Adolescent Discussion
Jaia3926
6283Chapter7CognitiveBehavioralApproachesPowerpointFall2020Online.pptxCognitive-Behavioral Approaches in Counseling Adolescents
Chapter 7
Adapted from Smith-Adcock & Tucker (2017) by:
Tiffany Brooks, Sarah Fucillo, Jennifer Day,
& Stacy Springston
Introduction
All CBT approaches and paradigms share a few basic assumptions:
Individuals respond to their cognitive representations (i.e., perceptions) of the circumstance and events rather than to the circumstance and events themselves.
Learning is mediated by cognitions.
Thoughts, behaviors, and emotions are causally interrelated.
Cognitions, including schemas, processes, and structures, must be taken
into account when planning and evaluating counseling interventions.
Introduction
5. Thoughts and feelings can be understood through observable and
testable means and addressed actively, through behavioral
interventions.
6. Within a CBT framework, the counselors roles include consultant,
educator, and diagnostician in order to help the individual identify and
remediate cognitive distortions, skill deficits, and patterns of maladaptive
behavior.
Introduction
Today, CBT continues to be a popular counseling approach for people of all ages, including adolescents.
It is action oriented, psychoeducational in nature, with the goal of helping clients learn to problem solve.
Introduction
The relationship between cognitions, affect, and behaviors is viewed as reciprocal rather than linear.
Ex: A girl who believes she is a poor athlete avoids engaging in sports. This avoidance of sports minimizes the probability of success and reinforces her perception that she is a poor athlete.
Given this reciprocal relationship, both cognitions and behaviors are simultaneously targeted in CBT.
CBT seeks to enhance a client’s awareness of their cognitive misperceptions or distortions and of the behavioral patterns that reinforces and are reinforced by these distortions.
Cognitive-Behavioral Connections
John Watson: Father of Behaviorism
Watson used classical conditioning to change human behavior by creating a phobia in Little Albert who previously displayed no phobia behaviors.
He exposed Albert to a variety of stimuli, including animals like rats, of which he was not afraid (neutral stimulus).
During the experimental stage, a loud noise (unconditioned stimulus) was paired with a rat, which elicited a fear and tears from Albert (unconditioned response).
After a time, Albert became distressed when the rat was introduced (conditioned response).
Albert also demonstrated stimulus generalization after the experiment because similar animals, like the bunny and dog, also caused Albert to become distressed.
Watson’s experiment with Little Albert demonstrates the core principle of behaviorism—when properly manipulated, the environment can be used to produce specific behavioral responses.
B.F.Skinner: Father of Radical Behaviorism
Skinner used operant conditioning, demonstrating the effectiveness of reinforcement for increasing or decreasing specific behaviors.
A reinforcer increases the frequency of a target behavior.
Reinforcers can be both positive (i.e. allowance, screen time) and negative (i.e. removing an aversive stimuli such as nagging or yelling).
Punishment is the introduction of an aversive stimulus (i.e. extra chores) or the removal of a preferred variable (i.e. screen time) which decreases the likelihood of a future behavior.
Natural punishments or consequences are powerful.
Putting It All Together: Anxiety
Two-factor model – A theoretical model that accounts for the development of phobic reactions on the basis of classical and operant conditioning.
The fear component of phobia is believed to be acquired through classical conditioning, as previously neutral objects and situations gain the capacity to evoke fear by being paired with noxious or aversive stimuli.
Relief from anxiety negatively reinforces the avoidance of the phobic stimulus.
Can occur through observational learning
Albert Ellis: REBT
Albert Ellis is the creator of rational emotive behavior therapy (REBT), an early form of cognitive behavioral therapy, blending the teaching methods of the behaviorists with the challenge of irrational thinking favored by the cognitive theorists.
It is easily adapted to treat adolescents.
The trademark of REBT is its emphasis on teaching adolescents to learn their ABC's of irrational beliefs.
A—activating events
B—beliefs about those events
C—the resulting consequences
For instance, adaptive feelings like disappointment or maladaptive feelings like anxiety and depression
Albert Ellis: REBT
Albert Ellis: REBT
Therapists alleviate emotional disturbance by helping clients to:
Identify irrational beliefs
Recognize that irrational beliefs are maladaptive
Replace dysfunctional cognitions with adaptive beliefs
The presence of negative emotions is not evidence of psychopathology.
Irrational thinking leads to anxiety, depression, and anger.
Rational thinking leads to concern, sadness, and annoyance.
Rigidity is at the core of psychological disturbance.
Flexibility is at the core of psychological health.
To challenge irrational beliefs, clients and therapists must “dispute” those beliefs.
Albert Ellis: REBT
1. I must do well and get the approval of everybody who matters to me or I will
be a worthless person.
