psyc 164
Cognitive behaviour therapy
Psychology 164, Fall 2020
1
What is Cognition?
Our cognitions are our beliefs, thoughts, expectations, attitudes and perceptions.
Historically, behaviourists didn't study cognitions because thoughts weren't directly observable. However, modern behaviourists understand that through talk therapy, cognitions can be studied by what the person says they are thinking and the actions they perform while they are describing those cognitions.
Types of CBT
There are many types of CBT, but we'll focus on the two most common:
Cognitive Re-structuring Methods: These therapies focus on changing dysfunctional thoughts that arise, as they often trigger negative emotional states and dysfunctional behaviours
Acceptance and Commitment Therapy: These therapies focus on fostering self-compassion and acceptance that sometimes negative thoughts will emerge.
Cognitive Restructuring
The foundational belief is that irrational/dysfunctional thoughts are the source behind many behavioural difficulties
If these irrational thoughts are replaced by rational thoughts, many of the individual’s difficulties will disappear
Types of "irrational" thoughts
All-or-nothing thinking - You see things in black-or-white categories. If a situation falls short of perfect, you see it as a total failure. When a person on a diet ate a spoonful of ice cream, they told themselves, “I’ve blown my diet completely.” This thought upset them so much that it triggered binge behaviour.
Overgeneralization - You see a single negative event, such as a romantic rejection or a career reversal, as a never-ending pattern of defeat by using words such as “always” or “never” when you think about it. e.g. Your partner forgets to reserve a restaurant for Valentine's Day and your thought is, "They never do anything romantic." Can result in an inflated negative feeling toward partner.
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Mental Filter - You pick out a single negative detail and dwell on it exclusively, so that your vision of reality becomes darkened, like the drop of ink that discolors a beaker of water. Example: You receive many positive comments about your presentation to a group of associates at work, but one of them says something mildly critical. You obsess about his reaction for days and ignore all the positive feedback.
Discounting the positive - You reject positive experiences by insisting that they “don’t count.” If you do a good job, you may tell yourself that it wasn’t good enough or that anyone could have done as well. Discounting the positives takes the joy out of life and makes you feel inadequate and unrewarded.
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Jumping to conclusions - You interpret things negatively when there are no facts to support your conclusion.
Mind Reading : Without checking it out, you arbitrarily conclude that someone is reacting negatively to you.
Fortune-telling : You predict that things will turn out badly. Before a test you may tell yourself, “I’m really going to blow it. What if I flunk?” If you’re depressed you may tell yourself, “I’ll never get better.”
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Magnification - You exaggerate the importance of your problems and shortcomings, or you minimize the importance of your desirable qualities. This is also called the “binocular trick.”
Emotional Reasoning - You assume that your negative emotions necessarily reflect the way things really are: “I feel terrified about going on airplanes. It must be very dangerous to fly.” Or, “I feel guilty. I must be a rotten person.” Or, “I feel angry. This proves that I’m being treated unfairly.” Or, “I feel so inferior. This means I’m a second rate person.” Or, “I feel hopeless. I must really be hopeless"
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“Should” statements - You tell yourself that things should be the way you hoped or expected them to be. After playing a difficult piece on the piano, a gifted pianist told herself, “I shouldn’t have made so many mistakes.” This made her feel so disgusted that she quit practicing for several days. “Musts,” “oughts” and “have tos” are similar offenders. “Should statements” that are directed against yourself lead to guilt and frustration. Should statements that are directed against other people or the world in general, lead to anger and frustration: “He shouldn’t be so stubborn and argumentative!” Many people try to motivate themselves with shoulds and shouldn’ts, as if they were delinquents who had to be punished before they could be expected to do anything. “I shouldn’t eat that doughnut.” This usually doesn’t work because all these shoulds and musts make you feel rebellious and you get the urge to do just the opposite.
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Labeling - Labeling is an extreme form of all-or-nothing thinking. Instead of saying “I made a mistake,” you attach a negative label to yourself: “I’m a loser.” You might also label yourself “a fool” or “a failure” or “a jerk.” Labeling is quite irrational because you are not the same as what you do. Human beings exist, but “fools,” “losers” and “jerks” do not. These labels are just useless abstractions that lead to anger, anxiety, frustration and low self-esteem.
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Personalization and Blame - Personalization comes when you hold yourself personally responsible for an event that isn’t under your control. e.g. Your partner reacts badly to something you shared and you blame yourself for those feelings, rather than letting the other personal hold accountability for their own feelings. Personalization leads to guilt, shame and feelings of inadequacy.
