is not disturbed by the...

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