2. Other people must treat me kindly and fairly or else they are bad.
3. I must have an easy, enjoyable life or I cannot enjoy living at all.
4. All the people who matter to me must love me and approve of me or it will be
awful.
5. I must be a high achiever or I will be worthless.
6. Nobody should ever behave badly and if they do I should condemn them.
7. I mustn’t be frustrated in getting what I want and if I am it will be terrible.
Albert Ellis: REBT
8. When things are tough and I am under pressure I must be miserable and
there is nothing I can do about this.
9. When faced with the possibility of something frightening or dangerous
happening to me I must obsess about it and make frantic efforts to avoid it.
10. I can avoid my responsibilities and dealing with life’s difficulties and still be
fulfilled.
11. My past is the most important part of my life and it will keep on dictating
how I feel and what I do.
12. Everybody and everything should be better than they are and, if they’re not,
it’s awful.
13. I can be as happy as is possible by doing as little as I can and by just
enjoying myself.
Aaron Beck: Father of Cognitive Therapy
Cognitive therapy seeks to change the way that individuals process information by challenging negative thoughts about themselves, the world, or the future.
An individual’s thoughts, attitudes, and perceptions about themselves and others influences their interpretation of an external event, and this interpretation can, in turn, influence subsequent emotions and behaviors.
Cognitive therapists maintain that it is not the event itself but rather the cognitive interpretation of an event that causes distress.
Aaron Beck: Father of Cognitive Therapy
According to Beck, most individuals can combat negative thoughts by using logic and reasoning.
For the most part, such distortions are universal, relatively benign, and can be key to healthy functioning.
A person with psychopathology experiences those thoughts so frequently that his or her perception of reality begins to reflect those maladaptive thoughts.
Ultimately, the goal of cognitive therapy is to reduce symptomology by teaching clients to directly challenge the legitimacy of their maladaptive thoughts.
Cognitive therapy has been used with young clients for a wide variety of problems, including anxiety, trauma, depression, and autism.
Aaron Beck: Father of Cognitive Therapy
Beck’s Cognitive Triad - The client’s:
Sense of their self
Sense of their environment
Sense of their future
Ex: Anxious client’s view themselves as unable to handle their distress, perceive elements in their immediate and past environment as dangerous and threatening, and view their future with fear and apprehension.
Aaron Beck: Father of Cognitive Therapy
Cognitions can be monitored and altered. This means:
The therapist and client have access to the client’s thoughts.
Once all cognitions are explored, the client can modify those cognitions.
Modifying distorted cognitions alone changes the client’s interpretation of events, which in turn increases the probability that the client’s behavior will be altered in response to this interpretation.
Aaron Beck: Father of Cognitive Therapy
Based on these three assumptions, the task of the CB therapist is to help the client:
Become aware of their distorted cognitions.
Identify the way these distorted cognitions are related to the client’s negative thoughts and behaviors.
Modify their distorted thinking and maladaptive behavior patterns which have reinforced their negative view of self and others.
In completing these tasks, it is assumed that client’s will perceive and react differently to events, thus leading to less distress and a more positive life outlook.
Merging Cognitive and Behavioral into CBT
Cognitive Behavioral Therapy is an umbrella term for a group of therapies that share some common elements.
Reality Therapy
Rational Emotive Behavior Theory (REBT)
Cognitive Behavioral Therapy (CBT)
Trauma-Focused CBT
Multimodal
Acceptance and Commitment Therapy (ACT)
Dialectical Behavioral Therapy (DBT)
Cognitive-Behavioral Play Therapy (CBPT)
Trauma-Focused CBT (TF- CBT)
Each approach has different explanations for the relationship between thoughts, feelings, and behaviors.
Trauma Focused CBT
12-18 Sessions
Designed to help adolescents and their non-abusive parent or caregiver reduce the emotional impact of the traumatic events (Cohen et al., 2006).
Supporting research for effectiveness with diverse groups
Reduce the symptoms of anxiety, sleep disturbance, depressed mood, irritability, anger, and other common problems following traumatic events or adverse childhood experiences.
Requires additional training
The Medical University of South Carolina offers a free introductory online training (10 hours)
Trauma Focused CBT
TF-CBT Treatment Protocol
P: Psychoeducation and parent training
R: Relaxation training
A: Affective expression and regulation
C: Cognitive coping and processing
T: Trauma narrative and processing
I: In-vivo experiencing
C: Conjoint parent and child sessions
E: Enhancing personal safety and growth
Modify each goal based on the developmental and cultural needs of the individual client
Dialectical Behavioral Therapy
Dialectical Behavioral Therapy (DBT) is a set of very structured and specific coping skills.
DBT-A is what is called when used with adolescents
Set of structured and specific coping skills
Reforming irrational thoughts with mindfulness training and very specific concrete skills to help clients learn to master emotional regulation, distress tolerance, and interpersonal effectiveness.