Some people do the opposite. They blame other people or their circumstances for their problems, and they overlook ways they might be contributing to the problem: “The reason my marriage is so lousy is because my spouse is totally unreasonable.” Blame usually doesn’t work very well because other people will resent being scape-goated and they will just toss the blame right back in your lap. It’s like the game of hot potato–no one wants to get stuck with it.
How do restructuring methods work?
Ellis' Rational-Emotive Behaviour Therapy:
1. Belief that the foundation for difficult emotions and behaviour stems from irrational cognitions.
2. Directly counters faulty logic in the client by asking for evidence and by countering with opposite data (for example, the statement “I have no friends” - the therapist would directly ask for evidence – so no one has ever talked to you, asked you over to hang-out, phoned you, wanted to spend time with you? Individual admits that people ask them to come over, phone, etc. and the therapist uses that as data to counter the faulty logic and replace it with something more functional such as “Hmm…I’m feeling lonely. I haven’t seen my friend in a while, I should call him/her.” ) If you think about your own life, what kinds of emotions and behaviours might be triggered by the first vs. the second statement?
Challenging the faulty logic is then followed by homework exercises that involve in vivo desensitization and awareness training so that the person becomes more aware of the role thoughts have in their lives.
Beck's Approach
Originally designed to treat depression, now used for many psychopathologies, this is also a restructuring method, although in Beck’s method, the therapist doesn’t play a directly confronting role, but rather a role of co-researcher – helping the individual test their own hypotheses through experience and journaling.
Three steps:
First, envisioning stress-invoking experience and emotions elicited by those experiences; and laddering to determine the core belief about oneself (bring awareness to the underlying belief behind the triggers.)
Second, hypothesis testing through experiences and data collection
third, homework assignments requiring overt behaviours that are incompatible with cognitions.
Wait…what? What does that mean?
Use of Journals
The journal is used to collect data about your own thoughts, emotions and behaviour
First: write down a trigger event (the trigger event is some event in the environment that elicits some response in you). For example, let’s say you suffer from exam anxiety. The trigger event might be the announcement of an upcoming exam.
Second: Write down the thought that was elicited by the trigger event. Using the case of exam anxiety, it might be “I’m going to crack under the pressure and fail the test!” or "My mind is going to go blank."
Third: Write down the emotion elicited by that thought. It is likely to be stress, anxiety, fear…
Fourth: Write down behaviours that occur as a result of these beliefs. Avoiding exams, leaving mid exam, avoiding studying, trying to study while highly anxious
Journaling cont'd
Continuing to journal this way for a few week’s, clients begin to understand their patterns of dysfunctional thoughts, which the therapist helps them challenge by engaging in small homework tasks that will have them taking practice tests in increasingly more demanding environments. Each time the person successfully passes the test, it further acts to contradict the original dysfunctional thought.
Each session, the journal is shared with the therapist and they discuss what happened, the patterns noticed and ways to contradict the core belief.
Excellent video example of a sample CBT session:
https://www.youtube.com/watch?v=8-2WQF3SWwo
Acceptance and Commitment Therapy
This method allows the client to understand that everyone has negative thoughts now and then…it’s normal. However, it isn’t the negative thought that is dangerous, but rather how much the individual attaches to that thought and allows it to elicit negative emotions and dysfunctional behaviour.
People are taught to practice relaxation and to just watch the thoughts come and go without forming an emotional attachment. Negative thoughts are just noticed, labeled “thinking” and let go.
The commitment part of therapy is similar to that of behavioural homework in re-structuring techniques. Using the example from before, the person would label the thought “I’m going to fail” as a “thought” and let it go. They would then commit to studying as much as they could for the exam.
We'll be covering the tools in much more detail in the document that follows.
Example for you to try...
Stephen is a shy senior at high-school, who has recently made the football team. As a result, he’s been invited to a lot of parties. However, he is extremely anxious about these parties and describes himself as getting completely tongue-tied and red, and feels like everyone in the room is looking at him, thinking he shouldn’t be there, what a geek, etc. He has noticed that over the past couple of weeks his anxiety about parties is getting worse. As soon as he gets there, the anxiety gets so bad that he finds some excuse to leave (he gets his friend to call him with a fake “emergency” so he can leave with an excuse) and he also has developed several fake “illnesses” to keep him from going to several of the parties. He’s so anxious that he’s even considering quitting the football team. Explain how you could use cognitive-behavioural therapy. How would you account for Stephen’s anxiety and what steps would you take to help him?
1.Give an example of a type of irrational thought exhibited by Stephen.
2.If you asked Stephen to write a journal entry showing the activating event, the cognition, the emotion and the behaviour, what would he likely write down?
3.How would you challenge his faulty cognitions? Give an example.
4.What kind of homework would you give Stephen to counter his current behaviour of escaping and avoiding parties?
If you could share your answers to these questions with the group that would be great.