临床与咨询心理学导论 19 - Cognitive Approaches

L19 Cognitive Approaches 

参考文献：Pomerantz, A. (2013). Clinical psychology: science, practice, and culture (3rd ed.). Thousand Oaks, CA: SAGE Publications.

19.1 General Information

Cognitive Approaches

- Aaron Beck & Albert Ellis

• View: Problems result from what we think (cognitive content) and how we think (cognitive process), including distorted views of situations/self, faulty reasoning, poor problem solving

• Focus: Thoughts and thought processes that cause problematic emotions / behaviors

• Approach: Clients learn adaptive ways of thinking about experiences through re-configuring problematic thought patterns

• Cognitions: Thoughts, beliefs, assumptions, interpretations - Determine how we respond to any given event/situation

Cognitive Theory

• A-B-C Model

A. Adversity or Activating event.

B. Your Beliefs about the event. It involves both obvious and underlying thoughts about situations, yourself, and others.

C. Consequences, which includes your behavioral or emotional response.

• Schemas: Pervasive themes activated by stress

- “Core Beliefs” (e.g., I’m a total failure)

• Automatic Thoughts

- Instant/immediate thoughts

- May not even notice them

• Content à Type of emotional problem one develops

- “The world is a dangerous place” - Anxiety

- “I’m worthless” - Depression

• Specific cognitive theories for different disorders

Key Aspects of Cognitive Therapy

• Therapist as Teacher

- Explain the theory behind therapy

- Coach clients to use techniques independently

- Over time, client learns skills and no longer needs a therapist

• Role of Homework

- Much work happens outside of session!

- Practice and apply what is learned in session

• Structured & Time-limited Treatment

- Often 15 sessions or fewer

- Weekly sessions, taper off

- Goal-focused sessions

Typical Session Structure

1. Check in and Update on Past Week

2. Create an Agenda (collaborative process)

3. Review Homework and Connect to Ideas from Previous Session

4. Review Agenda Items

5. Develop and Assign New Homework

6. Summarize Session and Get Client Feedback

19.2 Ellis’s Rational Emotive Therapy

Rational Emotive Therapy*

• Developed by Albert Ellis

- Originally called Rational Therapy; Now officially called Rational Emotive Behavior Therapy (REBT)

• Directly dispute irrational thoughts

• ABCDE model

- Notice Activating events, Beliefs, and Consequences

- Dispute their irrational beliefs

- Use disputation to help client develop new, more Effective beliefs

Example of ABCDE model:

Activating Event: Date doesn’t text you back

Belief: “I’m unlovable.”

Consequence: Feel sad

Dispute: “Just because she hasn’t contacted me yet, that doesn’t mean she’s won’t. Even if she does reject me, that’s just one person’s opinion. It doesn’t mean that I’m unlovable.”

Effective new belief: “I was hoping that this date would lead to a relationship. If it doesn’t, that will be disappointing. But no matter what happens, it doesn’t affect who I am as a person.”

19.3 Beck’s Cognitive Therapy

Cognitive Therapy

• Developed by Aaron Beck

• Includes similar techniques to REBT

- Dysfunctional thought records

- Teaching clients to dispute irrational or dysfunctional beliefs

• Some unique aspects of Beck’s approach

- Education about Common Thought Distortions

- Therapeutic Technique of Socratic questioning

- Behavioral Experiments

Cognitive Distortions

• Education about distortions helps client identify thoughts to dispute

All-or-nothing thinking: No middle ground

Catastrophizing: Expecting the worst

Magnification: Mountains out of mole hills

Minimization: Downplay the positives

Mind reading: Knowing what others are thinking

Socratic Questioning

• Rather than directly disputing thoughts, therapist asks questions to guide the client to their own new conclusion

• What use this questioning approach?

- Prevent defensiveness

- Teach client to challenge thoughts independently

- Can be used long after treatment ends

Behavioral Experiments

• Thoughts as hypotheses to be tested

• Client design an experiment to test out their thought - Can be more powerful than thought exercises alone