The course of treatment with DBT includes multiple modalities, including group, family, and individual sessions.
Phone call coaching sessions are also suggested as part of treatment follow-up after the conclusion of therapy for a short period of time to encourage continued use of new behaviors and cognitive strategies
General CBT Goals and Techniques
Is educative, aims to teach the client to be his or her own therapist and emphasizes relapse prevention.
Aims to be time limited.
Requires structured sessions.
Teaches clients to identify, evaluate and respond to their dysfunctional thoughts and beliefs.
Uses a variety of techniques to change thinking, mood and behavior.
General CBT Goals and Techniques
Coping skills therapies
Emphasizes skills acquisition (relaxation, specific social skills)
Problem-solving - early in therapy, the client and therapist create a problem list described in goal-oriented language. Throughout therapy, strategies are generated to solve these problems.
Cognitive restructuring
Directly challenging and refuting
Collaboratively examining the logic of the client’s perception and systematically testing its veracity.
Generalization - used to help the client apply their new skills to a variety of situations.
General CBT Goals and Techniques
Self-monitoring - The client keeps a record of cognitions, affect, and behaviors, including cues for symptoms.
Self-regulation - The client compares the number of recorded times they engaged in adaptive vs. maladaptive behaviors.
Modeling - Therapist displays an appropriate behavior or coping strategy.
Role-play - Therapist and client actual enact or rehearse a newly learned behavior or coping strategy.
General CBT Goals and Techniques
Relapse prevention - occurs toward the end of therapy and focuses on identifying post-treatment impediments.
Affective education or mindfulness- assist client to become aware of emotions and to recognize their emotions are cues to cognitive distortions.
The client learns that emotions do not always require a behavioral or cognitive reaction and sometimes it is permissible to accept the feeling as part of the human condition without doing anything.
Relaxation training - learning and practicing
Exposure therapy - imagery or in vivo
General CBT Goals and Techniques
Phases of therapy:
Goal setting
Development of the therapeutic alliance
Identifying cognitive distortions
Disputing and modifying those distortions
Skill development
Practice and generalization of new skills (homework)
Sequence of CBT sessions:
Setting the agenda
Review of the client’s homework
Goal setting
New skill is taught and practiced
Feedback
Homework assigned
CBT with Adolescents
Depression
Psychoeducation
Replacing self-defeating thoughts with more constructive and positive thinking
Increasing participation in pleasant activities
Teaching adaptive and constructive social and communication skills
Teaching conflict resolution skills
Teaching self-monitoring and goal-setting skills
Anxiety
Psychoeducation
Somatic management techniques
Cognitive restructuring
Problem solving
Exposure
CBT with Adolescents
Aggression
Assist the client to reexamine their selection of environmental cues, to seek more facts about the situation before formulating and selecting a behavior, to select less hostile and more adaptive problem-solving solutions, and to anticipate the consequences of their actions.
Interventions include role-playing, practicing social skills and cognitive reinterpretation in session, homework assignments, and involvement of parents.
CBT with Adolescents
Problem solving - response sequence to teach adolescents:
Is there actually a problem?
Stop and think.
Why is there a conflict?
What do I want?
Think of solutions.
Look at consequences.
Choose what to do and do it.
Evaluate the results.
CBT with Adolescents
CBT Family Interventions
Many of the characteristics of a disorder in the child are also manifested in the family.
The family may perceive the adolescent is the symptom.
Family members can assist therapy in:
Ensuring client practices weekly homework.
Helps client catch maladaptive cognitions.
Supporting client in trying new behaviors.
Creative CBT Techniques with Adolescents
Storytelling
Stories can be used to provide a way to introduce new ideas and help adolescents to perceive the world differently through metaphor.
Metaphors help make complex psychological situations more understandable.
Metaphors and stories can be more complex and abstract when working with adults.
Stories and metaphor can help the adolescent identify and reframe her thoughts.
Creative CBT Techniques with Adolescents
Drama
Scripts for new behavior and new skills can provide more support for adolescent clients.
Adolescents can be encouraged to improvise the resolution of the story and can also be asked to play multiple roles in the scenes.
Such enactments enable the adolescent to take the perspective of others as well as to practice possible reactions to different social situations.
Two popular and effective interventions include Coping Cat (for anxiety in children and adolescents) and the Penn Resiliency Program (for reducing depressive symptoms in adolescents).
Outcome Research
CBT is one of the most well researched theories
Significant empirical support in the literature demonstrating effectiveness in treatment and prevention
Researchers found CBT produced the greatest positive change in the following areas:
Depression
Generalized Anxiety Disorders, Panic Disorder, Social Phobia
Post-Traumatic Stress Disorder
Marital Distress
Anger
Chronic Pain
Childhood Depressive and Anxiety disorders, Somatic Disorders
Bulimia
Stress
